Pulmonary Aspergillosis: A Review and a Description of Three New Cases
Authors: J. N. Macartney
Journal: Thorax (1964)

Pulmonary aspergillosis: A review and a description of three new cases JAMES N. MACARTNEY From the Walsall Chest Clinic Aspergillosis, a comparatively rare disease in man though a common one in birds, is caused by the aspergillus, a genus of minute fungi which, in common with other fungi, lacks chlorophyll.It is either parasitic or saprophytic and has a particular affinity for decaying vegetable matter.Included among its species are Aspergillus fumigatus, A. niger, A. clavatus, A. nidulans, A. flavus, and A. versicolor, of which A. fumigatus is regarded as the most important, and only occasionally have other species been mentioned in connexion with human pulmonary infection (Montes, 1963).Bennett (1844) was the first to describe a case of fungal invasion of the lungs.The patient suffered from phthisis, but doubt exists as to whether the fungus was an aspergillus.The first case of pulmonary aspergillosis was reported by Sluyter (1847) in a woman dying from a chest illness who had a fungal mass in a lung cavity.The fungus, originally reported as a mucor, was later recognized as an aspergillus.A series of cases of pulmonary aspergillosis were recorded about this time (Friedreich, 1856; von Dusch and Pagenstecher, 1857; Cohnheim, 1865; Virchow, 1856).The latter described in detail four patients with dysentery, pneumonia, emphysema, and gastric carcinoma, in whom the role of the aspergillus was regarded as secondary.The first description of an allergic type of aspergillosis was in 1887, by Popoff.A woman of 21 years had symptoms of bronchial asthma, and her sputum was negative for tuberculosis but contained many bronchial casts made up of the mycelium and spores of A. fumigatus.The French contributions to the problem of aspergillosis have been many, especially in the late nineteenth century (Rdnon, 1893, 1897; Dieulafoy, Chantemesse, and Widal, 1890; Ddvd, 1938; and Monod, Pesle, and Labeguerie, 1952).Additional significant progress in aetiology and classification has come from Hinson, Moon, and Plummer (1952) and Pepys, Riddell, Citron, Clayton, and Short (1959), but many facets of the disease are still unexplained.The following case histories concern three patients in whom aspergillosis was confirmed histologically. CASE REPORTSCASE 1 (W.W.) A miner, aged 52 years at the time of admission in 1956, had been unfit for work since 1942.A chest radiograph in 1941 (Fig. 1) had suggested cystic bullae in the left upper lobe.After admission to hospital in 1943 because of a perforated gastric ulcer, pulmonary tuberculosis of the left apex was suspected, and, although the sputum was negative, he was transferred to a sanatorium for one month.7) revealed a slowly enlarging, solid mass, lying within a thick- walled cavity in the left upper lobe.Beginnning in 1947, haemoptysis of varying degree persisted inter- mittently.The patient was admitted to hospital in 1956 with a diagnosis of aspergilloma and had additional gross bronchiectasis in the left lower lobe.At bronchoscopy a generally inflamed mucosa was seen but no stenosis of the left upper lobe bronchus.Bronchial washings were cultured for fungi and tubercle bacilli, but only Candida albicans was isolated.Sputum examinations were repeatedly nega- tive for fungi.A blood count showed a haemoglobin of 80% (11-8 g./100 ml.); E.S.R. 49 mm.fall in one hour; W.B.C. 9,800/c.mm.; polymorphs 71%; lymphocytes 25% ; monocytes 3% ; and eosinophils 1%.Because of inadequate respiratory reserve and bronchiectasis, surgery was considered inadvisable.After discharge the patient survived until 1958 when he developed cor pulmonale due to bronchiectasis and died.At necropsy two adjacent mycetomata were found in the left upper lobe (Fig. 8).The larger of the two consisted of a brownish, putty-like, mycelial mass, lying loose within a thick-walled cavity.Culture after 48 hours at 37'C.produced a pure growth of A. fumigatus.CASE 2 (B.M.C.)A clerk aged 22 years was first seen at the chest clinic on 25 May 1955.Six days earlier he had had an haemoptysis which had persisted.