ASPERGILLOSIS IN ACQUIRED-IMMUNODEFICIENC Y-SYNDROME

From 1983 to 1991 only isolated cases of aspergillosis in AIDS patient s were reported; since 1991, an increasing number of cases have been r eported suggesting a recent emergence of this fungal infection. Asperg illosis occurs about 10 to 25 months after AIDS diagnosis in patients with CP, below 50/mm(3). Neutropenia and/or steroid therapy, which are known as predisposing factors in aspergillosis, are noticed in about one half of the patients. Previous pulmonary infection, especially pne umocystosis, are very common. Clinical signs are typical of an invasiv e pulmonary aspergillosis : constant fever, cough, dyspnea, frequent t horacic pains and haemoptysis. Radiologic signs frequently indicate an interstitial infiltration. Nodular and cavitating lesions, pleural ef fusions, thoracic lymph node enlargement are often present. Diagnosis procedures are realised on bronchoalveolar lavage by direct examinatio n, culture and antigen detection. Aspergillus fumigatus is the most us ually species detected. Post-mortem diagnosis is frequent. Invasive br onchial aspergillosis, localised infections (aspergilloma, otitis, sin usitis) or disseminated infections (nervous system, heart, kidney,lymp h nodes, thyroid) are also described. Prognosis is poor even with trea tment (amphotericin B or itraconazole). An earlier diagnosis and treat ment of the bronchial colonization could probably improve this prognos is.