Alba D, Gómez-Cerezo J, Cobo J, Fachal C, Molina F, Vázquez J J
Servicio de Medicina Interna, Hospital La Paz, Madrid.
Rev Clin Esp. 1995 Jan;195(1):22-5.
Invasive pulmonary aspergillosis (IPA) is a severe infection which is usually diagnosed at postmortem examination. This infection occurs mainly in immunosuppressed patients, although it has also been reported in immunocompetent patients. Clinical records from patients diagnosed with IPA in our institution from 1983 to 1992 were retrospectively studied to analyse clinical and therapeutical characteristics of IPA. Sixteen episodes of IPA were recorded, all of them but one from necrotic specimens. A total of 18.7% of patients were immunocompetent, one patient had the acquired immunodeficiency syndrome (AIDS), and the remaining patients had a classical immunosuppression. Fever and dyspnea were noted in all patients; hemoptysis was recorded in 12.5% of patients. The predominant radiological pattern was a bilateral alveolar infiltrate (75%). Diagnosis was made at postmortem examination in 15 cases (93.7%), and a clinical premortem suspicion was obtained only in 25% of patients. IPA can occur in immunocompetent patients more frequently than considered until now. The suspicion index for IPA is low, even in immunosuppressed patients.
侵袭性肺曲霉病（IPA）是一种严重感染，通常在尸检时才得以诊断。这种感染主要发生在免疫功能低下的患者中，不过在免疫功能正常的患者中也有报道。对1983年至1992年在我们机构诊断为IPA的患者的临床记录进行回顾性研究，以分析IPA的临床和治疗特征。记录了16例IPA发作，除1例来自坏死标本外，其余均来自坏死标本。共有18.7%的患者免疫功能正常，1例患者患有获得性免疫缺陷综合征（AIDS），其余患者有典型的免疫抑制。所有患者均有发热和呼吸困难；12.5%的患者有咯血记录。主要的放射学表现为双侧肺泡浸润（75%）。15例（93.7%）在尸检时确诊，仅25%的患者在生前得到临床怀疑。IPA在免疫功能正常的患者中发生的频率可能比目前认为的更高。即使在免疫抑制患者中，IPA的怀疑指数也较低。
