PubMed · 8357587
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M C Loury, D A Leopold, S D Schaefer. 1993. Allergic Aspergillus sinusitis.. https://doi.org/10.1001/archotol.1993.01880210136019
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During the last decades a sharp increase in the occurrence of invasive aspergillosis associated with a high mortality has been observed. This fact is mainly due to an increase in the number of immunosuppressed patients. Nosocomial aspergillosis usually is of exogenous origin and often related to building construction and reconstruction, road construction, contaminated ventilation systems and contaminated soil of pot plants. By institution of suitable prophylactic measures a reduction of incidence and mortality of invasive aspergillosis can be achieved. This review gives a short introduction into the epidemiology, pathogenesis and diagnosis of invasive aspergillosis and, in the second part summarizes internationally recommended guidelines for prevention of this severe complication.
In patients with hematological malignancies invasive mycoses occur frequently. In this retrospective study autopsy and histopathology material of 171 patients with hematological malignancy who had died between 1994 and 1996 at the 1st Department of Internal Medicine (Hematology), St. László Hospital, Budapest was analysed. In cases with invasive fungal infection post mortem results were compared to clinical and microbiological data. Through the three years' period an invasive mycosis could be confirmed in 33 patients by autopsy. Aspergillosis occurred in 21, candidiasis in 11, other fungal infections in 2 cases, a double infection was seen in 1 patient. The incidence was 19.2% (in invasive candidiasis: 6.4%, in aspergillosis 12.2%). Invasive aspergillosis most frequently was seen in the lung (71%), while candidiasis occurred mainly in the intestinal tract (42%). Cultures for mycology were collected from the autopsy material of 9 patients, of which 8 gave positive results. A previous fungal colonisation results was confirmed in 23 patients, but based on colonisation conclusions rarely could be driven concerning the species causing invasive infection. Sensitivity of Aspergillus antigen and antibody tests was 45 and 50%, respectively. Predisposing factors for invasive aspergillosis and candidiasis were similar, except for duration of neutropenia (24 vs. 12 days, p < 0.004). The antifungal drug most frequently used was amphotericin B. We observed a persisting infection in invasive pulmonary aspergillosis and chronic disseminated candidiasis in spite of the administration of a cumulative dosis of 1-2 g. Most frequently Aspergillus infections--primarily that of the lung--can be seen. Presence of invasive mycoses can usually be confirmed in vivo, but an early diagnosis still remains unsolved.
Life-threatening fungal infections have increased significantly in the past decade due to the rising number of immunocompromised patients. Serological diagnosis of most fungal infections is unreliable and blood cultures are positive in only 50% of premortem cases; therefore, tissue sampling together with fast, reliable staining of fungi should be carried out to reach the correct, timely diagnosis. We developed, partly serendipitously, a microwave silver staining method for fungi in histological sections. During a differentiation step in periodic acid, background staining is removed. This rapid staining method can be combined with immunostaining, for example, the alpha smooth muscle actin method, to visualize blood vessels. Silver staining results were optimized using the recently developed MicroMED BASIC microwave labstation for histology (Milestone srl, Italy), featuring no-touch temperature measurements and PC control.