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Pathogen:
Aspergillus, a fungal genus that includes several ubiquitous disease-causing species. They are frequently found in decaying vegetation and soil. Aspergillosis is relatively common among neutropenic cancer chemotherapy patients and those receiving immunosuppressive therapy for organ transplants. While it is still considered a rare infection in HIV-positive patients, it is becoming increasingly common as a late-stage manifestation of AIDS.
Sites of Infection:
Lungs and sinuses, with possible extrapulmonary dissemination.
Symptoms:
Cough, chest pain, difficulty breathing, fever, and night sweats, sinus pain and facial swelling. Predisposing factors include neutropenia, long-term steroid use, marijuana use, previous lung disease, and CMV disease.
Diagnosis:
Aspiration of lung or sinus, broncho-alveolar lavage, microscopy and culture of sputum.
Treatment:
Intravenous amphotexicin B (AMB) remains the standard of care for invasive aspergillosis. Oral itraconazole has also been approved by the FDA for the treatment of mild to moderate aspergillosis.
Oral itraconazole has been studied as an alternative to intravenous amphotericin B for the treatment of invasive aspergillosis. The Mycoses Study Group (Denning et al.) treated 76 patients with oral itraconazole. The overall response rate was 39%, however the failure rate was higher in patients with AIDS. Denning et at. reported variable results treatingpatients with amphotericin B, itraconazole or both. 10/13 patients died a median of three months after the diagnosis of aspergillosis.
A multi-center study comparing itraconazole to amphotericin B for invasive aspergillosis in HIV-negative and HIV-positive patients (MSG 21) has been closed prematurely due to poor accrual.
OTHER REPORTS:
Geissmann F et al. Aspergillus brain abscesses: Therapeutic effect of G-CSF and liposomal amphotericin B. Abstract #PB0602, X Int Conf AIDS, Yokohama, 1994.
Hawkins D et al. Pulmonary Aspergillosis in 4 patients with advanced AIDS. Abstract PO-B09-1363, IX Intl Conf AIDS, Berlin, 1993.
Just-Nuebling G et al. Aspergillus infection in AIDS. VI Intl Conf AIDS, San Francisco, 1:237 (Th.B.463), 1990.
Minamoto et al. Invasive aspergillosis in patients with AIDS. Clin Infect Dis 14: 66-74,1992.
Pursell et al. Aspergillus species colonization and invasive disease in patients with AIDS. Clin Infect Dis 14: 141-148, 1992.
Walsh TJ et al. Amphotericin B Lipid Complex in the treatment of 228 cases of invasive mycosis. Abstract #M69, 34th ICAAC, Orlando, 1994.
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