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Abstract：
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.
摘要：
真菌被忽视热带病（NTD）的诊断主要基于对可疑病例的初步视觉识别，然后进行确认性实验室测试。通常仅限于专门的设施。尽管分子和血清诊断工具已经取得了进步，在地方性环境中，理想和实用之间仍然存在很大的差距。为了进一步探讨这个问题，我们对主题专家进行了一项调查，研究了最佳诊断方法，该方法足以在设备齐全的医疗机构与基本医疗机构中启动治疗，以及最佳抽样方法，三种真菌NTD:霉菌瘤，成色真菌病,和孢子丝菌病。对23个中心的调查发现，与拭子或印模涂片相比，半侵入性取样方法如活检诊断的关键作用达成共识，关于组织病理学的重要性，直接显微镜,并在设备齐全的实验室中进行菌丝瘤和染色体成真菌病的培养。在基本的医疗保健环境中，据报道,直接镜检结合临床体征是提示转诊治疗的最有用的诊断指标.调查发现，除真菌培养外，在最广泛的实验室测试中，孢子丝菌病的诊断是最有问题的，敏感性差。强调需要提高真菌学诊断能力和开发创新的诊断解决方案。真菌显微镜和培养现在被认为是世卫组织必不可少的诊断测试，对其应用进行更好的培训将有助于改善这种情况。对于霉菌瘤和孢子丝菌病，特别是,识别特定标记抗原或基因组序列的进展可能为新的基于实验室或即时测试铺平道路，尽管这是一项艰巨的任务，因为有大量不同的生物可以引起真菌NTDs。
