220 An Introduction to Medical Mycology 



BIBLIOGRAPHY 



Hethehington, L. II.: Primary aspergillosis <>1 lungs, Am. Rev. Tuberc. 47:107, 1943. 

 [acobson, II. P.: Fungous Diseases (Springfield, 111.: Charles C Thomas, Publisher, 1932), 



p. 270. 

 Sayers, R. R., and Meriwether, K. V.: Miliary lung diseases due to unknown cause, Am. T. 



Roentgenol. 27:337, 1932. 

 Schneider, L. V.: Primary aspergillosis of lun^s, Am. Rev. Tuberc. 22:267, 1930. 

 Thom, C, and Church, M.: The Aspergilli (Baltimore: Williams & Wilkins Company, 1926). 



12. MYCOSES OF THE LUNGS 



Of the invasive, deep-seated and potentially fatal mycotic infections, 

 coccidioidomycosis is the only one that is regularly acquired by inhala- 

 tion. This results in an acute inflammation of the lungs simulating one of 

 the common acute upper respiratory diseases. Most patients recover spon- 

 taneously. The lungs may be involved late in the course of the disease in 

 the occasional instance in which there is not complete recovery from the 

 initial acute infection. It is probable that a primary and benign form of 

 histoplasmosis affecting the lung parenchyma is not uncommon in Ten- 

 nessee and in some other sections of the United States. With spontaneous 

 healing calcification occurs, with the final roentgen appearance of a miliary 

 nodular calcific process. With the other rare invasive fungous infections, 

 the lungs may share in a widespread involvement of many tissues and 

 organs. Infections due to B. dermatitidis, S. sehencki or A. bovis ma}' 

 become systemic and the lungs become invaded through the blood stream. 

 Another fungous disease of the lungs, due to inhalation of A. fumigatus, 

 is frequently of occupational origin among grain workers and is usually 

 comparatively banal, with a good prognosis for cure. In general, these infec- 

 tions are not difficult to diagnose provided the possibility of fungous dis- 

 ease is kept in mind. Tuberculosis may be simulated. The latter disease 

 is distinguished by the history, the sputum examination and the appearance 

 of the roentgenogram. In general, tuberculosis has a predilection for the 

 apexes, while the typical sites of involvement of the mycoses are the middle 

 and lower pulmonary fields. Positive identification of the causative fungus 

 is requisite to establishment of diagnosis. This is accomplished by study of 

 a fresh mount (as in actinomycosis), by examination of a specimen mounted 

 in hydroxide (coccidioidomycosis), by culture (sporotrichosis) or by a 

 combination oi these methods. Skin tests using specific antigens may be 

 useful, particularly with histoplasmosis of the benign type. It should be 

 remembered that tuberculosis also may be present. 



In addition to the aforementioned well defined and well recognized 

 types of involvement of the lungs, there is a considerable number of cases 



