[Invasive aspergillosis in patients with human immunodeficiency virus infection diagnosed by necropsy: the contribution of 4 cases and review of the literature].

BACKGROUND

Invasive aspergillosis is an infrequent clinicopathological entity which is difficult to diagnose (since it requires tissue samples, normally of the lung where the pathogenic effect of the fungi may be seen) and thus an important number of cases are not found until necropsy. In patients with human immunodeficiency virus (HIV) infection the real incidence has not been clearly defined and may be higher than reported.

MATERIAL AND METHODS

We herein present a series of necropsy reviews performed over a five year period (January 1993 to December 1997) in the Hospital Universitario San Carlos in Madrid (Spain) in patients with HIV infection. In the patients who presented invasive aspergillosis a collection protocol of clinical, analytical and radiologic data was undertaken.

RESULTS

Over this period necropsic studies were performed in 23 patients with HIV infection. Of these 4 (17.3%) presented invasive aspergillosis; 3 with disseminated involvement. Premortem diagnosis was not performed in any of the cases. The risk factors included: 3 had a CD4 count of less than 50, two were receiving glucocorticoids and only 1 had severe neutropenia. In 2 another opportunistic lung infection was also observed.

CONCLUSIONS

Invasive aspergillosis is an entity witch is found on autopsy with relative frequency in patients with HIV infection with severe immunodepresion. Other opportunistic infections may also coincide and it may not be associated with neutropenia, glucocorticoid treatment, which are considered as classical risk factors for invasive aspergillosis.