[Invasive aspergillosis: a study of 20 cases]

To assess the epidemiology of invasive aspergillosis (IA) and the frequency of recognition of this clinical entity.

Retrospective analysis of patients with the diagnosis of IA in the last three years. The diagnostic criteria of the American Institute of Infectious Diseases Mycoses Group were followed.

During this period, 20 patients were diagnosed of IA: 9 (45%) had a hematologic malignancy, 14 (70%) had received corticosteroids, five (25%) had neutropenia, and three (15%) had no factors for immunosuppression. The disease was suspected in 15 cases (75%). Aspergillus spp. was recovered from sputum samples of the 16 patients who had the sample obtained. Seventeen patients (85%) died, 12 of them in spite of receiving antifungal therapy. Time relapsed since the beginning of symptoms and therapy was 14 days.

The proportion of patients without neutropenia or severe immunosuppression is higher than usually thought. IA is a clinical entity of difficult diagnosis and occasionally it is diagnosed only at post-mortem examination. The high sensitivity of sputum culture may be due to the selection of cases with more severe infections as stringent diagnostic criteria were used. To improve the prognosis of IA it is necessary to initiate antifungal therapy early in the course of the disease and therefore, a high suspicion index is required, not only of the immunocompromised but also of the immunocompetent patient.