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Journal Article Epublish

PubMed: 42657100 DOI: 10.1515/jtim-2026-0065

Asian consensus on diagnostic algorithm for invasive pulmonary fungal diseases in high-burden settings.

J Transl Int Med 14(4):493-505

Authors: Wenjie Fang, Xinyao Liu, Hazrat Bilal, Mohammad Daud Habib, Ahmed Nasir Hanifi, Nek Wali Shah Momin, Cornelia Lass-Flörl, Chin Samnang, Li An, Cunwei Cao, Min Chen, Zhongju Chen, Shuwen Deng, Li Fan, Jie Gong, Bing Gu, Jian Guo, Xiaoping Huang, Yingqian Kang, Guanzhao Liang, Likai Lin, Jiayun Liu, Weida Liu, Shiyuan Liu, Wei Liu, Zhengtu Li, Zhuozhe Li, Binghuai Lu, Zhiming Lu, Yuxing Ni, Xiaosong Qin, Haibo Qiu, Yiqing Qu, Dongmei Shi, Yi Shi, Xin Su, Hao Tang, Minggui Wang, Yong Wang, Junxue Wang, Wenjuan Wu, Bin Xu, Jinfu Xu, Yingchun Xu, Feng Ye, Yunsong Yu, Liping Zhu, Lin Zhou, Zhiyong Zong, Abdella Gemechu … and 23 other authors

Affiliations

  • Shanghai Key Laboratory of Molecular Medical Mycology, Center for Basic Research and Innovation of Medicine and Pharmacy, Ministry of Education of the PRC, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
  • Laboratory of Pathogen Research, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
  • Jiangxi Key Laboratory of Oncology, Jiangxi Cancer Hospital & Institute, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China.
  • Pulmonology department, Amiri Medical Complex, Kabul, Afghanistan.
  • Central Public Health Laboratory (CPHL), Ministry of Public Health (MoPH), Kabul, Afghanistan.
  • French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan.
  • Institute of Hygiene and Medical Microbiology, ECMM Excellence Center of Medical Mycology, Medical University of Innsbruck, Innsbruck, Austria.
  • Advisors to the Royal Government of Cambodia, Phnom Penh, Cambodia.
  • Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Multimodal Intelligent Diagnosis and Treatment System for Respiratory Diseases, Beijing, China.
  • Department of Dermatology and Venereology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Jiangsu Province, China.
  • Department of Dermatology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
  • Department of Microbiology Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
  • Department of Medical Microbiology, The People's Hospital of Suzhou New District, Suzhou, Jiangsu Province, China.
  • Department of Radiology, Changzheng Hospital, Naval Medical University, Shanghai, China.
  • National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
  • Laboratory Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China.
  • Department of Laboratory Medicine, Shanghai East Hospital affiliated to Tongji University, Shanghai, China.
  • Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China.
  • Guizhou Key Laboratory of Microbiome and Infectious Disease Prevention & Control, School of Basic Medical Science, Institution of One Health Research, Guizhou Medical University, Gui'an New District, Guizhou Province, China.
  • Department of Medical Mycology, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China.
  • Hospital Management Institute of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, China.
  • Department of Clinical Laboratory Medicine, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi Province, China.
  • Department of Dermatology and Venereology, Peking University First Hospital; National Clinical Research Center for Skin and Sexually Transmitted Diseases; Beijing Key Laboratory of Innovative Clinical Research and Translation in Skin Diseases; Research Center for Medical Mycology, Peking University, Beijing, China.
  • State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, National Center for Respiratory Medicine, Guangzhou, Guangdong Province, China.
  • Department of pulmonary medicine, Zhongshan hospital. Fudan University, Shanghai, China.
  • Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, Beijing Key Laboratory of Surveillance, Early Warning and Pathogen Research on Emerging Infectious Diseases, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
  • Department of Clinical Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China.
  • Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  • Department of Laboratory Medicine, Liaoning Clinical Research Center for Laboratory Medicine, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China.
  • Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China.
  • Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
  • The Laboratory of Medical Mycology & Department of Dermatology, Jining No. 1 People's Hospital, Jining, Shandong Province, China.
  • Department of Respiratory and Critical Care Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province, China.
  • Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
  • Department of Respiratory and Critical Care Medicine, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
  • Institute of Antibiotics, Huashan Hospital Fudan University, Shanghai, China.
  • Department of Infectious Diseases, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
  • Department of Respiratory and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
  • Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
  • Department of Infectious Diseases, Center of General Practice Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang Province, China.
  • Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
  • Department of Laboratory Medicine, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
  • Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
  • Haramaya University, College of Health and Medical Sciences, School of Medical Laboratory Sciences, Harar, Ethiopia.

Abstract

Invasive pulmonary fungal diseases (IPFD) continue to posing an increasing clinical and public health burden on immunocompromised populations. In many Asian settings, the diagnosis of IPFD faces substantial challenges driven by the high prevalence of comorbidities, including poorly controlled diabetes, tuberculosis (TB), and human immunodeficiency virus (HIV) infection, considerable heterogeneity in local pathogens, and disparities in access to diagnostic resources. To address these unmet needs, experts from 18 countries collaboratively developed this consensus, which provides a diagnostic algorithm tailored to high-burden Asian settings based on existing international and regional guidelines. When clinical manifestations are atypical or diagnostic clues are limited, the algorithm prioritizes evaluation for common and regionally prevalent IPFD, followed by stepwise expansion to other potential fungal pathogens. In addition, this consensus outlines the regional accessibility of different diagnostic modalities across Asia. This consensus focuses exclusively on optimization of the diagnostic algorithm and does not provide specific recommendations regarding antifungal therapy. Notably, improved diagnosis of IPFD through this algorithm may contribute to better patient outcomes and strengthened public health strategies in high-burden regions.

MeSH

Public Health, Algorithms, Hiv, Lung Diseases, Fungal, Mycoses, Diagnosis, Immunocompromised Host