[Mycological and parasitological examinations in the management of lung infections].
Examens mycologiques et parasitologiques dans la prise en charge des infections pulmonaires
Résumé
Pulmonary parasitic diseases are rare whereas pulmonary fungal infections are increasing. The diversity of clinical presentations requires laboratory tests to confirm the diagnosis. Direct examination of lung samples and antibody detection are the basis of parasitological diagnosis. With regard to mycoses, the range of biological tests is broader. The conventional mycological examination allows identification of any type of fungus except Pneumocystis jirovecii. Its specificity is excellent but it lacks sensitivity. Detection of antibodies, antigens or nucleic acid complements the diagnostic tools. With regard to aspergillosis, there is a broad nosological set with variable prognosis. The choice of appropriate laboratory procedures depends on the clinical presentation and patient risk factors. The search for galactomannan antigen is effective and a new technique, "Lateral Flow Device", seems very promising. The detection of antibodies is also informative but various techniques are used. A good knowledge of the performance and limitations of these techniques allows targeted prescription. The use of PCR for the diagnosis of pulmonary fungal infections has limited indications. Biological and clinical co-operation is essential for the choice and interpretation of laboratory tests for parasitic or fungal pulmonary disease.