Reviewing autopsy records of Japan, number of pulmonary aspergillosis cases is increasing every year. Cases were classified into three types: allergic, fungus-ball and pneumonic type. The characteristics of disposition and disease process were comparatively analyzed. Recurrent pneumonia based on atopic disposition is particular to the allergic type, though scarcely found. Laboratory findings were the increase of serum IgE and the positive precipitin tests, indicative of allergic type I and III. It was pathohistologically featured by mucoid impaction with Aspergillus hyphae leading to the dilatation of rather proximal bronchi. A greater part of the fungus-ball type was a secondary infection to the foregoing diseases, mainly tuberculosis. Examining ten cases of fungus-ball type partial fall of cellular immunity and the rise of humoral immunity was found. A local factor may play an additional role in the pathogenesis. Characteristic process of primary type was massive pneumonia resolving into a large bullous dilatation followed by gradual diminution, and finally colonization of mycelial mass occurred. Positive precipitin tests were indicative of allergic type III and IV. Histological investigation revealed that many bronchi branching peripherally from cavity were ulcerated by mycelia and alveoli were also affected. Cavity with fungus-ball was used to extend from mid-lung to pleura. Histological reaction was allergic type III and IV. The terminal stage of malignant disease or blood dyscrasia, where humoral and cellular resistance decreased, was often complicated with the pneumonic or disseminated type of pulmonary aspergillosis. Precipitin tests were negative and allergic or immune reaction was not detected histologically. The rise of immunoglobulin levels in fungus-ball type was a prominent feature, contributory to clarify the pathogenesis.

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The relationship between Candida infection and cellular immunity was investigated in guinea pigs. Guinea pigs sensitized with heat killed C. albicans in complete Freund adjuvant exhibited positive delayed type skin reaction. In the macrophage migration inhibition test (MIT), both inhibition and stimulation of migration were observed as well as unreactivity. Lymphocytes of guinea pigs sensitized with viable C. albicans were cultured with solubilized Candida antigen, and their supernatants were named as lymphokines. This lymphokines showed inhibition or stimulation of migration in the MIT using peritoneal exudate cells from non-sensitized guinea pigs. The lymphokines distinctly enhanced adherence of alveolar macrophages from a normal guinea pig, but had no effect on their phagocytosis to C. albicans. It was suggested that lymphokines from guinea pigs sensitized with C. albicans were demonstrated to contain various factors, which affect diversely on macrophage function.

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The viable numbers of Candida in saliva, gastric juice and stool of 16 patients with stomach cancer, who were under anti-cancer chemotherapy, were determined before and after amphotericin B treatment. Without amphotericin B treatment, 10⁴/g or above viable numbers were obtained for saliva and stool of 50 and 75% of all the patients, respectively. Oral administration of amphotericin B (400mg per day, 3 weeks) induced a significant decrease in the viable numbers of Candida in saliva and in stool of 63 and 88% of patients, respectively. With one patient, moreover, there was a marked amphotericin B-induced decrease in the viable numbers in gastric juice. No patient given orally amphotericin B developed decreased renal or hepatic function. It is suggested from these results that oral administration of amphotericin B was effective in suppressing overgrowth of Candida in the intestinal tract of debiliated patients with malignant tumor.

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A simple staining and mounting method of KOH preparation for mycological examination was mentioned. The procedure is shown in the figures and the slides made by this method can be observed for several months unchanged.

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A six-year-old girl, a daughter of a farm house of melon, orage and tabacco, has suffered from a crusted erosion with erythema on her left cheek. The treatment was taken place two months later. The examination findings at the dermatology clinic of Shimabara Hospital, Nagasaki, the lesion consisted of a ∞-shaped, slightly elevated erythema with overlying scales (Fig. 1). Neither erosion nor pustules were recognized. Upon KOH-examination of the scale, frequently septated hyphae with irregular outline were found (Fig. 2) and Alternaria sp. was isolated on Sabouraud's glucose agar (Fig. 4-5). The lesion regressed spontaneously after two weeks, and left no scar. There have been reported occasional cases of cutaneous alternariosis in Japan (as summarized in the Table 1), Sweden, Switzerland and U. S. A. Their clinical feratures are, however, varied from superficial, transient form which is not so different from saprophytism, and intermediate form (cases of Nakama and Nishimoto) to deep-seated form with granulomatous tissue reaction fungal elements within it (cases of Kawasaki et al., Fukushiro et al. and Mikoshiba et al.). Differences in their responses to the treatments and in their prognoses among these three forms are also discussed.

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