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首页> 美国卫生研究院文献>Tropical Medicine and Infectious Disease >The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report
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The Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report

机译：真菌被忽视的热带病（真菌性NTD）的诊断以及调查和实验室检查的作用：专家共识报告

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The diagnosis of fungal Neglected Tropical Diseases (NTD) is primarily based on initial visual recognition of a suspected case followed by confirmatory laboratory testing, which is often limited to specialized facilities. Although molecular and serodiagnostic tools have advanced, a substantial gap remains between the desirable and the practical in endemic settings. To explore this issue further, we conducted a survey of subject matter experts on the optimal diagnostic methods sufficient to initiate treatment in well-equipped versus basic healthcare settings, as well as optimal sampling methods, for three fungal NTDs: mycetoma, chromoblastomycosis, and sporotrichosis. A survey of 23 centres found consensus on the key role of semi-invasive sampling methods such as biopsy diagnosis as compared with swabs or impression smears, and on the importance of histopathology, direct microscopy, and culture for mycetoma and chromoblastomycosis confirmation in well-equipped laboratories. In basic healthcare settings, direct microscopy combined with clinical signs were reported to be the most useful diagnostic indicators to prompt referral for treatment. The survey identified that the diagnosis of sporotrichosis is the most problematic with poor sensitivity across the most widely available laboratory tests except fungal culture, highlighting the need to improve mycological diagnostic capacity and to develop innovative diagnostic solutions. Fungal microscopy and culture are now recognized as WHO essential diagnostic tests and better training in their application will help improve the situation. For mycetoma and sporotrichosis, in particular, advances in identifying specific marker antigens or genomic sequences may pave the way for new laboratory-based or point-of-care tests, although this is a formidable task given the large number of different organisms that can cause fungal NTDs.
机译：真菌被忽视的热带病（NTD）的诊断主要基于对可疑病例的初步视觉识别，然后进行实验室确认试验，该实验室鉴定通常仅限于专门机构。尽管分子和血清诊断工具已经取得了进步，但在地方性流行的理想和实用工具之间仍然存在很大差距。为了进一步探讨这个问题，我们对主题专家进行了一次调查，调查了足以在设备完善的基础医疗机构中开始治疗的最佳诊断方法以及针对三种真菌NTD的最佳采样方法：真菌病，色母细胞病和孢子菌病。对23个中心的调查发现，对于半活检采样方法（如活检诊断）与拭子或压痕涂片相比的关键作用，以及组织病理学，直接显微镜检查和培养对于真菌瘤和色母细胞培养在设备齐全的确认中的重要性，已达成共识实验室。据报道，在基本的医疗机构中，直接显微镜检查结合临床体征是提示转诊治疗的最有用的诊断指标。该调查确定，除了真菌培养以外，在最广泛可用的实验室测试中，孢子虫病的诊断最棘手，敏感性较差，这突出表明需要提高真菌学诊断能力并开发创新的诊断解决方案。真菌显微镜检查和培养现已被认为是WHO必要的诊断测试，对其应用进行更好的培训将有助于改善这种情况。对于肌瘤和孢子体病，特别是鉴定特异性标志物抗原或基因组序列的进展可能为新的基于实验室或即时检验的方法铺平了道路，尽管鉴于大量不同的生物可能导致这种现象，这是一项艰巨的任务真菌NTD。

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