Document Detail


Pulmonary aspergilloma and AIDS. A comparison of HIV-infected and HIV-negative individuals.
MedLine Citation:
PMID:  9118696     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE AND METHODS: While pulmonary aspergilloma has been well described in immunocompetent hosts, to date and to our knowledge, there has not been a description of pulmonary aspergilloma in the HIV-infected individual. A retrospective review of cases seen by the Bellevue Hospital Chest Service from January 1992 through June 1995 identified 25 patients with aspergilloma. To investigate the impact of HIV status on pulmonary aspergilloma, we compared clinical presentation, progression of disease, treatment, and outcome in the HIV-infected patient vs the HIV-negative patient with aspergilloma. RESULTS: Of the 25 patients identified, 10 were HIV-infected and 15 were HIV-negative. Predisposing diseases included tuberculosis (18/25, 72%), sarcoidosis (4/25, 16%), and Pneumocystis carinii pneumonia (3/25, 12%). All 25 patients had evidence of aspergilloma on chest CT. In addition, 17 of 25 patients had evidence of Aspergillus species in fungal culture, pathologic specimens, or immunoprecipitins. Hemoptysis was present in 15 of 25 (60%) (11/15 [73%] of the HIV-negative group vs 4/10 [40%] of the HIV-infected group). Severe hemoptysis (> 150 mL/d) occurred in 5 of 15 (33%) of the HIV-negative group vs 1 of 10 (10%) of the HIV-infected group. Disease progression occurred more frequently among the HIV-infected group (4/8, 50% vs 1/13, 8% in HIV-negative individuals). All patients with disease progression had lymphocyte subset CD4+ < 100 cells per microliter. Four of eight (50%) of the HIV-infected group vs 1 of 13 (8%) of the HIV-negative group died. SUMMARY AND CONCLUSIONS: We conclude the following: (1) although tuberculosis and sarcoidosis are the most prevalent predisposing diseases, P carinii pneumonia in the HIV-infected individual is a risk factor for pulmonary aspergilloma; (2) HIV-infected individuals with CD4+ < 100 cells per microliter are more likely to have disease progression despite treatment; and (3) HIV-negative patients are more likely to have hemoptysis requiring intervention.
Authors:
D J Addrizzo-Harris; T J Harkin; G McGuinness; D P Naidich; W N Rom
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Chest     Volume:  111     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1997 Mar 
Date Detail:
Created Date:  1997-04-24     Completed Date:  1997-04-24     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  612-8     Citation Subset:  AIM; IM; X    
Affiliation:
Division of Pulmonary and Critical Care Medicine, New York University Medical Center, Bellevue Hospital Center, New York 10016, USA.
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / diagnosis*,  immunology,  therapy
Adult
Aged
Aspergillosis / complications,  diagnosis*,  immunology,  therapy
CD4 Lymphocyte Count
Disease Progression
Female
HIV Infections / immunology
HIV Seronegativity
Hemoptysis / etiology
Humans
Lung Diseases, Fungal / complications,  diagnosis*,  immunology,  therapy
Male
Middle Aged
Pneumonia, Pneumocystis / complications
Retrospective Studies
Risk Factors
Treatment Outcome
Tuberculosis, Pulmonary / complications
Grant Support
ID/Acronym/Agency:
MO1 00096//PHS HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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