Fungus Disease of the Chest

Abstract

Fungus infections are not rare in man. While the skin is the most usual site of inflammatory reaction, the lungs and bones are frequently involved. This paper presents a group of proved cases of infection of the lungs due to Coccidioides, Actinomyces, Aspergillus, Monilia albicans, Torula, and Blastomyces. In approximately one-fourth of these cases there were fungus infections elsewhere in the body when the patient was first seen. The presence of extrapulmonary lesions is an aid in the differential diagnosis of the lung lesion. A careful correlation of the clinical evidence of disease along with the roentgen evidence will usually enable the physician to make an accurate diagnosis. The roentgen diagnosis of pulmonary disease is based upon the variation from normal of the ventilating, vascular, and lymphatic systems, as well as the supportive framework of the lung and chest. An acute inflammatory lesion of the lungs is recognized by its uniform density, exudative in character. Later, as the lesion stimulates the production of fibrosis or leads to a cavity formation or varies in density because of a spread or clearing of the exudative reaction from the periphery, it is recognized as chronic in nature. In addition, certain lesions involve the bronchi or the alveolar portion of the lung primarily and are situated in characteristic locations in the lung fields. It should be noted in fungus infections that the clinical history may be of little value and that the radiographic picture may simulate any type of known inflammatory process in the lung. At times, the lesion may resemble metastatic or primary carcinoma, lymphoblastoma, or leukemic infiltration. For these reasons it is impossible in many cases for the clinician to arrive at an accurate diagnosis without additional information. The radiologist should be of considerable aid, in that he may suggest the probable etiological agent so that cultures and microscopic studies may be made of material from the lesions. In addition, skin and blood agglutination tests may be of value. In general, the diagnosis of fungus infection should depend upon the finding of the fungus in material from the lesion and the absence of other organisms that could be responsible for it. Fungi are often secondary invaders in cases of bronchiectasis and other chronic lesions of the lung. The improvement noted in certain cases of bronchiectasis following iodide therapy may be due in part to clearing of the secondary fungus infection. Coccidioidomycosis Twenty-four cases of coccidioidomycosis were diagnosed and confirmed by culture of the causative agent, Coccidioides immitis, from the sputum or by positive skin or agglutination tests on the blood. The latter were performed by Smith (1). Four of these patients had additional lesions involving bones. One died of a miliary infection. The roentgen evidence of pulmonary disease found in these cases varied considerably.