Antigenic and allergenic cross-reactivity of Epicoccum nigrum with other fungi

Dematiaceous fungal infections: clinical and pathologic conundrums

Dematiaceous fungi are defined by pigment within their cell walls. They are increasingly recognised human pathogens, causing a wide range of clinical presentations, from localised subcutaneous infections to disseminated disease in rare cases. We report our institutional experience with diagnosis of dematiaceous fungal infections from 2005 to 2022 and highlight four instructive cases that clinically and pathologically mimicked other diseases for which the diagnosis was confirmed by fungal culture (one case) or supported by PCR with 28S rRNA and internal transcribed spacer primers (three cases). Two patients were immunocompromised and two had presumed exposure to the organism. In each highlighted case, fungal infection was not clinically suspected, and the pathologist was critical in making the diagnosis and ensuring appropriate clinical management, which was supplemented by fungal stains and novel molecular methods.

Characterization of fungal aerosol in a landfill and an incineration plants in Guangzhou, Southern China: The link to potential impacts

To understand the characteristics and potential impacts of fungal aerosols in waste disposal treatments, we performed observations at a landfill and an incineration plants in Guangzhou, Southern China. Size-segregated airborne fungal concentrations were measured based on culture-dependent method, and fungal compositions in PM_2.5 were obtained using high-throughput sequencing method. Concentrations of airborne fungi varied from 376 to 9318 CFU/m³ in the landfill plant and from 53 to 8491 CFU/m³ in the incineration plant, respectively. The temporal and spatial variations of fungal aerosols indicate that waste disposal operation, garbage transport, air mixing, and meteorological factors can significantly influence the variations of airborne fungi in the outdoor environment in both plants. Among the meteorological factors, light/moderate rain could significantly increase the airborne fungal concentrations while heavy rain could decrease the concentrations due to wet scavenge. We observed that culturable fungal aerosols predominantly resided in the size range of 2.1-3.3 μm. Different fungal community structures in PM_2.5 were found between the landfill and the incineration plants, suggesting the influence of different waste sorts and treatment procedures. We further identified the pathogenic/allergenic fungal taxa (e.g., Alternaria, Epicoccum sp. and Stachybotrys sp.) in the two plants, implying the potential human health risks with long-term exposure for on-site workers and surrounding residents. The fungal genera producing microbial volatile organic compounds (MVOCs, e.g., Cladosporium, Fusarium sp., Penicillium sp. and Candida) were found in both plants. These MVOCs generation related fungal genera could contribute to the odor in the plants and, more importantly, affect the downwind area after aerosolization and transportation.

Fungi and Atopy

Atopy and fungi have a long associative history. Fungal spores were among the first substances to which humans were noted to be sensitized. Humans contact fungal spores in the outdoor, indoor, and occupational environments. As organisms, fungi have their own kingdom and are found in all environmental niches on earth. Currently, fungal exposure in the indoor environment especially related to wet housing conditions is of particular concern. Sensitization rates to fungi typically exceed 5% of the general public with higher rates among the atopic population. Alternaria is the best studied of the allergic fungi; however, cross sensitization to multiple fungi is well documented. Recent advances in understanding mechanisms of the innate immune system are beginning to explain why the fungal atopy relationship is unique and why fungal sensitivity seems to extend to many non-atopic individuals. Evidence has been accumulated that indicates fungal allergen exposure can be via intact spores as well as spore and mycelial fragments. Germinating spores produce a different and often increased allergen picture. Much evidence has been developed through animal studies that extends the mechanisms surrounding long-term low-level fungal exposure. However, it should be emphasized that the presence of fungi in the air does not necessarily equate with illness. Indeed, in the absence of an atopic individual and/or a significant immune response against fungi, there is little evidence suggesting pathology. Allergists frequently deal with patients who have concerns about indoor fungal exposure and respiratory disease in those patients with an allergic response.

Taxonomy of Allergenic Fungi

The Kingdom Fungi contains diverse eukaryotic organisms including yeasts, molds, mushrooms, bracket fungi, plant rusts, smuts, and puffballs. Fungi have a complex metabolism that differs from animals and plants. They secrete enzymes into their surroundings and absorb the breakdown products of enzyme action. Some of these enzymes are well-known allergens. The phylogenetic relationships among fungi were unclear until recently because classification was based on the sexual state morphology. Fungi lacking an obvious sexual stage were assigned to the artificial, now-obsolete category, "Deuteromycetes" or "Fungi Imperfecti." During the last 20 years, DNA sequencing has resolved 8 fungal phyla, 3 of which contain most genera associated with important aeroallergens: Zygomycota, Ascomycota, and Basidiomycota. Advances in fungal classification have required name changes for some familiar taxa. Because of regulatory constraints, many fungal allergen extracts retain obsolete names. A major benefit from this reorganization is that specific immunoglobulin E (IgE) levels in individuals sensitized to fungi appear to closely match fungal phylogenetic relationships. This close relationship between molecular fungal systematics and IgE sensitization provides an opportunity to systematically look at cross-reactivity and permits representatives from each taxon to serve as a proxy for IgE to the group.

Modifiable factors governing indoor fungal diversity and risk of asthma

Exposure to dampness and fungi in the home is a known risk factor for individuals with allergic asthma. Inadequate heating and ventilation may lead to dampness and concomitant increased exposure to spores of allergenic fungi such as Aspergillus and Penicillium. These fungi have been cultured from sputum of asthmatic and non-asthmatic individuals, and implicated in the initiation or exacerbation of asthma. Indoor environmental factors influence the presence and concentrations of fungal propagules and, in turn, risk of asthma outcomes. This review aims to identify modifiable risk factors in the built environment that have been shown to influence fungal composition indoors, and to examine this association with the risk of asthma development and/or exacerbation. A complex interaction between residential characteristics, the built environment and the behaviour of people regulate the diversity and concentrations of indoor fungi. Modifiable factors include build age, architectural design, level of maintenance, variations in construction materials, presence of pets, heating and ventilation patterns. Risk of fungal contamination and asthma outcomes are also influenced by low occupant awareness concerning potential health effects and socio-economic factors. Addressing these factors provides an opportunity to improve future housing interventions, though it is not clear how the built environment and occupant behaviours interact to modify the diversity of indoor fungi and resultant risk of asthma. A combination of housing improvements combined with awareness programmes and the alleviation of fuel poverty can be used to lower the allergen burden associated with damp homes. Further research is needed to identify factors that regulate the concentration and diversity of indoor fungi and how this may act as a modifier for asthma outcomes.

Purification and immunological characterization of a 12-kDa allergen from Epicoccum purpurascens

Exposure to Epicoccum purpurascens is implicated in respiratory allergies and asthma. Several allergens of clinical importance were identified in Epicoccum extract (EE), but only one allergen has been isolated and characterized. In the present study, a 12-kDa allergen was isolated from an Epicoccum spore-mycelial extract by concanavalin-A sepharose, reverse-phase hydrophobic and gel filtration chromatography. The purified protein was recognized as a single 12-kDa allergen on immunoblot with a serum pool of Epicoccum-sensitive patients. Of the 94 respiratory allergy patients tested intradermally, 17 showed marked positive skin reactions to EE and 12 of them reacted with the 12-kDa protein, indicating a diagnostic sensitivity of 70%. More than 80% patients' sera showed immunoglobulin E (IgE) reactivity to the purified protein in enzyme-linked immunosorbent assay and immunoblot, identifying it as a major allergen. Preincubation of pooled serum with the protein led to inhibition of IgE binding to solid-phase-bound EE (effective concentration 50%=180 ng). Twelve of the 17 serum samples showed significant basophil histamine release upon stimulation with purified protein. The protein induced significant proliferation of peripheral blood mononuclear cells of 13 patients. A high level of interleukin-4 in the culture supernatant of these cells indicated induction of a T-helper type 2 response. The purified 12-kDa protein is a clinically relevant allergen and has potential for the diagnosis and therapy of Epicoccum allergies.

Alternaria measures in inner-city, low-income housing by immunoassay and culture-based analysis

BACKGROUND

Sensitivity to Alternaria allergens has been associated with severe asthma and life-threatening exacerbations, and a high prevalence of Alternaria sensitivity has been reported among inner-city populations. Traditionally, epidemiologic studies have measured indoor Alternaria concentrations by cultural analyses; however, the number of viable spores may not be a good proxy for allergen levels. Furthermore, other genera share epitopes with Alternaria that may contribute to the allergenic effect.

OBJECTIVE

To compare measures of Alternaria antigen by enzyme-linked immunosorbent assay with measures of Alternaria and cross-reactive genera (Ulocladium, Curvularia, Epicoccum, and Stemphylium) by cultural analysis.

METHOD

Antigen assays and cultural analyses were performed on vacuum-collected bed dust samples collected between June 18, 2002, and February 9, 2004, from 3 inner-city, low-income public housing developments.

RESULTS

Alternaria antigen was found in all bed dust samples regardless of season. However, culturable Alternaria, Ulocladium, Curvularia, Epicoccum, and Stemphylium were only found in 50%, 35%, 6%, 11%, and 0% of bed samples, respectively. No correlations were found between Alternaria antigen and culturable concentrations of Alternaria or of its cross-reactive genera except for marginal correlation with Ulocladium culturable concentrations.

CONCLUSIONS

The results confirm that exposure to Alternaria antigens and allergens can occur even in the absence of culturable Alternaria or its cross-reactive genera, so further refinement and use of assays are essential for characterizing the distribution and determinants of indoor fungal allergen levels forsensitive populations.

Analytical bias of cross-reactive polyclonal antibodies for environmental immunoassays of Alternaria alternata

BACKGROUND

Alternaria alternata is recognized as an important aeroallergen indoors and outdoors, and exposure to the fungus has been identified as a risk factor for asthma. Two recent publications concluded that 95% to 99% of American homes contained detectable amounts of Alternaria antigens when analyzed with a polyclonal antibody (pAb)-based ELISA.

OBJECTIVES

We investigated the cross-reactivity of the commercially available pAbs that were used in those studies.

METHODS

Reactivity to 24 fungal species commonly found in indoor environments was analyzed by inhibition ELISA by using solid-phase A alternata antigen. The pAbs were also tested by immunoblotting and halogen immunoassay for a subgroup of fungi.

RESULTS

Spores of 7 fungi including species of Alternaria, Ulocladium, Stemphylium, Epicoccum, Drechslera, and Exserohilum strongly inhibited the binding of the pAbs when tested by ELISA. Six other fungi reacted in the ELISA at a lower level, and 11 fungal species including several Penicillium, Aspergillus, Fusarium, and Cladosporium species failed to show inhibition. The immunoblots and the halogen immunoassay staining confirmed the cross-reactivity patterns of the ELISA.

CONCLUSION

The pAbs against A alternata were found to cross-react broadly with related and nonrelated fungi. The prevalence data previously reported for A alternata should be considered to be fungal-reactive rather than A alternata-specific.

Personal exposure to airborne dust and microorganisms in agricultural environments

Airborne dust and microorganisms are associated with respiratory diseases and increased mortality and morbidity. Farmers are at high risk of exposure to both of these hazards. Very limited information, however, is available on the combined exposures to both hazards on different types of farms. Moreover, most of the previous studies have measured the mass concentration of particles ignoring the particle size. In this study, farmers' exposure to airborne dust and microorganisms was studied using our newly developed personal sampling system. Particle number concentration and size distribution were measured with an optical particle counter. Simultaneously, particles were collected on a filter and analyzed for microorganisms. The field measurements were conducted in animal confinements (swine, poultry, and dairy) and during grain harvesting (corn and soybean). The results show the following average concentrations on the workers' breathing zone: 1.7 x 10(6) to 2.9 x 10(7) particles/m(3) for total dust, 0.9 x 10(3) to 3.9 x 10(4) spores/m(3) for total fungal spores, 0.3 x 10(3) to 3.6 x 10(4)CFU/m(3) for culturable fungal spores, 0.3 x 10(4) to 3.3 x 10(8) CFU/m(3) for culturable bacteria, and limit of detection (LOD) to 2.8 x 10(3) CFU/m(3) for culturable actinomycetes in animal confinements. The respective concentrations were 4.4 x 10(6) to 5.8 x 10(7) particles/m(3), 3.4 x 10(4) to 6.1 x 10(6) spores/m(3), 8.2 x 10(4) to 7.4 x 10(6) CFU/m(3), 0.4 x 10(5) to 1.4 x 10(6) CFU/m(3), and LOD to 2.6 x 10(4) CFU/m(3) during grain harvesting. The highest contribution of large particles (3-10 microm) in total particles was found during grain harvesting, whereas the size distribution was dominated by smaller particles (< 3 microm) in animal confinements. High fraction (up to 37%) of particles between 2-10 microm was found to be fungal spores. The results indicate that an increase in the concentration of large dust particles (2-10 microm) during grain harvesting was partially attributed to the increase in the concentration of the fungal spores. Overall, the combined exposure to airborne dust and microorganisms was found to be more severe during harvesting than in animal confinements.

Correlation of ambient inhalable bioaerosols with particulate matter and ozone: a two-year study

In this study, we have examined the relationships between the concentrations of ambient inhalable airborne fungi and pollen with PM10, PM2.5, ozone, organic carbon, selected trace metals (cadmium, copper, lead, and zinc), temperature, and relative humidity. The database was collected in Cincinnati, Ohio, USA, during two consecutive years. Measurements of all environmental variables were performed at the same site continuously 5 days a week except during winter months. The airborne concentrations of biological and non-biological pollutants ranged as follows: total fungi: 184-16 979 spores m(-3); total pollen: 0-6692 pollen m(-3); PM10: 6.70-65.38 microg m(-3); PM2.5: 5.04-45.02 microg m(-3); and ozone: 2.54-64.17 ppb. Higher levels of total inhalable fungi and particulate matter were found during fall and summer months. In contrast, total pollen concentration showed elevated levels in spring. Peak concentrations of ozone were observed during summer and beginning of fall. Our study concluded that several types of inhalable airborne fungi and pollen, particulate matter, and ozone could be positively correlated as a result of the atmospheric temperature influence.

The development of species-specific immunodiagnostics for Stachybotrys chartarum: the role of cross-reactivity

Mold contamination and exposure to fungi in indoor environments has been associated with various adverse health effects but little is known about the significance of individual fungal species in the initiation or exacerbation of such effects. Using Stachybotrys chartarum as a model fungus we sought to demonstrate that monoclonal antibodies (mAbs) can provide species-specific diagnostic reagents and also be used to investigate immunological cross-reactivity patterns among fungi. Mice were immunized with S. chartarum spore walls and monoclonal antibodies were screened against 60 fungal species and 24 different isolates of S. chartarum using an indirect ELISA. One species-specific mAb (IgG(1)) reacted only with spore preparations but not mycelium of S. chartarum or propagules of any other fungus. Five cross-reactive mAbs (IgM) documented extensive cross-reactivity among nine related Stachybotrys species and several non-related genera including several species of Cladosporium, Memnoniella, Myrothecium and Trichoderma. We also found that the ELISA reactivity for cross-reactive antigens and different isolates of S. chartarum differed considerably for normalized total amounts of mycelial antigen. We demonstrate that mAbs and immunoassays have the potential to detect S. chartarum species-specifically. The observed reactivity patterns with cross-reactive mAbs suggest that several fungi may share common antigens and that the majority of antigens are expressed by spores and mycelia. The observed cross-reactivity patterns need to be considered for accurate interpretations of environmental and serological analyses.

Enumeration and detection of aerosolized Aspergillus fumigatus and Penicillium chrysogenum conidia and hyphae using a novel double immunostaining technique

The identification of collected airborne unicellular fungal conidia and hyphae using nonviable techniques is subjective and an imprecise process. Similarly, to determine whether an individual is allergic to a particular genus requires a separate immunodiagnostic analysis. This study demonstrates the development of a novel double immunostaining halogen assay, which enables (1) the simultaneous identification of collected airborne fungal conidia and hyphae of Aspergillus fumigatus and Penicillium chrysogenum using monoclonal antibodies and (2) the demonstration of patient-specific allergy to the same particles using human serum IgE. The results demonstrate that when conidia were ungerminated the binding of antibodies was homogeneous and localized in close proximity around the entire conidia for both species. However, when conidia were germinated, the proportion expressing antigen increased (P < 0.0001) for both species and the sites of binding of the two antibodies changed with double immunostaining restricted to the hyphal tips for A. fumigatus, in addition to the sites of germination for P. chrysogenum. The described immunoassay has the potential to identify fungal particles in personal environmental air samples, provided species-specific monoclonal antibodies are available, while simultaneously demonstrating allergic sensitization to the same particles by co-staining the samples with the patient's own serum. Such an immunoassay can use those fungi that the patient is actually exposed to and potentially avoids many problems associated with extract variability based on the performance of current diagnostic techniques for fungal allergy.

Cross-reactivity of Aspergillus, Penicillium, and Stachybotrys antigens using affinity-purified antibodies and immunoassay

In this study, the author examined the cross-reactivities of Stachybotrys chartarum, Aspergillus niger/fumigatus, and Penicillium notatum with affinity-purified rabbit sera. The molds were grown for expression of maximum numbers of antigens, after which they were extracted and mixed with commercially available extracts. The mixture was used for antibody preparation in rabbits, measurement of antibody levels, and for the demonstration of the degree of cross-reactivity. Control rabbits were injected with saline, yet they produced significant levels of immunoglobulin G antibodies against all mold extracts tested. The author interpreted this result to mean that sera obtained from rabbits immunized with pure mold extracts likely reflected cross-reactivity with other molds. Therefore, only affinity-purified antibodies and the most sensitive immunoassay technique (i.e., enzyme-linked immunosorbent assay [ELISA]) were used for the cross-inhibition studies. The antigenic cross-reactivities were as follows: (a) between Aspergillus and Penicillium, 19.6-21.0%; (b) between Stachybotrys and Aspergillus, 8.2-8.7%; and (c) between Stachybotrys and Penicillium, 7.0-9.6%. The findings of this study demonstrate that cross-reactivity studies between different molds require the use of affinity-purified antibodies and a sensitive and quantitative assay with untreated antigens. With the use of such an assay, it was determined that the cross-reactivity between Stachybotrys, Aspergillus, and Penicillium was at approximately 10%, which is less widespread than previously believed.

Clinical use of immunoassays in assessing exposure to fungi and potential health effects related to fungal exposure

OBJECTIVE

To review and summarize current evidence regarding the proper role of immunoassays in clinical assessments of exposure to fungi and health effects related to fungal exposure.

DATA SOURCES

We reviewed relevant scientific investigations and previously published reviews concerning this topic.

STUDY SELECTION

The authors' clinical, laboratory, and public health experiences were used to evaluate relevant data for scientific merit.

RESULTS

Testing to determine the presence of IgE to specific fungi may be a useful component of a complete clinical evaluation in the diagnosis of illnesses that can be caused by immediate hypersensitivity such as allergic rhinitis and asthma. Detection of IgG to specific fungi has been used as a marker of exposure to agents that may cause illnesses such as hypersensitivity pneumonitis. However, the ubiquitous nature of many fungi and the lack of specificity of fungal antigens limit the usefulness of these types of tests in the evaluation of potential building-related illness and fungal exposure. Specific serologic tests (such as tests for cryptococcal antigen, coccidioidal antibody, and Histoplasma antigen) have been shown to be useful in the diagnosis of some fungal infections, but these are the exception not the rule.

CONCLUSIONS

There is currently not enough scientific evidence to support the routine clinical use of immunoassays as a primary means of assessing environmental fungal exposure or health effects related to fungal exposure. Health care providers who care for persons expressing concerns about the relationship of symptoms to potential exposure to fungi are advised to use immunoassay results with care and only as an adjunct to a comprehensive approach to patient care.

Limitations of monoclonal antibodies for monitoring of fungal aerosols using Penicillium brevicompactum as a model fungus

Molds are ubiquitous in every environment and many species have been recently associated with an increase in opportunistic infections in immunocompromised patients or the exacerbation of asthmatic episodes in allergic patients. The degree of environmental contamination with fungi thus needs to be monitored and in this study we report the development of a monoclonal antibody (mAb)-mediated enzyme-linked immunosorbent assay (ELISA) for the detection of spores of Penicillium brevicompactum in experimental model aerosols. In addition, we have investigated the influence of different parameters of air sampling and sample recovery on ELISA performance. MAbs were produced with standard hybridoma techniques and cross-reactivities were determined against spores of 53 fungal species by indirect ELISA. Standardized experimental fungal aerosols were collected with the Button Personal Inhalable Aerosol Sampler onto polycarbonate or polytetrafluoroethylene filters (PTFE) and the effects of different extraction buffers and filter agitation methods during sample processing on spore recovery and ELISA detection were investigated. Five mAbs were produced and all of them cross-reacted with several of 31 related Aspergillus, Penicillium and Eurotium species. However, cross-reactivities with 21 non-related fungi were rare. Spores were recovered in much higher numbers from polycarbonate filters (PFs) than from polytetrafluoroethylene filters. Optical densities (ODs) in ELISA were higher for spores collected into carbonate coating buffer (CCB) than phosphate-buffered saline (PBS). Filter bath sonication following filter vortexing had no positive effects on ELISA sensitivity. The cross-reactivity patterns of mAbs suggest that Aspergillus and Penicillium species share multiple antigens. Quantitative ELISA results for fungal aerosols were found to be influenced by differential sample processing and thus method standardization will be essential to maintain the comparability of immunometric monitoring results.