Present State of Fungal Infections in Autopsy Cases in Japan: A Statistical Survey of All Autopsy Cases during the Ten-year Period from 1966 to 1975

Abstract

In order to clarify the present state of opportunistic fungal infections increasing in incidence in autopsy cases, all autopsy cases from 1966 to 1975 reported in the Annual of Pathological Autopsy Cases in Japan were reviewed. Of the total 233,130 autopsy cases, mycoses were present in 4,340 (1.86%). The incidence of mycoses has strikingly increased during the recent five-year period. In Japan, the mycoses most frequently occurring in autopsy cases were candidiasis (32.28%), aspergillosis (23.08%), cryptococcosis (9.63%), and mucormycosis (2.90%). These occurred more frequently in younger persons and were most commonly secondary and deep-seated infections (95.78%). Among the primary diseases associated with mycoses, aplastic anemia (14.36%), leukemia (9.89%), malignant lymphoma (5.73%), multiple myeloma (4.68%), and systemic lupus erythematosus (4.62%) were most frequent. The incidence of the primary diseases associated with mycoses is increasing extraordinarily, and this seems to be strongly related to the modern therapy of using high doses of anticancer or immunosuppressive agents.

Ten-Year Survey of Incidence of Infection as a Cause of Death in Hematologic Malignancies: Study of 90 Autopsied Cases

“…Comparisons between groups in the first half decade (1982)(1983)(1984)(1985)(1986)) and the sec ond half decade (1987)(1988)(1989)(1990)(1991) showed changes in the fre quency and types of infection as cause of death. The fre quency of fatal infections, especially those caused by bac teria, was lower in the second period than in the first, but there was a relative increase in the incidence of fatal fun gal infection, particularly aspergillosis, consistent with recent published reports [9][10][11]. Diagnosing aspergillosis at an early stage is difficult and depends largely on a high index of suspicion.…”

Systemic zygomycosis

“…These began with three classic cases described by Gregory et al in 1943, and now include many substantial series (Straatsma et al, 1962;Meyers et al, 1979;Blitzer et al, 1980;Marchevsky et al, 1980;Abedi et al, 1984). Systemic zygomycosis is clearly relatively common in Mexico (Rangel-Carrillo et al, 1982;del Real Mora, 1983;Rangel-Guerra et al, 1985), and not infrequent in Japan (Hotchi et al, 1980) and Southern Africa (Neame & Rayner, 1960;Deal & Johnson, 1969;Dannheimer et al, 1974;Lawson & Schmaman, 1974). Reports have come from many other countries, especially India, usually of single cases.…”

Granulomas infecciosos del hígado

“…Debe buscarse una causa predisponente como la inmunosupresión, administración de antibióticos de amplio espectro, diabetes, cirrosis, hiperalimentación parenteral, uso de citotóxicos y corticoides, transplante renal y presencia de enfermedad tumoral, principalmente linfoproliferativa. La candidiasis sistémica es la micosis oportunista más frecuente en autopsias (46)(47)(48). El compromiso hepático es común, porque es la vía de llegada de la Candida, desde el intestino, a través de la circulación portal.…”

“…En un estudio, todos los pacientes tuvieron candidiasis gastrointestinal (46). La incidencia de candidiasis diseminada va en aumento y compromete principalmente a personas jóvenes con tratamiento inmunoterápico para leucemias, linfomas, anemia aplástica y lupus eritematoso sistémico (46)(47)(48).…”