Disseminated fungal infection. A review of 20 autopsy cases

In the study of disseminated fungal infection, in consecutive autopsy cases between 1974 and 1982, we have found this infection in 20 cases (2.55% in all autopsy cases and 16.8% of deep-seated fungal infection). Candidiasis was present in 11 cases, aspergillosis in 8 cases, and mucormycosis and cryptococcosis in 1 case each. One case showed the disseminated infection by both Candida and Aspergillus. All of the 20 cases had underlying disorders. Hematologic disorders were most frequent and were present in 15 cases. In contrast to the small yellow disseminated foci of candidiasis, the lesion by Aspergillus and Mucor were relatively larger, hemorrhagic, and necrotic. Cryptococcal lesion showed a small gelatinous appearance. All of the fungal lesion were devoid of significant inflammatory reaction. Lymphocytopenia (less than 500/mm3) was present in 13 cases out of 16 cases (not examined in the remaining 4 cases). Eight cases had long-standing indwelling intravenous catheters, including two cases in which the catheters apparently played an important role in the development of disseminated candidiasis. Ante-mortem diagnosis was established or suspected in only seven cases. Possible means of the prevention of fungal infection is also discussed.