Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
Ulcerative and plaque-like tracheobronchitis due to Aspergillus in AIDS.
Int Conf AIDS. 1992 Jul 19-24;8(2):B119 (abstract no. PoB 3196). Unique Identifier : AIDSLINE ICA8/92400930 Kemper C; Hostetler J; Follansbee S; Ruane P; Covington D; Leong S; Deresinski S; Stevens D; Santa Clara Valley Medical Center, San Jose, CA.
Abstract:
OBJECTIVE: At least 58 cases of invasive aspergillus tracheobronchitis have been described since 1962, but only 3 cases have been reported in HIV infection. We report 4 patients with AIDS and tracheobronchitis due to Aspergillus spp., and review 9 cases of aspergillus airways disease in HIV infection. METHODS: Three patients presented with ulcerative bronchitis and 1 with ulcerative tracheitis due to Aspergillus spp. between May 1990 and May 1991. All 4 patients had bronchoscopic examination with bronchoalveolar lavage (BAL) and endobronchial or endotracheal biopsies, and 1 had transbronchial biopsies. BAL specimens and biopsies were cultured for fungus in all 4 patients. All 4 patients received itraconazole. Postmortem examinations were performed in 2 of 3 patients who died. RESULTS: The median time from diagnosis of AIDS to infection with Aspergillus was 19 mo, with a range of 25 d to 41 mo. The median CD4 count in 3 patients was 32/mm3. Three patients had received corticosteroids or were neutropenic, but 1 patient had neither of these well-defined risk factors. Three patients had ulcerative bronchitis with varied degrees of diffuse tracheobronchitis, multiple ulcerative or inflammatory plaques and occasional nodules involving the mainstem and segmental bronchi. The remaining patient had ulcerative tracheitis with a single deep 1.5 cm ulceration of the proximal trachea. Aspergillus was isolated from biopsy and BAL specimens in all 4 patients. There were varied degrees of mucosal, submucosal and cartilaginous invasion on histologic examination in 3 patients, but only 1 patient had evidence of disseminated aspergillosis. This latter patient died at 8 d of his disseminated disease. One patient had an initial clinical response, but died of bacterial sepsis at 5 mo. One patient had a clinical response, but died of disseminated cytomegalovirus infection at 11 mo; autopsy revealed a small focus of peribronchial infection. The remaining patient was lost to follow-up. CONCLUSIONS: Tracheobronchitis due to Aspergillus can be a progressive and fetal illness. Despite histologic evidence of limited mucosal invasion, tracheobronchitis may herald occult or incipient pulmonary parenchymal infection and dissemination in profoundly immunocompromised hosts. Itraconazole may be an effective therapeutic option to amphotericin B in the treatment of this disease.
Keywords: Acquired Immunodeficiency Syndrome/*COMPLICATIONS Aspergillosis/*COMPLICATIONS/DRUG THERAPY/PATHOLOGY Biopsy, Needle Bronchitis/*COMPLICATIONS/DRUG THERAPY/PATHOLOGY Bronchoalveolar Lavage Fluid Bronchoscopy Human Tracheitis/*COMPLICATIONS/DRUG THERAPY/PATHOLOGY ABSTRACT 921230
M92C4417
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Important note: Information in this article was accurate in 1992. The state of the art may have changed since the publication date.
