Invasive Aspergillus Sinusitis in Human Immunodeficiency Virus Infection: Case Report and Review of the Literature

Abstract

Invasive Aspergillus (IA) sinusitis is a life-threatening opportunistic infection in immunocompromised individuals, but it is uncommon in human immunodeficiency virus (HIV) infection. To gain a better understanding of the characteristics of IA sinusitis in this population, we present a unique case of chronic IA sinusitis in an HIV-infected patient taking antiretroviral therapy and review the literature summarizing published cases of invasive aspergillosis of the paranasal (n = 41) and mastoid (n = 17) sinuses in HIV-infected individuals. Among these cases, only 4 were reported after 1999, and 98% of patients had acquired immune deficiency syndrome. Orbital invasion occurred in 54% of paranasal sinus cases, whereas intracranial invasion was reported in 53% of mastoid sinus cases. The overall mortality was 79%. We also discuss various clinical and immunologic factors that may play a role in the development of IA and consider the changing epidemiology of aspergillosis in the era of effective antiretroviral therapy.

The spectrum of pulmonary aspergillosis

“…Aspergillus tracheobronchitis is a unique form of IPA in which the infection is limited to the tracheobronchial tree [104]. Invasive Aspergillus rhinosinusitis is another form of the disease that has also been recognized [105]. IPA has a relatively rapid progression, over days to few weeks, with a high mortality rate, often exceeding 50% [106].…”

A multi‐institutional review of outcomes in biopsy‐proven acute invasive fungal sinusitis

“…Its mortality is high even with timely diagnosis and treatment: ∽50% in the largest meta‐analysis to date . Risk factors for AIFS are related to functional and quantitative neutropenia, such as in cases of uncontrolled diabetes mellitus, hematologic malignancy (especially acute myeloid leukemia), chemotherapy, corticosteroid use, renal/liver failure, bone marrow transplantation (BMT), HIV/AIDS, or autoimmune disease …”

The pathogenicity ofAspergillus fumigatus, drug resistance, and nanoparticle delivery

“…Most individuals are able to quickly eliminate the pathogen by the action of the ciliated epithelium of the upper respiratory tract and pulmonary macrophages that effectively remove conidia that reach the alveoli. Nonetheless, infections due to Aspergillus inhalation are still common in immunosuppressed patients as a result of AIDS, and treatments for cancer and organ transplants (Latgé 1999;Küpeli et al 2015;Humphrey et al 2016;Kaur et al 2017;Lipový et al 2017;Schwartz and Patterson 2018). Even though AIDS deaths overall are slowly decreasing every year, fungal infections overall account for 47% of those deaths (9% for CPA) compared with 30% for tuberculosis in 2015 (Denning 2016;Limper et al 2017).…”