[Sero-diagnosis for pulmonary aspergillosis--its utility in early diagnosis]

The clinical utility of Pastorex Aspergillus, a commercially available circulating aspergillus galactomannan antigen detection kit was evaluated. In animal models of pulmonary aspergillosis, it was extremely sensitive for detection of not only A. fumigatus antigen but also antigens of A. flavus and A. niger both in serum and urine. In a preliminary study in autopsied or clinically proven cases with aspergillus infections a high positive rate of antigen detection was obtained when it was applied prospectively. A total of 1,373 clinical samples obtained from patients with suspected aspergillus infection were examined. Among 67 patients giving antigen-positive results in their clinical samples including serum, urine, sputum and others, 17 patients proved to have aspergillus infection by histological or cultural studies. Sixteen patients were judged to be suspicious of aspergillus infection. Measurement of serum (1 --> 3) beta-D glucan by G-test in these cases was well correlated to the results of the antigen detection test. However, the serum showed often antigen-negative even when it was examined at the peak of illness. The rapid clearance of the antigen from circulation was considered to be one of the reasons for this phenomenon. In these cases, antigen detection in samples other than serum, such as urine, sputum, and pleural fluid was also useful. In conclusion, when using Pastorex Aspergillus to obtain the early diagnosis of aspergillus infection frequent examination in different types of samples is recommended.