microbiological testing, including four qualified
as proven and 11 as probable infection.
A. fumigatuswas cultured from nine clinical
specimens. S€onmez et al. ( 2015 ) have described
199 patients at high risk of invasive fungal infec-
tion and classified three patients as proven and
16 as probable infection, distinguishing high and
low risk of infection. The galactomannan antigen
was detected in serum samples of the three
patients classified as proven infection.
The diagnostics of invasive aspergillosis,
including the detection of the galactomannan
antigen has been described in a number of studies
for different patient groups (Leeflang et al. 2008 ;
Pfeiffer et al. 2006 ). Detection of galactomannan
apparently is well associated withAspergillus
spp.infection (Backx et al. 2014 ; Cordonnier
et al. 2009 ). Therefore, most clinical studies
rely mainly on galactomannan detection to diag-
nose probable invasive aspergillosis (Ceesay
et al. 2015 ; Marks et al. 2011 ). According to the
EORTC/MSG guidelines, galactomannan detec-
tion is the only reliable and recommended test
supporting the diagnosis and enabling the classi-
fication of patients to the proven, probable, and
possible groups. Monitoring the presence of this
antigen may be used to implement pre-emptive
therapy in patients with clinical symptoms of an
infection before onset of a full-blown disease and
visible lesions (Backx et al. 2014 ; Cordonnier
et al. 2009 ; Maertens et al. 2005 ). However, in
the present study, the galactomannan antigen was
detected less frequently thanA. fumigatuswas
cultured. Similar findings have been reported in
some other studies (S€onmez et al. 2015 ; Wheat
and Walsh 2008 ), which may put the essential
diagnostic role of the detection of galactomannan
into doubt. Differential diagnostics consisting of
complimentary tests such as culture,
galactomannan detection, and others narrows
down the search for the etiologic background of
an infection and distinguishes the risk groups;
thus distinctly helping the decision making
concerning the implementation of antifungal
treatment.
Conflicts of Interest The authors declare no conflicts of
interest in relation to this article.
ReferencesAndreoni S, Farina C, Lombardi G (2004) Medical
mycology atlas. Gilead Systems. GRAFIK@rt srl –
Paderno Dugnano
Ascioglu S, Rex JH, de Pauw B, Bennett JE, Bille J,
Crokaert F, Denning DW, Donnelly JP, Edwards JE,
Erjavec Z, Fiere D, Lortholary O, Maertens J, Meis JF,
Patterson TF, Ritter J, Selleslag D, Shah PM, Stevens
DA, Walsh TJ, Invasive Fungal Infections, Coopera-
tive Group of the European Organization for Research
and Treatment of Cancer, Mycoses Study Group of the
National Institute of Allergy and Infectious Diseases
(2002) Defining opportunistic invasive fungal
infections in Immunocompromised patients with can-
cer and hematopoietic stem cell transplants: an inter-
national consensus. Clin Infect Dis 34:7–14
Backx M, White PL, Barnes RA (2014) New fungal
diagnostics. Br J Hosp Med (Lond) 75:271–276
Ceesay MM, Desai SR, Berry L, Cleverley J, Kibbler CC,
Pomplun S, Nicholson AG, Douiri A, Wade J,
Smith M, Mufti GJ, Pagliuca A (2015) A comprehen-
sive diagnostic approach using galactomannan,
targetedβ-d-glucan, baseline computerized tomogra-
phy and biopsy yields a significant burden of invasive
fungal disease in at risk haematology patients. Br J
Haematol 168:219–229
Chabi ML, Goracci A, Roche N, Paugam A, Lupo A,
Revel MP (2015) Pulmonary aspergillosis. Diagn
Interv Imaging 96:435–442
Cordonnier C, Botterel F, Ben Amor R, Pautas C,
Maury S, Kuentz M, Hicheri Y, Bastuji-Garin S,
Bretagne S (2009) Correlation between
galactomannan antigen levels in serum and neutrophil
counts in haematological patients with invasive asper-
gillosis. Clin Microbiol Infect 15:81–86
De Pauw B, Walsh TJ, Donnelly JP, Stevens DA,
Edwards JE, Calandra T, Pappas PG, Maertens J,
Lortholary O, Kauffman CA, Denning DW, Patterson
TF, Maschmeyer G, Bille J, Dismukes WE,
Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ,
Marr KA, Mun ̃oz P, Odds FC, Perfect JR,
Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell
TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE
(2008) Revised definitions of invasive fungal disease
from the European Organization for Research and
Treatment of Cancer/Invasive Fungal Infections
Cooperative Group and the National Institute of
Allergy and Infectious Diseases Mycoses Study
Group (EORTC/MSG) Consensus Group. Clin Infect
Dis 46:1813–1821
Desoubeaux G, Bailly E ́, Chandenier J (2014) Diagnosis
of invasive pulmonary aspergillosis: updates and
recommendations. Med Mal Infect 44:89–101
Haddad TM, Narayanan MA, Shaw KE, Vivekanandan R
(2015) Fatal case of probable invasive aspergillosis
after five years of heart transplant: A case report and
review of the literature. Case Rep Infect Dis
2015:864545. doi:10.1155/2015/86454532 E. Swoboda-Kopec ́et al.