Aspergillus antigen in serum, urine and bronchoalveolar lavage specimens of neutropenic patients in relation to clinical outcome

We have used a new, commercial enzyme-linked immunosorbent assay (ELISA, Pl atelia(R) Aspergillus) to detect Aspergillus antigen in serum, urine and br onchoalveolar lavage (BAL) samples of 105 haematological patients who recei ved empirical amphotericin B treatment for suspected fungal infection. 14% (60/419) of serum and 5% (18/373) of urine samples were positive. Ten-fold concentration of urine increased the number of positive samples to 31 (8%). The antigen was detected in 5 of 20 BAL samples, but fungal culture was ne gative in all of them. 22 patients had positive antigen test. Serum was pos itive in 17, urine in 7 and concentrated urine in 12 patients. Six patients had confirmed invasive aspergillosis. In all these patients, antigen was d etected in serum, but urine was positive in only 2 patients. Patients whose antigen test turned negative during the amphotericin B treatment had signi ficantly lower mortality than patients with persistently positive antigen t est (2/10 vs. 8/8, p = 0.002). We conclude that Aspergillus galactomannan c an be detected by ELISA in serum, urine and BAL samples of haematological p atients, but the higher sensitivity of serum testing makes it preferable fo r screening. Disappearance of the antigen during antifungal therapy seems t o correlate with good, and persistence with poor, clinical outcome.