Minamoto G Y, Barlam T F, Vander Els N J
Division of Allergy, Clinical Immunology, and Infectious Diseases, St. Luke's/Roosevelt Hospital Center, New York, New York 10025.
Clin Infect Dis. 1992 Jan;14(1):66-74. doi: 10.1093/clinids/14.1.66.
Invasive aspergillosis is a rare complication of AIDS. We discuss the cases of 18 patients with AIDS and invasive aspergillosis who were identified at our institution and 19 patients who are described in the literature. Twenty-one patients were either homosexual or bisexual, eight were intravenous drug users, three were hemophiliacs, two attributed their disease to a heterosexual contact, and one was a transfusion recipient; risk factors for AIDS were unknown for two patients. Twenty-eight of the 37 patients had pulmonary aspergillosis; for 18 of these 28, the lung was the sole site of disease. Aspergillosis involved the brain in 12 cases, the heart in five cases, and the kidney, sinuses, or skin in six other cases. Eleven patients had multiple sites of disease, and eight patients had extrapulmonary disease alone. Possible risk factors for aspergillosis included leukopenia (7 patients, of whom 5 were also neutropenic) and use of corticosteroids (8 patients), alcohol (6 patients), broad-spectrum antibiotics (5 patients), and antineoplastic agents (4 patients); 14 patients had no identifiable risk. Death was the usual outcome, despite treatment of patients with amphotericin B. In cases of AIDS and invasive aspergillosis, early diagnosis may lead to improved outcome.
侵袭性曲霉病是艾滋病的一种罕见并发症。我们讨论了在我们机构确诊的18例患有艾滋病和侵袭性曲霉病的患者以及文献中描述的19例患者的情况。21例患者为同性恋或双性恋，8例为静脉吸毒者，3例为血友病患者，2例将其疾病归因于异性接触，1例为输血接受者；2例患者的艾滋病危险因素不明。37例患者中有28例患有肺曲霉病；在这28例中的18例中，肺部是唯一的病变部位。曲霉病累及脑部12例，心脏5例，肾脏、鼻窦或皮肤6例。11例患者有多个病变部位，8例患者仅有肺外病变。曲霉病的可能危险因素包括白细胞减少（7例患者，其中5例也有中性粒细胞减少）、使用皮质类固醇（8例患者）、酒精（6例患者）、广谱抗生素（5例患者）和抗肿瘤药物（4例患者）；14例患者无明确危险因素。尽管用两性霉素B治疗患者，但死亡仍是常见结局。在艾滋病合并侵袭性曲霉病的病例中，早期诊断可能会改善结局。
