Secondary Aspergillosis

Abstract

The clinical and pathological features of 22 cases of secondary aspergillosis have been described. 20 of the 22 patients had underlying neoplastic diseases, and in 16 this was acute leukemia. Pulmonary involvement occurred in 21 patients and central nervous system disease in five patients. Focal involvement of the heart, gastrointestinal tract, kidneys and thyroid were less frequent. Associated bacterial and fungal infections occurred in 20 patients; however, aspergillosis was the primary cause of death in seven patients. 19 patients were receiving corticosteroids within the 30-day period preceding death. In the last 30 days of life, 95% of the patients were on broad-spectrum antibiotics, and the majority were receiving antineoplastic drugs and had leukopenia which was drug or disease induced. Pulmonary infiltrates and consolidation ascribable to aspergillosis on chest films were seen only within the last two weeks of life in 11 patients. Only two patients had ante mortem cultures of Aspergillus, and seven had positive cultures at post mortem examination, of which four were A. fumigatus. Histopathological lesions consisted of filamental fungi occluding small blood vessels and bronchioles, with thrombosis, infarction, and necrosis of lungs, brain and other organs. Inflammatory reaction to the infection was often slight. The pre mortem diagnosis of aspergillosis was difficult to establish in these patients. More aggressive attempts to obtain histological or cultural evidence of aspergillosis must be made so that definitive therapy for this disease can be instituted.