Fungoid Conditions of the Lungs—Part II

The subject matter of this paper deals with fungous and fungoid infections of the lungs, or broncho-mycosis, from a radiological point of view. The occurrence in agricultural workers of acute pulmonary symptoms, the most severe of which is extreme dyspnoea, and showing a distinctive type of X-ray picture, led to my starting some investigations on the subject. The cases were similar to the five recorded by Munro Campbell, three of which are described in conjunction with six or more cases which came under my observation. These patients we believe to be suffering from primary bronchomycosis, and in the sputa of cases referred to me, fungi of the aspergillus group have been isolated. Further investigations are in progress. This condition has (in my experience) been confined so far to the farming class when working amongst mouldy hay or cereals, and may be termed a temporary occupational disease. An interesting and important point is that all these cases referred to us were suspected to be suffering from pulmonary tuberculosis. Other similar milder cases have undoubtedly occurred in Westmorland, South Cumberland, and the Lake District, but have not reached the radiological department. The isolation of the fungi is not easy, and entails time and expense which as yet few County Health Authorities are in a position to undertake; the presence, or absence, of tubercle bacilli in the sputum being all that is sought. This is unfortunate, as the administration of potassium iodide alleviates the symptoms and, in some cases, brings about a cure. A brief résumé of other types of broncho-mycosis follows (special reference being made to broncho-moniliasis and broncho-actinomycosis) and are compared with other types of lung lesions from a radiological standpoint. As a result of these investigations, I have been particularly impressed by the fact that the incidence of broncho-mycosis is, in all probability, a great deal higher than is supposed. The sputa of patients demonstrating certain symptoms and radiological appearances call for systematic and thorough investigation—the mere report “No tubercle bacilli found” may be traught with great danger. Medical mycology has not received the attention in this country which it has on the Continent and in the United States of America. It is impossible to arrive at a correct interpretation of the films of many of these patients suffering from broncho-mycosis without the co-operation of the clinician, and a pathologist who is an efficient mycologist. The failure to recognise these types of cases may lead to the patient being suspected of pulmonary tuberculosis, and referred to a sanatorium with disastrous results, as bronchomycotics are very prone to secondary infections. On the other hand, they might be considered inevitable cases of chronic bronchitis and emphysema of accepted and doubtful aetiology without any thought of fungus infection, and therefore no treatment by potassium iodide given.