Broncho-pulmonary Aspergillosis : A Review and a Report of Eight New Cases

Abstract

The fungus Aspergillus is sometimes found in patients suffering from certain chronic lung diseases such as tuberculosis. In these patients it does not alter the clinical or the pathological picture to any material extent and causes merely a harmless secondary or saprophytic infection. In some reports aspergillosis, often on scanty evidence, is claimed to be a primary infection presenting as bronchitis, pneumonia, lung abscess, or multiple granulomata. In this paper the literature is reviewed and eight new cases are reported, including three of a kind not previously recognized; the clinical mani-festations of this type of aspergillosis are discussed in detail. The three cases resemble to some extent the condition recently described under the term "pulmonary eosinophilia." Evidence is offered that in our patients sensitization of the host to infection by this fungus led to pathological changes which warrant a description of the con-dition as a true broncho-pulmonary aspergillosis, whether the fungal infection was implanted on a pre-existing lesion-or not. MYCOLOGY The genus of moulds, Aspergillus, was first described and named by Micheli (1729). The similarity in appearance between its fruiting heads and the brush used for sprinkling holy water (aspergilluni) probably suggested the name. This fungus is very commonly found in soil and decay-ing organic matter (Thom and Raper, 1945). It is present in compost heaps, proprietary hop manures, spoiled grain, hay, and straw, and also in rotting wood. The ubiquity of its spores is respon-sible for frequent contamination of laboratory cultures, and therefore the diagnosis of aspergil-losis should not rest solely on cultural findings. This fungus can be grown on simple media. Originally we used Sabouraud's (1894) maltose agar to which sterile horse or human blood was * Based on papers read before the Thoracic Society on February