Tissue Reactions to Aspergillus in Cases of Hodgkin's Disease and Leukaemia

Abstract

Five cases of aspergillosis complicating Hodgkin's disease and leukaemia are reported. The organs involved were: lungs (all five cases), stomach (Case 3); brain and meninges (Case 4); heart, kidneys, spleen, thyroid, and liver (Case 2). Cultures ofAspergillus fumigatuswere obtained from the post-mortem tissues of three patients.All the lesions in Case 2 were suppurative. The other four cases had non-suppurative lesions characterized by spreading coagulation necrosis with peripheral hyperaemia, exudation, and haemorrhage. Invasion and occlusion of blood vessels occurred frequently.The various factors that may be responsible for the initiation and progression of the fungal infection are discussed. The available evidence suggests thatAspergillus fumigatuscan produce toxic metabolites which are able to cause tissue necrosis and vascular damage. In patients suffering from neoplastic conditions of the lympho-reticular system, especially if steroid hormones or radiomimetic drugs are given, spreading, necrotizing lesions can develop unchecked by antibody or cellular defences.

The Pathogenesis of Fatal Outcome in Murine Pulmonary Aspergillosis Depends on the Neutrophil Depletion Strategy

“…Bronchopneumonia is the most common pattern observed in human invasive pulmonary aspergillosis (58). Distal lung disease results either from aspiration of conidia into the respiratory bronchioles and alveolar ducts with direct spread or from colonization of the bronchial mucosa by invasion through the wall (25). Thus, the pathology observed in this model is consistent with that of human disease in neutropenic hosts.…”

“…Angioinvasion, a feature that can occur in any pattern of invasive aspergillosis but that is particularly associated with disease in neutropenic patients (23), also was observed. Necrosis may result from vascular invasion or toxic fungal products (25,28). In BALB/c mice, inflammatory infiltrates bordered necrotic lungs, and the fungal burden in lethally infected mice was inconsistent.…”

Pneumonic aspergillosis complicating healed tuberculosis.

“…. ' i Y i s Samuels, 1963), Hodgkin's disease (Gowing & Hamblin, 1960), carcinoma of bronchus (Utz & Treger, 1959), leukopenia (Welsh & Buchness, 1955), staphylococcal pneumonia (Wahner et al, 1963). Treatment with broad-spectrum antibiotics, corticosteroids, antimitotic agents or radiotherapy have also been incriminated.…”

“…Treatment with broad-spectrum antibiotics, corticosteroids, antimitotic agents or radiotherapy have also been incriminated. These factors are reviewed by Zimmerman (1955) and by Gowing & Hamblin (1960). Several factors explain the pathogenesis.…”

Disseminated Aspergillosis and Bleeding Colonic Ulcers in Renal Transplant Patient

“…The sigmoid ulcer contained Aspergillus mycelium and its absence from the caecal and ileal ulcers may have resulted from amphotericin B treatment, although similar lesions have been described in gastrointestinal aspergillosis without the presence of mycelium (Fraumeni & Fear 1962). Bleeding from such ulcers may be due to the release of an endotoxin causing tissue destruction and haemorrhage (Gowing & Hamlin 1960) or may be related to rupture of vessels by direction invasion of the mycelium (Welsh & McClinton 1954).…”