Fungi are an important but frequently overlooked cause of morbidity and mortality in humans. Life-threatening fungal infections mainly occur in immunocompromised patients, and are typically caused by environmental opportunists that take advantage of a weakened immune system. The filamentous fungus Aspergillus fumigatus is the most important and well-documented mold pathogen of humans, causing a number of complex respiratory diseases, including invasive pulmonary aspergillosis, an often fatal disease in patients with acute leukemia or in immunosuppressed bone marrow or solid organ transplant recipients. However, non-Aspergillus molds are increasingly reported as agents of disseminated diseases, with Fusarium, Scedosporium, Lomentospora and mucormycete species now firmly established as pathogens of immunosuppressed and immunocompetent individuals. Despite well-documented risk factors for invasive fungal diseases, and increased awareness of the risk factors for life-threatening infections, the number of deaths attributable to molds is likely to be severely underestimated driven, to a large extent, by the lack of readily accessible, cheap, and accurate tests that allow detection and differentiation of infecting species. Early diagnosis is critical to patient survival but, unlike Aspergillus diseases, where a number of CE-marked or FDA-approved biomarker tests are now available for clinical diagnosis, similar tests for fusariosis, scedosporiosis and mucormycosis remain experimental, with detection reliant on insensitive and slow culture of pathogens from invasive bronchoalveolar lavage fluid, tissue biopsy, or from blood. This review examines the ecology, epidemiology, and contemporary methods of detection of these mold pathogens, and the obstacles to diagnostic test development and translation of novel biomarkers to the clinical setting.

真菌是人类发病和死亡的重要但经常被忽视的原因。威胁生命的真菌感染主要发生在免疫功能低下的患者中，通常是由利用免疫系统弱化的环境机会主义者引起的。丝状真菌烟曲霉是人类最重要且有据可查的霉菌病原体，引起多种复杂的呼吸系统疾病，包括浸润性肺曲霉病，这是急性白血病患者或免疫抑制性骨髓或实体器官移植受者中经常致命的疾病。但是，越来越多地报道了非曲霉霉菌与镰刀菌，景天孢子虫，现已将根孢菌和粘菌菌种牢固地确立为免疫抑制和具有免疫能力的个体的病原体。尽管有充分的文献证明侵袭性真菌疾病的危险因素以及对威胁生命的感染的危险因素的认识有所提高，但由于缺乏易于获取的真菌，在很大程度上可能低估了由霉菌引起的死亡人数便宜，准确的测试方法，可以检测和区分感染物种。早期诊断对患者生存至关重要，但与曲霉菌不同疾病，目前已有大量CE标记或FDA批准的生物标记物测试可用于临床诊断，而fusariosis，scedosporosis和mucormycosis的类似测试仍处于试验阶段，其检测依赖于侵入性支气管肺泡灌洗液，组织中病原体的不敏感和缓慢培养活检或血液。这项审查审查生态，流行病学和当代检测这些霉菌病原体的方法，以及诊断测试发展和新型生物标志物转化为临床环境的障碍。