Fungous Diseases in Great Britain

J. T. Duncan
1945 BMJ (Clinical Research Edition)  
The new interest manifested in fungous diseases during the last three decades is in some measure a result, but probably in greater measure the cause. of the recent notable advances made in medical mycology, especially in the United States, some South American States, France, and Italy. The study of medical mycology has been neglected by -us, but it should not be thought that fungous diseases are less important in Great Britain and the Colonial Empire than in other countries. At the present time
more » ... At the present time little is known of the nature, the incidence, or the gravity of our indigenous or imported systemic mycoses, and much remains to be learned of our common epiphytic infections. Towards the end of 1943 the Committee for Research in Medical Mycology (Medical Research Council) proposed a survey of fungous diseases in Great Britain, and a tentative scheme to collect data was prepared. Pathologists of the Emergency Pathological Service and members of the Pathological Society of Great Britain and Ireland were invited to submit, for mycological examination and identification, morbid specimens or cultures from known, suspected, or possible mycoses, and at a later date a similar invitation was made to readers of the British Medical Journal through an annotation (B.M.J., 1944, 2, 283). The response to these appeals, during the first eighteen months, has been gratifying. and correspondence and specimens were received from 140 pathologists and clinicians-the correspondence bearing evidence of the increasing interest which is being taken in the subject. In all, 1,094 specimens were received, which may be classified as follows: From suspected epiphytic infections, 688; fixed tissues for sectioning, 41 ; fresh tissues for culture, 42; smears and sections, 130; pus, exudates, and other body fluids, 16: cultures for identification, 62; miscellaneous specimens, including sputum, 115. As no report of any of the grave systemic mycoses referred to in this paper has yet been published by the doctor concerned, detailed clinical or other descriptions of the cases cannot be given in the following summary. Mycoses of the Central Nervous System Torulosis.-Fresh and preserved specimens were received from three cases of torulosis of the central nervous system, in all of which a diagnosis of tuberculosis had been made on the symptoms and clinical signs. In two of these cases torulosis was diagnosed at necropsy, and both showed extensive involvement of the brain and spinal cord and their meflinges. In the third case the diagnosis of cerebellar tuberculoma was corrected at operation, and this case is of additional interest because a culture of Debaryomyces neoformans (syn. Torula histolytica) similar to that isolated from the cerebellar lesion was obtained by nasopharyngeal swabbing, which suggests the possible path of the infection. The cultures from these three cases will be compared with those from earlier English cases and several foreign ones. Mycotic Meningitis.-Mounted sections were received of the spinal cord and meninges of a case of chronic mycotic spinal meningitis. The causative fungus was present in the greatly thickened pia arachnoid, but in the absence of repro-ductive forms it could not be identified generically. No culture was available for examinat on. Mycotic Cerebral Abscess.-Preserved material was received of a localized abscess of the brain, in the pus of which the mycel'um of the causative fungus was present in masses. No reproductive form was found, and in the absence of a culture the gener c identity of the fungus could not be determined. The abscess seems to have been secondary to a similar infection in the lung. A cuinomycosi.v.-Pus from lumbar puncture on a case of cerebrospinal actinomycosis yielded a culture of Actinomyces bovis Harz. The meningeal infection seems to have started in the region of the temporal bone, and the disease was rapidly fatal. Mycoses of the Lung Pulmonary Moniliasis.-M any specimens of spuitum were examined from conditions suspected to be moniliasis of the lung, and from the greater number of these Candida albicans (-= Monilia albicans) was cultivated, buit as this pathogenic species is known to vegetate as a saprophyte or a harmless parasite in the throats of healthy persons its mere presence in the sputum is of uncertain diagnostic s;gnificance. In one case, however, the fresh sputum contained masses of actively vegetating Candida tropicalis intimately associated with pulmonary cells: the reported symptoms and physical signs and the x-ray picture were consistent with the accepted description of pulmonary moniliasis, and the disease yielded quickly to treatment with potassium iodide. OnIN a sinele specimen was available for examination, and it is regrettable that a more complete mycological examination of the case could not be made. As a precauitionary measure against contam;nation of the sputum by fungi present in the fauces and adjacent cavities, it is a common practice to gargle. wash the mouth. and clean the teeth before expectorating into a sterilized receptacle. This method was used in the controlled exam;nation of the sputum of 32 patients suffering from pulmonary tuberculosis with cavitation. In 68.75% of these patients Candidn alhicans was more or less constantly present in the sputum both before and after mouth-cleansing, and it seems posstble that in some of these cases the fungus may have been vegetatine saprophytically in the lung cavity; but as bronchoscopic exploration was not feasible in this series of cases the significance of the fungus in the sputum is uncertain. In another group of patients with non-tuberculous cavitation of the lung. on whom bronchoscopic swabbing was allowed, Can(lida alhicans. although found in the sputum of some both before and after mouth-cleansing, was never found in the bronchoscop-c swabbings. It would seem, therefore, that the method of mouth-cleansing in use is not a safeguard against the contarrinat on of the expectorated matter by fungi vegetating in the mouth and adjacent cavities. Mould Infections.-The potentially pathogen c mould A spergillus fumigatus was found occasionally in samples of sputum, chiefly from tuberculous patients. but its pathological significance could not be established from examination of the sputum alone. However, in one patient with tuberculous cavitation of 4429
doi:10.1136/bmj.2.4429.715 fatcat:ujip6mxqazdnrlamekrexovhcu