Invasive pulmonary aspergillosis in an immunocompetent patient with severe dengue fever.

Sir,

We read the article “invasive pulmonary aspergillosis in an immunocompetent patient with severe dengue fever” by Nasa et al.[1] with interest. The author reported a case of a 65-year-old female patient who was admitted with severe dengue fever and developed invasive pulmonary aspergillosis (IPA). We want to highlight certain issues regarding diagnosis of this patient.

The patient developed features of IPA on day 6 of admission and was thought to be “immunocompetent.” This patient did not have neutropenia, which is an important predisposing factor for IPA. But it is well known that abnormalities of T cell-mediated immunity predispose to systemic fungal infections.[2] Mathew et al.[3] had reported impaired T cell proliferation and cell-mediated responses with acute dengue infection. We believe that in this case the severe dengue might have caused T cell abnormality, which made the host susceptible to invasive aspergillosis. Again La Russa and Innis[4] had reported that severe dengue causes bone marrow suppression within 3-4 days of infection. Hence, it would be better if the term “immunocompetent” is avoided for this patient.