Invasive aspergillosis in patients with acquired immunodeficiency syndrome: Report of 33 cases

doi:10.1016/0002-9343(93)90258-Q

The American Journal of Medicine

Volume 95, Issue 2, August 1993, Pages 177-187

https://doi.org/10.1016/0002-9343(93)90258-Q Get rights and content

Abstract

purpose: Acquired immunodeficiency syndrome (AIDS)-associated invasive aspergillosis (IA) is a rare condition, which is mainly reported as isolated cases either antemortem or at autopsy. The role of AIDS itself is controversial, because many of the reported patients exhibited the classic risk factors such as neutropenia and steroid therapy. The aims of this study were to report 33 patients with IA during AIDS and their outcome, focusing on the risk factors and the value of diagnostic procedures.

patients and methods: Thirty-three patients from 17 different medical centers in France were retrospectively included in the study. For pulmonary IA, we defined two types of patients: those with “confirmed IA,” describing all the patients with histologically proven disease, and those with “probable IA,” who had the development of a new pulmonary infiltrate on chest radiograph and a positive bronchoalveolar lavage (BAL) fluid culture for Aspergillus species without identification of other pathogens. For extra-pulmonary IA, the diagnostic criteria included both positive histology and culture.

results: Of the 33 cases included in this series, 91% were recorded during the last 3 years (1989 to 1991), suggesting that aspergillosis is an emerging complication in AIDS. Approximately 50% of the patients did not exhibit any classic risk factor, i.e., neutropenia and steroid treatment; almost all patients had a CD4 cell count less than 50/mm³. The mycologic culture from BAL was the method of choice for the diagnosis of invasive pulmonary disease because it was known to correlate well with histology findings obtained either antemortem or postmortem. Of 28 patients with a positive BAL culture for Aspergillus, 15 underwent a biopsy or autopsy and 14 were positive at histology. Serum antigen detection was positive in only 4 of 16 tested patients. Clinical and radiologic signs did not differ from those observed in neutropenic patients without human immunodeficiency virus, except for the higher incidence of neurologic complications in AIDS. Interestingly, we observed three cases of invasive necrotizing tracheobronchial aspergillosis with acute dyspnea and wheezing. The use of amphotericin B (0.5 mg/kg/d) and/or itraconazole (200 to 600 mg/d) was most often unsuccessful. Only four patients experienced clinical and radiologic improvement. The mean interval between the diagnosis of IA and death was 8 weeks (range: 3 days to 13 months).

conclusions: This study suggests that aspergillosis is an important life-threatening condition in the advanced stage of AIDS. It requires an early diagnosis with BAL fluid culture and careful therapeutic evaluation.

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¹: Dr. Lortholary's current address: Service de Médecine Interne, Hôpital Avicenne, Université Paris Nord, 93009 Bobigny, France.

^∗: See Appendix.

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Invasive aspergillosis in patients with acquired immunodeficiency syndrome: Report of 33 cases

Abstract

Am J Cardiol

Hum Pathol

Lancet

Am J Med

Am J Med

Lancet

Am J Med

J Am Acad Dermatol

Am J Med

Clinical manifestations and management of aspergillosis in the compromised patient

Fungal infections in HIV-infected patients

The growing problem of mycoses in patients infected with the human immunodeficiency virus

Rev Infect Dis

Acquired immune deficiency syndrome: is disseminated aspergillosis predictive of underlying cellular immune deficiency?

J Infect Dis

Pathology of the mycoses in patients with the acquired immunodeficiency syndrome (AIDS)

Curr Top Med Mycol

Invasive aspergillosis in AIDS

South Med J

Invasive aspergillosis: an unusual manifestation of AIDS

NY State J Med

Aspergillus infection of the central nervous system in patients with acquired immunodeficiency syndrome

Arch Neurol

Pseudomembranous necrotizing bronchial aspergillosis

Ultrasonographic and microbiological diagnosis of mycotic liver abscesses in patients with AIDS

Microbiologica

Invasive aspergillosis-an AIDS typical opportunistic infection?

Invasive aspergillosis in AIDS: clinical manifestations and predisposing factors

Disseminated histoplasmosis, invasive pulmonary aspergillosis and other opportunistic infections in a homosexual patient with the acquired immune deficiency syndrome

Sex Transm Dis

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

J Acquir Immune Defic Syndr

Invasive external otitis caused by Aspergillus fumigatus in two patients with AIDS

AIDS

Aspergillus otomastoiditis in acquired immunodeficiency syndrome

Am J Otol

Cardiopulmonary aspergillosis in an AIDS patient

A peripancreatic abscess containing Aspergillus in a patient with the acquired immune deficiency syndrome

Am J Gastroenterol