Case of Aspergillosis Treated with Amphotericin ‘B’

Abstract

The problem of pulmonary aspergillosis is not new. The genus of moulds “Aspergillus” was described and named by Micheli in 1729. The name was probably given because of the similarity of the spore-bearing heads, and the brush used for sprinkling holy water (aspergillum). This fungus was first found to be invasive in 1815 by Mayer, who discovered it in the lungs of a jay, later by others in different birds, and stifi later, in 1887, in a laryngeal swelling in a horse. Fungus infection in man was probably first described by Hughes Bennett in 1842 in the Transactions of the Royal Society of Edinburgh. The fungus in this case was thought at that time to be a penicililum, but may have been a species of aspergillus. The same year a more or less similar case was described in Germany, and in 1855 a fungus infection was found in a patient who also had cancer of the lung. The first unquestioned case of human pulmonary aspergillosis was described by Sluyter in 1847 in Berlin, and in 1856 Virchow collected four cases of pulmonary aspergillosis in patients dying of other diseases. Virchow’s account (the only one in the history of the disease mentioned in Garrison-Morton) begins, as we still must begin, with the problems of definite diagnosis, and a rather vexed statement of the special problems of mycology. One might note in passing the preponderance of cases from the European mainland. The best readily available history of the disease is given by Hinson et al in Thorax, December 1952. This fungus can be grown on simple media. Sabouraud’s media is often used, but ordinary blood agar is reported to be adequate for primary isolation. Clayton has pointed out recently that fungi may be separated more readily by incubating cultures at both 22 degrees room temperature, and 37 degrees centigrade simultaneously. Penicillium, for example, grows more commonly at 22 degrees, but aspergillus fumigatus at 37 degrees. Aspergillus may be incubated at temperatures up to 45 degrees centigrade which may be of further help in differentiating it. If sub-cultures are made on medium containing penicillin and streptomycin, to which aspergillus is resistant, bacterial contamination should be eliminated. A colony of aspergillus is a white mass of interweaving mycelial threads, from which occasional cells enlarge known as “foot cells.” These give off a shoot which elongates upward, and bears a swollen vesicle at its free uppermost extremity. From this vesicle shorter stalks arise like the bristles of a brush (phialides), and on these, in turn, are born the spores (conidia). These may be coloured, giving the different tints to the mature colonies, and assisting in separating the genus into at least four groups, pathogenic to man, of which aspergillus fumigatus is much the most common (Figure 1).