1
|
Petnak T, Moua T. Exposure assessment in hypersensitivity pneumonitis: a comprehensive review and proposed screening questionnaire. ERJ Open Res 2020; 6:00230-2020. [PMID: 33015147 PMCID: PMC7520171 DOI: 10.1183/23120541.00230-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
Hypersensitivity pneumonitis is an immune-mediated inflammatory lung disease characterised by the inhalation of environmental antigens leading to acute and chronic lung injury. Along with suggestive clinical and radiological findings, history and timing of suspected antigen exposure are important elements for diagnostic confidence. Unfortunately, many diagnoses remain tentative and based on vague and imprecise environmental or material exposure histories. To date, there has not been a comprehensive report highlighting the frequency and type of environmental exposure that might lead to or support a more systematic approach to antigen identification. We performed a comprehensive literature review to identify and classify causative antigens and their associated environmental contexts or source materials, with emphasis on the extent of the supportive literature for each exposure type. Eligible publications were those that reported unique inciting antigens and their respective environments or contexts. A clinical questionnaire was then proposed based on this review to better support diagnosis of hypersensitivity pneumonitis when antigen testing or other clinical and radiological variables are inconclusive or incomplete.
Collapse
Affiliation(s)
- Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
Moretti ML, Busso-Lopes AF, Tararam CA, Moraes R, Muraosa Y, Mikami Y, Gonoi T, Taguchi H, Lyra L, Reichert-Lima F, Trabasso P, de Hoog GS, Al-Hatmi AMS, Schreiber AZ, Kamei K. Airborne transmission of invasive fusariosis in patients with hematologic malignancies. PLoS One 2018; 13:e0196426. [PMID: 29698435 PMCID: PMC5919535 DOI: 10.1371/journal.pone.0196426] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/12/2018] [Indexed: 01/01/2023] Open
Abstract
From 2006 to 2013, an increasing incidence of fusariosis was observed in the hematologic patients of our University Hospital. We suspected of an environmental source, and the indoor hospital air was investigated as a potential source of the fungemia. Air samplings were performed in the hematology and bone marrow transplant (BMT) wards using an air sampler with pre-defined air volumes. To study the molecular relationship among environmental and clinical isolates, 18 Fusarium spp. recovered from blood cultures were included in the study. DNA sequencing of a partial portion of TEF1α gene was performed for molecular identification. Molecular typing was carried out by multi-locus sequence typing (MLST) using a four-gene scheme: TEF1α, rDNA, RPB1 and RPB2. One hundred four isolates were recovered from the air of the hematology (n = 76) and the BMT (n = 28) wards. Fusarium isolates from the air were from five species complexes: Fusarium fujikuroi (FFSC, n = 56), Fusarium incarnatum-equiseti (FIESC, n = 24), Fusarium solani (FSSC, n = 13), Fusarium chlamydosporum (FCSC, n = 10), and Fusarium oxysporum (FOSC, n = 1). Fifteen Fusarium isolates recovered from blood belonged to FSSC, and three to FFSC. MLST identified the same sequence type (ST) in clinical and environmental isolates. ST1 was found in 5 isolates from blood and in 7 from the air, both identified as FSSC (Fusarium petroliphilum). STn1 was found in one isolate from blood and in one from the air, both identified as FFSC (Fusarium napiforme). F. napiforme was isolated from the air of the hospital room of the patient with fungemia due to F. napiforme. These findings suggested a possible clonal origin of the Fusarium spp. recovered from air and bloodcultures. In conclusion, our study found a diversity of Fusarium species in the air of our hospital, and a possible role of the air as source of systemic fusariosis in our immunocompromised patients.
Collapse
Affiliation(s)
- Maria Luiza Moretti
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
- * E-mail:
| | | | - Cibele Aparecida Tararam
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Renato Moraes
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Yasunori Muraosa
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Yuzuru Mikami
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Tohru Gonoi
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Hideaki Taguchi
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Luzia Lyra
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Franqueline Reichert-Lima
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Plínio Trabasso
- Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Gerrit Sybren de Hoog
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institutes of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
- Basic Pathology Department, Federal University of Paraná State, Curitiba, Paraná, Brazil
- Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Mohammed Said Al-Hatmi
- CBS-KNAW Fungal Biodiversity Centre, Utrecht, The Netherlands
- Institutes of Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
- Directorate General of Health Services, Ibri Hospital, Ministry of Health, Muscat, Oman
| | - Angelica Zaninelli Schreiber
- Department of Clinical Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Sao Paulo, Brazil
| | - Katsuhiko Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| |
Collapse
|
3
|
Hypersensitivity pneumonitis and antigen identification--An alternate approach. Respir Med 2015; 112:97-105. [PMID: 26831202 DOI: 10.1016/j.rmed.2015.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 07/07/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Identification of the causal antigen for patients with hypersensitivity pneumonitis (HP) is challenging in a standard clinical setting. The purpose of this pilot study was to determine whether it was possible to evaluate the home/workplace of patients, and identify the causal antigen. METHODS Using a case-control study design we compared the presence of antibody to antigen collected in the environment of individuals with HP and controls consisting of family members/co-workers. Based on patient interviews, homes/workplaces were evaluated and suspected sources of antigen collected for use in immunoassays. RESULTS Nineteen individuals with HP participated with 15 classified as having fibrotic disease. Up to 54 bulk samples were collected from each patient's environment, with multiple isolates (antigens) cultured from each. Of the seven individuals who tested positive to one or more environmental samples, three had a positive response to more than 1 antigen from the environmental sample (range 1-9). Twelve individuals tested positive to antigen(s) on a standard panel, with only one overlapping with the antigen from the home/workplace sample. A significant association existed between results of interviews/site evaluations, and ability to collect antigen eliciting a positive response (p < 0.001). CONCLUSION Antigen identification was successful for patients with 'active' disease. Antigens for which patients test positive on standard panels may not be present in their environment. One benefit to patient-centered testing is the ability to develop recommendations specific to their environment. As most individuals tested positive for >1 antigen, further investigation is warranted to determine the actual antigen responsible for disease.
Collapse
|
4
|
Dickson SD, Tankersley MS. Fatal Hypersensitivity Pneumonitis from Exposure to Fusarium vasinfectum in a Home Environment: A Case Report. Int Arch Allergy Immunol 2015; 166:150-3. [PMID: 25871746 DOI: 10.1159/000377631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is a rare, non-IgE-mediated inflammatory lung disease caused by inhalational exposure to various antigens found in occupational, avocational and home environments. The prognosis is favorable with early detection and prompt removal of the causative agent, and fatalities are unusual. We present a fatal case of HP caused by chronic exposure to Fusarium vasinfectum mold in the home. CASE REPORT A 37-year-old white male presented with a 6-month history of progressively worsening dyspnea, cough, weight loss and fatigue associated with the self-renovation of his water-damaged, mold-infested mobile home. Evaluation included a physical examination (hypoxia, inspiratory crackles and expiratory rhonchi), baseline pulmonary function testing (mixed obstructive/restrictive pattern), chest computed tomography (bronchiectasis, fibrosis and diffuse interstitial involvement), bronchoalveolar lavage (macrophages 20%, lymphocytes 28% and neutrophils 52%) and transbronchial biopsy (interstitial fibrosis and chronic inflammatory infiltrate). Mold culture from the home grew out F. vasinfectum. An Ouchterlony double diffusion technique documented high antibody titer to F. vasinfectum. Despite aggressive intravenous corticosteroid treatment, the patient's lung function declined to the extent that he could not be removed from ventilator support following an open lung biopsy, eventually resulting in death. CONCLUSION This is the first reported case of fatal HP related to an acute exacerbation of a chronic form of HP following continuous and intense exposure to F. vasinfectum. Although uncommon, a high index of suspicion for HP is necessary in patients with progressive respiratory symptoms and known environmental antigen exposure. With early detection and prompt removal of the causative antigen, HP prognosis is generally favorable, but can progress to fatal disease with continued exposure.
Collapse
Affiliation(s)
- Scott D Dickson
- Department of Allergy and Immunology, 56th MDG/SGOMA, Luke Air Force Base, Glendale, Ariz., USA
| | | |
Collapse
|
5
|
Taxonomy and Clinical Spectra of Fusarium Species: Where Do We Stand in 2014? CURRENT CLINICAL MICROBIOLOGY REPORTS 2014. [DOI: 10.1007/s40588-014-0003-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
6
|
|
7
|
Ramirez RM, Jacobs RL. Hypersensitivity pneumonitis by Fusarium vasinfectum in a home environment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:483-4. [DOI: 10.1016/j.jaip.2014.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/19/2014] [Accepted: 04/04/2014] [Indexed: 11/30/2022]
|
8
|
Homa M, Shobana CS, Singh YRB, Manikandan P, Selvam KP, Kredics L, Narendran V, Vágvölgyi C, Galgóczy L. Fusarium keratitis in South India: causative agents, their antifungal susceptibilities and a rapid identification method for the Fusarium solani species complex. Mycoses 2013; 56:501-511. [PMID: 23437826 DOI: 10.1111/myc.12062] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 01/23/2013] [Accepted: 01/23/2013] [Indexed: 09/07/2023]
Abstract
Seventy Fusarium isolates derived from human keratomycosis were identified based on partial sequences of the β-tubulin (β-TUB) and translation elongation factor 1α (EF-1α) genes. Most of the isolates were confirmed as members of the F. solani species complex (75.71%), followed by the F. dimerum species complex (8.57%), the F. fujikuroi species complex (8.57%), the F. oxysporum species complex (4.29%) and the F. incarnatum-equiseti species complex (2.86%). A combined phylogenetic tree was estimated including all the 70 isolates. Isolates belonging to different species complexes formed separate clades. In this study, we also report the first isolation of F. napiforme from human keratomycosis. A new method based on a specific EcoRI restriction site in the EF-1α gene was developed for the rapid identification of F. solani. In vitro antifungal susceptibilities of the isolates to seven antifungals were determined by broth microdilution method. Terbinafine, natamycin and amphotericin B proved to be the most effective drugs, followed by voriconazole. The minimal inhibitory concentrations of clotrimazole, econazole and itraconazole were generally high (≥64 μg ml(-1) ). The interactions between the two most effective antifungals (natamycin and terbinafine) were determined by checkerboard microdilution method. Synergism (71.8%) or no interaction (28.2%) was revealed between the two compounds.
Collapse
Affiliation(s)
- Mónika Homa
- Faculty of Science and Informatics, Department of Microbiology, University of Szeged, H-6726 Szeged, Hungary
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Griese M, Haug M, Hartl D, Teusch V, Glöckner-Pagel J, Brasch F. Hypersensitivity pneumonitis: lessons for diagnosis and treatment of a rare entity in children. Orphanet J Rare Dis 2013; 8:121. [PMID: 23924322 PMCID: PMC3751081 DOI: 10.1186/1750-1172-8-121] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 07/03/2013] [Indexed: 11/25/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) also called exogenous allergic alveolitis = extrinsic allergic alveolitis in children is an uncommon condition and may not be recognized and treated appropriately. To assess current means of diagnosis and therapy and compare this to recommendations, we used the Surveillance Unit for Rare Paediatric Disorders (ESPED) to identify incident cases of HP in Germany during 2005/6. In addition, cases of HP reported for reference from all over Germany to our center in the consecutive year were included. Twenty-three children with confirmed pediatric HP were identified. All (age 9.4 y (4.4-15.1) presented with dyspnoea at rest or with exercise, mean FVC was 39% of predicted, seven of the 23 children already had a chronic disease state at presentation. IgG against bird was elevated in 20, and against fungi in 15. Bronchoalveolar lavage was done in 18 subjects (41% lymphocytes, CD4/CD8 1.99), and lung biopsy in 6. Except 2, all children were treated with prolonged courses of systemic steroids. Outcome was not favourable in all cases. Late diagnosis in up to a quarter of the children with HP and inappropriate steroid treatment must be overcome to improve management of HP. Inclusion of children with HP into international, web-based registry studies will help to study and follow up such rare lung diseases.
Collapse
Affiliation(s)
- Matthias Griese
- Dr. von Haunersches Kinderspital, University of Munich, Member of the German Center for Lung Research, Lindwurmstr, 4a, D-80337 Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
10
|
Caillaud D, Raobison R, Evrard B, Montcouquiol S, Horo K. Pneumopathies d’hypersensibilité domestiques. Alvéolites allergiques extrinsèques domestiques. Rev Mal Respir 2012; 29:971-7. [DOI: 10.1016/j.rmr.2012.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 03/17/2012] [Indexed: 10/27/2022]
|
11
|
Unoura K, Miyazaki Y, Sumi Y, Tamaoka M, Sugita T, Inase N. Identification of fungal DNA in BALF from patients with home-related hypersensitivity pneumonitis. Respir Med 2011; 105:1696-703. [PMID: 21824758 DOI: 10.1016/j.rmed.2011.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 07/16/2011] [Accepted: 07/18/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND In Japan, a major type of home-related hypersensitivity pneumonitis (HP) is summer-type HP, which is caused by Trichosporon asahii (T. asahii) or Trichosporon mucoides. Some patients with home-related HP test negative for antibodies against Trichosporon; yet, a causative mold antigen cannot be identified. METHODS We analyzed 19 patients with home-related HP, 8 healthy volunteers, and 35 patients with other diseases. We extracted DNA from cell pellets of bronchoalveolar lavage fluid (BALF), amplified the DNA by PCR using Trichosporon-specific primers or other fungus-specific primers, and cloned as well as sequenced the PCR amplicon. Other primers used were specific for Acremonium chrysogenum, Aspergillus fumigatus, Aspergillus niger, Fusarium napiforme, Humicola fuscoatra, Penicillium corylophilum, and Pezizia domiciliana. RESULTS We detected Trichosporon DNA (n = 17) and F. napiforme DNA (n = 2) by PCR in 19 patients with home-related HP; however, these species were not identified in healthy volunteers. After sequencing of the PCR amplicon for Trichosporon species, we identified T. asahii (n = 11), Trichosporon japonicum (n = 1), and Cryptococcus uzbekistanesis (n = 4). CONCLUSION We could detect fungal DNA in BALF cell pellets from patients with home-related HP. These data suggest that this method might be useful to detect antigens responsible for home-related HP.
Collapse
Affiliation(s)
- Koji Unoura
- Department of Integrated Pulmonology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | | | | | | | | | | |
Collapse
|
12
|
Metersky ML, Bean SB, Meyer JD, Mutambudzi M, Brown-Elliott BA, Wechsler ME, Wallace RJ. Trombone player's lung: a probable new cause of hypersensitivity pneumonitis. Chest 2010; 138:754-6. [PMID: 20823006 DOI: 10.1378/chest.10-0374] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
13
|
Lombardi C, Griffiths E, McLeod B, Caviglia A, Penagos M. Search engine as a diagnostic tool in difficult immunological and allergologic cases: is Google useful? Intern Med J 2009; 39:459-64. [DOI: 10.1111/j.1445-5994.2008.01875.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Sahakian N, Park JH, Cox-Ganser J. Respiratory morbidity and medical visits associated with dampness and air-conditioning in offices and homes. INDOOR AIR 2009; 19:58-67. [PMID: 19076249 DOI: 10.1111/j.1600-0668.2008.00561.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED We used data from 4345 adult US residents who were part of a 2004 national random mail survey to investigate associations between dampness and air-conditioning (AC) in homes and offices, and health outcomes, sick leave due to respiratory symptoms and medical visits during the past 12 months. We identified from this group 1396 office workers employed in professional, executive, administrative, managerial or administrative support occupations. Office workers reporting home dampness had an elevated prevalence of nasal symptoms [prevalence ratio (PR) = 1.4, P = 0.01] and constitutional symptoms (PR = 1.3, P = 0.01) in the previous year. Office workers reporting workplace dampness had an elevated prevalence of sick leave attributed to respiratory symptoms (PR = 1.3, P = 0.04) in the previous year. Office workers with home AC were more likely to have visited a medical specialist in the previous year (PR = 1.3, P = 0.02). We did not find any statistically significant associations between workplace AC and any of the health outcomes. We estimated an annual cost of US$1.4 billion for excess respiratory-related sick leave among office workers with workplace dampness. Our study strengthens the evidence of a relationship between dampness and health effects, and highlights the resulting economic impact. PRACTICAL IMPLICATIONS This study adds to the literature on respiratory morbidity associated with home and office exposures to mold and dampness. Public health response to lessen these exposures will improve the health and well-being of residents and workers as well as diminish the economic burden of lost work time and medical costs.
Collapse
Affiliation(s)
- N Sahakian
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, Morgantown, WV 26505, USA.
| | | | | |
Collapse
|
15
|
Katayama N, Fujimura M, Yasui M, Ogawa H, Nakao S. Hypersensitivity pneumonitis and bronchial asthma attacks caused by environmental fungi. Allergol Int 2008; 57:277-80. [PMID: 18493169 DOI: 10.2332/allergolint.c-07-56] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2007] [Accepted: 12/10/2007] [Indexed: 11/20/2022] Open
Abstract
We report a case of hypersensitivity pneumonitis and asthma attacks caused by environmental fungi in a 75-year-old man. The diagnosis was established by inhalation challenge with Bjerkandera adusta and Aspergillus fumigatus. The patient was admitted for treatment of fever, wheezing, and dyspnea. Chest computed tomography showed small nodular shadows with diffuse, partially patchy, ground-glass opacities. The findings of bronchoalveolar lavage fluid were compatible with hypersensitivity pneumonitis. His symptoms and objective findings, including chest radiographs, worsened after returning home, suggesting the existence of causative antigens in his house. B. adusta and A. fumigatus were isolated from the living room and bedroom. Based on the results of antigen inhalation bronchoprovocation test, he was given a diagnosis of hypersensitivity pneumonitis caused by B. adusta and bronchial asthma attacks caused by B. adusta and A. fumigatus. After cleaning the entire house, the patient has had no recurrence of the symptoms on returning home.
Collapse
Affiliation(s)
- Nobuyuki Katayama
- Respiratory Medicine, Kanazawa University Hospital, Ishikawa, Japan.
| | | | | | | | | |
Collapse
|
16
|
Hypersensitivity pneumonitis secondary to residential exposure to Aureobasidium pullulans in 2 siblings. Ann Allergy Asthma Immunol 2008; 99:562-6. [PMID: 18219839 DOI: 10.1016/s1081-1206(10)60387-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is an immune-mediated hypersensitivity reaction to a variety of inhaled particles that may lead to acute, subacute, or chronic interstitial pneumonitis and possibly end-stage lung disease. Avian antigens most commonly cause HP in children, but fungi have also been implicated. OBJECTIVE To describe a 15-year-old girl and her 6-year-old brother who developed HP from residential exposure to Aureobasidium pullulans. METHODS Allergy skin testing, serum precipitating antibodies, pulmonary function testing, chest radiography, chest computed tomography, bronchoalveolar lavage, and a home survey for possible causative antigens were performed. RESULTS Both patients lived on a horse farm and had fatigue, weight loss, cough, and dyspnea. The siblings had restrictive patterns on pulmonary function tests, with decreased diffusion capacity of carbon monoxide, ground-glass opacities on high-resolution chest computed tomography, and serum precipitins to A pullulans. Bronchoalveolar lavage in the girl demonstrated lymphocytosis, with a preponderance of CD8+ T cells and natural killer cells. Symptoms improved after the children vacated the home and recurred on repeated exposure in both patients. Home evaluation revealed extensive mold contamination, with A pullulans counts of 659, 329, and 71 CFU/m3 in the boy's bedroom, the girl's bedroom, and outdoors, respectively. CONCLUSIONS The diagnosis of HP in these siblings is supported by the clinical history, the diagnostic findings, and the recurrence of symptoms on repeated exposure. These cases represent the second report of HP resulting from nonoccupational exposure to A pullulans in North America and the first report in children.
Collapse
|
17
|
Colin G, Lelong J, Tillie-Leblond I, Tonnel AB. [Hypersensitivity pneumonitis in a chicory worker]. Rev Mal Respir 2007; 24:1139-42. [PMID: 18176392 DOI: 10.1016/s0761-8425(07)74265-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We report a case of occupational hypersensitivity pneumonitis in a patient handling chicory leaves. CASE REPORT The diagnosis was based symptoms of broncho-alveolitis with pyrexia, positive precipitins to moulds present on chicory, especially Fusarium, and the disappearance of the clinical and radiological manifestations following cessation of exposure to chicory. CONCLUSION "Chicory worker's lung" is an occupational disease which should be considered in cases of respiratory symptoms suggestive of hypersensitivity pneumonitis and chronic exposure to chicory leaves.
Collapse
Affiliation(s)
- G Colin
- Service de Pneumologie et Immuno-Allergologie, Hôpital Albert-Calmette, Lille, France
| | | | | | | |
Collapse
|
18
|
Abstract
Mold is ubiquitous, and exposure to mold and its products of metabolism is unavoidable, whether indoors or outdoors. Mold can produce a variety of adverse health outcomes by four scientifically validated pathophysiologic mechanisms: hypersensitivity, toxicity, infection, and irritation. Some adverse health outcomes have been attributed to mold for which mechanisms of injury are not well defined or are implausible. This article discusses these adverse health outcomes, focusing predominantly on those for which valid associations have been established.
Collapse
Affiliation(s)
- James M Seltzer
- Division of Occupational and Environmental Medicine, University of California, Irvine, School of Medicine, 5201 California Avenue, Suite 100, Irvine, CA 92617, USA.
| | | |
Collapse
|
19
|
Galante D, Hartung de Capriles C, Mata-Essayag S, Conesa A, Córdova Y, Trejo E, Tassinari P. Respiratory allergies in Venezuela: are fungi responsible? Mycoses 2006; 49:493-8. [PMID: 17022767 DOI: 10.1111/j.1439-0507.2006.01273.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exposure to fungi in the indoor environment may trigger hypersensitivity to a variety of fungi and is known to be an influencing factor in allergic rhinitis and asthma. A wide list of airborne fungal spores and dust containing fungi have been described for different environments; however, their clinical relevance is seldom clear. In this survey we measure levels of fungi indoor and outdoor of domestic dwellings of 10 patients with known chronic allergic respiratory disease to fungi. To measure hypersensitivity to fungi, Prick (sensitivity to fungi), RAST (specific serum IgE levels) and PAR (persistent allergic rhinitis) severity are assessed in relation to fungal load in the environment. Only association of PAR and indoor fungal load were found to be significant (P = 0.1648). No direct causality with sensitivity to the amount of exposure, or a hypersensitivity to a specific fungal genus could be established. There is still no consensus on the most relevant methods for measuring personal exposure and 'no safe levels' have been established yet.
Collapse
Affiliation(s)
- David Galante
- Instituto de Inmunología, Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela
| | | | | | | | | | | | | |
Collapse
|
20
|
Lee YM, Kim YK, Kim SO, Kim SJ, Park HS. A case of hypersensitivity pneumonitis caused by Penicillium species in a home environment. J Korean Med Sci 2005; 20:1073-5. [PMID: 16361826 PMCID: PMC2779313 DOI: 10.3346/jkms.2005.20.6.1073] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 12/15/2004] [Indexed: 11/20/2022] Open
Abstract
We report a case of hypersensitivity pneumonitis in a 30-yr-old female housewife caused by Penicillium species found in her home environment. The patient was diagnosed according to history, chest radiograph, spirometry, high-resolution chest CT, and transbronchial lung biopsy. To identify the causative agent, cultured aeromolds were collected by the open-plate method. From the main fungi cultured, fungal antigens were prepared, and immunoblot analysis with the patient's serum and each fungal antigen was performed. A fungal colonies were isolated from the patient's home. Immunoblotting analysis with the patient's sera demonstrated a IgG-binding fractions to Penicillium species extract, while binding was not noted with control subject. This study indicates that the patient had hypersensitivity pneumonitis on exposure to Penicillium species in her home environment.
Collapse
Affiliation(s)
- Young-Mok Lee
- Department of Respiratory Medicine and Allergy, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Yang-Ki Kim
- Department of Respiratory Medicine and Allergy, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Shin-Ok Kim
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Seoul, Korea
| | - Sang-Jae Kim
- Korean Institute of Tuberculosis, Korean National Tuberculosis Association, Seoul, Korea
| | - Hae-Sim Park
- Department of Allergy and Rheumatology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
21
|
Jacobs RL, Andrews CP, Coalson JJ. Hypersensitivity pneumonitis: beyond classic occupational disease-changing concepts of diagnosis and management. Ann Allergy Asthma Immunol 2005; 95:115-28. [PMID: 16136760 DOI: 10.1016/s1081-1206(10)61200-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To review inhaled antigens in home environments that cause hypersensitivity pneumonitis (HP) of varied clinical expressions and histopathologic patterns. DATA SOURCES Computer-assisted MEDLINE and manual searches for articles concerning HP, interstitial lung disease (ILD), epidemiology of HP and ILD, challenge procedures of HP, and indoor fungi. STUDY SELECTION Published articles concerning inhaled antigens in home environments and HP were selected. RESULTS Current criteria for the diagnosis of HP are too restrictive, because most apply only to the classic acute presentation and are of limited value in the subacute and insidious forms. Clinical expressions vary across the gamut of respiratory tract signs and symptoms. Patterns on lung biopsy may include all histopathologic descriptions of idiopathic ILD. The home is the likely causative environment rather than the workplace. Exposures may be occult and require in-depth environmental histories and on-site investigations to detect antigens and sources. CONCLUSIONS Natural or environmental challenges have become an important tool for diagnosing HP and determining effectiveness of remediation. Early diagnosis and effective remediation of the cause lead to a high survival rate, whereas diagnosis in advanced stages leads to disability and/or premature death.
Collapse
Affiliation(s)
- Robert L Jacobs
- Biogenics Research Institute, San Antonio, Texas 78229, USA.
| | | | | |
Collapse
|
22
|
Shoemaker RC, House DE. A time-series study of sick building syndrome: chronic, biotoxin-associated illness from exposure to water-damaged buildings. Neurotoxicol Teratol 2005; 27:29-46. [PMID: 15681119 DOI: 10.1016/j.ntt.2004.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2004] [Revised: 07/30/2004] [Accepted: 07/30/2004] [Indexed: 11/15/2022]
Abstract
The human health risk for chronic illnesses involving multiple body systems following inhalation exposure to the indoor environments of water-damaged buildings (WDBs) has remained poorly characterized and the subject of intense controversy. The current study assessed the hypothesis that exposure to the indoor environments of WDBs with visible microbial colonization was associated with illness. The study used a cross-sectional design with assessments at five time points, and the interventions of cholestyramine (CSM) therapy, exposure avoidance following therapy, and reexposure to the buildings after illness resolution. The methodological approach included oral administration of questionnaires, medical examinations, laboratory analyses, pulmonary function testing, and measurements of visual function. Of the 21 study volunteers, 19 completed assessment at each of the five time points. Data at Time Point 1 indicated multiple symptoms involving at least four organ systems in all study participants, a restrictive respiratory condition in four participants, and abnormally low visual contrast sensitivity (VCS) in 18 participants. Serum leptin levels were abnormally high and alpha melanocyte stimulating hormone (MSH) levels were abnormally low. Assessments at Time Point 2, following 2 weeks of CSM therapy, indicated a highly significant improvement in health status. Improvement was maintained at Time Point 3, which followed exposure avoidance without therapy. Reexposure to the WDBs resulted in illness reacquisition in all participants within 1 to 7 days. Following another round of CSM therapy, assessments at Time Point 5 indicated a highly significant improvement in health status. The group-mean number of symptoms decreased from 14.9+/-0.8 S.E.M. at Time Point 1 to 1.2+/-0.3 S.E.M., and the VCS deficit of approximately 50% at Time Point 1 was fully resolved. Leptin and MSH levels showed statistically significant improvement. The results indicated that CSM was an effective therapeutic agent, that VCS was a sensitive and specific indicator of neurologic function, and that illness involved systemic and hypothalamic processes. Although the results supported the general hypothesis that illness was associated with exposure to the WDBs, this conclusion was tempered by several study limitations. Exposure to specific agents was not demonstrated, study participants were not randomly selected, and double-blinding procedures were not used. Additional human and animal studies are needed to confirm this conclusion, investigate the role of complex mixtures of bacteria, fungi, mycotoxins, endotoxins, and antigens in illness causation, and characterize modes of action. Such data will improve the assessment of human health risk from chronic exposure to WDBs.
Collapse
Affiliation(s)
- Ritchie C Shoemaker
- Chronic Fatigue Center, 500 Market Street, Suite 103, Pocomoke City, MD 21851, United States
| | | |
Collapse
|
23
|
Winck JC, Delgado L, Murta R, Lopez M, Marques JA. Antigen characterization of major cork moulds in Suberosis (cork worker's pneumonitis) by immunoblotting. Allergy 2004; 59:739-45. [PMID: 15180761 DOI: 10.1111/j.1398-9995.2004.00472.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We characterized by immunoblotting the antigenicity of the most frequent fungi colonizing cork during its industrial processing, Penicillium glabrum and Chrysonilia sitophila. Penicillium glabrum is the main causative agent of Suberosis, a hypersensitivity pneumonitis of cork workers. Chrysonilia sitophila induces both IgE sensitization and occupational asthma in the wood processing industry. METHODS Serum-specific IgG, IgG4 and IgE to P. glabrum and C. sitophila from nine cork workers with hypersensitivity pneumonitis (HP) and seven with asthma (four with occupational asthma) were analysed by immunoblotting. RESULTS Both HP and asthmatic patients' sera showed immunoreactivity to several proteins resolved in the specific immunoblot strips. The frequency of specific IgG recognition to 12-13.5 and 33 kDa proteins of P. glabrum was significantly higher in HP patients. The sera of HP patients had significantly higher specific IgG recognition to 16 and 51-55 kDa proteins of C. sitophila. There was no specific IgE recognition in the sera of HP or asthmatic patients to both fungi. CONCLUSIONS Different patterns of antibody reactivity to P. glabrum and C. sitophila are seen in cork workers with hypersensitivity pneumonitis or asthma. The 12-13.5 and 33 kDa proteins of P. glabrum and the 16 and 51-55 kDa proteins of C. sitophila may be major antigens in Suberosis.
Collapse
Affiliation(s)
- J C Winck
- Pneumology Department, Faculdade de Medicina, Universidade do Porto, Portugal
| | | | | | | | | |
Collapse
|
24
|
|