National Reference Center (NRC) for Mycosis

Important communication

Invoicing Aspergillus and Mucorales PCR from July 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 July1, 2024, at a cost of 70€ for an Aspergillus PCR and 53€ for a Mucorales PCR.

Candida auris (September 2025)

​Now in Belgium, Candida auris was isolated from 21 patients  (between 2016 and 2025), but in five patients, no link with a foreign hospital residence could be found. 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. Six of the 14 cases reported until then 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 (interpretation according to the recent EUCAST breakpoints). Up until now, all strains except 4 cases (clade III) were typed as clade I (South Asia).

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. Sensitivity determination is therefore essential to guide treatment choices. Recommendations to control the spread of this yeast were published by the Superior Health Council (https://www.hgr-css.be/en/report/9575/candida-auris).

Recommendations Belgian Risk Assessment Group and National Reference Centre

• Always identify yeasts from normally sterile samples at species level. In case of identification problems, isolates can be sent to the National Reference Centre for Mycosis (UZ Leuven or CHU Liège).
• Send all yeasts identified as Candida auris to the NRC for confirmation of identification and sensitivity determination.
• Hospitals detecting an individual case of C. auris or 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 Hospital Outbreak Support Team (HOST). Contact can be made through the regional infection control teams.
• Candida auris was included in the list of human pathogens with mandatory notification in Flanders, Wallonia and Brussels.

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 and Information session June 2023 CHU Liège