The Deep Mycoses (Essentiallti or Potentiallt/ Si/stemic) 219 



11. ASPERGILLOSIS 



'Tin's is an uncommon and ill defined disorder which usually affects the 

 Lungs. It is due to one or more species o\ Aspergillus. 



(a) Etiology.— In our routine work we commonly isolate by accident 



one ol many species ol Aspergillus. The assumption is that tin's genus is 

 widespread in nature. Thorn and Church were able to collect 350 different 

 species. Aspergillus fumigatus lias been isolated more frequently from dis- 

 eased tissue than any other species, and the consensus is that it may be 

 pathogenic (see Chapter XXXIV, "Fungi Probably Pathogenic"). Pigeons, 

 parrots and other birds are vulnerable and may be the medium of ex- 

 posure. Bird fanciers, grain handlers and wheat threshers are said to be 

 prone to the infection. In a group of cases reported by Sayers and Meri- 

 wether, A. fumigatus and Aspergillus niger were thought to be the cause 

 of a lung infection simulating miliary tuberculosis. 



(b) Symptoms.— The lungs may become primarily involved. The course 

 max be acute or chronic. Acute bronchopneumonia is simulated in the first 

 instance and tuberculosis in the second. According to Jacobson, hemoptysis 

 is commonly associated with this infection. There is less emaciation than 

 with pulmonary tuberculosis of similar involvement. The recovery of a 

 species of Aspergillus from lesions on the skin may at times be significant 

 (see section on otomycosis, pp. 168 f. ), but careful controls and experiments 

 are required, since the organism is notoriously a secondary invader. 



(c) Differential diagnosis.— If the lungs are infected, the chief dis- 

 ease to be differentiated is tuberculosis. Repeated failure to isolate tubercle 

 bacilli, the freedom of the apexes of the lungs as seen by roentgen study, 

 the atypical onset and course and at times the history of exposure all 

 favor the diagnosis of mycotic infection. Infection with M. albicans may be 

 readily differentiated by microscopic and cultural studies. Before making 

 a diagnosis of probable aspergillosis, one must exclude other diseases and 

 must repeatedly isolate the micro-organism in massive quantities. Asper- 

 gilli may be cultured from normal sputum. 



(d) Prognosis.— The course of the disorder may be prolonged. 



(e) TREATMENT.— 1. The origin of the infection should be ascertained 

 if possible, and the patient may be' advised to change his environment 

 or occupation in order to escape further exposure. A gauze mask should be 

 worn by grain threshers, if susceptible. 



2. If tuberculosis can be definitely excluded, potassium iodide should 

 be employed in ascending dosage. 



3. Bed rest, wholesome food and fresh air are advisable. 



