Meyohas M C, Roux P, Poirot J L, Meynard J L, Frottier J
Service de Parasitologie, Hôpital Tenon, Paris, France.
Pathol Biol (Paris). 1994 Sep;42(7):647-51.
From 1983 to 1991 only isolated cases of aspergillosis in AIDS patients were reported; since 1991, an increasing number of cases have been reported suggesting a recent emergence of this fungal infection. Aspergillosis occurs about 10 to 25 months after AIDS diagnosis in patients with CD4 below 50/mm3. Neutropenia and/or steroid therapy, which are known as predisposing factors in aspergillosis, are noticed in about one half of the patients. Previous pulmonary infection, especially pneumocystosis, are very common. Clinical signs are typical of an invasive pulmonary aspergillosis: constant fever, cough, dyspnea, frequent thoracic pains and haemoptysis. Radiologic signs frequently indicate an interstitial infiltration. Nodular and cavitating lesions, pleural effusions, thoracic lymph node enlargement are often present. Diagnosis procedures are realised on bronchoalveolar lavage by direct examination, culture and antigen detection. Aspergillus fumigatus is the most usually species detected. Post-mortem diagnosis is frequent. Invasive bronchial aspergillosis, localised infections (aspergilloma, otitis, sinusitis) or disseminated infections (nervous system, heart, kidney, lymph nodes, thyroid) are also described. Prognosis is poor even with treatment (amphotericin B or itraconazole). An earlier diagnosis and treatment of the bronchial colonization could probably improve this prognosis.
从1983年至1991年，仅报告了艾滋病患者中曲霉病的个别病例；自1991年以来，报告的病例数量不断增加，提示这种真菌感染近期出现。曲霉病发生在艾滋病诊断后约10至25个月，患者的CD4低于50/mm³。中性粒细胞减少和/或类固醇治疗是曲霉病的已知易感因素，约一半的患者存在这些因素。既往肺部感染，尤其是肺孢子菌病非常常见。临床症状是侵袭性肺曲霉病的典型表现：持续发热、咳嗽、呼吸困难、频繁胸痛和咯血。放射学征象常提示间质性浸润。结节状和空洞性病变、胸腔积液、胸内淋巴结肿大也常出现。诊断程序通过支气管肺泡灌洗进行直接检查、培养和抗原检测。烟曲霉是最常检测到的菌种。尸检诊断很常见。也描述了侵袭性支气管曲霉病、局部感染（曲菌球、中耳炎、鼻窦炎）或播散性感染（神经系统、心脏、肾脏、淋巴结、甲状腺）。即使进行治疗（两性霉素B或伊曲康唑），预后也很差。支气管定植的早期诊断和治疗可能会改善这种预后。
