Advances in diagnosis and management of invasive fungal infections in organ transplant recipients

Invasive fungal infections are an important cause of morbidity and mortality in organ transplant recipients. Because conventional diagnostic tools such as culture lack sensitivity and specificity, alternative diagnostic tests have been developed in recent years. Serologic tests and molecular assays such as polymerase chain reaction of blood or other body fluids have become increasingly important for the diagnosis of invasive fungal infections in organ transplant recipients. Among the most useful antigen detection systems are the detection of cryptococcal and histoplasma polysaccharide antigen for the diagnosis of cryptococcosis and histoplasmosis. A promising assay is the detection of circulating galactomannan, which is known to be a sensitive marker for invasive aspergillosis. However, advances in the management of invasive mycoses have been limited, perhaps as a result of difficulties in performing randomized clinical trials of fungal infections. This review summarizes current knowledge of the rapid diagnostic tests and treatment of invasive fungal infections in organ transplant recipients.