Diagnostic Studies: Role of Biomarkers

The range of non-culture mycological tests (biomarkers) to aid the diagnosis of aspergillosis continues to expand with lateral flow tests (LFT) and low throughput β-D-glucan assays increasing access to rapid testing. There has been significant progress in the standardization/development of molecular tests to detect Aspergillus and genetic markers of azole resistance across a range of clinical samples that complement Aspergillus antigen (galactomannan) ELISA testing, where an array of commercial options are available for both assays, including low-throughput automated galactomannan assays. Despite this, no single perfect test exists, and combining tests (e.g. antigen and molecular testing) and including classical approaches is likely required for the optimal diagnosis of aspergillosis. Next-generation sequencing will likely play an increasing role in how we diagnose disease, but optimization, standardization and validation are required. Identifying host biomarkers to stratify risk in individual patients must be exploited. While in low- and middle-income countries, improved access to and simplification of diagnostic testing is critical.