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Pulmonary Aspergillosis and Invasive Disease in AIDS : Review of 342 Cases

Eleftherios Mylonakis; Timothy Flanigan; Josiah D. Rich; Tamar F. Barlam
Author and Funding Information

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

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


1998 by the American College of Chest Physicians


Chest. 1998;114(1):251-262. doi:10.1378/chest.114.1.251
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Abstract

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.


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