Editorial: Diagnostic Approaches for Aspergillus Infections.


Salzer HJF, Prattes J, Hoenigl M
Front Microbiol. 2019 Mar 19.


Infections caused by Aspergillus spp. affect immunocompromised patients, patients with certain genetic defects including CARD-9 deficiency and patients with pre-existing lung conditions or liver cirrhosis, and are associated with devastating mortality rates. Early and reliable diagnosis and subsequent rapid initiation of appropriate antifungal therapy has shown to improve survival significantly, at least for invasive Aspergillosis. However, invasive Aspergillus infections progress rapidly and are difficult to diagnose especially at early stages. Culture based approaches are important for detection of fungal species and resistance testing, however they are limited by low sensitivities—in particular during early phases of infection—and long turnaround time. Important advances to the field were brought by the introduction of non-cultural diagnostic tests for aspergillosis in blood and bronchoalveolar lavage fluid, including, galactomannan antigen testing, PCR, and 1,3-ß-D-glucan testing in patients at risk. Complicating is the fact that performance of these tests may vary not only by fungal disease, but also by risk group.

The current Research Topic includes in total 19 high quality manuscripts, ranging from reviews of current state of the art of treatment of aspergillosis in solid organ transplant recipients, the pediatric population, and the veterinary setting, to a variety of original articles focusing on new diagnostics of invasive and chronic forms of aspergillosis, including detection of azole resistance.

Importantly, several new diagnostic approaches for diagnosis of invasive aspergillosis have been studied within the last years assays for which results were shown to be quantitatively correlated to galactomannan levels in one study of this Research Topic, the Aspergillus specific lateral flow assay, Triacetylfusarinine C, Bis(methylthio)gliotoxin, PET imaging studies, interleukins. These new diagnostic approaches may overcome the limitations observed with the currently available diagnostic tools. Our Research Topic includes also a review on serum galactomannan testing in a promising indication other than diagnosis, namely for outcome prediction and treatment stratification.