Respiratory infections caused by fungal pathogens present a growing global health concern and are a major cause of death in immunocompromised patients. Worryingly, coronavirus disease-19 (COVID-19) resulting in acute respiratory distress syndrome has been shown to predispose some patients to airborne fungal co-infections. These include secondary pulmonary aspergillosis and mucormycosis. Aspergillosis is most commonly caused by the fungal pathogen Aspergillus fumigatus and primarily treated using the triazole drug group, however in recent years, this fungus has been rapidly gaining resistance against these antifungals. This is of serious clinical concern as multi-azole resistant forms of aspergillosis have a higher risk of mortality when compared against azole-susceptible infections. With the increasing numbers of COVID-19 and other classes of immunocompromised patients, early diagnosis of fungal infections is critical to ensuring patient survival. However, time-limited diagnosis is difficult to achieve with current culture-based methods. Advances within fungal genomics have enabled molecular diagnostic methods to become a fast, reproducible, and cost-effective alternative for diagnosis of respiratory fungal pathogens and detection of antifungal resistance. Here, we describe what techniques are currently available within molecular diagnostics, how they work and when they have been used.

由真菌病原体引起的呼吸道感染日益引起全球健康关注，并且是免疫功能低下患者死亡的主要原因。令人担忧的是，导致急性呼吸窘迫综合征的冠状病毒病 19 (COVID-19) 已被证明会使一些患者容易发生空气传播的真菌合并感染。这些包括继发性肺曲霉病和毛霉菌病。曲霉菌病最常由真菌病原体烟曲霉引起，主要使用三唑药物组进行治疗，但近年来，这种真菌迅速获得了对这些抗真菌药物的耐药性。这是一个严重的临床问题，因为与唑类敏感感染相比，多唑类耐药形式的曲霉病具有更高的死亡风险。随着 COVID-19 和其他类别的免疫功能低下患者数量的不断增加，真菌感染的早期诊断对于确保患者的生存至关重要。然而，目前基于培养的方法很难实现限时诊断。真菌基因组学的进步使分子诊断方法成为诊断呼吸道真菌病原体和检测抗真菌耐药性的快速、可重复且经济有效的替代方法。在这里，我们描述了分子诊断中目前可用的技术、它们的工作原理以及何时使用它们。