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Correspondence

Response to van Assen et al

Bone Marrow Transplantation volume 26, page 1132 (2000)Cite this article

A case of Aspergillus tracheobronchitis has been reported by van Assen et al. Interestingly, the galactomannan detection test had remained negative even in the patient with Aspergillus infection causing respiratory failure. They discussed that fungal tracheobronchitis is divided into two different morphological types. One type is characterized by intraluminal growth with only superficial invasion. We agree that the patient reported by van Assen et al might be classified into this type of Aspergillus tracheobronchitis, in which vascular invasion by Aspergillus rarely occurs. However, we would like to make some comments on the limitations of the Aspergillus antigen detection test for the diagnosis of invasive aspergillosis, and to discuss other possible causes of the negative blood tests.

van Assen et al describe a percentage of 4.5% false negatives in a group of patients with proven invasive aspergillosis. However, the sensitivity of the blood test was reported to vary widely from 67 to 90%.123 We presume that the blood tests detecting circulating fungal components may be insensitive in some patients with invasive aspergillosis. In our experience, sensitivities of the blood tests are influenced by the distribution of invasive aspergillosis. In our institutions, the sensitivities of the latex agglutination test detecting galactomannan antigen, which is less sensitive than enzyme-linked immunosorbent assay, and the beta-D-glucan assay were 75 and 63%, respectively, in patients with disseminated invasive aspergillosis. However, the value decreased to 13 and 38%, respectively, in patients with localized invasive aspergillosis.4

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References

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Authors and Affiliations

  1. Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo, 109-8639, Japan

    U Machida

  2. Department of Hematology, Toranomon Hospital, Tokyo, Japan

    M Kami

  3. Department of Hematology and Oncology, University of Tokyo Hospital, Tokyo, Japan

    Y Tanaka & H Hirai

  4. Hematopoietic Stem Cell Transplant Unit, National Cancer Center Hospital, Tokyo, Japan

    Y Kanda

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  1. U Machida
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  2. M Kami
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  5. H Hirai
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Machida, U., Kami, M., Tanaka, Y. et al. Response to van Assen et al. Bone Marrow Transplant 26, 1132 (2000). https://doi.org/10.1038/sj.bmt.1702680

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