Invasive aspergillosis in human immunodeficiency virus-infected children.
BACKGROUND
Aspergillosis is an uncommon yet serious opportunistic infection in patients with AIDS. It has been extensively reported in HIV-infected adult patients. To our knowledge there are no studies that describe the epidemiology, clinical manifestations and outcome of aspergillosis in a large HIV-infected pediatric population.


METHODS
We reviewed the records of all 473 HIV-infected children followed in the Pediatric Branch of the National Cancer Institute for 9 years from 1987 through 1995 for the presence of Aspergillus infection.


RESULTS
Seven (1.5%) patients developed invasive aspergillosis during the study period. All patients had low CD4 counts reflecting severe immunosuppression. Sustained neutropenia (> 7 days) or corticosteroid therapy as a predisposing factor for invasive aspergillosis was encountered in only two patients (28%). Invasive pulmonary aspergillosis developed in five patients and cutaneous aspergillosis in two. The most common presenting features in patients with pulmonary aspergillosis were fever, cough and dyspnea. Patients with cutaneous aspergillosis were diagnosed during life and successfully treated with amphotericin B and surgery, whereas diagnosis of pulmonary aspergillosis was made clinically in only one patient.


CONCLUSIONS
Aspergillosis is an uncommon but highly lethal opportunistic infection in HIV-infected children. Invasive pulmonary aspergillosis should be considered in the differential diagnosis in febrile, HIV-infected children with persistent pulmonary infiltrates.
Shetty
D
D
Infectious Diseases Section, National Cancer Institute, Bethesda, MD 20892, USA.
Giri
N
N
Gonzalez
C E
CE
Pizzo
P A
PA
Walsh
T J
TJ
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D000293:Adolescent; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008297:Male; D009503:Neutropenia; D012189:Retrospective Studies
D000935:Antifungal Agents