Allergenic properties of a feed protein of microfungal origin

Hypersensitivity pneumonitis with Paecilomyces as suspected inciting antigen

A 73-year-old man visited our hospital for persistent cough. Chest high-resolution CT (HRCT) showed infiltration shadows in lower lobes and diffuse ground glass opacities in the upper lobes. Blood tests showed elevated white blood cell, C-reactive protein, surfactant protein D, and Krebs von den Lungen-6 levels. After an antigen avoidance test, his HRCT and blood test findings improved; we diagnosed him with hypersensitivity pneumonitis (HP). A culture of the rotting interior walls within his home revealed Paecilomyces, which we believe caused his HP. Given the few patients with Paecilomyces-induced HP, systematic approach was important to identify the inciting antigen.

A case of acute hypersensitivity pneumonitis associated with an oil fan heater

We report here a case of acute hypersensitivity pneumonitis induced by an oil fan heater. A 57-year-old man was admitted to our hospital because of fever, nonproductive cough, and dyspnea. Paeccilomyces variotii and Paeccilomyces nivea were identified from an oil fan heater in his house. The result of an environmental challenge test was positive. Intradermal reaction and precipitin results to sugar antigen of those fungi were positive only in the patient. This is the first described case of acute hypersensitivity pneumonitis caused by an oil fan heater.

Peritoneal eosinophilia associated with Paecilomyces variotii infection in continuous ambulatory peritoneal dialysis

A 65-year-old woman maintained on continuous ambulatory peritoneal dialysis (CAPD) presented with a 5-month history of intermittent cloudy bags and sterile peritoneal and peripheral blood eosinophilia, which failed to clear despite conventional antibiotics. Impaired catheter inflow and delayed effluent drainage gradually occurred and intracatheter streptokinase, administered to rectify catheter dysfunction, dislodged a catheter cast composed of fungal hyphae of Paecilomyces variotii. Fungal peritonitis and Paecilomyces fungemia ensued, which were treated with amphotericin B and catheter removal. Peripheral eosinophilia rapidly resolved. Paecilomyces is a saprophytic fungus found in soil and water that is capable of infecting prosthetic devices. Eosinophils may have accumulated in this case in response to particulate fungal cell antigens being washed into the peritoneal cavity during dialysis. Chronic fungal catheter infection should be excluded in cases of late onset, persistant peritoneal eosinophilia on CAPD.

Occurrence of moulds in modern living and working environments

The occurrence of saprophytic moulds in indoor environments and their potential hazards to human health are discussed. In addition to mesophilic species, xerophilic moulds appear to be common, often developing together with mites. Allergic and non-allergic symptoms are reported when patients are exposed to moulds in homes, schools and working places. Air-conditioning systems are consistently involved with mould development. Complaints of eye-, nose- and throat-irritation as well as fatigue seem to be correlated with unpleasant odours produced by abundant mould growth, but the relationship between the symptoms and the odours is not understood. The role of air-borne mycotoxins is discussed. Methods to detect moulds in indoor environments are described. Because no single method or cultivation medium is sufficient to detect all the various indoor moulds, a combination of air sampling, direct microscopic examination and cultivation on both standard and low water activity media is recommended.