[Invasive aspergillosis in "nonimmunocompromised" patients (case reports)].

Abstract

Invasive aspergillosis (IA) is a major cause of morbidity and mortality in immunocompromised patients. Given the rising numbers of patients at risk of opportunistic infections, there has been a significant increase in Aspergillus infections in recent years. Patients most at risk are mainly those with prolonged neutropenia or receiving long-term corticosteroid or other immunosuppressive thera pies and those with impaired pulmonary defense. Relatively recently, critically ill patients without traditional risk factors were also classified as at-risk, that is patients in intensive care units, those with chronic obstructive pulmonary disease, post-flu and so on. Chronic obstructive pulmonary disease is one of the most common predisposing conditions due to frequent Aspergillus airway colonization. Other significant risk factors for IA are decompensated liver disease and cirrhosis, AIDS, corticosteroid treatment, impaired mucociliary transport after cure from pneumonia (both bacterial and viral), immune deficiency in long-lasting diseases and autoimmune disorders. Additionally, various immunosuppressive drugs increase the risk of IA (e.g. tumor necrosis factor blockers). The case reports describe two patients who developed disseminated aspergillosis after a severe illness, with the right diagnosis being made only at autopsy. The author´s aim is to draw attention to the need to consider IA also in patients who initially do not appear to be at risk for disseminated fungal infection.