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Abstract:
We have then a disease that, for many years (since 1942), was known only to infect lower animals; after a sporadic encapsulated adiaspore was observed by Doby-Dubois in 1964 in a patient's lung, a widely disseminated, clinically symptomatic case was reported from Czechoslovakia, rapidly followed by three mildly disseminated cases, one from Russia and two from Guatemala, with innumerable granulomas similar to the patient of Kodousek et al. patient. Alert observers contributed descriptions of single adiaspores in arrested granulomas of the lung. The finding of presumed adiaspores in the lumen of an appendix seems unique. The reaction to the adiaspores is a tubercular granuloma, with fibroblast, (few) epithelioid, and giant cells representing the main component of the tissue response. Most observers agree on the absence of necrosis--one reason why the lesions do not calcify. The natural history of the disease seems to be self-limited, even if the extent of the involvement of the lung parenchyma determines the gravity of symptoms. The sudden flurry of reports makes it likely that cases previously had been mistaken for C. immitis or infestation by parasites.
Insights
This study details a fungal disease, previously only in animals, now increasingly reported in humans. The granulomatous lung response is typically self-limiting, though severe cases occur.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pathology
Background:
- A fungal disease, historically known only in lower animals since 1942, has seen a rise in human cases.
- Sporadic adiaspore findings in human lungs were reported starting in 1964, followed by disseminated cases.
- The unique finding of adiaspores in the appendix lumen is noted.
Purpose of the Study:
- To describe the clinical and pathological features of a disseminated fungal infection.
- To highlight the host's granulomatous response to fungal adiaspores.
- To discuss the self-limiting nature and potential misdiagnosis of the disease.
Main Methods:
- Case report analysis of disseminated fungal infections.
- Histopathological examination of granulomatous lung and appendix tissues.
- Review of previously published adiaspore findings.
Main Results:
- Human cases of disseminated fungal infection, characterized by numerous granulomas, have been reported globally.
- The host response involves tuberculous granulomas composed of fibroblasts, epithelioid, and giant cells.
- Lesions lack necrosis, contributing to their non-calcifying nature and a generally self-limiting course.
Conclusions:
- The disease appears to be self-limiting, with symptom severity correlating to lung parenchyma involvement.
- Increased reporting suggests previous cases may have been misdiagnosed as other fungal infections or parasitic infestations.
- Further recognition of adiaspore morphology is crucial for accurate diagnosis.