Kemper C A, Hostetler J S, Follansbee S E, Ruane P, Covington D, Leong S S, Deresinski S C, Stevens D A
Department of Medicine, Santa Clara Valley Medical Center, San Jose, California 95128.
Clin Infect Dis. 1993 Sep;17(3):344-52. doi: 10.1093/clinids/17.3.344.
Tracheobronchitis is an uncommon manifestation of infection due to Aspergillus species, occurring in < 7% of cases of pulmonary aspergillosis. At least 58 cases of invasive aspergillus tracheobronchitis have been described since 1962. We describe four patients with AIDS, all of whom were severely immunocompromised, who had ulcerative tracheobronchitis due to Aspergillus species demonstrated histologically. Three patients had received corticosteroids or were neutropenic at presentation. At bronchoscopy, three patients had some degree of diffuse tracheobronchitis, multiple ulcerative or "plaque-like" inflammatory lesions, and occasionally nodules involving the mainstem and segmental bronchi. The remaining patient had a single deep ulceration of the proximal trachea. Aspergillus was isolated from biopsy specimens from all four patients. There were varied degrees of invasion of the mucosa, submucosa, and cartilage on histological examination in three patients, one of whom had evidence of disseminated aspergillosis. Two patients subsequently developed pulmonary parenchymal disease due to Aspergillus. A review of aspergillus tracheobronchitis, including a discussion of airway disease in patients infected with human immunodeficiency virus, is presented.
气管支气管炎是曲霉菌属感染的一种罕见表现，在肺曲霉病病例中发生率<7%。自1962年以来，至少已描述了58例侵袭性曲霉气管支气管炎病例。我们描述了4例艾滋病患者，他们均严重免疫功能低下，经组织学证实患有曲霉菌属所致的溃疡性气管支气管炎。3例患者在就诊时接受过皮质类固醇治疗或存在中性粒细胞减少。在支气管镜检查中，3例患者有一定程度的弥漫性气管支气管炎、多处溃疡性或“斑块状”炎性病变，偶尔可见累及主支气管和段支气管的结节。其余1例患者近端气管有单个深部溃疡。从所有4例患者的活检标本中均分离出曲霉菌。3例患者组织学检查显示黏膜、黏膜下层和软骨有不同程度的侵袭，其中1例有播散性曲霉病的证据。2例患者随后发生了曲霉菌所致的肺实质疾病。本文对曲霉气管支气管炎进行了综述，包括对感染人类免疫缺陷病毒患者气道疾病的讨论。
