Serological diagnosis plays an important role in the diagnosis of pulmonary aspergillosis, however, precipitation- in- gel test is neither sensitive nor quantitative. Recently, several investigators have used the ELISA technique for the detection of antibodies against Aspergillus fumigatus and reported the usefulness of this method.
In this report, we measured IgG-, IgM-, and IgA-antibody titers against Aspergillus fumigatus by means of ELISA in sera from patients with several different lung diseases including pulmonary aspergillosis.
The results obtained were as follows:
1) Measurement of IgG-antibody titers was most useful for the diagnosis of pulmonary aspergillosis.
2) Measurement of IgG-antibody titers was more sensitive than precipitation-in-geltest.
3) IgG-antibody titer was quantitative and reflected the clinical course of pulmonary aspergillosis.

View full abstract

Seven cases of miliary tuberculosis in patients with hematologic disease were analyzed clinicopathologically.
Mean age of the patients was 65 years, and the hematologic diseases were CML, AML, ALL, MDS and malignant lymphoma.Diabetes mellitus was present as a complication in three patients.Miliary tuberculosis was found in 5 cases during the first admission to our hospital owing to hematologic problems.In 4 of 6 cases, fever had started more than two months before admission, consequently, the tuberculosis probably began about that time. After admission, chemotherapy was administered in 5 cases, and steroid in 6 cases for hematologic disease.The mean total quantity of steroid administered was 2, 134mg of prednisolone and average treatment duration was 69 days.The chest roentgenographic shadow was so atypical that miliary tuberculosis was suspected in only one case. The initial chest roentgenogram showed hilar and mediastinal lymph node swelling as well as the shadow of pulmonary tuberculosis in two cases.It was thought that the hilar and mediastinal lymph node swelling could be explained by primary complex, although the patients were of advanced age, or by “secondary complex” reported by Terplan, K in 1940. The diagnosis of tuberculosis was made in two patients before their death by smear of aspirated fliud of cervical lymph node and by bone marrow cell block in one patients, and by pathological examination of mediastinal lymph node biopsy in the other patients. Tubercles were found from bone marrow cell block in 2 out of 5 patients and from bone marrow biopsy in 1 out of 3 patients, but the positive results were reported in 2 patients following death.Smears of sputum, gastric juice, urine, spinal fluid and pleural effusion were negative in all cases.One patient diagnosed as miliary tuberculosis also had pneumocystis carinii pneumonia.This case was treated with antituberculosis drugs for 20 days without improvement.Another patient diagnosed as miliary tuberculosis improved under treatment with antituberculosis drugs, but died of cytomegalovirus pneumonia. Autopsy in 5 cases revealed non-reactive miliary tuberculosis, and pulmonary hemorrhage probably due to DIC was present as a complication in two cases.
In these cases, severe immunosuppression, which is a major precipitating factor of miliary tuberculosis, is thought to be induced by hematologic disease itself, chemotherapy, steroid or other underlying disease such as diabetes mellitus.Miliary tuberculosis in such compromised host is cryptic and progresses rapidly.Consequently, early diagnosis is very important.Retrospectively, the unexplained pyrexia was most important to suspect tuberculosis.Examination of bone marrow cell block is considered to be the diagnostic procedure of choice to diagnose cryptic miliary tuberculosis in patients with hematologic disease.And therapeutic administration with antituberculosis drugs should be tried for a few months, when the cause of fever of unknown origin cannot be clarified.

View full abstract

Three cases of pulmonary atypical mycobacteriosis (AM) were reported.Two cases were associated with lung cancer in which the diagnosis of malignancy was difficult and delayed by the coexistence of AM.The third was a case of adult T-cell leukemia (ATL) which manifested during the course of AM.
In case 1 (73 years, male) and case 2 (86 years, male), chest roentgenogram abnormalities as well as clinical symptoms were considered to be caused by mycobacteriosis because of positive smear of acid-fast bacilli in sputa on admission.Therefore it took four months and three months respectively for final diagnosis of lung cancer.
The autopsy of case 1 revealed a poorly differentiated adenocarcinoma with coexisting foci of squamous cell carcinoma in right lower lung, and granulomatous inflammations with caseating necroses in right mid and lower lungs.M.avium complex was cultured from sputum on admission, and also a high titer of HTLV-I antibody was demonstrated.
In case 2 malignant cells were detected in sputa (class V), however his general condition did not allow an aggresive anticancer chemotherapy and he died of malignancy with complication of thromboangitis obliterans on ritht lower leg.
Case 3 was a 76-year-old male who had been diagnosed as lung AM for more than two years.His chest radiography showed bilateral infiltrative shadows with frequent positive cultures of M.avium complex (more than 100 colonies) from sputum.A generalized lymphadenopathy including right hilar lymph node on chest X-ray film was followed by the presence of atypical lymphocytes in peripheral blood and the elevation of HTLV-I antibody in serum.Four months later he died with hypercalcemia and renal failure in spite of chemotherapy (CPM+VCR+ADR+PLS).
The above cases suggest that AM as well as tuberculosis should be considered when pulmonary infiltrates were observed in malignant patients, especially in patients with retrovirus infections.

View full abstract

A case of 22-year-old female with mediastinal tuberculous lymphadenitis and pericostal tuberculosis was reported.Her complaint was right chest pain and subcutaneous mass on the right chest wall.Chest contrast CT showed right paratracheal lymph node swelling with central low density area and surrounding rim enhancement, which has been reported as typical characteristics of mediastinal tuberculous lymphadenit is.Pigeon-egg sized subcutaneous mass with fluctuation was palpable on the right sternal border and the smear of its content showed acid-fast bacilli.In spite of two months therapy with antituberculous drugs, both masses were unchanged in size.The lesions resected surgically, were both encapsulated abscesses containing yellowish pus, and microscopic examination of these specimen disclosed the finding of tuberculosis.Mycobacterium tuberculosis was cultured from contents of both masses.After nine months of anti-tuberculous therapy, no sign of recurrence is observed until now.Both masses were discontinuous and the possibility of lymphangitic spread of organism was speculated as its etiology.

View full abstract

Utilization of n-butanol and iso-butanol by Mycobacterium avium and M. intra cellulare classified by DNA probe test (20 strains each) was studied.The majority (14 strains) of M.avium could grow at 45°C, but none of M. intracellulare grew at the same temperature.All M.avium and the majority of M.intracellulare (80%) utilized n-butanol but failed to utilize iso-butanol.Therefore, the utilization test of butanols is inadequate for classification of these species.

View full abstract