Critical assessment of issues in the diagnosis of invasive aspergillosis

Invasive aspergillosis remains a devastating disease, which is partly because of the inability to identify infected patients at an early stage of the disease. Recently, new diagnostic tests and procedures have been developed to help in identifying high-risk patients. High-resolution computed tomography has been shown to be a potent tool for detecting pulmonary abnormalities in neutropenic patients. Assays for the detection of circulating markers such as fungal antigens or Aspergillus DNA have been developed and show that markers can be detected in the blood at an early stage of infection. Also, the markers correlate with the fungal burden in the tissue, which allows monitoring of response to antifungal therapy. The tests and procedures that are now available need to be incorporated into management strategies for at-risk patients and evaluated in clinical trials. Although we now have markers that allow the early detection of fungal products, many questions remain unanswered with respect to the kinetics of the markers in different patient groups, the optimal management strategy and the effect of prophylaxis and treatment on the markers. Nevertheless, the implementation of new approaches for the management of invasive aspergillosis offers opportunities to improve outcome of patients.