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 Original Articles |
| Clinical Study on Aspergillosis |
| Kwang Jae Lee, Sun Ju Lee, Je Duk Oh, Jee Sook Hahn, Yun Woong Ko, Woo Ick Yang |
| Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, Department of Pathology |
Vol.23 Num.2 (p73~85)
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The Aspergilli are among the most common and ubiquitous saprophytic fungi in the environment. Aspergillosis is divided into several cartegories. among wihch the invasive aspergillsois (IA) causes significant morbidity and mortality in immunocompromized host especially from pulmonary infection.
The clinical aspect of 40 cases of aspergillosis were studied, who were admitted Severance Hospital between January, 1985 and June, 1990. The following results were observed.
1) Among these 40 cases, 1 was diagnosed as allergic aspergillosis, 25 as aspergilloma (pulmonary 22, paranasal sinus 3), 11 as IA (pulmonary 5, brain 3, sinus with contiguous invasion 3) and 3 as pleural aspergillosis.
2) Among 22 cases of pulmonary aspergilloma, the most frequently associated underlying diseases were pulmonary tuberculosis in 17 and others were COPD in 3, bronchiectasis in 2 and bronchial asthma in 1. Among 5 cases of invasive pulmonary aspergillosis (IPA), acute lymphocytic leukemia was the underlying disease in 3, acute myelogenous leukemia in 1 and myelodysplastic syndrome in 1.
3) The specific diagnosis of aspergilloma was made by surgical biopsy in 15, transbronchial lung biopsy in 4 and compatible finding of chest X-ray with positive antibody against Aspergillus antigen in 6. Among 3 cases of pleural aspergillosis, 2 were diagnosed by pleural biopsy and 1 by culture of pleural fluid.
4) In cases of IA, the specific diagnosis was made by histopathologic findings in 9. Among 5 cases of IPA, 2 were diagnosed by needle aspiration biopsy, 2 by clinical diagnostic criteria and 1 by open lung biopsy.
5) The severe granulocytopenia (<500/mm3) before pulmonary infiltrates was noted in all cases of IPA.
6) All the 22 cases of pulmonary aspergilloma were improved with surgical resection in 13 and 9 with conservative treatment. In contrast, 3 of 5 IPA were dead inspite of amphotericin B treatment and 2 were recovered with improvement of underlying disease or granulocytopenia. Six cases of invasive sinus or brain aspergillosis were improved with surgical removal and amphotericin B treatment, and 2 pleural aspergillosis with surgical drainage.
With the above results, several types of aspergillosis were confirmed and the prognosis seemed to depend on underlying disease. Because of high fatality of IPA, it is more stressed that the prophylactic measures, efforts of discrnible diagnostic approaches and as early empirical antifungal treatment as possible might give rise to not only the therapeutic success of IPA but also the improvement in prognosis of uderlying diseases.
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