肺アスペルギルス症の基礎と臨床

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  • Basic and Clinical Aspects of Pulmonary Aspergillosis

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Reviewing autopsy records of Japan, number of pulmonary aspergillosis cases is increasing every year. Cases were classified into three types: allergic, fungus-ball and pneumonic type. The characteristics of disposition and disease process were comparatively analyzed. Recurrent pneumonia based on atopic disposition is particular to the allergic type, though scarcely found. Laboratory findings were the increase of serum IgE and the positive precipitin tests, indicative of allergic type I and III. It was pathohistologically featured by mucoid impaction with Aspergillus hyphae leading to the dilatation of rather proximal bronchi. A greater part of the fungus-ball type was a secondary infection to the foregoing diseases, mainly tuberculosis. Examining ten cases of fungus-ball type partial fall of cellular immunity and the rise of humoral immunity was found. A local factor may play an additional role in the pathogenesis. Characteristic process of primary type was massive pneumonia resolving into a large bullous dilatation followed by gradual diminution, and finally colonization of mycelial mass occurred. Positive precipitin tests were indicative of allergic type III and IV. Histological investigation revealed that many bronchi branching peripherally from cavity were ulcerated by mycelia and alveoli were also affected. Cavity with fungus-ball was used to extend from mid-lung to pleura. Histological reaction was allergic type III and IV. The terminal stage of malignant disease or blood dyscrasia, where humoral and cellular resistance decreased, was often complicated with the pneumonic or disseminated type of pulmonary aspergillosis. Precipitin tests were negative and allergic or immune reaction was not detected histologically. The rise of immunoglobulin levels in fungus-ball type was a prominent feature, contributory to clarify the pathogenesis.

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