CONCISE ARTICLE Quick and reliable galactomannan detection in crude minced lung specimens from haematological patients with suspected invasive fungal infection: results from a case series D. D’Antonio & A. Manna & V. Savini & D. Onofrillo & G. Di Bonaventura & R. Piccolomini & G. Parruti Received: 26 September 2007 / Accepted: 18 December 2007 # Springer-Verlag 2008 Abstract Invasive aspergillosis (IA) is the leading direct or contributory cause of death in patients with haematological malignancies. Early diagnosis remains difficult and often elusive due the heterogeneity of clinical presentations and the low sensitivity of both histological examination and cultures of specimens obtained from patients at risk. We report two cases of IA, both of which lacked both histological and cultural evidence of IA from pulmonary specimens. In both patients, detection of galactomannan (GM) by enzyme immunoassay (EIA) on pulmonary tissue homogenates led to the diagnosis of IA, which was confirmed by Aspergillus DNA (real time PCR). In conclusion, we provide preliminary evidence that lung homogenates may be prepared for GM EIA assays, which may contribute to quick diagnosis of IA on otherwise negative samples. We feel that our results open up the opportunity of a prospective and comparative evaluation of this diagnostic technique. Introduction In patients with haematological malignancies and in those receiving allogeneic haematopoietic stem cell transplanta- tion, cytotoxic chemotherapy, profound and long lasting neutropenia, prolonged exposure to corticosteroids, large spectrum antibiotics, and central vein catheterization are all well known and concurring risk factors for invasive fungal infections (IFI) [1, 2]. After the widespread introduction of fluconazole for fungal prophylaxis over the past decade, a dramatic shift in the epidemiology of IFI has been observed in these patients. Concomitant to a remarkable decrease in the incidence of invasive candidiasis, invasive aspergillosis (IA) emerged as the most challenging and common mycosis [2, 3]. IA is the leading direct or contributory cause of death in immunosup- pressed patients, as early diagnosis remains difficult and often elusive, given the heterogeneity of clinical presentation and the low sensitivity of both histological and cultural evaluation of specimens obtained from patients at risk [4]. Currently, antifungal agents are prescribed empirically in neutropenic patients with persistent fever under broad- spectrum antibiotics and pulmonary signs or symptoms of Eur J Clin Microbiol Infect Dis DOI 10.1007/s10096-007-0453-7 D. D’Antonio (*) : A. Manna : V. Savini Unità Operativa Complessa di Microbiologia e Virologia Clinica, Dipartimento di Medicina Trasfusionale, Ospedale Civile Spirito Santo, Via Fonte Romana 8, CAP 65125( Pescara, Italy e-mail: domenicodantonio@virgilio.it D. Onofrillo Dipartimento di Ematologia, Ospedale Civile Spirito Santo, Pescara, Italy G. Di Bonaventura Laboratorio di Microbiologia Clinica, Centro Studi Invecchiamento (Ce.S.I.), Università G. D’Annunzio, Chieti-Pescara, Italy R. Piccolomini Laboratorio di Microbiologia Clinica, Dipartimento di Scienze Biomediche, Università G. D’Annunzio, Chieti-Pescara, Italy G. Parruti Unità Operativa di Malattie Infettive, Ospedale Civile Spirito Santo, Pescara, Italy