Recommendations for the Clinical Use of Diagnostic Tools in Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Turkish Expert Opinion (TEO-3)

The difficulties in the diagnosis of invasive fungal disease (IFD) in hematological malignancies and the proper use of the diagnostic tests are among the important problems the clinician face. Although, the defi nitions of IFD from the European Organization for Research and Treatment of Cancer (EORTC) and Mycosis Study Group (MSG) are aimed to standardize the subject, these are only for clinical research. Especially, the diffi culty of mycological diagnosis and the necessity of immediate intervention in molds have led to the adoption of “surrogate markers” which does not verify, but strongly suggests fungal infection. The markers commonly used are galactomannan (GM), beta-glucan and imaging methods. Although there are numerous studies on these diagnostic approaches, none of these markers serve as a support for the clinician, as is in human immunodefi ciency virus (HIV) or cytomegalovirus (CMV) infections. Clinician has an important role in diagnosis and he/she have to make the correct decision by corroborating these diagnostic tools with clinical state of the patient and the available epidemiological data.This paper has been prepared to show the clinician how the available resources can be used. As molecular tests have not been standardized and not used routinely in the clinics, they will not be mentioned here

First multicentre report of in vitro resistance rates in candidaemia isolates in Turkey

Objectives: This study investigated the antifungal resistance rates of isolates from candidaemia patients in 12 tertiary-care centres in Turkey

Frequency of azole resistance in clinical and environmental strains of Aspergillus fumigatus in Turkey: a multicentre study

Objectives Aspergillus fumigatus causes several diseases in humans and azole resistance in A. fumigatus strains is an important issue. The aim of this multicentre epidemiological study was to investigate the prevalence of azole resistance in clinical and environmental A. fumigatus isolates in Turkey. Methods Twenty-one centres participated in this study from 1 May 2018 to 1 October 2019. One participant from each centre was asked to collect environmental and clinical A. fumigatus isolates. Azole resistance was screened for using EUCAST agar screening methodology (EUCAST E.DEF 10.1) and was confirmed by the EUCAST E.DEF 9.3 reference microdilution method. Isolates with a phenotypic resistance pattern were sequenced for the cyp51A gene and microsatellite genotyping was used to determine the genetic relationships between the resistant strains. Results In total, resistance was found in 1.3% of the strains that were isolated from environmental samples and 3.3% of the strains that were isolated from clinical samples. Mutations in the cyp51A gene were detected in 9 (47.4%) of the 19 azole-resistant isolates, all of which were found to be TR34/L98H mutations. Microsatellite genotyping clearly differentiated the strains with the TR34/L98H mutation in the cyp51A gene from the strains with no mutation in this gene. Conclusions The rate of observed azole resistance of A. fumigatus isolates was low in this study, but the fact that more than half of the examined strains had the wild-type cyp51A gene supports the idea that other mechanisms of resistance are gradually increasing