Ferré A, Domingo P, Alonso C, Franquet T, Gurguí M, Verger G
Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona.
Med Clin (Barc). 1998 Mar 28;110(11):421-5.
Invasive pulmonary aspergillosis (IPA) is an infectious complication appearing mainly in immunosuppressed patients, whose diagnosis is often difficult and lately made, and that usually bears a dismal prognosis. Patients diagnosed as having IPA from 1989 to 1994 were retrospectively analyzed. Probable IPA was diagnosed on the basis of a positive culture for Aspergillus together with a consistent radiological image. Confirmed IPA was diagnosed if there was, in addition to the former, a pathological examination showing Aspergillus hifae invading pulmonary parenchyma and/or pulmonary vessels. There were 25 men and 8 women with a mean age of 53.7 +/- 16.9 years (range: 22-86 years). IPA was confirmed in 11 cases and probable in 22. Sixty three percent of the patients had hematologic malignancy or solid cancer, whereas 30.3% did not have prior granulocytopenia or immunosuppressive therapy. The mean (SD) interval between admission and diagnosis was 40.2 (37.1) days (range: 1-180 days), and the diagnosis was made while the patient was still alive in 75% of the cases. Fifteen percent of the patients had extrapulmonary aspergillosis. The most frequent finding both on X-ray film of the chest and pulmonary computed tomography were bilateral multiple pulmonary nodules. Thirteen patients were treated with itraconazole, 6 with amphotericin B, 5 received both drugs, and 2 received fluconazole. Nineteen patients (57.6%) died and the case-fatality rate among treated patients was 46.1%. IPA presents mainly in immunosuppressed patients, but there was a not negligible proportion of patients lacking the classical risk factors. IPA is often a lately made diagnosis and in a quarter of the patients it is not made when the patient is alive. The most frequent radiological presentation are multiple bilateral nodules. The case-fatality rate of IPA is exceedingly high, even when if the patient has been adequately treated.
侵袭性肺曲霉病（IPA）是一种主要出现在免疫抑制患者中的感染性并发症，其诊断往往困难且延迟，预后通常不佳。对1989年至1994年诊断为IPA的患者进行回顾性分析。可能的IPA根据曲霉属阳性培养以及一致的放射影像进行诊断。如果除上述情况外，病理检查显示曲霉菌丝侵犯肺实质和/或肺血管，则诊断为确诊IPA。共有25名男性和8名女性，平均年龄为53.7±16.9岁（范围：22 - 86岁）。确诊IPA 11例，可能IPA 22例。63%的患者患有血液系统恶性肿瘤或实体癌，而30.3%的患者既往无粒细胞减少或免疫抑制治疗史。入院至诊断的平均（标准差）间隔时间为40.2（37.1）天（范围：1 - 180天），75%的病例在患者仍存活时做出诊断。15%的患者有肺外曲霉病。胸部X线片和肺部计算机断层扫描最常见的表现是双侧多发性肺结节。13例患者接受伊曲康唑治疗，6例接受两性霉素B治疗，5例同时接受两种药物治疗，2例接受氟康唑治疗。19例患者（57.6%）死亡，治疗患者的病死率为46.1%。IPA主要出现在免疫抑制患者中，但有相当比例的患者缺乏经典危险因素。IPA诊断往往延迟，四分之一的患者在存活时未做出诊断。最常见的放射学表现是双侧多发性结节。即使患者得到充分治疗，IPA的病死率仍然极高。
