SERIAL MONITORING OF ASPERGILLUS ANTIGEN IN THE EARLY DIAGNOSIS OF INVASIVE ASPERGILLOSIS - PRELIMINARY INVESTIGATIONS WITH 2 EXAMPLES

A recently developed sandwich ELISA, which detects Aspergillus galacto mannan, was tested retrospectively in serial serum samples from an all ogeneic bone marrow transplant recipient with proven invasive aspergil losis (patient 1) and another with suspected disease (patient 2). Gala ctomannan was detected in the serum 4 and 28 days, respectively, befor e pulmonary infiltrates suggestive of fungal infection first became ap parent on the chest X-ray. Aspergillus was detected by ELISA and PCR i n BAL fluid samples from both patients, and in CSF from patient 1. The diagnosis was confirmed at autopsy for patient 1 by histopathology an d the recovery of Aspergillus fumigatus from the lung and brain. Furth ermore, in both patients the course of the antigen titer in the serum during antifungal treatment corresponded with the clinical outcome, Th ese results confirm that the sandwich ELISA appears to be useful for t he early diagnosis of invasive aspergillosis. The value of the test fo r monitoring the response to antifungal treatment remains to be establ ished in prospective trials.