Diagnosing pulmonary aspergillosis is much easier than it used to be: A new diagnostic landscape

Significant innovations in the past decade have resulted in more sensitive and faster diagnosis of allergic, chronic and invasive pulmonary aspergillosis, as well as Aspergillus bronchitis and Aspergillus nodules. This new diagnostic landscape has revealed that the incidence and prevalence of aspergillosis is substantially higher than previously understood. Oral and intravenous antifungal therapy offers good clinical response rates for affected patients. Yet, missed diagnosis leaves patients over-treated with antibacterial agents, corticosteroids and anti-tuberculous drugs resulting in continuing illness and often death. The clinical introduction of several high performing diagnostic tests is helping to redefine patient management. Assuredly, Aspergillus antigen can be detected in 70-95% of bronchoscopy samples in patients with invasive and chronic aspergillosis in less than 1 hour. Aspergillus IgG (precipitins) is >90% sensitive and 98% specific for chronic and allergic aspergillosis. High volume respiratory fungal culture and Aspergillus PCR have 3-5 fold much higher sensitivity than routine bacterial culture. Aspergillus IgE (or skin prick testing) diagnoses Aspergillus sensitisation in asthma, cystic fibrosis, COPD and after TB, and correlates well with poorer lung function and/or exacerbations. Across the world, clinicians and laboratorians need to mainstream these excellent new tools to improve clinical outcomes by delivering results in a more timely and accurate fashion.