ATS GUIDELINES Bundle

Diagnosis of Fungal Infections

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Key Points Î The rising prevalence of fungal infections is likely related to several factors, including an ever-growing population of susceptible patients. Î Furthermore, endemic mycoses continue to pose a threat to both immunocompetent and immunosuppressed individuals. Î Recent advances in laboratory diagnostics have evolved to assist the diagnosis of pulmonary fungal infections. Î These guidelines focus on the use of galactomannan (GM) antigen and PCR testing in the diagnosis of invasive pulmonary aspergillosis (IPA), (1➝3)-β-D-glucan (BDG) assays or invasive candidiasis (IC), and the use of antigen and antibody testing in the diagnosis of endemic mycoses. Table 1. Interpretation of Strong and Conditional Recommendations Strong recommendation Conditional recommendation Patients Most individuals in this situation would want the recommended course of action, and only a small proportion would not. Most individuals in this situation would want the suggested course of action, but many would not. Clinicians Most individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. Recognize that different choices will be appropriate for different patients and that you must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may well be useful in helping individuals making decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision. Policy makers e recommendation can be adopted as policy in most situations, including for use as performance indicators. Policy making will require substantial debate and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place.

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