Epidemiology of visceral mycoses: Analysis of data in Annual of the Pathological Autopsy Cases in Japan

The data on visceral mycoses that had been reported in the Annual of the Pa thological Autopsy Cases in Japan from 1969 to 1994 by the Japanese Society of Pathology mere analyzed epidemiologically, The frequency of visceral my coses among the annual total number of pathological autopsy cases increased noticeably from 1.60% in 1969 to a peak of 4.66% in 1990. Among them, the incidences of candidiasis and aspergillosis increased the most. After 1990, however, the frequency of visceral mycoses decreased gradually. Until 1989 , the predominant causative agent was Candida, followed in order by Aspergi llus and Cryptococcus, Although the rate of candidiasis decreased by degree s from 1990, the rate of aspergillosis increased up to and then surpassed t hat of candidiasis in 1991, Leukemia was the major disease underlying the v isceral mycoses, followed by solid cancers and other blood and hematopoieti c system diseases. Severe mycotic infection has increased over the reported 25-year period, from 6.6% of the total visceral mycosis cases in 1969 to 7 1% in 1994, The reasons for this decrease of candidiasis combined with an i ncrease of aspergillosis or of severe mycolic infection might be that (i) n onsevere (not disseminated) infections were excluded from the case totals, since they have become controllable by antifungal drugs such as fluconazole , but (iii) the available antifungal drugs were not efficacious against sev ere infections such as pulmonary aspergillosis, and (iii) the number of pat ients living longer in an immunocompromised state had increased because of developments in chemotherapy and progress in medical care.