[Saprophytic and invasive pulmonary aspergillosis]

The characteristics of chest x-ray films in 19 patients with saprophytic pulmonary aspergillosis secondary to acid-fast bacilli infection were reported. The saprophytic form, exemplified by the classic fungus ball or mycetoma, results from the growth of fungal mycelia within a pre-existing area of destroyed lung, typically a pre-existing cavity such as that resulting from tuberculosis. Aspergillus fumigatus was detected in 52.6% of sputum cultures from 19 patients. Aspergillus precipitin test was positive in 68.4% of patients. Thickening of cavitary walls was first found in 85% of chest x-ray films. Eighty percent of patients had pulmonary aspergillosis within 3 years after cavitary lesions were stable. Invasive pulmonary aspergillosis (IPA) is characterized by hyphal invasion and destruction of pulmonary tissue. The risk of acquiring IPA correlates with the duration and degree of immunosuppression or neutropenia. IPA recently has been encountered in patients with human immunodeficiency virus (HIV) infection. The number of case reports on chronic necrotizing pulmonary aspergillosis is increasing, but it is supposed the clinical entity of this disease still has not been established.