Chronic Pulmonary Aspergillosis in a Patient With AIDS

Chronic pulmonary aspergillosis (CPA) is caused by saprophytic fungi Aspergillus spp. Certain conditions predispose individuals to pulmonary aspergilloses, for example, neutropenia, prolonged steroid therapy, immunosuppressive drugs, and solid organ transplants. Individuals are infected with Aspergillus spores by inhalation. CPA is diagnosed through imaging features, such as cavities, fungal balls, peripheral air crescent signs, and the direct visualization of the Aspergillus spp. (microscopy or culture from biopsy) or immunological response to Aspergillus spp. (serum IgG confirms the diagnosis of CPA). All these should be present for at least three months. An Aspergillus infection is uncommon in those with the human immunodeficiency virus (HIV) due to intact phagocytic cell function. However, HIV-infected individuals with CD4+ T cell < 100 cells/mL are more likely to experience disease progression. Chronic tubercular cavities predispose one to the colonization of cavities with Aspergillus spp. When HIV advances to AIDS (acquired immunodeficiency syndrome), the aspergilloma transforms into an invasive form.