Chest
Volume 114, Issue 2, August 1998, Pages 629-634
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Selected Reports
Acute Community-Acquired Pneumonia due to Aspergillus in Presumably Immunocompetent Hosts: Clues for Recognition of a Rare but Fatal Disease

https://doi.org/10.1378/chest.114.2.629Get rights and content

This article reports a case of acute community-acquired pneumonia due to Aspergillus fumigatus in a healthy patient and reviews 11 previously reported cases occurring in presumably immunocompetent hosts. The diagnosis was delayed for all patients; mortality was 100%. Clues that might suggest Aspergillus as a pathogen in community-acquired pneumonia include a chest radiograph revealing diffuse infiltrates or new cavitation; lack of bacterial or viral cause; a preceding influenza A infection; and respiratory secretion cultures positive for Aspergillus, When these clues are present, the physician should consider an early biopsy of lung tissue. Increased recognition and more timely diagnosis in future cases will improve the outcome of this rare but fatal infection.

Section snippets

Study Data

Previous case reports were identified through a Medline search of the English-language literature from 1966 to the present. Terms searched were: Aspergillus or fungus, and fungal, pneumonia, and immunocompetent. Reports referenced in articles identified through the search also were reviewed.

Case Definition

All cases included in this review fulfilled the following criteria: (1) onset of respiratory symptoms within 14 days of presentation to a health care provider; (2) no underlying medical condition or

Case Report

A 58-year-old previously healthy woman presented to the hospital with a nonproductive cough, fever, and nonspecific flu-like symptoms, starting suddenly 5 days prior to admission. These symptoms did not respond to treatment with clarithromycin. She had no significant past medical history, although she did have a 50 pack-year history of cigarette smoking. She was not taking any medications prior to her illness; she did not smoke marijuana or take other illicit drugs.

Upon admission, laboratory

Discussion

Including this report, only 12 cases of invasive pulmonary aspergillosis presenting as acute community-acquired pneumonia in apparently immunocompetent hosts have been reported in the English-language literature (Table 1).7, 8, 9, 10, 11, 12, 13, 14, 15 All patients were infected with A fumigatus. Patients ranged in age from 14 months to 67 years old (median: 41 years); 6 patients were female. Nine patients were previously healthy, one had chronic obstructive pulmonary disease, one had

Conclusion

Acute community-acquired pneumonia due to Aspergillus is a rare infection in immunocompetent hosts that carries a uniformly fatal prognosis. Aspergillus should be considered as a possible etiologic agent in patients with acute onset of diffuse bilateral pneumonia, cavitary pneumonia, or localized pneumonia rapidly progressing to diffuse pneumonia despite therapy with broad-spectrum antibiotics or with worsening pneumonia following influenza infection. Aspergillus recovered from cultures of

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