Aspergillosis Complicating Pulmonary Tuberculosis

Abstract

MEETING AT THE LUTON AND DUNSTABLE HOSPITAL, LUTON, BEDS Aspergiliosis Complicating Pulmonary Tuberculosis.-DoNALD BARLOW, M.S., F.R.C.S. M. N., female, aged 25. Had bronchiectasis of the whole left lung with a large apical cavity and secondary tuberculous infection. A left pneumonectomy was undertaken and during the removal of the lung the apical cavity was opened.Aspergillosis developed in the pleura and later she had a bronchopleural fistula. She became sensitized to the fungus and ran a persistent high temperature and steadily became more ill and emaciated. The fungus infection in the pleura failed to respond to any of the known antibiotics, to PAS, isoniazid or the sulphonamides. It was resistant to iodides, neoarsphenamine, actidione and hydroxystilbamide. Fortunately it responded well to Phenoxetol and after prolonged treatment of the pleural cavity with this drug, she eventually made steady improvement and has now put on 1 J st.

Miliary tuberculosis and disseminated aspergillosis

“…Locally invasive Aspergillus infections have also been described complicating tuberculosis, often following pneumonectomy (Barlow, 1954;Golebiowski, 1958;Kelmenson, 1959). Disseminated forms of aspergillosis are recognized with increasing frequency in patients with haematological, malignant and other diseases (Finegold et al, 1959;Gowing and Hamlin, 1960;Young et al, 1970), but although tuberculosis is often listed as one such predisposing cause, the authors have been unable to find a similar recorded case of combined disseminated aspergillosis and miliary tuberculosis.…”

Pulmonary Aspergillosis: A Review and a Description of Three New Cases

“…Saprophytism probably explains cases associated with bronchial cysts (Hemphill, 1946;Gerstl, Weidman, and Newmann, 1948;Corpe and Cope, 1956), bronchiectasis (Boyce, 1893;Barlow, 1954;Bruce, 1957), pneumoconiosis (Heppleston and Gloyne, 1949), tuberculosis (Barlow, 1954;Kelmenson, 1959;Peer, 1960), cardiac disease (Zimmerman, 1950), mastoiditis (Stuart and Blank, 1955), carcinoma (Sochocky, 1959), asbestosis (Hinson et al, 1952), endocarditis (Welsh and Buchness, 1955), pneumonia (Hertzog, Smith, and Goblin, 1949 ;Ross, 1951 ;Abbott, Fernando, Gurling, and Meade, 1952;Darke, Warwick, and Whitehead, 1957;Toigo, 1960), histoplasmosis (Procknow and Loewen, 1960), the orbit (Wright, 1927), sarcoidosis (Pepys et al, 1959), and lung abscess (Wheaton, 1890;Yesner and Hurwitz, 1950;Stevenson and Reid, 1957). Hinson et al (1952) classified aspergillosis as allergic, saprophytic, and septicaemic.…”

Progressive cavitating pulmonary changes in rheumatoid arthritis: a case report.

“…In the course of a few years this patient had pleuritis, pneumothorax, and empyema, all well recognised complications of RA.1 2 In addition he developed a progressive, destructive, cavitary process, most obvious in the upper lobes, which is not typical of RA but has been described in association with the upper lobe fibrosis in both ankylosing spondylitis" and recently RA.12 Our patient had no sacroiliitis or limitation of spinal movement and fulfilled the preliminary ARA criteria for RA. '3 Secondary colonisation of cavities by aspergillus species is not unusual,1 13 14 but eradication of infection is difficult. The intensive antifungal therapy, including bronchial instillations, was successful in our patient as judged by the subsequent negative cultures and the improvement in the Ouchterlony test.…”