Allergic Bronchopulmonary Mycosis due to fungi other than Aspergillus

Allergic Bronchopulmonary Mycosis Caused by Mucor Overlapping With Invasive Pulmonary Mucormycosis: A Case Report

Mucormycosis is a rare and invasive fungal infection with high mortality. Cases of invasive pulmonary mucormycosis that involve allergic reactions such as allergic bronchopulmonary mycosis are rarely reported. Herein, we describe a case of invasive pulmonary mucormycosis overlapping with allergic diseases in a patient who presented with eosinophilia and high total plasma immunoglobulin E (IgE). The patient was successfully treated with systemic corticosteroids (initial dose of prednisolone approximately 0.5 mg/kg per day, total duration less than 3 months) combined with posaconazole antifungal therapy. The treatment resulted in recovery of peripheral-blood eosinophil count and total plasma IgE, and significant reduction in lung lesions. A subsequent lobectomy was performed. The findings in this case indicate that systemic corticosteroid therapy may contribute to the treatment of pulmonary mucormycosis combined with allergic factors.

Comprehensive Fungal Community Analysis of House Dust Using Next-Generation Sequencing

Fungal community analyses in homes have been attracting attention because fungi are now generally considered to be allergens. Currently, these analyses are generally conducted using the culture method, although fungal communities in households often contain species that are difficult to culture. In contrast, next-generation sequencing (NGS) represents a comprehensive, labor- and time-saving approach that can facilitate species identification. However, the reliability of the NGS method has not been compared to that of the culture method. In this study, in an attempt to demonstrate the reliability of this application, we used the NGS method to target the internal transcribed spacer 1 (ITS1) in the fungal genome, conducted fungal community analyses for 18 house-dust samples and analyzed fungal community structures. The NGS method positively correlated with the culture method regarding the relative abundance of Aspergillus, Penicillium, Cladosporium and yeasts, which represent the major fungal components found in houses. Furthermore, several genera, such as Malassezia, could be sensitively detected. Our results imply that the reliability of the NGS method is comparable to that of the culture method and indicates that easily available databases may require modifications, including the removal of registrations that have not been sufficiently classified at the genus level.

The Pathogenesis of Fungal-Related Diseases and Allergies in the African Population: The State of the Evidence and Knowledge Gaps

The prevalence of allergic diseases in the African continent has received limited attention with the allergic diseases due to fungal allergens being among the least studied. This lead to the opinion being that the prevalence of allergic disease is low in Africa. Recent reports from different African countries indicate that this is not the case as allergic conditions are common and some; particularly those due to fungal allergens are increasing in prevalence. Thus, there is need to understand both the aetiology and pathogenies of these diseases, particularly the neglected fungal allergic diseases. This review addresses currently available knowledge of fungal-induced allergy, disease pathogenesis comparing findings from human versus experimental mouse studies of fungal allergy. The review discusses the potential role of the gut mycobiome and the extent to which this is relevant to fungal allergy, diagnosis and human health.

Taking a look on fungi in cystic fibrosis: More questions than answers

Cystic fibrosis (CF) is one of the most frequent recessive inherited diseases in western countries. Advances in medical care have led to a substantial increase in the life expectancy of CF patients. Survival beyond adolescence has permitted to see fungi not only as late colonizers, but also as potential pathogens responsible of allergic reactions and chronic infections related to lung function deterioration. The role of fungi, nevertheless, has been overlooked until recently. As a result, a number of questions on their epidemiology, clinical significance, or diagnosis, among others, remain unanswered. Besides more in depth studies about the extent of the deleterious effect of fungi on the CF host, new technologies may provide the key to understand its pathogenic role, its interaction with other microbial components of the respiratory microbiota, and should pave the way to define subsets of patients at risk who would benefit from specific therapy. This review is intended to provide a quick overview on what we know about the presence of fungi in the CF airway and its repercussion in the host, and to point out some of the many knowledge gaps needed to understand and advance in the management of fungi in the airway of CF subjects.

Misinterpretation of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis due to diverse characteristics in different clinical stages

Background

Allergic bronchopulmonary mycosis (ABPM) is a complex pulmonary disorder caused by a hyperimmune response to the endobronchial growth of certain fungi. This study aims to aid physicians in better understanding the need for earlier recognition of ABPM.

Methods

Patients with a confirmed diagnosis of ABPM after evaluation were analyzed retrospectively. Clinical features, previous diagnoses and potential diagnostic errors, laboratory findings were reviewed and compiled.

Results

Fifty-seven patients were diagnosed with ABPM in which 22 were misdiagnosed. Eosinophilia was observed in 11 patients and an elevated total serum Ig E level greater than 1,000 kU/L was detected in 25 of the 57 patients. All of the patients were tested for specific Ig E in which positive to different fungi. The two most common abnormalities found on chest high-resolution computed tomography (HRCT) exams were central bronchiectasis and mucus plugs. A mild to moderate obstructive pattern of lung function was observed in 32 cases. By bronchofiberscopic observation, bronchial lumen was seen to have significant inflammation in 12 patients. After 3 weeks of treatment, a decreased serum total Ig E value was observed.

Conclusions

This study highlights the importance of increasing awareness and understanding of non-Aspergillus-ABPM among physicians and draws attention to the need for establishing more elaborate diagnostic criteria for non-Aspergillus-ABPM, which is a rare kind of disease.