Keating J J, Rogers T, Petrou M, Cartledge J D, Woodrow D, Nelson M, Hawkins D A, Gazzard B G
Department of HIV and Genitourinary Medicine, Chelsea and Westminster Hospital, London.
J Clin Pathol. 1994 Sep;47(9):805-9. doi: 10.1136/jcp.47.9.805.
To review the clinical, radiographic, and therapeutic features of 11 cases of respiratory Aspergillus infection in patients with AIDS.
All induced sputum and bronchoalveolar lavage samples obtained from HIV seropositive patients between January 1985 and March 1993 were analysed for Aspergillus species. Additionally, where appropriate, bronchial or renal biopsy specimens, or both, were taken before treatment had started.
In 11 patients Aspergillus fumigatus was identified in alveolar samples obtained by sputum induction. This was confirmed by bronchoalveolar lavage in eight. Three patients had Aspergillus plaques in the trachea and bronchus, while a fourth patient had an aspergilloma. Risk factors for Aspergillus infection were present in all patients, including corticosteroid treatment in three cases and neutropenia in four, three of whom had received chemotherapy for Kaposi's sarcoma. Four patients had concomitant cytomegalovirus infection. Ten patients had a CD4 count of less than 50 cells/mm3 while one patient had a disseminated T cell lymphoma with a CD4 count of 242 cells/mm3. Of the three patients with samples obtained by sputum induction who did not undergo bronchoscopy, two had a normal chest x ray picture and the third had a right lobar pneumonia complicating an aggressive lymphoma. All three were treated with itraconazole 200 mg twice a day without further investigation. Survival from the time of diagnosis of Aspergillus infection was short: seven patients died within six weeks, although only one death was directly attributed to pulmonary aspergillosis. At six monthly follow up, one patient, who initially had a positive Aspergillus culture from bronchial washings and a normal chest radiograph, developed a renal aspergilloma despite the disappearance of Aspergillus sp from the sputum.
Pulmonary aspergillosis is an important clinical problem in patients with AIDS with a CD4 count of less than 50 cells/mm. Furthermore, patients with Aspergillus sp in sputum induction or bronchial washings may develop disseminated disease despite adequate treatment of the primary infection.
回顾11例艾滋病患者呼吸道曲霉菌感染的临床、影像学及治疗特征。
对1985年1月至1993年3月间从HIV血清学阳性患者获取的所有诱导痰和支气管肺泡灌洗样本进行曲霉菌属分析。此外，在适当情况下，于治疗开始前采集支气管或肾活检标本，或两者都采集。
在11例患者中，通过诱导痰获取的肺泡样本中鉴定出烟曲霉菌。8例通过支气管肺泡灌洗得以证实。3例患者气管和支气管有曲霉菌斑，而第4例患者有曲菌球。所有患者均存在曲霉菌感染的危险因素，包括3例接受皮质类固醇治疗，4例有中性粒细胞减少症，其中3例因卡波西肉瘤接受过化疗。4例患者合并巨细胞病毒感染。10例患者CD4细胞计数低于50个/立方毫米，而1例患有播散性T细胞淋巴瘤的患者CD4细胞计数为242个/立方毫米。在3例通过诱导痰获取样本但未接受支气管镜检查的患者中，2例胸部X线片正常，第3例患有右叶肺炎，并发侵袭性淋巴瘤。这3例患者均接受每日2次、每次200毫克伊曲康唑治疗，未作进一步检查。自曲霉菌感染诊断之时起生存期较短：7例患者在6周内死亡，尽管仅1例死亡直接归因于肺曲霉菌病。在6个月的随访中，1例最初支气管灌洗曲霉菌培养阳性且胸部X线片正常的患者，尽管痰中曲霉菌属消失，但仍发生了肾曲菌球。
肺曲霉菌病是CD4细胞计数低于50个/立方毫米的艾滋病患者的一个重要临床问题。此外，痰诱导或支气管灌洗中有曲霉菌属的患者，尽管原发感染得到充分治疗，仍可能发生播散性疾病。
