American Board of Internal Medicine (ABIM) Certification Practice Exam

Which diagnostic method is critical for early detection of invasive aspergillosis?

1. Culture of sputum

2. Galactomannan assay

3. Complete blood count

4. CT scan of the chest

The correct answer is: Galactomannan assay

The galactomannan assay is crucial for the early detection of invasive aspergillosis due to its ability to detect specific polysaccharide components of the Aspergillus cell wall in the patient's serum or bronchoalveolar lavage fluid. This test, based on antigen detection, can provide results much earlier than traditional culture methods, as cultures may take days to weeks to yield results and may be negative even in the presence of invasive disease. Early identification of invasive aspergillosis is vital, particularly in immunocompromised patients, where timely initiation of antifungal therapy can significantly improve outcomes. The galactomannan assay has shown a high sensitivity and specificity for diagnosing this condition, making it an essential tool in clinical practice. There are other diagnostic methods listed, such as a CT scan of the chest, which can reveal characteristic findings associated with invasive aspergillosis, but these findings can take time to develop and often follow clinical suspicion. Similarly, while sputum cultures and complete blood counts can provide some information, they are not as specific or timely in identifying invasive aspergillosis compared to the galactomannan assay. Therefore, the galactomannan assay stands out as the most effective method for early diagnosis.