Fungal diseases can give a very colorful radiological picture, which can most likely be mixed with chronic tuberculosis processes, cancer and lymphogranulosis atosis. For all chronic, unclear processes that do not respond to sulfonamides, one should think about fungal etiology.
Actinomycosis of the lungs . It is clinically characterized by an extremely long course of secondary pneumonic processes with fever, mucopurulent sputum, often with leukocytosis. Isolated actinomycosis of the lungs is rare, more often it is also found in other places, especially in the mouth and lower jaw.
The diagnosis is based on the detection of fungi in the sputum, which is repeated in almost all cases with repeated studies.
In addition to the radiant fungus other fungi may also be etiological factors, but in Central Europe they are very rare. With prolonged treatment with massive doses of antibiotics, they seem to be more common. They should be thought of if, after antibiotic treatment, the picture on the part of the lungs worsens, the intermittent temperature is delayed, and other, more frequent causes of this are excluded. The diagnosis here is made in the presence of fungi in the sputum. We can talk about streptotrichosis, candidiasis (candida albicans), torulopsis, leptotrichosis, aspergillosis, oosporosis, oidiomycosis, in America – blastomycosis (workers in the tobacco industry), coccidiosis and histoplasmosis. With histoplasmosis, foci in the lungs calcify and they must be differentiated from tuberculous dissemination. If fungi are not found, the diagnosis is based on a reaction with an antigen, local and general phenomena, and a positive complement binding reaction (Wegmann).
Fungal diseases can be layered a second time on existing lung lesions (bronchiectasis, cavity formation). Aspergillus-infected lung cysts acquire double contours (Brunner, oral communication). Aspergilloma appears, apparently, as an independent primary lung disease. Aspergilloma can be thought of in the presence of prolonged (months, years) blackouts in the lungs with a good general well-being of the patient and the absence of other causes. Fungal cultures in bronchial secretions obtained by bronchoscopy confirm the diagnosis (Scarinci). Secondary fungal pneumonia with prolonged therapy with cortisone (leukemia, lymphogranulomatosis) are common complications.
With toxemycosis (Gsell), lung lesions are caused by toxic decomposition products of fungi. Of the clinical pictures of such toxicosis, the most famous is the threshing fever (farmer’s disease), which occurs in persons participating in the threshing of moldy grains – barley or Oats. The disease begins suddenly with fever, headache, cough and basal bronchopneumonia. It is clear that the disease is caused by a fungal infection of the threshed grain.
Eosinophilic pulmonary infiltrates.
– Löffler’s volatile eosinophilic infiltrate has the following characteristic features. – Volatility : the classic eosinophilic infiltrate should completely disappear after a few days, at most after 10 days. With a longer duration of infiltration, one should be careful with this diagnosis. – Eosinophilia ranges between 7 and 70% with a normal or only slightly increased white blood cell count. Often, eosinophilia is most pronounced not during the highest density of the infiltrate, determined radiologically, but a few days later (phase shift). Sometimes, therefore, it is necessary to re-search for eosinophilia in the blood.
– Clinically, infiltration can be completely asymptomatic: in these cases, it is found by chance. In other cases, there is an indefinite feeling of some indisposition, especially often pleuritic pains are felt over several days, intensifying with breathing; often there is a slight cough. – Infiltrate has no favorite places of localization. Any parts of the lungs can be affected, and consequently, the tops of the lungs and basal areas. In most cases, the infiltrate is solitary, but there may be multiple infiltrates; infiltrates can also appear repeatedly.
– In laboratory , in addition to eosinophilia, a slightly accelerated ROE is often observed, but it can be completely normal. – Since with volatile infiltrates in the vast majority of cases we are talking about invasion of roundworms, it is necessary to examine feces on roundworm eggs. But they do not appear during the presence of an infiltrate, but more than 50% after 2 months after the end of the ascaris larvae of their development cycle.
Eosinophilic infiltrates are found not only with Ascaris invasion, but also with bronchial asthma, in sensitized individuals as a result of hypersensitivity to plants (privet, lion’s tooth, lime blossom, May bell, etc.) ”as well as bacterial allergens.
Minor eosinophilia may sometimes be accompanied by tuberculous infiltrates, but they are not so volatile and there are other tuberculous manifestations.