title: The use of biomarkers and molecular methods for the earlier diagnosis of invasive aspergillosis in immunocompromised patients.
abstract: Invasive aspergillosis (IA) is an opportunistic infection that is often life threatening in the immunocompromised host. Early diagnosis is critical, especially given the efficacy and availability of several new anti-fungal therapies. Current (2008) diagnostic criteria have limited ability to detect early infection and are aimed at establishing disease. Although histopathology and culture techniques have traditionally been used to make a proven diagnosis of IA, their dependence on tissue samples and slow turnaround times hamper early confirmation of IA. Serologic detection of circulating galactomannan and 1,3-β-D-glucan fungal biomarkers show promise for improving the diagnosis of IA, and their use is included in the EORTC/MSG diagnostic criteria for IA. Numerous studies have evaluated the diagnostic performance of these two biomarkers and shown that they have suboptimal sensitivity when used alone for early diagnosis of proven IA. Currently available molecular assays also suffer from a lack of standardization. Evaluation of the use of different combinations of test methods to enhance diagnostic accuracy is also being done but prompt, accurate diagnosis of IA remains a clinical and diagnostic challenge. The clinical validity and limitations of biomarkers and current molecular methods for the early diagnosis of IA are summarized in this review with respect to the different patient populations at risk for this serious infection.
authors.affiliation: Medicine, University of Calgary, Calgary, Alta.
authors.forename: Anshula
authors.initials: A
authors.lastname: Ambasta
authors.affiliation: Division of Microbiology, University of Calgary, Calgary, Alta Calgary Laboratory Services, and the Departments of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alta.
authors.forename: Julie
authors.initials: J
authors.lastname: Carson
authors.affiliation: Division of Microbiology, University of Calgary, Calgary, Alta Calgary Laboratory Services, and the Departments of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alta Medicine, University of Calgary, Calgary, Alta deirdre.church@cls.ab.ca.
authors.forename: Deirdre L
authors.initials: DL
authors.lastname: Church
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D042241:Early Diagnosis; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis*; D008351:Mannans / Q000032:analysis; D016533:Mycological Typing Techniques; D016133:Polymerase Chain Reaction
chemical_list: D015415:Biomarkers; D008351:Mannans; C012990:galactomannan; D005690:Galactose
keywords: aspergillus culture; diagnosis; galactomannan; invasive aspergillosis; polymerase chain reaction