Libanore M, Prini E, Mazzetti M, Barchi E, Raise E, Gritti F M, Bonazzi L, Ghinelli F
Dept. of Infectious Diseases, St. Anna Hospital and University of Ferrara, C.so Giovecca 203, I-44100 Ferrara, Italy.
Infection. 2002 Dec;30(6):341-5. doi: 10.1007/s15010-002-2033-1.
We studied the prevalence, epidemiological features, symptoms, diagnosis, treatment and outcome of invasive aspergillosis in AIDS patients in Italy.
All patients affected by both aspergillosis and AIDS hospitalized between January 1986 and April 1997 (before highly-active antiretroviral therapy, HAART) in four Italian Department of Infectious Disease. Patients were included in the study only if culture, cytology or histology showed firm evidence of Aspergillus infection. Invasive aspergillosis was defined as the presence of characteristic, closely septate hyphae with repeated acute angle branching in either biopsy materials or percutaneous aspirates from tissues other than the lung. Hyphae were identified using hematoxylin-eosin and methenamine silver stain.
During the study, 54 out of 2,614 patients admitted with AIDS showed aspergillosis (2.1%). The disease usually occurred in patients with < 50 CD4 cells/mm(3). Aspergillosis was associated with neutropenia and steroid treatment. Nonspecific symptoms were frequently encountered. Fever and cough were both present in > 70% of the cases of pulmonary aspergillosis. Biopsy specimens were analyzed for definitive diagnosis. Invasive aspergillosis is usually treated with amphotericin B, but in 90% of the cases this did not prevent death.
In AIDS patients with neutropenia and long-term steroid therapy, it is important to consider invasive aspergillosis in the differential diagnosis of opportunistic infections.
我们研究了意大利艾滋病患者侵袭性曲霉病的患病率、流行病学特征、症状、诊断、治疗及转归。
1986年1月至1997年4月（高效抗逆转录病毒治疗，即HAART之前）期间，在意大利四个传染病科住院的同时患有曲霉病和艾滋病的所有患者。仅当培养、细胞学或组织学显示有确凿的曲霉感染证据时，患者才被纳入研究。侵袭性曲霉病定义为在活检材料或来自肺部以外组织的经皮抽吸物中存在特征性的、紧密分隔且有反复锐角分支的菌丝。使用苏木精-伊红和亚甲胺银染色鉴定菌丝。
在研究期间，2614例艾滋病住院患者中有54例患有曲霉病（2.1%）。该疾病通常发生在CD4细胞<50/mm³的患者中。曲霉病与中性粒细胞减少和类固醇治疗有关。经常出现非特异性症状。超过70%的肺曲霉病病例同时出现发热和咳嗽。对活检标本进行分析以明确诊断。侵袭性曲霉病通常用两性霉素B治疗，但90%的病例未能避免死亡。
在患有中性粒细胞减少和长期接受类固醇治疗的艾滋病患者中，在机会性感染的鉴别诊断中考虑侵袭性曲霉病很重要。
