Kumar, et al. [1] published their findings on
Galactomannan antigen test for early diagnosis of invasive aspergillus
infection in a recent issue of Indian Pediatrics [1]. The article
was interesting and I seek certain clarifications:
1. What were the sites from which authors were
able to isolate aspergillus for proven invasive fungal infection?
2. What were the species? Was sensitivity testing
performed on all the isolates? Did authors come across any species
which was resistant to voriconazole/amphotericin B?
3. Authors mentioned that antibiotics like
piperacillin-tazobactam can lead to false positive galactomannan
test; it has been shown to be no longer cross-reactive [2].
4. Did some of the patients in this study have
pulmonary leucostasis/hyperleukocytosis which could have led to a
false impression of a fungal nodule or ground glass opacities on
computed tomography.
5. Authors mentioned that they were not able to
perform bronchoalveolar lavage (BAL) on patients due to
thrombocytopenia; did they attempt the procedure when the platelets
improved, at the end of induction therapy or on recovery from the
febrile event. It is well-established that BAL galactomannan is more
sensitive as well as specific for invasive fungal infections [3].
1. Kumar J, Singh A, Seth R, Xess I, Kabra SK.
Galactomannan antigen test for early diagnosis of invasive aspergillus
infection in pediatric febrile neutropenia. Indian Pediatr.
2018;55:257-8.
2. Vergidis P, Razonable RR, Wheat LJ, Estes L,
Caliendo AM, Baden LR, et al. Reduction in false-positive
aspergillus serum galactomannan enzyme immunoassay results associated
with use of piperacillin-tazobactam in the United States. J Clin
Microbiol. 2014;52:2199-201.
3. Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S,
Herbrecht R, et al. Practice Guidelines for the Diagnosis and
Management of Aspergillosis: 2016 Update by the Infectious Diseases
Society of America. Clin Infect Dis. 2016;63:e1-60.
