title: Invasive pulmonary aspergillosis: A study of 39 cases at autopsy.
abstract: BACKGROUND
  Aspergillus is a common cause of invasive mycosis, especially in immunocompromised or immunosuppressed individuals.
  
  
  OBJECTIVE
  To study the incidence of invasive pulmonary aspergillosis and evaluate the predisposing factors and clinico-pathological manifestations.
  
  
  METHODS
  Retrospective analysis of autopsy material from a tertiary care hospital.
  
  
  METHODS
  All autopsies performed over a 12-year period were reviewed and cases with invasive aspergillosis were analysed with respect to their clinical presentation, predisposing factors, gross and histological features, complications and causes of death.
  
  
  RESULTS
  Among a total of 20475 autopsies performed in 12 years, 39 patients (0.19 %) had invasive pulmonary aspergillosis. There were 28 males and 11 females. Their ages ranged from five months to 67 years. Dyspnoea, fever, cough with mucopurulent expectoration, chest pain and haemoptysis were commonly encountered symptoms. Forty-one per cent of the patients had no respiratory symptoms. Fungal aetiology was not entertained clinically in any of the patients. The major underlying conditions were prolonged antibiotic therapy, steroid therapy, and renal transplantation, often associated with underlying lung diseases. Pneumonia, abscesses, vascular thrombosis and infarction were common findings at autopsy. Antecedent tuberculosis, mucormycosis, Pneumocystis carinii pneumonia and Cytomegalovirus infection were also present. In most cases, death was related to extensive pulmonary involvement or fungal dissemination.
  
  
  CONCLUSIONS
  A diagnosis of invasive pulmonary aspergillosis should always be borne in mind whenever one is dealing with recalcitrant lung infections even with subtle immunosuppression. Radiological investigations and serologic markers can be utilised for confirmation and prompt therapy.
authors.affiliation: Department of Pathology, Seth G. S. Medical College, Mumbai, India. shreeprajai@yahoo.co.in
authors.forename: P
authors.initials: P
authors.lastname: Vaideeswar
authors.forename: S
authors.initials: S
authors.lastname: Prasad
authors.forename: J R
authors.initials: JR
authors.lastname: Deshpande
authors.forename: S P
authors.initials: SP
authors.lastname: Pandit
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D008172:Lung Diseases, Fungal / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies