03159nas a2200421   4500000000100000008004100001653001300042653001400055653002400069653002500093100001000118700001500128700001400143700002100157700001100178700001700189700001800206700002200224700001400246700001300260700001400273700002200287700001200309700001300321700000900334700001500343700001200358700002700370700002800397700001500425700001500440700001500455245015000470856018600620490000600806520191100812022001402723       2019                            d10aMycetoma10aSkin NTDs10aIntegrated approach10aLaboratory diagnosis1 aHay R1 aDenning DW1 aBonifaz A1 aQueiroz-Telles F1 aBeer K1 aBustamante B1 aChakrabarti A1 aChávez-López MG1 aChiller T1 aCornet M1 aEstrada R1 aEstrada-Chávez G1 aFahal A1 aGomez BL1 aLi R1 aMahabeer Y1 aMosam A1 aSoavina Ramarozatovo L1 aRakoto Andrianarivelo M1 aRabenja FR1 aSande WW J1 aZijlstra E00aThe Diagnosis of Fungal Neglected Tropical Diseases (Fungal NTDs) and the Role of Investigation and Laboratory Tests: An Expert Consensus Report.  uhttp://scholar.google.nl/scholar_url?url=https://www.mdpi.com/2414-6366/4/4/122/pdf&hl=nl&sa=X&d=2667681130376958573&scisig=AAGBfm2SeyqZG1rSZDPvwALS7Iruse8nMA&nossl=1&oi=scholaralrt0 v43 a<p>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.</p>
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