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Endemic areas of coccidioidomycosis are described. The mycology of Coccidioides immitis is reviewed, with special reference to the risk of laboratory infection. A classification of coccidioidomycosis is listed and two cases from Finland are presented. The first patient had typical X-ray and clinical findings, including a positive coccidioidin test. The second case, occurring soon after a visit to Arizona, was confirmed by positive fungal cultures from the sputum and from a resected specimen. Because the latter patient became pregnant and the risk of dissemination was considered great, legal abortion was performed. The resection of the pulmonary cavitation with infiltration around it took place under coverage of pre- and postoperative amphotericin B medication. Complete recovery was obtained. The indications for thoracic surgery are briefly listed. Diagnostic and mycologic aspects of this rare and exotic disease are discussed. Among other things, the importance of a good medical history in finding the contact with infective environment or material is stressed.

Antibodies to two commercial extracts of Aspergillus fumigatus were determined by a class-specific enzyme-linked immunosorbent assay (ELISA) in 203 serum samples from 139 patients with various pulmonary diseases. In 22 patients with aspergilloma immunoglobulin (Ig)M, IgA, and especially IgG antibodies were found, whereas in 50 patients with allergic alveolitis IgG antibody was most frequent, IgM occurring rarely. One patient with allergic bronchopulmonary aspergillosis demonstrated IgG and IgA antibodies. Of 20 cases with bronchial asthma, 10% reacted against A. fumigatus in immunodiffusion as well as in ELISA. Of 46 cases with carcinoma, tuberculosis, and miscellaneous pulmonary diseases, 17% were positive by immunodiffusion and 26% demonstrated antibodies usually IgG, by ELISA. Of 100 healthy blood donors, none had Aspergillus antibodies of the IgG class, whereas 3% were positive in the IgM and 3% in the IgA assay. The ELISA proved to be sensitive and useful in the follow-up of patients with aspergilloma after operation.

Summary In Finland occupational asthma caused by protein allergens and reactive chemicals present in the air of work environments is increasing. This communication describes provocative challenge tests and methods for measuring exposure under simulated work conditions. The importance of lung function measurements during non-exposure and placebo periods is stressed. Especially late reactions are difficult to assess because of the great circadian variation in the lung function parameters of asthmatics. For a positive challenge test, a decrease in peak flow values of at least 15% and a clear deviation from normal circadian variation and placebo periods is required. The allergens of vegetable or animal origin primarily affect patients with an atopic constitution. Chemical allergens seem to attack all exposed workers in the same way. The report lists the occupations with risk for asthma and refers to the population at risk; bakers seem to be the group with the most risk. The importance of early diagnosis, removal of the worker from exposure and improvement of the hygienic aspects of the work environment are stressed.