The role of nuclear magnetic resonance in medical mycology

With the continued emergence of drug-resistant invasive mycoses, rapid fungal identification and susceptibility testing are needed. Nuclear magnetic resonance (NMR) spectroscopy generates complex data (“fingerprints”) based on chemical composition and metabolite profiles, which can be applied to suspensions of living microorganisms or mammalian cells, cell and tissue extracts, biological fluids, tissue biopsies, and noninvasive diagnosis in patients when linked to MRI. Closely related fungal species can be rapidly identified based on their NMR spectra, and antifungal drug effects can be measured as metabolic end points. The feasibility of classifying groups of microorganisms directly from biological samples has been demonstrated in animal models and human infections. Potential advantages of NMR spectroscopy in medical mycology include accurate identification, automated sample delivery, automated analysis using computer-based methods, rapid turnaround time, high throughput, and low running costs. More work is needed to validate the automated approach on large data sets covering a broad spectrum of potential pathogens.