Incidence Rate of Pulmonary Aspergillosis in the High Tatra Mountains Sanatoria for Tuberculosis and Respiratory Diseases of Adults

Abstract

SummaryIn 1967 and 1968, we examined for the presence of antiaspergillus precipitins the sera of 362 patients suspected of pulmonary aspergillosis who were hospitalized in five sanatoria for tuberculosis and respiratory diseases of adults in the High Tatra Mountains area. All the tests were performed in parallel in two serological laboratories. Precipitins were demonstrated in 43 patients, i. e. 12 % of the group under study. The respective rates among patients with and without a previous history of tuberculosis were 32 out of 175 (18%) and 11 out of 187 (6%). Rather extensive anatomic changes in the lungs amounting to fibrosis with cavities were probably a prerequisite for the nidation of Aspergillus in both of these basic groups, but especially among the posttuberculosis patients.Professional exposure to organic dust was a factor which could not be neglected in either of these basic groups; in both of them the frequency of the disease was statistically significantly higher among patients who had had this exposure. The dependence on professional exposure was especially marked in the group of nontuberculous patients, where 10 out of 11 aspergillosis patients had professional exposure in their anamnesis. Susceptibility to aspergillosis was twice as high in females as in males in both of the basic groups. Patients with a history of tuberculosis suffered from aspergillosis at younger age than patients with nonspecific diseases.Aspergillus fumigatus was demonstrated in 37 patients, Asp. flavus in four and Asp. niger in two. Only Asp. fumigatus proved to be clinically offensive, producing typical and atypical aspergillomas and being the cause of haemoptysis, which developed in half the cases. The intensity of Aspergillus growth on Sabouraud's medium and the intensity of agar‐gel precipitation reactions were good indicators of the activity of the process. Parallel testing of sera in two laboratories permitted us, where corresponding results were obtained, to take into consideration also the weaker positive reactions.In the posttuberculosis cases, pulmonary aspergillosis usually developed within three years of the “debacillization”. In five patients in whom we had the possibility to observe the development of aspergillomas in the course of hospitalization, we witnessed the supporting effect of antibiotics and corticosteroids on the growth and development of aspergillomas. In respect of domicile, the cases were distributed evenly throughout the territory of the Slovakian Republic, but the West Slovakia Region was represented by only a small number of instances in our material.