National Reference Center (NRC) for Mycosis
Important communication
Invoicing Aspergillus and Mucorales PCR from May 1, 2024 (UZ Leuven)
Both Aspergillus and Mucorales species are among the most important pathogens of invasive fungal infections and it is therefore crucial to detect them timely and correctly. As part of the diagnosis of invasive aspergillosis, we perform the Aspergillus species PCR on BAL, biopsies and various fluids, determining both the Aspergillus species as well as detecting the two most common triazole resistance mechanisms in the cyp51A gene of A. fumigatus. To diagnose invasive mucormycosis, we perform the Mucorales PCR on BAL, biopsy, blood and various fluids. Recent data on the good performance of this test on blood and the importance of co-infections with Aspergillus species ensure that this test is rightly requested more frequently than before. Given the large number of requests for both tests and the current availability of commercial methods to perform these PCRs, we can no longer perform these PCR tests under NRC budget. We will start billing for these PCR tests from May 1, 2024, at a cost of 70€ for an Aspergillus PCR and 53€ for a Mucorales PCR.
Candida auris (December 2023)
Now in Belgium, 14 patients were isolated from Candida auris (between 2016 and 2023), but in three patients, no link with a foreign hospital residence could be found, for a case at the end of 2021, one during the first half of 2022 and the final one in the second half of 2023. Before the end of 2021, it was always an imported infection. This finding, together with the reporting of an increasing number of Candida auris cases and outbreaks in other countries in Europe, requires additional vigilance for the detection and follow-up of C. auris fallen. Six of the 14 cases were diagnosed in the year 2023.
For all C. auris strains a sensitivity determination as well as a typing is performed to determine the clade type. Up until now, all strains except two cases were typed as clade I (South Asia). Based on the CDC’s tentative breakpoints (as there are no established clinical breakpoints available for the interpretation of C. auris), all strains except one are resistant to fluconazole. With the exception of two strains, all other strains are susceptible to amphotericin B and echinocandins.
C. auris has an unusual ability to persist in the surrounding area and in asymptomatic patients which has contributed to outbreaks in different hospitals. In addition, this yeast is potentially multiresistant. Adequate isolation measures are important for confirmed clinical cases (see final global report Quality Control Sciensano enquête 2018/2. French and Dutch only.
Recommendations Belgian Risk Assessment Group and National Reference Center
- Always identify yeasts from normally sterile samples at species level. In case of identification problems, isolates can be sent to the National Reference Center for Mycosis (UZ Leuven or CHU Liège).
- Send all yeasts identified as Candida auris to the NRC for confirmation of identification and sensitivity determination.
- Send all yeasts identified as Candida haemulonii or Candida pseudohaemuloniii to the NRC.
- Send all yeasts that are resistant to fluconazole (except for Candida glabrata and Candida stool) to the NRC.
Hospitals facing an outbreak of C. auris (i.e. two or more cases with a potential link in time, place, or person) are asked to involve the Outbreak Support Team (Ost). Contact can be made through the regional infection control teams.
Helpful links
The slides of the information session (08/06/2023) regarding the activities of the NRC Mycosis can be consulted via: Information session June 2023 UZ Leuven andInformation session June 2023 CHU Liège
