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Treadwell S, Green M, Gowda G, Levetin E, Carlson JC. Fungal Sensitization and Human Allergic Disease. Curr Allergy Asthma Rep 2024; 24:281-288. [PMID: 38575791 DOI: 10.1007/s11882-024-01144-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE OF THE REVIEW Fungal sensitizations have been associated with hypersensitivity reactions with variable levels of evidence available to link types of fungi with human disease. We conducted systematic reviews of the literature to identify the strength of evidence linking lesser-studied fungi for which there are commercially available extracts to identify populations in which they were useful in clinical practice. RECENT FINDINGS Excluding five fungi for which hundreds of articles were identified, there are 54 articles on the remaining fungi with clinical data. For 12 of the fungi, the prevalence of fungal sensitization varies in different hypersensitivity disorders due to factors related to geographic areas, age, and other underlying medical conditions. There were no studies linking seven genera to human disease. Most of the commercially available fungal extracts are uncommonly associated with hypersensitivity reactions in humans. Specific extracts may be useful in particular disease states such as allergic fungal sinusitis or allergic bronchopulmonary mycosis, or when routine testing fails to identify a cause of uncontrolled disease, such as in asthma.
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Affiliation(s)
- Scout Treadwell
- Tulane University School of Medicine, 1430 Tulane Avenue New, Orleans, LA, 70112, USA
| | - Maxwell Green
- Tulane University School of Medicine, 1430 Tulane Avenue New, Orleans, LA, 70112, USA
| | - Geetha Gowda
- Tulane University School of Medicine, 1430 Tulane Avenue New, Orleans, LA, 70112, USA
| | - Estelle Levetin
- University of Tulsa, 800 S. Tucker Drive, Tulsa, OK, 74104, USA
| | - John C Carlson
- Ochsner Health Center, 1401 Jefferson Hwy, New Orleans, LA, 70121, USA.
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Hartsough EM, Foreman RK, Martinez-Lage M, Branda J, Sohani AR, Zukerberg L. Dematiaceous fungal infections: clinical and pathologic conundrums. J Clin Pathol 2024; 77:352-357. [PMID: 38272660 DOI: 10.1136/jcp-2023-209239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
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.
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Affiliation(s)
- Emily Mae Hartsough
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruth K Foreman
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Martinez-Lage
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Branda
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lawerence Zukerberg
- Department of Pathology and Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Park JH, Lemons AR, Croston TL, Park Y, Roseman J, Green BJ, Cox-Ganser JM. Mycobiota and the Contribution of Yeasts in Floor Dust of 50 Elementary Schools Characterized with Sequencing Internal Transcribed Spacer Region of Ribosomal DNA. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:11493-11503. [PMID: 35901271 PMCID: PMC10183301 DOI: 10.1021/acs.est.2c01703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The assemblage of fungi including unicellular yeasts in schools is understudied. We conducted an environmental study to characterize fungal communities in classroom floor dust. We collected 500 samples from 50 elementary schools in Philadelphia, PA, and evaluated room dampness/mold conditions. Genomic DNA from dust was extracted for internal transcribed spacer 1 Illumina MiSeq sequencing to identify operational taxonomic units (OTUs) organized from DNA sequences. Differential abundance analyses were performed to examine significant differences in abundance among groups. We identified 724 genera from 1490 OTUs. The genus Epicoccum was not diverse but the most abundant (relative abundance = 18.9%). Fungi were less diverse but most dissimilar in composition in the most water-damaged classrooms compared to the least water-damaged, indicating differential effects of individual classroom water-damage on fungal compositions. We identified 62 yeast genera, representing 19.6% of DNA sequences. Cyberlindnera was the most abundant (6.1%), followed by Cryptococcus, Aureobasidium, Rhodotorula, and Candida. The average relative abundance of yeasts tended to increase with increasing dampness and mold score and was significantly (p-value = 0.048) higher in the most water-damaged classrooms (22.4%) than the least water-damaged classrooms (18.2%). Our study suggests the need for further research on the potential health effects associated with exposures to yeasts in schools.
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Affiliation(s)
- Ju-Hyeong Park
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, United States
| | - Angela R Lemons
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, United States
| | - Tara L Croston
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, United States
| | - Yeonmi Park
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, United States
| | - Jerry Roseman
- Philadelphia Federation of Teachers Health & Welfare Fund & Union, Philadelphia, Pennsylvania 19103, United States
| | - Brett J Green
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, United States
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia 26505, United States
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Moran-Mendoza O, Aldhaheri S, Black CJA, Clements-Baker M, Khalil M, Boag A. Mold in Foam Pillows and Mattresses: A Novel Cause of Hypersensitivity Pneumonitis. Chest 2021; 160:e259-e263. [PMID: 34488964 DOI: 10.1016/j.chest.2021.04.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 03/20/2021] [Accepted: 04/02/2021] [Indexed: 10/20/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is an inflammatory and/or fibrotic disease affecting the lung parenchyma and small airways. It typically results from an immune-mediated reaction provoked by an overt or occult inhaled antigen in susceptible individuals. The chronic or fibrotic form of HP has a poor prognosis, especially when no inciting antigen is identified, which occurs in up to 60% of cases. We report two cases of HP associated with exposure to mold in foam pillows and a mattress, which has not previously been reported as a risk factor for HP. Given the high prevalence of foam in pillows and mattresses, mold in foam in bedding may explain many HP cases with a previously unrecognized cause. Early identification and avoidance of foam in bedding may prevent HP progression to end-stage pulmonary fibrosis and death.
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Affiliation(s)
- Onofre Moran-Mendoza
- Queen's University, Kingston, ON, Canada; Kingston Health Sciences Center, Kingston, ON, Canada.
| | | | | | - Marie Clements-Baker
- Queen's University, Kingston, ON, Canada; Kingston Health Sciences Center, Kingston, ON, Canada
| | - Mohamed Khalil
- Queen's University, Kingston, ON, Canada; Kingston Health Sciences Center, Kingston, ON, Canada
| | - Alexander Boag
- Queen's University, Kingston, ON, Canada; Kingston Health Sciences Center, Kingston, ON, Canada
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Kawamoto Y, Oda S, Tanaka M. Antigen avoidance in people with hypersensitivity pneumonitis: A scoping review. Heart Lung 2021; 50:407-416. [PMID: 33621839 DOI: 10.1016/j.hrtlng.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/31/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antigen avoidance (AA) is essential for people with hypersensitivity pneumonitis (HP). An intervention programme to promote continuous AA in people with HP will be the focus of future research. OBJECTIVES We systematically analysed the AA behaviour of people with HP, interventions of health-care providers to promote AA behaviour, clinical outcomes after AA, and evaluation methods after AA. METHODS We conducted a scoping review using six online databases and manual searches. Papers written in English or Japanese that reported cases on AA were selected. The extracted data were classified qualitatively. RESULTS In total 205 cases included in 109 eligible papers were examined. CONCLUSIONS This review clarified the fundamental evidence of AA in people with HP. These people required the continuous support of health-care providers to continue appropriate AA. This review highlighted four aspects that require further research to design interventions for promoting effective and continuous AA in people with HP.
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Affiliation(s)
- Yuko Kawamoto
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Sumika Oda
- Nursing Division, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Abed RM. Exploring Fungal Biodiversity of Genus Epicoccum and Their Biotechnological Potential. Fungal Biol 2021. [DOI: 10.1007/978-3-030-67561-5_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Soumagne T, Dalphin ML, Dalphin JC. [Hypersensitivity pneumonitis in children]. Rev Mal Respir 2019; 36:495-507. [PMID: 31010760 DOI: 10.1016/j.rmr.2018.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/14/2018] [Indexed: 12/13/2022]
Abstract
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by an immune response to a variety of antigens to which patients have been previously sensitised. It can occur at any age. In children, it is a rare disease, probably under-diagnosed, with an estimated prevalence of 4 per million. The paediatric forms are not really different from those of adults but present some particularities. Avian exposure is by far the most frequent cause of HP, accounting for nearly two-thirds of cases. Although there is no current recommendation for the diagnosis of HP, it is commonly considered that the diagnosis can be made with confidence on the combination of (1) compatible respiratory symptoms, (2) exposure to a known offending antigen, (3) lymphocytic alveolitis, (4) decreased transfer factor for carbon monoxide or hypoxia on exertion and (5) compatible radiologic features. The treatment is based on antigen avoidance that must be complete and definitive. Corticosteroids can be necessary in severe forms. The prognosis of HP in children is better than in adults, with a full clinical and functional recovery in the majority of cases after complete antigenic withdrawal.
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Affiliation(s)
- T Soumagne
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.
| | - M L Dalphin
- Service de pédiatrie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France
| | - J C Dalphin
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; UMR CNRS 6249, Chrono-environnement, université de Franche-Comté, 25000 Besançon, France.
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Segura-Medina P, Vargas MH, Aguilar-Romero JM, Arreola-Ramírez JL, Miguel-Reyes JL, Salas-Hernández J. Mold burden in house dust and its relationship with asthma control. Respir Med 2019; 150:74-80. [PMID: 30961954 DOI: 10.1016/j.rmed.2019.02.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Some evidences indicate that exposure to molds or their products can be relevant for the loss of asthma control. Thus, we measured the mold burden present inside houses of subjects with asthma, and evaluated its relationship with asthma control. METHODS Markers of asthma control in adult patients residing in Mexico City were evaluated through questionnaires and spirometry. Dust was collected from the patients' houses and its fungal content was determined by mold specific quantitative PCR (MSQPCR) for 36 fungal species. RESULTS Forty-two patients with asthma (12 males, 30 females) with a mean age of 45 years (18-76 years) were included in the study. The level of asthma control measured through the Asthma Control Test ranged from 9 to 25 (mean 20.9). The FEV1/FVC ratio fluctuated from 38 to 106 %predicted (mean, 87.4 %predicted). Associations between mold burden and asthma control differed between males and females. Thus, concentrations of some molds, particularly Aspergillus fumigatus, Aureobasidium pullulans, Stachybotrys chartarum, Alternaria alternata, Cladosporium cladosporioides 2, Cladosporium herbarum, and Epicoccum nigrum, were negatively associated with parameters of asthma control in male subjects, but not in female patients. CONCLUSION Our results showed that potential indoor exposure to some molds is associated with less asthma control in male subjects.
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Affiliation(s)
- Patricia Segura-Medina
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, CP 14080, Mexico City, Mexico
| | - Mario H Vargas
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, CP 14080, Mexico City, Mexico.
| | - José Manuel Aguilar-Romero
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, CP 14080, Mexico City, Mexico
| | - José Luis Arreola-Ramírez
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, CP 14080, Mexico City, Mexico
| | - José Luis Miguel-Reyes
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, CP 14080, Mexico City, Mexico
| | - Jorge Salas-Hernández
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, CP 14080, Mexico City, Mexico
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Levetin E, Horner WE, Scott JA. Taxonomy of Allergenic Fungi. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 4:375-385.e1. [PMID: 26725152 DOI: 10.1016/j.jaip.2015.10.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/19/2015] [Accepted: 10/16/2015] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Estelle Levetin
- Faculty of Biological Science, University of Tulsa, Tulsa, Okla.
| | | | - James A Scott
- Division of Occupational & Environmental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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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.
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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.
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Reboux G, Bellanger AP, Roussel S, Grenouillet F, Millon L. Moisissures et habitat : risques pour la santé et espèces impliquées. ARCH MAL PROF ENVIRO 2011. [DOI: 10.1016/j.admp.2011.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Reboux G, Bellanger AP, Roussel S, Grenouillet F, Millon L. Moisissures et habitat : risques pour la santé et espèces impliquées. REVUE FRANCAISE D ALLERGOLOGIE 2010. [DOI: 10.1016/j.reval.2010.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[Moulds in dwellings: health risks and involved species]. Rev Mal Respir 2010; 27:169-79. [PMID: 20206065 DOI: 10.1016/j.rmr.2009.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Accepted: 09/10/2009] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In industrialized countries the population spends 90% of its time in enclosed spaces. Since 1973, energy consumption for heating decreased on average by 36% per dwelling. Low-quality insulation, a fall in temperature and inadequate ventilation translated into high humidity in dwellings, which led to proliferation of moulds. BACKGROUND The allergenic, toxic and infectious effects of moulds on human health are documented. However, the potential dose/effect relationship between measured concentrations of indoor moulds and respiratory disorders often remains difficult to assess accurately. In several cases, fungi were demonstrated only as a promoter of health disorders. In a few cases (hypersensitivity pneumonitis, invasive fungal infections), the pathogenesis is without doubt due to environmental fungal exposure in a limited number of patients. On the other hand, the role of fungi was suspected but not proven for some well-defined pathologies, and some ill-defined health disorders, affecting large numbers of patients, such as the Sick Building Syndrome, rhinitis, sinusitis and conjunctivitis, as well as asthma and exacerbations of bronchitis. Eighteen fungal species, suspected of playing a role in public health, have been listed by the French Superior Council of Public Health. For each species, the proliferation conditions, type of substrates contaminated and heath effects reported in the literature are described. VIEWPOINT The lack of standardization of measurements of concentrations of fungal species, the interactions with chemical compounds (formaldehydes), organic compounds (mycotoxins, endotoxins) and between species, makes the analysis of indoor fungal contamination complicated. The time has come to establish clearly a relationship between exposure to fungi and health disorders, rather than continuing to investigate factors related to the level of indoor fungal contamination.
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Kukreja N, Sridhara S, Singh BP, Gaur SN, Arora N. Purification and immunological characterization of a 12-kDa allergen from Epicoccum purpurascens. ACTA ACUST UNITED AC 2009; 56:32-40. [PMID: 19239492 DOI: 10.1111/j.1574-695x.2009.00542.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- Neetu Kukreja
- Allergy and Immunology Section, Institute of Genomics and Integrative Biology (CSIR), Delhi University Campus, Delhi, India
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Engelhart S, Rietschel E, Exner M, Lange L. Childhood hypersensitivity pneumonitis associated with fungal contamination of indoor hydroponics. Int J Hyg Environ Health 2009; 212:18-20. [DOI: 10.1016/j.ijheh.2008.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Revised: 01/08/2008] [Accepted: 01/16/2008] [Indexed: 10/22/2022]
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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.
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Kukreja N, Arora N, Singh BP, Das HR, Sridhara S. Role of Glycoproteins Isolated from Epicoccum purpurascens in Host-Pathogen Interaction. Pathobiology 2007; 74:186-92. [PMID: 17643064 DOI: 10.1159/000103378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Accepted: 03/16/2007] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Attachment to host matrix is an important provisory step for the institution of any fungal infection. The present study investigates the role of glycoproteins of Epicoccum purpurascens in host-fungal adherence. METHODS Epicoccum spore-mycelial extract was fractionated on a concanavalin A-Sepharose column. Three glycoproteins of 12, 17 and 33 kDa (Epi p 1) were electroeluted and checked for hemagglutination and hemagglutination inhibition. The monosaccharide content of the highly potent protein Epi p 1 was determined by high-performance anion exchange chromatography and pulsed amperometric detection. The interaction of Epi p 1 with mannose-binding lectin (MBL) leading to the activation of the complement system was studied by immunoblot, ELISA and ELISA inhibition techniques. Immunoblot and immunoblot inhibition were carried out with culture filtrate to determine the nature of Epi p 1. RESULTS 33 (Epi p 1)-, 17- and 12-kDa proteins were 58, 46 and 38 times more potent than crude extract in hemagglutination activity (HA). The HA of Epi p 1 was inhibited by N-acetyl glucosamine, glucose and laminin. Epi p 1 had a high mannose content, showed MBL binding in ion-dependent manner and caused complement activation. The protein was detected in culture filtrate and thus seems to play a significant role in fungal invasion. CONCLUSION Epi p 1, an allergenic glycoprotein of E. purpurascens, is involved in host-fungal interactions through MBL.
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Affiliation(s)
- Neetu Kukreja
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research, Delhi University, Delhi, India
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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.
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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.
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Abstract
Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a form of immune-mediated inflammatory lung disease involving the distal portions of the lungs associated with intense or repeated exposure to a variety of finely dispersed environmental antigens. Although once believed to be a disease of adults because of its frequent association with the occupational setting, HP exists in the pediatric population and often goes unrecognized. Childhood HP is often associated with exposure to antigens in the home environment as well as with certain hobbies. Patients present in any one of the three disease stages: acute, subacute, and chronic, all with unique clinical presentations. Histopathologic findings depend on the disease stage at the time of evaluation. The immuno-pathogenesis is complex, but immune-complex (type III hypersensitivity) and cell-mediated (type IV hypersensitivity) immune responses appear to be the primary immune mechanisms involved in the pathogenesis of HP. Diagnosis can be very challenging. Although no single diagnostic or clinical laboratory test is available to diagnose HP, the most significant diagnostic tool is a detailed environmental exposure history. Avoidance of the inciting antigen is the most important form of treatment. Acute HP is responsive to antigen removal alone. However, a short course of prednisone for 2-3 weeks can be useful in patients with severe attacks. Subacute and chronic HP may require higher doses of corticosteroids for a longer duration (i.e. months); however, the long-term efficacy of using corticosteroids is still not well defined. As with most hypersensitivity diseases, early diagnosis provides the best prognosis.
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Affiliation(s)
- Purnima Venkatesh
- Section of Clinical Immunology, Allergy and Rheumatology, Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA
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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.
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Affiliation(s)
- Robert L Jacobs
- Biogenics Research Institute, San Antonio, Texas 78229, USA.
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Bisht V, Arora N, Singh BP, Pasha S, Gaur SN, Sridhara S. Epi p 1, an allergenic glycoprotein ofEpicoccum purpurascensis a serine protease. ACTA ACUST UNITED AC 2004; 42:205-11. [PMID: 15364105 DOI: 10.1016/j.femsim.2004.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2004] [Revised: 05/10/2004] [Accepted: 05/12/2004] [Indexed: 11/20/2022]
Abstract
Epicoccum purpurascens (EP) is a ubiquitous saprophytic mould, the inhalant spores and mycelia of which are responsible for respiratory allergic disorders in 5-7% of population worldwide. The diagnosis/therapy of these disorders caused by fungi involves the use of standardized and purified fungal extracts. A 33.5 kDa glycoprotein, Epi p 1 released histamine from whole blood cells of EP allergic patients at a concentration of 50-ng protein. The high specific IgE values detected in EP hypersensitive sera indicated that Epi p 1 is capable of mediating type I hypersensitive reaction in predisposed individuals. It also showed protease activity by virtue of its dose dependent cleavage of serine protease specific synthetic substrate, N-benzoyl arginine ethyl ester hydrochloride (BAEE). The serine protease nature of Epi p 1 was confirmed by its N-terminal sequence (ADG/FIVAVELD/STY) homology to a subtilisin like serine protease. The protease activity of Epi p 1 may be responsible for making its way into the system of pre-disposed individuals through epithelial cell detachment and the histamine releasing ability by cross-linking of IgE antibodies on cell surface is the cause of its allergenic nature.
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Affiliation(s)
- Vandana Bisht
- Institute of Genomics and Integrative Biology, Mall Road, DU Campus, Delhi 7, India.
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Abstract
Mold growth within homes and other buildings has been associated to varying degrees with human health problems. These problems vary from allergenic disease to toxicosis. Case definitions for mold exposure have not been adequately defined to allow for a pathognomonic diagnosis of mold-caused disease following indoor exposure. Some important factors that may contribute to the pathogenesis of indoor mold induced disease include beta (1,3)-D-glucans, outer cell wall fungal hydrophobins, 1,8-dihydroxynaphthalene melanin, fungal volatile organic compounds, mycotoxins, and stachylysin. The information in this contribution was presented as the ISHAM Presidential address as a means to clarify some of the confusing surrounding indoor mold-related health issues.
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Affiliation(s)
- Michael R McGinnis
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555-0609, USA.
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Nordness ME, Zacharisen MC, Fink JN. Toxic and other non-IgE-mediated effects of fungal exposures. Curr Allergy Asthma Rep 2003; 3:438-46. [PMID: 12906783 DOI: 10.1007/s11882-003-0081-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There are more than 100000 recognized species of fungi, comprising 25% of the biomass of the earth. Allergic, IgE-induced, manifestations of airborne fungi are common, whereas non-IgE manifestations are rare. Recently, much focus has been placed on the non-IgE-mediated effects of various molds, including hypersensitivity pneumonitis, infectious disease, and mycotoxicoses. Hypersensitivity pneumonitis is a clinical syndrome associated with systemic and interstitial lung disease that occurs in susceptible individuals following fungal inhalation. Most fungi are not pathogenic to man; however, certain fungi are capable of infecting immunocompetent individuals. Although mycotoxins and exposure to mycotoxins ("toxic mold syndrome") are implicated in causing numerous, nonspecific, systemic symptoms, currently, there is no scientific evidence to support the allegation that human health is affected by inhaled mycotoxins. However, if mold is discovered in a home, school, or office setting, the source should be investigated and appropriate remediation undertaken to minimize structural damage and potential allergic sensitization.
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Affiliation(s)
- Mark E Nordness
- Section of Allergy/Immunology, Medical College of Wisconsin, 9000 W Wisconsin Avenue, Suite 411, Milwaukee, WI 53226, USA.
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Bisht V, Singh BP, Arora N, Gaur SN, Sridhara S. Antigenic and allergenic cross-reactivity of Epicoccum nigrum with other fungi. Ann Allergy Asthma Immunol 2002; 89:285-91. [PMID: 12269649 DOI: 10.1016/s1081-1206(10)61956-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous studies have identified Epicoccum nigrum (EN) as an important aeroallergen. Shared allergenicity among some fungi responsible for type I allergic disorders has been reported. OBJECTIVE To study the cross-reactivity among different fungi and to identify immunoglobulin (Ig)G and IgE binding components shared between EN and 10 other fungi known to cause respiratory allergy. METHODS Cross-reactivity studies were carried out by enzyme-linked immunoadsorbent assay (ELISA) and immunoblot inhibition using both rabbit antiserum raised against EN and pooled sera from patients' EN-positive skin test. RESULTS A large number (82%) of EN-sensitive patients showed positive skin reactivity to other fungal extracts. ELISA inhibition revealed >50% inhibition in binding of EN-specific rabbit antibodies with Alternaria alternata, Curvularia lunata, Cladosporium herbarum, and Penicillium citrinum extract, whereas the other extracts showed only 20 to 40% inhibition. Rabbit antisera to A. alternata, C. herbarum, and C. lunata reacted with five to seven bands in EN, demonstrating the presence of shared antigens among these fungi. EN requires an amount of 100 ng for 50% IgE ELISA inhibition, whereas 175 ng of A. alternata, 160 ng of C. lunata, and 268 ng of C. herbarum and P. citrinum were required for the same. IgE immunoblot and immunoblot inhibition further revealed that 43-, 26-, and 17-kD allergenic bands were shared by EN and A. alternata, whereas the 80- and 37-kD bands were common to both EN and C. lunata. EN and C. herbarum shared 63- and 36-kD allergenic bands, whereas EN and P. citrinum shared the 34-kD band. CONCLUSION EN showed maximum cross-reactivity with A. alternata followed by C. lunata, C. herbarum, and P. citrinum. This information will be useful in treating EN-allergic patients.
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Bisht V, Singh BP, Arora N, Sridhara S, Gaur SN. Allergens of Epicoccum nigrum grown in different media for quality source material. Allergy 2000; 55:274-80. [PMID: 10753019 DOI: 10.1034/j.1398-9995.2000.00371.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Epicoccum nigrum (EN) extract used in allergy disorders exhibits batch-to-batch variations in protein composition and allergenic potency. In this study, the allergens of EN grown in different media were investigated. METHODS EN was grown in five different nutrient media as stationary cultures at 25 degrees C for 5-23 days. The growth pattern was characterized by measuring dry weight, protein and carbohydrate content. The antigenic and allergenic content of EN extract was evaluated with EN-positive patients' sera and antibodies raised in rabbit. RESULTS The growth of EN in Czapeck Dox medium yielded insufficient material, while Sabouraud's broth with yeast extract (SBY) gave maximum spore-mycelial mass and protein content. Potato dextrose broth (PDB) and potato dextrose agar (PDA) showed higher dry weight and protein in 7-9-day cultures. SDS-PAGE resolved 26, 22, and 21 protein bands in EN extracts from cultures of day-13 SBY, day-7 PDB, and day-9 PDA, respectively. IgE/IgG immunoblots showed more allergenic (25)/antigenic (25) bands in EN cultured in SBY than in the others. Specific IgE ELISA and intradermal tests showed EN extract from day-13 culture in SBY to be the most potent. CONCLUSIONS The day-13 culture of EN in SBY was the most potent and may be selected for preparing EN extracts for diagnosis of allergy and future studies.
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Affiliation(s)
- V Bisht
- Centre for Biochemical Technology, Delhi University Campus, India
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Noble J, Crow S, Ahearn D, Kuhn F. Allergic fungal sinusitis in the southeastern USA: involvement of a new agentEpicoccum nigrumEhrenb. ex Schlecht. 1824. Med Mycol 1997. [DOI: 10.1080/02681219780001501] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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