INVASIVE ASPERGILLOSIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN

Background. Aspergillosis is an uncommon yet serious opportunistic inf ection in patients with AIDS, It has been extensively reported in HIV- infected adult patients. To our knowledge there are no studies that de scribe the epidemiology, clinical manifestations and outcome of asperg illosis in a large HIV-infected pediatric population. Methods. We revi ewed the records of all 473 HIV-infected children followed in the Pedi atric Branch of the National Cancer Institute for 9 years from 1987 th rough 1995 for the presence of Aspergillus infection. Results. Seven ( 1.5%) patients developed invasive aspergillosis during the study perio d. All patients had low CD4 counts reflecting severe immunosuppression . Sustained neutropenia (>7 days) or corticosteroid therapy asa predis posing factor for invasive aspergillosis was encountered in only two p atients (28%). Invasive pulmonary aspergillosis developed in five pati ents and cutaneous aspergillosis in two, The most common presenting fe atures in patients with pulmonary aspergillosis were fever, cough and dyspnea, Patients with cutaneous aspergillosis were diagnosed during l ife and successfully treated with amphotericin B and surgery, whereas diagnosis of pulmonary aspergillosis was made clinically in only one p atient. Conclusions. Aspergillosis is an uncommon but highly lethal op portunistic infection in HIV-infected children. Invasive pulmonary asp ergillosis should be considered in the differential diagnosis in febri le, HIV-infected children with persistent pulmonary infiltrates.