[Adiaspiromycosis--a little known lung disease]

Abstract

Adiaspiromycosis produced by the fungus Emmonsia crescens is a pulmonary disease afflicting primarily small wild mammals. Man, too, may become an accidental link of the saproparatrophic circulation of the agent. Humans are infected--similarly to other mammals--by inhaling the elements of the saprophytic stage of the fungus living for long time periods in the soil substrates. After the infecting cells, aleuriospores, have invaded the host lungs, they are converted into the elements of the parasitic stage--adiaspores. These are surrounded by granulomatous tissue and reach up to 700 microns in diameter. In the circulation of the agent, the infected wild mammals play a role of reservoir hosts harbouring the parasitic stage of the fungus in nature for a relatively long time. In some cases these animals also enable spread of adiaspiromycosis from exoanthropic foci into human habitations. Clinical and experimental studies show that the result of an infection may be--in addition to its liquidation--an asymptomatic form of disease or a disseminated pulmonary process. In addition to as yet insufficiently proved proper action of fungus cells, a reduction in the functional pulmonary parenchyma plays a role in the pathogenesis of the pulmonary forms. An existence of extrapulmonary forms of adiaspiromycosis is not excluded. Serological methods have not been routinely used for diagnosis as yet: immune reaction of the organism has a character of antibody response and delayed hypersensitivity. Cell mediated immunity has not been studied as yet. Treatment of human disease is primarily a surgical one. The fungistatic drugs pimaricin or amphotericin B may be employed, corticosteroids may be indicated in individual cases. The efficacy of modern antifungal substances has not been established as yet.