Comparison of serial diagnostic tests in a patient with invasive aspergillosis

Studies on a liver transplant recipient with fatal disseminated aspergillosis are described. The concentration of IgG antibodies to Aspergillus rose sharply with the onset of fever and changes in the chest X-ray, reaching a peak on day 10. Thereafter, antibody concentrations fell and were within the normal range by day 21, when Aspergillus was first isolated from an endotracheal aspirate and one day before death. The fall in antibodies preceded a rise in circulating immune complexes but Aspergillus antigens were not detected in the serum. Serial quantitative assay for antibodies to Aspergillus may be more appropriate than culture or attempts to detect antigen in the early diagnosis of invasive aspergillosis in immunocompromised patients.