Poor Outcome of Central Nervous System Invasive Aspergillosis in HIV Infection Despite Galactomannan-Based Diagnosis-A Case Series and Literature Review

摘要

Invasive aspergillosis is recognized as a devastating disease in some immunocompromised populations, although it is not accepted as an established complication of human immunodeficiency virus/acquired immunodeficiency syndrome under the World Health Organization's staging criteria. Complications affecting the central nervous system are rarely reported, which may relate to a lack of adequate diagnostic tests. We report the use of the galactomannan Platelia assay in 3 patients with invasive cerebral infection and advanced human immunodeficiency virus, as defined by the World Health Organization, with CD4 T-lymphocyte counts of less than 350 cells/muL. The clinical use of the assay in early detection, particularly when used in a serial fashion, is compared to standard microbiological techniques. The limitations of the current assay are described in the context of future diagnostic approaches, such as sampling of cerebrospinal fluid and bronchoalveolar lavage specimens and the use of nucleic acid techniques.