Infect Chemother.  2014 Sep;46(3):209-215. 10.3947/ic.2014.46.3.209.

Aspergillus Tracheobronchitis and Influenza A Co-infection in a Patient with AIDS and Neutropenia

• Lee JY
• Joo EJ
• Yeom JS
• Song JU
• Yim SH
• Shin DS
• Yu JH
• Ju DY
• Yim JW
• Song YS
• Sohn YJ
• Do SI

• KMID: 2284980
• DOI: http://doi.org/10.3947/ic.2014.46.3.209

Abstract

Aspergillus tracheobronchitis (AT), an unusual form of invasive pulmonary aspergillosis (IPA), is characterized by pseudomembrane formation, ulcer or obstruction that is predominantly confined to tracheobronchial tree. Hematologic malignancies, neutropenia, solid organ transplantation, chronic corticosteroid therapy and acquired immunodeficiency syndrome (AIDS) are known to be major predisposing conditions. However, since the introduction of highly active antiretroviral therapy, there is only one reported case of AT in AIDS patient. After pandemic of influenza A/H1N1 2009, there are several reports of IPA in patient with influenza and most of them received corticosteroid or immunosuppressive therapy before the development of IPA. We present a 45 year-old AIDS patient with influenza A infection who developed pseudomembranous AT without corticosteroid use or immunosuppressive therapy.

Keyword

Aspergillus; Bronchitis; Influenza; AIDS

MeSH Terms

Acquired Immunodeficiency Syndrome
Antiretroviral Therapy, Highly Active
Aspergillus*
Bronchitis
Coinfection*
Hematologic Neoplasms
Humans
Influenza, Human*
Invasive Pulmonary Aspergillosis
Neutropenia*
Organ Transplantation
Pandemics
Transplants
Ulcer

Figure

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  Figure 1 Chest CT of the patient on hospital day 13 shows numerous small centrilobular nodules and peribronchovascular consolidations on both lungs.

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  Figure 2 Bronchoscopic findings of the patient. Cream-colored thick pseudomembrane were found from vocal cord (A), carina (B), bronchus intermedius (C) to whole bronchi.

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  Figure 3 Microscopical findings of the specimen obtained from bronchoscopic biopsy and lavage show the numerous fungal hyphae invading the necrotic mucosa & submucosal layer, not the tracheal cartilage (A) (hematoxylin & eosin stain × 100) and tangled septate branching hyphae of Aspergillus species (B) (× 400), (C) (× 200), (D) (× 400).

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  Figure 4 Clinical courses of the case patient according to hospital day (HD), with absolute neutrophil count (ANC), prescribed antibacterial, antiviral and antifungal agents, performed laboratory tests and the results of chest X-ray. Tx, therapeutic methods; Dx, diagnostic methods; FEP, cefepime; IPM, imipenem; MEM, meropenem; VAN, vancomycin; OTV, oseltamivir; AMB, amphotericin B deoxyclolate, VRC, voriconazole; G-CSF, granulocyte colony stimulating factor; RT-PCR, real-time reverse transcription polymerase chain reaction for influenza A; CT, computed tomography; BR, bronchoscopy; BAL, broncho-alveolar lavage; CFP, cefepime; IMP, imipenem; MEP, meropenem; AMP-D, amphotericin B deoxycholate; G-CSF, ganulocyte colony-stimulating factor; RT-PCR, reverse transcription polymerase chain reaction for influenza A.

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