Molecular tools for identification of Zygomycetes and the diagnosis of zygomycosis

The identification of Zygomycetes and diagnosis of zygomycosis are notoriously difficult. However, there have been recent advances, particularly in the availability and evaluation of new molecular approaches. Two main issues are of importance: the identification to species level of a strain isolated in culture, and the identification of a zygomycete in tissues. By using several molecular targets and by increasing the number of available DNA sequences in international databases, several studies have shown that accurate molecular identification of Zygomycetes to species level is feasible. The internal transcribed spacer (ITS) region may be used as a first-line molecular target for the identification of Zygomycetes in pure culture. However, cultures from infected tissues are often negative and the different Zygomycetes share similar morphology according to histopathology. Furthermore, differentiation of a zygomycete from another hyalohyphomycete can sometimes be difficult in histopathology. Thus, alternative methods for the diagnosis of zygomycosis and for species identification directly from tissues are needed. For this purpose, molecular methods have been recently evaluated, both on unfixed fresh/frozen material and on formalin-fixed, paraffin-embedded biopsies. This review discusses the molecular approaches currently available for the identification of Zygomycetes and the diagnosis of zygomycosis.