The fifth important area is the monitoring of host response to disease and treatment may become possible using mRNA profiling. Variation in host genotype is supporting genome wide profiling which is leading to identifying host groups at risk for disease, monitoring markers that are surrogates for host response to disease and treatment, and using peripheral blood cells to interrogate the condition of deeper host tissues and organs. Arrays can score more mRNAs but kinetic RT-PCR is more sensitive and has a greater dynamic range. Kinetic RT-PCR is being used to profile chemokines, cytokines and receptors found in PBMCs and is showing that mRNA levels vary among individuals and are stable over time per individual but are variable when the host disease state changes. Technically, monitoring host genetic variation is becoming increasingly useful but social hurdles involving regulation and acceptance can be expected and will be difficult to overcome.
Recommendations Develop a standard, rapid, and reliable way of identifying fungal pathogens.
Move toward looking at fungal genotypes for clinical and biological relevance. Consider a pilot program focused on a set of fungi causing either endemic or opportunistic mycoses. Such a pilot could examine key genetic factors from the pathogen and the host from which it was derived. Increase efforts to complete fungal genome sequences for the systemic pathogens, Coccidioides immitis and Histoplasma capsulatum , for comparison with ongoing projects for the opportunistic pathogens, Candida albicans, Cryptococcus neoformans, Pneumocystis carinii and Aspergillus fumigatus .