NOTE: Patients with HIV disease will have an IRIS as T cell immune function recovers. With neutropenia the immune system is not reconstituting but rather the effector cells.
Features:
(1) presence of pulmonary aspergillosis
(2) new onset or worsening of clinical and radiologic pulmonary findings consistent with fungal pneumonia
(3) change coincides with restoration of the neutrophil count
(4) >= 50% decrease in the serum galactomannan index titers on 2 consecutive tests performed within 4 days of each other without a change in therapy
(5) absence of new extrapulmonary lesions of aspergillosis
(6) absence of other processes (medication side effect, onset of a new infection, progression of another infection, etc.)
(7) biopsy shows an exuberant inflammatory response and/or well-formed granulomatous inflammation
The authors monitored patients with the serum galactomannan index titers. A fall in titers predicted eventual improvement, while a rise indicates progressive aspergillosis and the need for more intensive antifungal therapy.
