Aspergillus infections: problems in diagnosis and treatment.

Invasive aspergillosis is a common infection in patients who are immunocompromised, particularly in oncology patients, patients receiving other immunosuppressive therapy, bone marrow transplant patients, and HIV-infected patients. The diagnosis of invasive aspergillosis is difficult in the absence of tissue biopsy and histologic confirmation. Therefore, the need for and progress in recent advances in the development of highly sensitive and specific serodiagnostic tests for the early diagnosis of invasive aspergillosis have been reviewed. Anti-Aspergillus antibody detection lacks the utility to lead to early diagnosis of invasive aspergillosis. However, sensitive methods that detect significant amounts of Aspergillus antigen in body fluids, primarily serum, of high risk patients are currently being evaluated and may provide a noninvasive early diagnostic test that is both sensitive and specific. Our recent results with an inhibition enzyme-linked immunosorbent assay, which detects small but significant amounts of Aspergillus antigen in serum, in 35 patients with invasive aspergillosis are discussed. Also, current antifungal agents with anti-Aspergillus activity that have the potential for use as therapy or prophylaxis are briefly reviewed.