Pulmonary aspergillosis and invasive disease in AIDS: review of 342 cases.
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.
Department of Medicine, The Miriam Hospital, Brown University Medical School, Providence, RI 02906, USA.
E
E
Mylonakis
T F
TF
Barlam
T
T
Flanigan
J D
JD
Rich
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control; D001706:Biopsy; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D018791:CD4 Lymphocyte Count; D003371:Cough / Q000503:physiopathology; D004417:Dyspnea / Q000503:physiopathology; D005260:Female; D005334:Fever / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000503:physiopathology* / Q000517:prevention & control; D008297:Male; D009503:Neutropenia / Q000150:complications / Q000517:prevention & control; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D000666:Amphotericin B