Pulmonary fungal infection. Survey of 159 cases with surgical implications

A survey of 159 cases of pulmonary fungal disease treated at the Hospital of the University of Mississippi is presented. The fungal diseases encountered were blastomycosis, 75 cases (47%); histoplasmosis, 38 cases (24%); aspergillosis, 17 cases (11%); cryptococcosis, 13 cases (8%); nocardiosis, nine cases (6%); and actinomycosis, seven cases (4%). Coccidioidomycosis is not endemic to Mississippi. Histoplasmosis was probably more common than diagnosed, but clear cytologic evidence or detection of the organisms was the rigid criterion required for diagnosis. Immunosuppressed patients appeared to be especially susceptible to infection by certain of the fungi. Fungal diseases were found to mimic numerous other pulmonary lesions, and specific diagnosis was often long delayed. Seventy-one operations were required for diagnosis or therapy or both, with two deaths. The major pulmonary complications of the several fungal diseases have been reviewed. Pulmonary hemorrhage constituted the major emergency. Amphotericin B was the mainstay of drug therapy, but upon occasion stilbamidine, penicillin, sulfonamides, and other agents were useful in specific circumstances. Accurate diagnosis, appropriate drug therapy, and judicious operative intervention when required will achieve gratifying clinical results in the vast majority of pulmonary fungal diseases.