Issues with galactomannan testing.

Within the past decade detection of the aspergillus antigen galactomannan has become an important and reliable tool for the early diagnosis of invasive aspergillosis. The galactomannan molecule, that is detected by the commercial sandwich ELISA (Platelia Aspergillus, Biorad), was found not to be a single molecule, but a family of molecules that have the epitope that reacts with the monoclonal antibody. Also the cut off level is now world-wide lowered to 0.5 which will help to further standardize and compare this diagnostic tool. Despite the advantages of galactomannan detection, there are several issues that have impact on its use in clinical practice. Both false negative and false positive reactivity is encountered and although the causes of false reactivity are not fully understood, new insights have become available which help us to optimize the use of the assay. This review discusses present issues with galactomannan testing with a view to future research and management.