Pulmonary aspergillosis. A survey of its occurrence in patients with chronic lung disease and a discussion of the significance of diagnostic tests.

The occurrence of pulmonary aspergillosis and of precipitins, positive skin tests, and sputum containing abundant has been assessed and correlated in a survey of 107 consecutive patients attending hospital in Bristol with various chronic chest diseases. The series included three with aspergilloma, five with allergic aspergillosis, and one with chronic invasive aspergillosis. Of 46 asthmatic patients, 11% had definite and 22% had probable or definite allergic aspergillosis. Seven patients (15%) in the asthmatic group were found to have chronic upper lobe contraction, probably attributable to long-standing allergic aspergillosis. One of these patients developed aspergilloma, and another, invasive aspergillosis. The significance of precipitins is discussed, based on the survey patients together with 21 additional patients who had aspergillosis but were from outside the survey. In the survey patients without definite aspergillosis, precipitins and positive sputum were significantly associated and were found most commonly in patients with asthma, bronchiectasis, or cavitated lungs. Two patients with invasive aspergillosis who had weak precipitins are reported. We think that precipitins reflect recent or continuing fungal growth in body tissues or within damaged bronchi, and that their presence can be a useful indication of occult fungal colonization, which might rarely become invasive if host resistance were lowered as by steroids. Allergic aspergillosis is a more common condition and a more frequent cause of upper lobe damage than has been appreciated.