ASPERGILLOSIS 209 



gillosis give positive tuberculin reactions; conversely Nicaud found 

 that an advanced case of tuberculosis gave positive cutaneous reac- 

 tions with an extract of A. fumigatus. Extensive cavity formation 

 occurs in the lungs. The diagnosis is made by finding the mycelium 

 in the sputum, where it occurs as short hyphal fragments, often en- 

 crusted, and by isolating the fungus in culture. See Fig. 106. The 

 latter procedure is easy when sputum is planted on Sabouraud agar 

 slants because the fungus grows fairly rapidly and is not inhibited 

 by bacterial growth. The prognosis is not good. Internal adminis- 

 tration of iodides is said to be of value, even curative, in some cases, 

 but this treatment must be followed with caution since it may result 

 in the rapid spread of the disease as in the case of blastomycosis. 



A considerable number of cases of primary pulmonary aspergil- 

 losis were reported in France some years ago, especially by Renon."* 

 In these cases the infection was an occupational disease occurring in 

 individuals engaged at that time in occupations which peculiarly 

 subjected them to the possibility of inhaling large numbers of spores. 

 These were the "gaveurs des pigeons" who fattened squabs for the 

 market by filling their mouths with grain, chewing it fine, and then 

 with their tongues forcing the mass into the esophagus of the birds. 

 The second group was the "peigneurs des cheveux" who prepared 

 hair for the manufacture of wigs by mixing it with corn meal to 

 remove oil and then combing it out. In both cases the source of the 

 infection is obvious enough, though in the first it is possible that the 

 infection may have come from the bird rather than the grain, for 

 some of the pigeons were found to have aspergillosis infections of 

 the mouth. 



Experimentally inoculated into laboratory animals, A. fumigatus 

 produces lesions which vary according to the virulence of the strain 

 and the dosage. Many strains isolated from air or vegetable matter 

 show no pathogenicity. Strains freshly isolated from spontaneous 

 infections may exhibit a surprising degree of virulence, a small dose 

 of spores suspended in salt solution killing a pigeon overnight when 

 inoculated intravenously. No lesions are apparent in such acute 

 infections. With smaller doses or less virulent strain, multiple miliary 

 abscesses occur in various viscera, especially the lungs. Intravenous 

 inoculations into rabbits usually causes death within 3 to 5 days. 

 Multiple minute abscesses in the cortex of the kidneys are the most 

 striking lesions in these rabbits. Subcutaneous or intraperitoneal 

 inoculations produce localized lesions which may not be fatal. 



Experimental infections may also be produced by causing the 

 spores to be inhaled. If one dusts spores into a tumbler and holds 



