A clinical study of pulmonary aspergillosis with pneumoconiosis

It has been well known that the rate of complication of pulmonary tuberculosis in pneumoconiosis is high and that tuberculosis worsens the prognosis strikingly In our hospital there have been many cases that were diagnosed as pulmonary tuberculosis with pneumoconiosis and were given antituberculous drugs. We had some cases in which X-ray films revealed similar signs of tuberculosis and in which Mycobacterium tuberculosis was not isolated and there was no effect whatsoever produced by antituberculous drugs. During the investigation in some cases infiltrative shadows and cavitary mass lesions with a fungus ball which were gradually formed in the lung and aspergillus, were detected from clinical specimens including sputum, endotracheal aspirates, and lung biopsy. We considered these factors to be indicative of chronic necrotizing pulmonary aspergillosis; CNPA as proposed by Binder [4] in 1982. We gave antifungal drugs to all the considered CNPA cases and as a consequence the symptoms and clinical signs, including a chest X-ray film improved in almost all of the cases. Thus it is assumed that when infiltrative shadows and cavitary mass lesions with a fungus ball are gradually formed in pneumoconiosis, the differential diagnosis of CNPA is necessary. After the diagnosis of CNPA is determined antifungal drugs should then be given.