The role of Aspergillus species as a pathogen in
acquired immunodeficiency syndrome (
AIDS) has not been clearly defined. From 1984 to 1989, more than 2,000
AIDS patients were seen at Beth Israel Medical Center, New York. Aspergillus was isolated in ten patients; seven had invasive disease and three had noninvasive disease.
Invasive pulmonary aspergillosis (IPA) was diagnosed in six patients and invasive renal
aspergillosis was found in one patient. Five were homosexual men and two were intravenous drug users. At presentation, all ten had
fever, seven had
cough, eight had
dyspnea, and five had pleuritic
chest pain. Chest roentgenograms revealed focal infiltrates in six patients, bilateral interstitial infiltrates in two patients, and bilateral pneumothoraces in one patient. Predisposing conditions included
corticosteroid therapy in four,
granulocytopenia (less than 1,000/cu m) in two, and broad-spectrum
antibiotic therapy in five. Three of the four patients receiving
corticosteroids received them as adjuvant
therapy for
Pneumocystis carinii pneumonia (PCP). Aspergillus was identified antemortem in eight patients, in bronchoalveolar lavage (BAL) fluid in six, in transbronchial biopsy specimen in three, in open lung biopsy specimen in one, and postmortem in one patient. Six of seven patients had at least one concomitant pulmonary process. Six underwent necropsy and findings showed IPA in three, disseminated
aspergillosis in two, and PCP in one. Invasive
aspergillosis, although significant, is uncommon in
AIDS. When Aspergillus is isolated in the setting of
corticosteroid therapy,
antibiotics, or
granulocytopenia, one must suspect invasive disease.