Pulmonary aspergillosis in the acquired immunodeficiency syndrome

Article Abstract:

Although aspergillosis, a serious fungal infection of the lung, is common among patients who have impaired immune systems (immunocompromised patients), it has been reported rather rarely in AIDS patients. The cases are described of 13 male patients infected with HIV (human immunodeficiency virus, associated with AIDS) who also developed pulmonary aspergillosis. This disease developed late in the course of AIDS, after a median time of 25 months from diagnosis. The factors that may have predisposed these patients to develop aspergillosis include cytomegalovirus infection, previous Pneumocystis carinii pneumonia (a type of pneumonia common among AIDS sufferers), reduced numbers of neutrophils (a type of white blood cell) as a result of treatment with zidovudine (a drug for treating AIDS), or the use of marijuana, corticosteroids, or certain antibiotics. Detailed descriptions are presented of laboratory and other findings for the 10 patients with invasive aspergillosis (confirmed by histopathology or culture of lung fluid) and the three with obstructing bronchial aspergillosis (major respiratory symptoms and fungi in lung fluid or sputum samples, but no invasion of tissue). Initial symptoms consisted of cough and fever; those with obstructing bronchial disease were more acutely ill than those with invasive disease. Two illustrative case histories are presented. Aspergillosis was treated with amphotericin B or itraconazole (antifungal agents), with generally poor results: of the six (of seven treated) patients who responded to drug therapy, three relapsed and one died. While itraconazole is usually a desirable drug in such cases because it is active when taken orally, its pharmacological properties, for unknown reasons, are unpredictable in AIDS patients; this may be the result of interactions with other drugs. It is likely that AIDS patients, who now live longer with improved treatment, will develop infections rarely seen at present. Pulmonary aspergillosis is undoubtedly an example of such a complication. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Complications and side effects, Diseases, AIDS patients, AIDS (Disease)

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A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis

Article Abstract:

Patients with allergic bronchopulmonary aspergillosis may benefit from the anti-fungal drug itraconazole. Allergic bronchopulmonary aspergillosis is an infection of the lungs by the fungus Aspergillus fumigatus. Researchers randomly assigned 55 patients with allergic bronchopulmonary aspergillosis to take itraconazole or a placebo every day for 16 weeks. Almost half the patients taking itraconazole experienced an improvement in symptoms and were able to reduce their corticosteroid dose. Only 19% of the placebo group improved. The drug caused no more side effects than the placebo.

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Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome

Article Abstract:

High-dose amphotericin B plus flucytosine followed by fluconazole or itraconazole appears to be an effective treatment for cryptococcal meningitis in AIDS patients. Researchers randomly assigned 381 AIDS patients with cryptococcal meningitis to take 0.7 milligrams per kilogram of amphotericin B per day with or without flucytosine. Two weeks later, they were switched to itraconazole or fluconazole. The use of amphotericin and flucytosine combined led to faster cures and lower mortality rates. Fluconazole was more effective than itraconazole.

Cryptococcal infections, Meningitis, Cryptococcosis, Fluconazole, Amphotericin B, Flucytosine

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