HANOBUCH DER SPEZIELLEN PATHOLOGISCHEN ANATOMIE UNO HISTOLOGIE BEGRONDET VON O. LUBARSCH UNO F. HENKE FORTGEFOHRT VON R. ROSSLE HERAUSGEGEBEN VON E. UEHLINGER ZORICH DRITTER BAND ATMUNGSWEGE UNO LUNGEN HERAUSGEGEBEN VON E. UEHLINGER ZORICH FUN FTER TEll SPRINGER-VERLAG BERLIN· HEIDELBERG · NEW YORK 1971
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HANOBUCH DER SPEZIELLEN PATHOLOGISCHEN ANATOMIE UNO HISTOLOGIE
BEGRONDET VON
O. LUBARSCH UNO F. HENKE
FORTGEFOHRT VON
R. ROSSLE
HERAUSGEGEBEN VON
E. UEHLINGER ZORICH
DRITTER BAND
ATMUNGSWEGE UNO LUNGEN
HERAUSGEGEBEN VON
E. UEHLINGER ZORICH
FUN FTER TEll
SPRINGER-VERLAG
BERLIN· HEIDELBERG · NEW YORK
1971
THE PATHOLOGIC ANATOMY OF MYCOSES
HUMAN INFECTION· WITH FUNGI ACTINOMYCETES AND ALGAE
BY
ROGER DENIO BAKER
AND
A. ANGULO O .. C. BARROSO-TOBILA . L. M. CARBONELL
R. CESPEDES F. . E. W . CHICK . B. M. CLARK· O. DUQUE
G. M. EDINGTON · B. F. FETTER· J. H. GRA HAM · D. J. GUIDRY
R. W. HUNTINGTON, JR . . H. ICHINOSE . G. K. KLINTWORTH
H.1. LURIE· L. N. MOHAPAT!A . J. MORENZ . H. S. NIELSEN, JR.
J. C. PARKER, JR . . C. E. PENA . P. PIZZOLATO · L. POLLAK
A special US·edition is available under the title: BAKER. Human Infection with Fungi, Actinomycetes and Algae
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-use of illustrations, broadcasting, reproduction
by photocopying machine or similar means, and storage in data banks.
Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to be determined by agreement with the publisher.
Soflcovcr reprint of the hardcover 1st edition 1971
The use of general descriptive names, trade names, trade marks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as nnderstood by the Trade
Marks and Merchandise Marks act, may accordingly be nsed freely by anyone.
HUMAN INFECTION WITH
FUNGI, ACTINOMYCETES
AND ALGAE
BY
ROGER DENIO BAKER
AND
A. ANGULO O .. C. BARROSO-TOBILA . L.M.CARBONELL
R. CESPEDES F. . E. W. CHICK· B. M. CLARK· O. DUQUE
G. M. EDINGTON· B. F. FETTER· J. H. GRAHAM· D. J. GUIDRY R. W. HUNTINGTON, JR .. H. ICHINOSE . G. K. KLINTWORTH
H. I. LURIE· L. N. MOHAPAT~A . ]. MORENZ . H. S. NIELSEN, JR. J. C. PARKER, JR .. C. E. PENA . P. PIZZOLATO· L. POLLAK
K. SALFELDER . J. SCHWARZ· J. P. WIERSEMA H. I. WINNER· D.]. WINSLOW
Special edition of Handbuch der speziellen pathologischen Anatomie und Histologie, Band III/5
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically those of translation, reprinting, re-Ilse of illustrations, broadcasting, reproduction
by photocopying machine or similar means, and storage in data banks.
Under § 54 of the German Copyright Law where copies are made for other than private use, a fee is payable to the publisher, the amount of the fee to he determined by agreement with the publisher_
Softcover reprint of the hardcover 1 st edition 1971
The use ofgenerai descriptive names, trade names, trade marks, etc. in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as nnderstood by the Trade
Marks and Merchandise Marks act, may accordingly be used freely by anyone.
Preface
Half a century ago our knowledge of mycoses, especially pulmonary mycoses, was rather fragmentary. It was limited to rare case reports as oddities. Accordingly, in the "Handbuch der speziellen pathologischen Anatomie und Histologie" the chapter on lung diseases caused by budding and spore-forming fungi by J. WATJEN (Halle) took up as little as 27 pages. Only ARNDT (G6ttingen) could report on several cases from which he made his observations on actinomycotic changes of the lungs and pleura.
Since then our knowledge of mycoses has deepened and expanded in an unpredictable manner. This progress was mainly due to research and publications in the USA and South America. In Central Europe the number of cases of mycoses has increased during the last two decades, being reported especially as a second disease in patients with spontaneous or iatrogenic destruction of the bone marrow after treatment of cancer with cytostatic agents.
The number of known types of pathogenic fungi has increased. The knowledge of their types and conditions of growth have given rise to a subspecialty. Therefore, a great need has arisen for a new edition of the chapter on mycoses in the HenkeLubarsch-Roessle Handbook of Special Pathological Anatomy and Histology.
The publishers as well as the editors had the great fortune to find as author Prof. ROGER D. BAKER, who himself has contributed substantially to the knowledge of human mycoses. It is thanks to Prof. Baker that a large number of eminent scientists could be won as co-authors. Today, under his guidance, a complete handbook on human infection with Fungi, Actinomycetes and Algae has been written. At the present time no other book exists which describes so extensively the fundamentals of human mycology, including taxonomy, clinical aspects, epidemiology, and pathological anatomy.
For all the great progress of the past decades we should not forget that 50 years ago MAX ASKANAZY wrote, for the textbook of General Pathology edited by LUDWIG ASCHOFF, a substantial and thoughtful chapter on fungi as germs. Among his illustrations there is a marvelous colorprint of an aspergilloma of the lungs. This, an early milestone, should not get lost among the abundance of genuine and supposed newer discoveries.
Zurich/Heidelberg 1971 Prof. Dr. E. UEHLINGER
Contents List of Authors Introduction. .
XV . XVII
General Chapters (Chapter I-III) Chapter I: The Scope and General Pathology of Human Infection with Fungi, Actinomy-
cetes, and Algae. R.D. BAKER, New Brunswick, New Jersey, USA The Causative Organisms . . . . . . . . . . . . . 1 Fungus Diseases . . . . . . . . . . . . . . . . . . . . . . . 2 The Distribution and Epidemiology of Fungus Diseases. . . . . . 2 How Pathogenic Fungi Infect Man. . . . . . . . . . . . . . . 3 Mycoses Associated with Lowered Host Resistance, and Caused by Fungi which are
usually Nonpathogenic and "Opportunistic" . 4 Fungi as Inflammatory Irritants . . . . . 4 Tissue Changes in Fungus Diseases. . . . . . 5 Morbidity and Mortality in Mycotic Disease . . 6 The Demonstration of Fungi in Tissues . . . . 6 Examination for Fungi at Postmortem Examination and in Surgical Specimens 9 Infection by Actinomycetes 10 Infection by Algae 10 References. . . . . . . . 10
Chapter II: Mycology of the Agents Producing Deep Mycoses. J. SCHWARZ, Cincinnati, Ohio, USA (With 21 Figures). . . . . . . . . . . . 12
Different Mechanisms of Conversion from M to Y Phase 12 Blastomyces Dermatitidis . . . . . . . . 13 Blastomyces (Paracoccidioides) Brasiliensis 17 Histoplasma Capsulatum . 19 Histoplasma Duboisii. . . 23 Sporotrichum Schenckii. . 24 Cryptococcus Neoformans . 27 Candida Albicans. . 29 Coccidioides Immitis 31 Dematiaceous Fungi 34 References. . . . . 36
Chapter III: Ultrastructure of Human Pathogenic Fungi and Their Mycoses. L. M. CARBONELL, Caracas, Venezuela (With 25 Figures) 38
Introduction. 38 Methods. . . . . 38 Cell Wall . . . . 39 The Cell Contents 45 Developmental Studies 50 Action of Drugs on Fine Structure of Pathogenic Fungi 54 Action of Ultrasound on Pathogenic Fungi 55 Fine Structure of Mycoses ...... 55 Actinomyces, Nocardia and Streptomyces 58 Concluding Remarks 63 References. . . . . . . . . . . . . . 64
Chapter IV: Definition . History ..
The Great Endemic Mycoses (Chapter IV-VII) Histoplasmosis. J. SCHWARZ, Cincinnati, Ohio, USA (With 35 Figures) . 67
66 66
Contents
Epidemiology . . . . . . . . . . . . . . . Geographic Pathology. . . . . . . . . . . . Mycology ................ . Staining of Histoplasma Capsulatum in Tissues. Pathogenesis . . . . . . . . The Primary Lesion in the Lung Histoplasmoma . . . . . Cavitary Histoplasmosis . "Epidemic" Histoplasmosis The Spleen ...... . The Liver ....... . Bone-Marrow, Bone and Joints Lymph Nodes . . . . . . . . Lymphoma and Histoplasmosis Heart and Mediastinum . . . . Interpretation of Indirect Diagnostic Methods Adrenals ......... . Mucocutaneous Histoplasmosis Larynx ....... . Gastrointestinal Tract Genitourinary System. . Brain, Meninges and Eye Associated Diseases. References. . .
Chapter VII: Dermal Pathology of Superficial Fungus Infections. J. H. GRAHAM, Irvine, California, USA, and C. BARRoso·ToBILA, Maracaibo, Venezuela (With 156 Figures) 211
Introduction. . . . . 211 Material and Methods. 212 Tinea Capitis 214
and H.S. NIELSEN, Jr., Durham, N.C., USA (With 15 Figures) 1081 Organism . . . . . . 1081 Prototheca and Disease 1087 References. . . 1093
Authors Index .
Subject Index .
1094
1178
List of Authors
ALBERTO ANGULO 0., M.D. Profesor Titular, Director del Instituto de Anatomia Patologica Facultad de Medicina, Universidad Central e Instituto National de Tuberculosis Correos de Sabana Grande A partado 50647 Caracas, Venezuela
ROGER DENIO BAKER, M.D. Professor of Pathology Rutgers Medical School New Brunswick, New Jersey 08903, USA Formerly Professor of Pathology, Louisiana State University, School of Medicine New Orleans, Louisiana, USA
CESAR BARROso-ToBILA, M.D., Jefe Dermatologia y Dermapathologia Policlinica Maracaibo Av. 8 (Santa Rita) Esq. Calle 71 Maracaibo, Venezuela
LUIS M. CARBONELL, M.D. Jefe del Departamento de Microbiologia, Instituto Venezolano de Investigaciones Cientificas (1. V. 1. C), Apartado 1827 Caracas, Venezuela
RODOLFO CESPEDES F., M.D. Profesor de Anatomia Patologica en la Facultad de Medicina, Universidad de Costa Rica, J efe del Servicio de Anatomia Patologica del Hospital San Juan de Dios y Hospital Central del Seguro Social Apartado 3275, San Jose Costa Rica
ERNEST W. CHICK, M.D., Professor Department of Community Medicine Mycology Program, University of Kentucky, College of Medicine Lexington, Kentucky 40506, USA Formerly Professor and Chairman Division of Preventive Medicine West Virginia, Medical Center of Morgantown, West Virginia, USA
BETTY M. CLARK, M.B., M.R.C. Path. Associate Professor Department of Medical Microbiology University College Hospital Ibadan, Nigeria
OSCAR DUQUE, M. D. Profesor y Jefe del Departamento de Patologia, Facultad de Medicina Universidad de Antioquia Medellin, Colombia
GEORGE M. EDINGTON, C. B. E., M. D. M.R.C. Path. Professor and Head of the Department of Pathology University College Hospital Ibadan, Nigeria
BERNARD F. FETTER, M.D. Professor of Pathology Duke University, Medical Center Durham, North Carolina 27706, USA
JAMES H. GRAHAM, M.D. Professor of Medicine (Dermatology) Chairman, Division of Dermatology Professor of Pathology, Department of Pathology, California College of Medicine, University of California Irvine, California, USA Address at Orange County Medical Center 101 South Manchester Avenue Orange, California 92668, USA
D.J. GUIDRY, Ph.D. Associate Professor of Microbiology Louisiana State University Medical Center 1542 Tulane Avenue New Orleans, Louisiana 70112, USA
ROBERT W. HUNTINGTON, JR., M.D. Clinical Professor of Pathology University of Southern California School of Medicine Los Angeles, California. USA Address: Pathologist, Kern County General Hospital Bakersfield, California 93305, USA
HERBERT ICHINOSE, M.D. Associate Professor of Pathology Tulane University, School of Medicine 1430 Tulane Avenue New Orleans, Louisiana 70112, USA
GORDON K. KLINTWORTH, M.D., Ph. D. Associate Professor, Department of Pathology, Duke University Medical Center Durham, North Carolina 27706, USA
XV! List of Authors
HARRY I. LURIE, B.Sc., M.B., Ch.B. M. R. C. Path., Professor of Pathology Medical College of Virginia Richmond, Virginia 23219, USA
L.N. MOHAPATRA, M.D., Dip. Bact. (London), Professor of Microbiology All-India Institute of Medical Sciences New Delhi 16, India
J. MORENZ, M.D. Professor of Medical Microbiology and Epidemiology Medizinische Akademie Magdeburg 301 Magdeburg, Leipziger StraJ3e 44, GDR
HARRY S. NIELSEN, JR., Ph.D. Formerly Assistant Professor of Microbiology, Duke University Medical Center. Presently Director California Allergenics Laboratories 2602 First Avenue, Suite 104 San Diego, California 92103, USA
JOSEPH C. PARKER, JR., M.D., M.S. Formerly Fellow in Neuropathology Duke University, Medical Center Presently at Laboratory of Pathology New England Deaconess Hospital 185 Pilgrim Road Boston, Massachusetts 02215, USA
CARLOS E. PEN-A, M.D. Formerly Assistant Professor of Pathology, University of Pittsburg, School of Medicine Presently Assistant Professor of Pathology, Georgetown University Medical School Washington, D.C. 20007, USA
PHILIP PIZZQI,ATO, M. D. Professor of Pathology, Louisiana State University, Medical Center Pathologist, Veterans Administration Hospital. Address at Veterans Administration Hospital Perdido Street New Orleans, Louisiana 70140, USA
LADISLAO POLLAK, M.D. Profesor Asociado, Jefe de la Catedra de Microbiologia Escuela Vargas, Facultad de Medicina Universidad Central e Instituto National de Tuberculosis Correos de Sabana Grande Apartado 50647 Caracas, Venezuela
K. SALFELDER, M.D. (Prof. Titular) Jefe del Departamento de Patologia Instituto de Anatomia Patol6gica Universidad de los Andes Hospital "Los Andes" Apartado No. 75 Merida, Venezuela
JAN SCHWARZ, M.D. Associate Professor of Pathology The University of Cincinnati School of Medicine The Jewish Hospital Cincinnati, Ohio 45229, USA
JAN P. WIERSEMA, M.D. Formerly Research Pathologist Leonard Wood Memorial Special Mycobacterial Diseases Branch, Geographic Pathology Division, Armed Forces Institute of Pathology Washington, D.C., USA Presently Pathologist Good Samaritan Hospital 1425 West Fairview Avenue Dayton, Ohio 45406, USA
H.I. WINNER, M.D., M.R.C.P. F.C. Path., Professor of Bacteriology Charing Cross Hospital Medical School, University of London 13 William IV Street London WC2N 4DW, England
DONALD J. WINSLOW, M.D. Formerly Chief, Infectious Disease Branch, Geographic Pathology Division, Armed Forces Institute of Pathology Washington, D.C., USA Presently Chief Laboratory Service Veterans Administration Center Bay PiDiols, Florida 33504, USA
Introduction
At the First Symposium on Mycotic Diseases of The International Academy of Pathology, meeting in London, Professor Dr. E.A. UEHLINGER of the Institute of Pathology of the University of ZUrich, Switzerland, invited me to prepare a volume on the pathologic anatomy of the mycoses. This treatise would be a part of the section on the lung ofthe "Handbuch der speziellen pathologischen Anatomie und Histologie", now edited by Professor UEHLINGER, and would be published in English. It was my good fortune to persuade pathologists, microbiologists, and epidemiologists the World over to contribute chapters on subjects in which they had long experience and special competence.
The result is this authoritative volume of monographs, a number of which presently represent the most comprehensive exposition of "Infection with Fungi, Actinomycetes, and Algae". The investigation of the literature necessary to write the chapters has lead to new insights and correlations concerning the nature, epidemiology, diagnosis, prevention, and treatment of these increasingly significant diseases. This material is indispensable not only to pathologists, but to microbiologists, research workers, dermatologists and other practising physicians.
I owe a debt of gratitude to the co-authors of this volume, to my wife, ELEANOR U SSHER BAKER, who helped in the preparation and editing of the volume, and to Springer-Verlag.
Professor ROGER DENIO BAKER, M.D. Senior Author New Brunswick, N.J., ]971