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(Chest. 1998;114:251-262.)
© 1998 American College of Chest Physicians

Pulmonary Aspergillosis and Invasive Disease in AIDS

Review of 342 Cases

Eleftherios Mylonakis MD1; Timothy Flanigan MD1; Josiah D. Rich MD, MPH1; and Tamar F. Barlam MD2

1 From the Department of Medicine, The Miriam Hospital, Brown University Medical School, Providence, RI
2 From the Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston

Aspergillosis is an infrequent but commonly fatal infection among HIV-infected individuals. We review 342 cases of pulmonary Aspergillus infection that have been reported among HIV-infected patients, with a focus on invasive disease. Invasive pulmonary aspergillosis usually occurs among patients with <50 CD4 cells/mm3. Major predisposing conditions include neutropenia and steroid treatment. Fever, cough, and dyspnea are each present in >60% of the cases. BAL is often suggestive, but biopsy specimens are necessary for definite diagnosis. Amphotericin B is the mainstay of treatment and mortality is >80%. Avoiding neutropenia and judicious use of steroids may be helpful in prevention. Aggressive diagnostic approach, early initiation of treatment, adequate dosing of antifungals, and close follow-up may improve the currently dismal prognosis.

Key Words: AIDS • amphotericin B • aspergillosis • fungal infection • HIV • itraconazole • liposomal amphotericin B

Submitted on August 21, 1997
Accepted on December 18, 1997




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