Fig 1 - uploaded by Shinji Okada
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Cladosporium cladosporioides . Cladosporium is a common fungus frequently encountered in most areas on the earth. The colony of the fungus appears gray to black or very dark green. The fungus used for the antibody assay was isolated from an air conditioner in the office of a patient with HP as a causative antigen.
Source publication
Interstitial lung diseases (ILDs) represent a large group of different diseases, with a large part comprising idiopathic interstitial pneumonias. Differentiating hypersensitivity pneumonitis (HP), especially its chronic form and other ILDs, is difficult because of similarities in radiological manifestation and clinical course, and the difficulty of...
Contexts in source publication
Context 1
... in all sera was measured by an immunofluorescence assay (IFA). Antibody titer to Cladosporium herbarum or Leptosphaerulina spp. was measured in sera from ILD patients. Fungi used in this study were isolated from the environments of patients with HP as causative antigens, and identified at the Medical Mycology Research Center, Chiba University (Fig. 1). Fungi were suspended in saline and 50 μL of sus- pension was mounted onto a glass slide, dried overnight in a box, and then fixed. Four-fold dilutions of sera from 10 to 327,680 times were mounted onto a glass slide and incubated for one hour at room tem- perature. After washing twice with PBS, FITC-labeled rabbit anti- human Kappa ...
Context 2
... this purpose, it is important to find common antigens to indicate HP from the wide variety of HP antigens. Cladosporium is a common fungus frequently encoun- tered in most areas on the earth (Al-Doory 1984). The col- ony of the fungus appears gray to black or very dark green on dead plants, food, straw, soil, paint, textiles, and many other organic materials. ...
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Citations
... 1). Finally, in their study, Watanuki et al. [ 8 ] found an increased prevalence of IgG antibody to Cladosporium in interstitial lung disease. Therefore, greater attention than hitherto should be paid to this inhalation challenge-proven antigen in allergic alveolitis. ...
Bisher wurde erst einmal in der Weltliteratur eine allergische Alveolitis infolge Verarbeitung und Transport von Zwiebeln und Kartoffeln beschrieben. Bei knapp einjähriger Expositionsdauer war die Krankheit folgenlos ausgeheilt. Als Verursacher konnten die Schimmelpilze Penicillium und Fusarium ausfindig gemacht werden.
... 1). Finally, in their study, Watanuki et al. [8] found an increased prevalence of IgG antibody to Cladosporium in interstitial lung disease. Therefore, greater attention than hitherto should be paid to this in- halation challenge-proven antigen in allergic alveolitis. ...
... 77 Similar cases have been reported in adults for other fungi including taxa such as Cladosporium. 78 Morbidity clearly is increased if exposure to the offending substance persists. What is less clear is whether having the patient avoid exposure to the offending agent can reduce morbidity. ...
Fungi are ubiquitous microorganisms that are present in outdoor and indoor environments. Previous research has found relationships between environmental fungal exposures and human health effects. We reviewed recent articles focused on fungal exposure and dampness as risk factors for respiratory disease development, symptoms, and hypersensitivity. In particular, we reviewed the evidence suggesting that early exposure to dampness or fungi is associated with the development of asthma and increased asthma morbidity. Although outdoor exposure to high concentrations of spores can cause health effects such as asthma attacks in association with thunderstorms, most people appear to be relatively unaffected unless they are sensitized to specific genera. Indoor exposure and dampness, however, appears to be associated with an increased risk of developing asthma in young children and asthma morbidity in individuals who have asthma. These are important issues because they provide a rationale for interventions that might be considered for homes and buildings in which there is increased fungal exposure. In addition to rhinitis and asthma, fungus exposure is associated with a number of other illnesses including allergic bronchopulmonary mycoses, allergic fungal sinusitis, and hypersensitivity pneumonitis. Additional research is necessary to establish causality and evaluate interventions for fungal- and dampness-related health effects.
Despite making up a significant proportion of airborne allergens, the relationship between fungal spores and asthma is not fully explored. Only 80 taxa of fungi have so far been observed to exacerbate respiratory presentations, with Cladosporium spp., Aspergillus spp., Penicillium spp., and Alternaria spp. found to comprise the predominant allergenic airborne spores. Fungal spores have been found in indoor environments, such as hospitals and housing due to poor ventilation. Meanwhile, outdoor fungal spores exhibit greater diversity, and higher abundance and have been associated with hospitalizations from acute asthma presentations. In addition, fungal spores may be the underlying, and perhaps the “missing link”, factor influencing the heightened rate of asthma presentations during epidemic thunderstorm asthma events. To improve our knowledge gap on fungal spores, airborne allergen monitoring must be improved to include not only dominant allergenic fungi but also provide real-time data to accurately and quickly warn the general public. Such data will help prevent future asthma exacerbations and thus save lives. In this review, we examine the health risks of prominent allergenic fungal taxa, the factors influencing spore dispersal and distribution, and why improvements should be made to current sampling methods for public health and wellbeing.
Background
Only one case of occupational extrinsic allergic alveolitis due to mold inhaled during the sorting and transportation of onions and potatoes has been described in the literature to date. While having been exposed for one year the disease had healed up completely. Penicillium and Fusarium molds could be identified as cause of the extrinsic allergic alveolitis. We observed the second such patient albeit with more pronounced symptoms. We describe the patient’s severe symptoms as well as his broader range of antibodies.
Methods
Assessment of comprehensive documentation as part of the medical examination, interview of former attending physicians, and additional IgG antibody investigations by ELISA and CAP-FEIA technique in order to detect more than the thus far known antigens.
Results
A 53-year-old male non-smoker of German descent, who had worked in the sorting and transportation business of onions and potatoes for more than 20 years was diagnosed with an occupational extrinsic allergic alveolitis. Possible triggers are the molds Penicillium chrysogenum, Aspergillus fumigatus, Fusarium proliferatum, and Cladosporium herbarum—against all of which IgG antibodies were detected in the patient’s serum. After antigen avoidance symptoms improved. Interstitial lesions visible on X-ray, a significant diffusion impairment, and a pulmonary hypertension have persisted, though. The disease was accepted as a occupational disease.
Conclusions
Sorting onions and potatos not only can elicit moderate symptoms of an allergic alveolitis that heal without consequences, but can also lead to irreversible lung fibrosis associated with pulmonary hypertension. According to our findings, in addition to Penicillium, Fusarium, and Aspergillus molds Cladosporium herbarum is a possible antigen, too. Thus, this type of extrinsic allergic alveolitis is a serious notifiable occupational disease.
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.
