Rodríguez-Arrondo F, Iribarren J A, Arrizabalaga J, Grocin A I, von Wichmann M A, Garde C
Unidad de Enfermedades Infecciosas, Hospital Nuestra señora de Aránzazu, San Sebastián.
Enferm Infecc Microbiol Clin. 1991 Oct;9(8):477-83.
Invasive aspergillosis is a disease that affects immunosuppressed patients, in close relationship with the presence and duration of neutropenia. Although formerly included among the AIDS definition criteria, it was thereafter dropped out because of its very low prevalence. We describe here four cases of invasive aspergillosis in HIV infected patients, diagnosed at our institution. Three patients presented with invasive pulmonary aspergillosis, including one patient with chronic ulcerative pulmonary aspergillosis. The fourth patient developed aspergillosis of the brain. Taking into account the difficulties in establishing a diagnosis of this infection before death (most of published cases were from autopsy reports) and because of the paramount importance of early diagnosis for improving survival, we support the use of invasive pulmonary aspergillosis diagnostic criteria in a similar way as used in patients suffering lymphoproliferative disorders. Although classic treatment of this infection is based on the use of amphotericin B (with or without 5 fluorocytosine), the potential usefulness of itraconazole (a new imidazole drug) has to be considered. In spite of the low number of published cases, we believe that invasive aspergillosis among HIV infected patients has to be included as a likely diagnosis, specially in view of the prolonged survival and widespread use of cancer chemotherapy in this population.
侵袭性曲霉病是一种影响免疫抑制患者的疾病，与中性粒细胞减少的存在和持续时间密切相关。尽管它曾被列入艾滋病定义标准，但由于其患病率极低，后来被剔除。我们在此描述了在我们机构诊断出的4例HIV感染患者的侵袭性曲霉病病例。3例患者表现为侵袭性肺曲霉病，其中1例为慢性溃疡性肺曲霉病。第4例患者发生了脑部曲霉病。考虑到在患者死亡前确诊这种感染存在困难（大多数已发表的病例来自尸检报告），并且由于早期诊断对提高生存率至关重要，我们支持以类似于用于淋巴增殖性疾病患者的方式使用侵袭性肺曲霉病诊断标准。尽管这种感染的经典治疗方法是使用两性霉素B（加或不加5-氟胞嘧啶），但必须考虑伊曲康唑（一种新型咪唑类药物）的潜在效用。尽管已发表的病例数量较少，但我们认为HIV感染患者中的侵袭性曲霉病必须被列为可能的诊断，特别是考虑到该人群中癌症化疗的广泛使用和生存期的延长。
