Study of serial bronchoalveolar lavage in patients with aspergilloma: cell reaction at the affected sites and penetration of miconazole and flucytosine into the lesion

Abstract

We have performed serial bronchoalveolar lavage (BAL) examination in two patients with asperigilloma and compared that of total cell count and cell population with control groups (5 non-smokers, 10 smokers) and other pulmonary infectious diseases: 7 each with mycoplasmal pneumonia and pulmonary tuberculosis, 6 with bacterial pneumonia, and 5 with chlamydial pneumonia. Miconazole (MCZ) by drip intravenous infusion of 400 mg/day and flucytosine (5-FC) by oral intake of 4.5 to 6.0 g/day were administered to one patient with aspergilloma, and we studied the serum and BALF concentration about 5 hours after administration. The followings results were obtained: 1. In aspergilloma, the cell population of neutrophils in BALF increased compared with control groups (p < 0.01) and other pulmonary infectious disease. 2. The serum and BALF levels of MCZ ranged from 0.1 to 0.3 micrograms/ml, < 0.1 14.4 micrograms/ml, respectively. On the other hand, the serum and BALF levels of 5-FC ranged from < 0.2 to 9.3 micrograms/ml, and < 0.4 to 1.5 micrograms/ml, respectively. From these results, we consider that neutrophils play the main role in the immune host defense in aspergilloma, and the combination of intracavitary infusion of MCZ and oral administration of 5-FC should be the treatment of choice.