Fungal pneumonia in hematologic disorders - With special reference to diagnosis of aspergillus pneumonia.

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  • Ishizaki Takeshi
    The Third Department of Internal Medicine , Fukui Medical School
  • Miyabo Susumu
    The Third Department of Internal Medicine , Fukui Medical School
  • Koshino Takeshi
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Fujimura Masaki
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Okafuji Kazuhiro
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Minami Shinji
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Kanamori Kazunori
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Saga Tsutomu
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Funada Hisashi
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Hattori Kenichi
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University
  • Matsuda Tamotsu
    The Third Department of Internal Medicine, School of Medicine, Kanazawa University

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Other Title
  • 血液疾患と肺真菌感染症　　特にアスペルギルス肺炎の診断を主として
  • With Special Reference to Diagnosis of Aspergillus Pneumonia
  • 特にアスペルギルス肺炎の診断を主として

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Description

Twenty-one cases of hematologic disorder, consisting of 16 cases of leukemia, 2 of malignant lymphoma and 3 of aplastic anemia, complicated by fungal pneumonia, were studied in terms of symptoms, roentgenological findings and immunoserological findings.<br>The causative fungi in 17 of 21 cases were aspergillus, one of mucor and three were unclear. Eight of 21 cases had an antemortem diagnosis of fungal pneumonia; two were proved by transbronchial lung biopsy, and six, confirmed later by postmortem findings were strongly suspected from clinical findings at antemortem stage. Six of these patients were successfuly treated with amphotericin B, 5-fluorocytosine and ketoconazole although two cases died despite antifungal therapy. The major distinguishing factor was that recovery of hematologic symptoms was recognized in the former and not in the latter.<br>In terms of symptoms, all had fever refractory to antibiotic therapy, cough was seen in 15 of them, sputa in 10, bloody sputum in 10, chest pain 9, rale in 16 and dyspnea in 9. On chest x-ray film, 12 had pneumonia-like shadows, 3 had patchy infiltration, 3 diffuse fine reticulonodular shadows and there was 1 cyst-like shadow. Circulating antibodies and antigens to Aspergillus fumigatus were not detected in any of our cases.<br>As a whole, early diagnosis of fungal pneumonia based on careful observation of symptoms, chest x-ray films and an aggressive diagnostic approch, including transbronchial lung biopsy, are warranted for prompt antifungal therapy with resultant resolution of these potentially fatal infections.

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