Chest

Chest

Volume 114, Issue 1, July 1998, Pages 251-262
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Pulmonary Aspergillosis and Invasive Disease in AIDS: Review of 342 Cases

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Aspergillosis is an infrequent but commonly fatal infection among HIV-infected individuals. We review 342 cases of pulmonary Aspergillus infection that have been reported among HIV-infected patients, with a focus on invasive disease. Invasive pulmonary aspergillosis usually occurs among patients with <50 CD4 cells/mm3. Major predisposing conditions include neutropenia and steroid treatment. Fever, cough, and dyspnea are each present in >60% of the cases. BAL is often suggestive, but biopsy specimens are necessary for definite diagnosis. Amphotericin B is the mainstay of treatment and mortality is >80%. Avoiding neutropenia and judicious use of steroids may be helpful in prevention. Aggressive diagnostic approach, early initiation of treatment, adequate dosing of antifungals, and close follow-up may improve the currently dismal prognosis.

Section snippets

Materials and Methods

Through a computer-based search of MEDLINE and AIDS-LINE—National Library of Medicine, Bethesda, Md—(with the use of key terms, including Aspergillus, aspergillosis, HIV, AIDS, and text word searching) complemented by a manual search of the Index Medicus, the published abstracts of the major relevant conferences and by cross-referencing published articles, we reviewed the English-language literature as of March 31, 1997, and identified reported cases of pulmonary aspergillosis among

Results

We identified 342 cases of pulmonary aspergillosis among HIV-infected individuals.2, 3, 4, 5,7,9,19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38,40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87, 88, 89, 90, 91, 92, 93 Gender was noted in 203 (169 male and 34 female). Aspergillus fumigatus was the most common pathogen (95% of

Discussion

Invasive pulmonary aspergillosis remains an enigmatic disease that occurs predominantly among immunosuppressed patients, including those with HIV infection.3,94, 95, 96, 97, 98 Invasive aspergillosis was included as an AIDS-defining opportunistic infection in the initial definition developed by the Centers for Disease Control.99 It was removed in 1984 when only 3 cases had been reported among 1,762 patients.99, 100, 101 Among the first 30,632 patients with AIDS, the incidence of invasive

Acknowledgments

We would like to thank Dr. C.C.J. Carpenter for his editorial assistance and guidance.

References (166)

  • McLeodDT et al.

    Pulmonary diseases in patients infected with the human immunodeficiency virus in Zimbabwe, Central Africa

    Trans R Soc Trop Med Hyg

    (1989)
  • MillerWT et al.

    Pulmonary aspergillosis in patients with AIDS: clinical and radiographic correlations

    Chest

    (1994)
  • MoranCR et al.

    The spectrum of pathological changes in the lung in children with the acquired immunodeficiency syndrome: an autopsy study of 36 cases

    Hum Pathol

    (1994)
  • PisaniRJ et al.

    Clinical utility of bronchoalveolar lavage in immunocompromised hosts

    Mayo Clin Proc

    (1992)
  • HenochowiczS et al.

    Cardiac aspergillosis in acquired immune deficiency syndrome

    Am J Cardiol

    (1985)
  • VivianiMA et al.

    European experience with itraconazole in systemic mycoses

    J Am Acad Dermatol

    (1990)
  • WilkesMS et al.

    Value of necropsy in acquired immunodeficiency syndrome

    Lancet

    (1988)
  • GrollAH et al.

    Trends in the postmortem epidemiology of invasive fungal infection at a university hospital

    J Infect

    (1996)
  • BrownE et al.

    Invasive pulmonary aspergillosis in an apparently nonimmunocompromised host

    Am J Med

    (1980)
  • AnaissieE.

    Opportunistic mycoses in the immunocompromised host: experience at a cancer center and review

    Clin Infect Dis

    (1992)
  • MinamotoGA et al.

    Invasive aspergillosis in patients with AIDS

    Clin Infect Dis

    (1992)
  • DenningDW et al.

    Pulmonary aspergillosis in the acquired immunodeficiency syndrome

    N Engl J Med

    (1991)
  • KemperCA et al.

    Ulcerative and plaque-like trancheobronchitis due to infection with Aspergillus in patients with AIDS

    Clin Infect Dis

    (1993)
  • DenningDW et al.

    Antifungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases

    Rev Infect Dis

    (1990)
  • ClarkeA et al.

    Fungal trancheobronchitis: report of nine cases and review of the literature

    Medicine

    (1991)
  • MeyerRD et al.

    Phycomycosis complicating leukemia and lymphoma

    Ann Intern Med

    (1972)
  • YoungRC et al.

    Aspergillosis: the spectrum of the disease in 98 patients

    Medicine

    (1970)
  • KramerMR et al.

    Ulcerative tracheobronchitis after lung transplantation: a new form of invasive aspergillosis

    Am Rev Respir Dis

    (1991)
  • KatzensteinAL et al.

    Bronchocentric granulomatosis, mucoid impaction, and hypersensitivity reactions to fungi

    Am Rev Respir Dis

    (1975)
  • DenningDW.

    Aspergillus trancheobronchitis [letter]

    Clin Infect Dis

    (1994)
  • KhooSH et al.

    Invasive aspergillosis in patients with AIDS

    Clin Infect Dis

    (1994)
  • DenningDW.

    Diagnosis and management of invasive aspergillosis

    Curr Clin Top Infect Dis

    (1996)
  • DeckerCF et al.

    Invasive aspergillosis in patients with HIV infection: report of two patients and a review of the literature

    J Acquir Immune Defic Syndr Hum Retrovirol

    (1991)
  • PursellKJ et al.

    Aspergillus species colonization and invasive disease in patients with AIDS

    Clin Infect Dis

    (1992)
  • SinghN et al.

    Invasive aspergillosis in AIDS

    South Med J

    (1991)
  • TumbarelloM et al.

    An emerging opportunistic infection in HIV patients: a retrospective analysis of 11 cases of pulmonary aspergillosis

    Eur J Epidemiol

    (1993)
  • BrittonCB et al.

    A new complication of AIDS: thoracic myelitis caused by herpes simplex virus

    Neurology

    (1985)
  • NagasakiM et al.

    An autopsy case of acquired immune deficiency syndrome (AIDS) with preceding aplastic anemia

    Pathol Int

    (1994)
  • WallaceMR et al.

    Invasive aspergillosis in patients with AIDS [letter]

    Clin Infect Dis

    (1994)
  • GrosseG et al.

    Invasive aspergillosis—an AIDS typical opportunistic infection? [abstract No. MBP 95]

    (1989)
  • MylonakisE et al.

    Extrapulmonary invasive aspergillosis in AIDS patients [abstract No. Mo. B. 1232]

    (1996)
  • KeisterR et al.

    Tracheal rupture caused by aspergillosis and Nocardia: a case report [abstract No. We. B. 3321]

    (1996)
  • WrightM et al.

    Aspergillosis in children with acquired immune deficiency

    Pediatr Radiol

    (1993)
  • FrolandSS et al.

    Acquired immunodeficiency syndrome (AIDS): clinical, immunological, pathological, and microbiological studies of the first case diagnosed in Norway

    Scand J Gastroenterol

    (1985)
  • PervezNK et al.

    Pseudomembranous necrotizing bronchial aspergillosis: a variant of invasive aspergillosis in a patient with hemophilia and acquired immune deficiency syndrome

    Am Rev Respir Dis

    (1985)
  • AsnisDS et al.

    Invasive aspergillosis: an unusual manifestation of AIDS

    N Y State J Med

    (1988)
  • WrightJL et al.

    An unusual form of pulmonary aspergillosis in two patients with the acquired immunodeficiency syndrome

    Am J Clin Pathol

    (1993)
  • FairleyCK et al.

    Invasive aspergillosis in AIDS

    Aust N Z J Med

    (1991)
  • StaplesCA et al.

    Invasive pulmonary aspergillosis in AIDS: radiographic, CT, and pathologic findings

    Radiology

    (1995)
  • ShettyF et al.

    Invasive aspergillosis in human immunodeficiency virus-infected children

    Pediatr Infect Dis J

    (1997)

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    Supported by the National Institutes of Health, National Institute on Drug Abuse, grant DA00268 (Dr. Rich).

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    Copyright © 1998 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.