The data on visceral
mycoses that had been reported in the Annual of the Pathological Autopsy Cases in Japan from 1969 to 1994 by the Japanese Society of Pathology were analyzed epidemiologically. The frequency of visceral
mycoses 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 Aspergillus and Cryptococcus. Although the rate of
candidiasis decreased by degrees from 1990, the rate of
aspergillosis increased up to and then surpassed that of
candidiasis in 1991.
Leukemia was the major disease underlying the visceral
mycoses, followed by solid
cancers and other blood and hematopoietic 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 71% in 1994. The reasons for this decrease of
candidiasis combined with an increase of
aspergillosis or of severe mycotic
infection might be that (i) nonsevere (not disseminated)
infections were excluded from the case totals, since they have become controllable by antifungal drugs such as
fluconazole, but (ii) the available antifungal drugs were not efficacious against severe
infections such as
pulmonary aspergillosis, and (iii) the number of patients living longer in an immunocompromised state had increased because of developments in
chemotherapy and progress in medical care.