Sección 1. Consenso colombiano para el diagnóstico y seguimiento de la aspergilosis invasora y de la enfermedad aspergilar en pacientes adultos y pediátricos
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Durante mucho tiempo la aproximación diagnóstica de una AI/enfermedad aspergilar ha sido un desafío. El diagnóstico definitivo, se lleva a cabo mediante la correcta documentación microbiológica y/o histopatológica, indudablemente la piedra angular que resulta fundamental para la toma de decisiones terapéuticas, sin embargo, se considera limitada por la falta de sensibilidad y rapidez, siendo a menudo contraproducente, ya que se requiere en muchos casos de procedimientos invasivos (ej., fibrobroncoscopia [FBC] o biopsia de tejido), lo que retrasa el tratamiento y socava la supervivencia de los pacientes en situación de riesgo. Esto pone de relieve la necesidad de herramientas diagnósticas más rápidas y precisas, y aunque se han desarrollado métodos serológicos y moleculares novedosos, que han demostrado su potencial para reemplazar las pruebas de diagnóstico convencionales, las inconsistencias en interpretación y validación entre los diferentes enfoques limitan su reproducibilidad y su aplicación clínica a gran escala. Sin embargo, un diagnóstico inmunológico y/o molecular debería realizarse siempre que sea posible, ya que ha demostrado su utilidad en diferentes estrategias de detección y diagnóstico, que con la comprensión de sus fortalezas y limitaciones, y la estandarización de las diferente técnicas disponibles, pueden ser incorporados a protocolos de atención y algoritmos de diagnóstico, como una ayuda para administrar y vigilar los diferentes tratamientos antifúngicos y predecir los posibles resultados clínicos. Debido a la limitada sensibilidad (S) de muchas de las pruebas, y las variaciones en la especificidad (E) de algunas de ellas, el uso de varias herramientas diagnósticas disponibles en combinación, durante el período de alto riesgo para una enfermedad invasora y/o durante el periodo temprano en el curso de una AI/enfermedad aspergilar, permitirían una adecuada aproximación diagnóstica, siempre que sus resultados se interpreten de manera conjunta con la información clínica e imagenológica existente.
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