ATS GUIDELINES Bundle

Table 2. Recommendations Suspected condition Recommendation Candidiasis In critically ill patients in whom there is clinical concern for invasive candidiasis, the ATS suggests against reliance solely on results of serum BDG testing for diagnostic and treatment decisions. (Conditional recommendation, low quality evidence) Histoplasmosis e ATS recommends the use of Histoplasma antigen in urine or serum for rapid diagnosis of suspected disseminated and acute pulmonary histoplasmosis where timely diagnosis and treatment are paramount to outcome. (Strong recommendation, high quality evidence) e ATS suggests the use of Histoplasma serologies in immunocompetent patients with suspected pulmonary histoplasmosis. (Conditional recommendation, moderate quality evidence) Note: Adding Histoplasma antigen to serological testing might improve the diagnostic yield . Blastomycosis In patients with appropriate geographic exposure and illness compatible with infection or pneumonia due to blastomycosis, the ATS suggests using more than one diagnostic test, including direct visualization and culture of sputum BAL or other biopsy material, urine antigen testing, and serum antibody testing. (Conditional recommendation, moderate quality evidence) Note: The current evidence cannot support a single best test as being sensitive enough to be ordered in isolation of other testing. The approach should be tailored based on the severity of illness, the clinical context and availability of tests In patients with suspected blastomycosis, the ATS suggests that serum antibody testing specifically directed against the anti- BAD-1 antigen for blastomycosis be used along with clinical and epidemiological data to establish the diagnosis. (Conditional recommendation, low quality evidence) In patients with suspected blastomycosis, particularly in immunocompromised patients, the ATS suggests that urinary antigen testing for blastomycosis be used along with clinical and epidemiological data to establish the diagnosis. (Conditional recommendation, moderate quality evidence) (cont'd) Diagnosis

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