Respiratory Treatment and Prevention (Advances in Experimental Medicine and Biology)

a negative result, although they manifested clini-
cal symptoms of respiratory tract infections.
These patients were classified as probable
aspergillosis.

Okuturlar et al. ( 2015 ) have analyzed

165 cases from the invasive fungal infection

risk group. Fifteen patients were diagnosed with

invasive pulmonary aspergillosis by

Table 2 Advantages and disadvantages of different diagnostic methods in invasive pulmonary aspergillosis

Method Advantages Disadvantages

Culture Simple and cheap; Time-consuming;

Allows to identify the fungus and to perform

antifungal susceptibility testing;

Low sensitivity;

High rate of isolation in blood cultures for

Fusarium spp.

Results conditioned by proper sampling;

Possibility of contamination;

Recently improved strategy needs testing in

multiple laboratories for other molds.

Galactomannan

(GM) detection

Non-invasive method; Differences in diagnostic and prognostic values

in non‐neutropenic patients;

Useful for early diagnosis; Mold antifungal drug therapy influences

detection sensitivity;

Reproducible methodology; Persistent GM antigenemia during therapy

points to poor prognosis and the need to

reassess therapy.

Greater sensitivity and specificity for mold

diagnosis, particularly when non-fumigatus

Aspergillus spp. are involved.

1,3-β-glucan

detection

Non-invasive method; False/+ results (bacteremia);

Useful and reproducible method, particularly in

early diagnostics;

Limited experience, less widely used than GM

detection;

Broad coverage of fungal species; Threshold for positive results depends on a kind

of test used;

Can be used to screen patients with suspected

mold disease;

Antigenemia wanes in invasive aspergillosis

and pneumocystis pneumonia under antifungal

therapy;

Useful in patients under antifungal therapy. Antigen may remain for long above usual

threshold after disappearance of clinical

symptoms of primary infection;

Less accurate in hematological patients.

Molecular

techniques:

Real-Time PCR

Non-invasive method; Non‐mycological criterion is still in

development;

Useful and reproducible method, particularly in

early diagnostics;

Limited to reference laboratories, thus of low

accessibility;

Broad coverage of fungal species; High cost, sophisticated equipment;

Can be used to screen patients with potential

mold disease;

Laborious and difficult efficient fungal DNA

extraction from untoward clinical specimens.

Useful in patients under antifungal therapy;

Assessment of mold species and molecular

susceptibility.

Imaging Computer tomography helpful in early

diagnosis;

Not accepted as proof of a mold disease;

X-ray raises attention to the possibility of mold

disease when pulmonary symptoms are

manifested.

Image specific not only to invasive aspergillosis

(halo sign observed also in other lesions);

X-ray does not show a fungus ball, therefore

requires assessment by highly trained staff.

Histology Can be useful in diagnostics; Requires invasive sampling;

Fungal hyphae are rapidly detected in tissue. Rarely recommended by physicians;

Unable to determine the species.

Diagnosis of Invasive Pulmonary Aspergillosis 31