Abstract
Invasive pulmonary aspergillosis usually occurs in patients with severe granulocytopenia or defects of cell-mediated immunity secondary to cytotoxic chemotherapy or high-dose corticosteroids, but it is an unusual opportunistic infection in patients with AIDS. Eleven cases of Aspergillus pulmonary disease were diagnosed in HIV-infected patients from January 1985 to December 1992, in the Department of Infectious Diseases of the Catholic University. Four patients had invasive pulmonary aspergillosis, six probable pulmonary invasive aspergillosis and one allergic broncopulmonary aspergillosis. Fiberoptic broncoscopy with bronco-alveolar lavage was confirmed to be an useful tool for the diagnosis of pulmonary aspergillosis in AIDS patients. The response of aspergillosis to therapy, either amphotericin B or itraconazole, has usually been poor. It is possible to speculate that the longer survival of AIDS patients and the latter development of other functional immunological abnormalities related to HIV infection may allow the appearance of opportunistic infection, such as pulmonary aspergillosis, different from those more often observed.
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AlbeldaS.M., TalbotG.H., GersonS.L., MillerW.T and CassilethP.A. (1984): Role of fiberoptic broncoscopy in the diagnosis of invasive pulmonary aspergillosis in patients with acute leukemia - Am. J. Med. 76: 1027–1034.
Asnis D.S., Chitkara R.K., Jacobson M. and Goldstein J. (1988): Invasive aspergillosis: an unusual manifestation of AIDS - New York State J. Med. 653–655.
BennettJ.E. (1990): Aspergillus species, p. 1958–1962. In: Mandell G.L., Douglas R.G. and Bennett J.E. (eds.), Principles and practice of infectious diseases -Churchill Livingstone, New York.
ChusidM.J., GelfandJ.A., NutterC. and FauciA.S. (1975): Pulmonary aspergillosis, inhalation of contaminated marijuana smoke, chronic granulomatous disease - Ann. Intern. Med. 82: 682–683.
CohenM.S., IsturizR.E., MalechH.L., RootR.K.WilfertCM., GutmanL. and BuckleyR.H. (1981): Fungal infection in chronic granulomatous disease: the importance of the phagocyte in defence against fungi - Am. J. Med. 71: 59–66.
DeckerC.F. and ParentiD. (1991): Invasive aspergillosis in patients with HIV infection: report of two patients and review of the literature - J. AIDS 4: 603–606.
DenningD.W., TuckerR.M., HansonL.H. and StevensD.A. (1989): Treatment of invasive aspergillosis with itraconazole - Am. J. Med. 86: 791–800.
DenningD.W. and StevenD.A. (1990): Anti-fungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases - Rev. Infect. Dis. 12: 1147–1201.
DenningD.W., FollansbeeS.E., ScolaroM., NorrisS., EldesteinH. and StevenD.A. (1991): Pulmonary aspergillosis in the acquired immunodeficiency syndrome - N. Engl. J. Med. 324: 654–662.
DiamondR.D., KrzesickiR., EpsteinB. and JaoW. (1978): Damage to hyphal forms of fungi by human leukocytes in vitro: a possible host defence mechanism in aspergillosis and mucormycosis - Am. J. Pathol. 91: 313–328.
EllisM., GuptaS., GalantS., HakimS., VandeVenC., ToyC. and CairomS. (1988): Impaired neutrophil function in patients with AIDS or AIDS-related complex: a comprehensive evaluation - J. Infect. Dis. 158: 1268–1276.
FauciA.S. (1988): The human immunodeficiency virus: infectivity and mechanisms of pathogenesis -Science 239: 617–622.
GersonG.L., TalbotT.H., HurwitzS., StromBL., KuskE.J. and CassilethP.A. (1984): Prolonged granulocytopenia: the major risk factor for invasive pulmonary aspergillosis in acute leukaemia - Ann. Intern. Med. 100: 345–351.
GustafsonT.L., SchaffnerLavelyG.B., StrattonC.W., JohnsonH.K. and HutchesonR.H. (1983): Invasive aspergillosis in renal transplant recipients: correlation with corticosteroid therapy - J. Infect. Dis. 148: 230–238.
JaffeH.W. and SelikR.M. (1984): Acquired immune deficiency syndrome: is disseminated aspergillosis predictive of underlying cellular immune deficiency?- J. Infect. Dis. 149: 828–829.
Just-Nubling G., Helm E.B., Laubenberger C., Falk S., Keul H.G., Hubner K., Grafin Vitzhum H., Wolki U., Schlote E. and Stille W. (1990): The incidence of colonisation and invasive disease in a population of AIDS patients with Aspergillus species - VI Int. Conf. on AIDS, San Francisco abs. ThB462.
Just-Nubling G., Ganger G., Keul H.G., Jacobi V., Hubner D., Schlote W., Helm K.B. and Stille W. (1992): Invasive aspergillosis infections (IA) in AIDS: a rising problem in Frankfurt - VIII Int. Conf. on AIDS, Amsterdam abs. POB3337.
KahnF.W., JonesJ.M. and EnglandD.M. (1986): The role of bronco-alveolar lavage in the diagnosis of invasive pulmonary aspergillosis - Am. J. Clin. Pathol. 86: 518–523.
KauffmanH.F. and BeaumontF. (1988): Serologic diagnosis of Aspergillus infection - Mycoses 31(2): 21–26.
KlapholzA., SalomonN., PerlmanD.C. and TalaveraW. (1991): Aspergillosis in the Acquired Immunodeficiency Syndrome - Chest 100: 1614–1618.
KrickJ.A. and RemingtonJ.S. (1976): Opportunistic invasive fungal infections in patients with leukaemia and lymphoma - Clin. Haematol. 5: 249–310.
LazzarinA, Uberti FoppaC., GalliM., MantovaniA., PoliG., FranzettiF. and NovatiR. (1986): Impairment of polymorphonuclear leukocyte function in patients with acquired immunodeficiency syndrome and with lymphadenopathy syndrome - Clin. Exp. Immunol. 65: 105–111.
LehrerR.I., GanzT., SelstedM.E., BabiorB.M. and CurnutteJ.T. (1988): Neutrophils and host defence -Ann. Intern. Med. 109: 127–142.
MertinsS.D. and CaudaR. (1990): The role of polymorphonuclear leukocytes in infection by retrovirus with emphasis on the human immunodeficiency virus - Viral Immunol. 3: 173.
MeyerR.D., YoungL.S. and YuB. (1973): Aspergillosis complicating neoplastic disease - Am. J. Med. 54: 6–15.
Meyohas M.C., Cadranel J., Porot J.L., Couaid C., Siaikowski F., Girard P.M. and Frottier J. (1992): Invasive pulmonary aspergillosis (IPA) in 15 patients with AIDS - VIII Int. Conf. on AIDS, Amsterdam abs. POB3346.
MinamotoG.Y., BarlettT.F. and VendermElsN.J. (1992): Invasive aspergillosis in patients with AIDS -Clin Infect. Dis. 14: 66–74.
MurrayJ.F., FeltonC.P., GarayS., GottliebM.S., HopewellP.C., StoverD.E. and TeirsteinA.S. (1984): Pulmonary complications of the acquired immunodeficiency syndrome: report of a National Heart, Lung and Blood Institute workshop - N. Engl. J. Med. 310: 1682–1688.
Sambat M.A., Gurgui M., Ausina V., Cadafalch J., Domingo P., Ris J., Fuster H., Mertinkz E., Serra J., Barrio J.L., Verger G. and Nolla J. (1992): Pulmonary aspergillosis in patients with AIDS - VIII Int. Conf. on AIDS, Amsterdam abs. POB3248.
StaibF., SeiboldM. and GrosseG. (1989): Aspergillus findings in AIDS patients suffering from cryptococcosis - Mycoses 32: 516–523.
WeinerM.H., TalbotG.H., GersonS.L., FiliceG. and CassilethP.A. (1983): Antigen detection in the diagnosis of invasive aspergillosis - Ann. Intern. Med. 99: 777–782.
WilliamsD.M., KrickJ.A. and RemingtonJ.S. (1976): Pulmonary infection in the compromised host - Am. Rev. Respir. Dis. 114: 359–394.
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Tumbarello, M., Ventura, G., Caldarola, G. et al. An emerging opportunistic infection in HIV patients: A retrospective analysis of 11 cases of pulmonary aspergillosis. Eur J Epidemiol 9, 638–644 (1993). https://doi.org/10.1007/BF00211439
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DOI: https://doi.org/10.1007/BF00211439