Amoebae as sources of hypersensitivity pneumonitis

Abstract

Pulmonary hypersensitivity has been associated with inhalation of many diverse occupational and environmental airborne agents. Of biological materials, spores of thermophilic actinomycetes have been recognized frequently as causative agents of the disease. Amoebae have rarely been associated with inhalation hypersensitivity. However, recent isolation of several species of amoebae from heated humidification systems in homes and factories has prompted concern for the role of amoebae in hypersensitivity pneumonitis. In this study, an animal model was employed to investigate hypersensitivity to nonpathogenic Naegleria gruberi. Guinea pigs were sensitized by injection of axenic as well as nonaxenic N. gruberi emulsified in Freund's complete adjuvant. Animals were evaluated for three distinguishing characteristics of hypersensitivity pneumonitis. Delayed-onset skin reactivity was apparent in all animals upon intradermal challenge with N. gruberi antigen. Test sites on animals sensitized with axenic N. gruberi developed extensive rashes lasting 96 h. Antibodies were detected in experimental animals. However, antibodies in animals sensitized with nonaxenic N. gruberi were directed mainly toward the bacteria Enterobacter aerogenes, which was used as the feeder culture. This finding points out the importance of using axenic cultures of amoebae. Bronchial provocation challenge was employed to investigate pulmonary hypersensitivity. Animals sensitized with axenic N. gruberi displayed delayed-onset respiratory responses beginning 6 h post challenge. The study indicates that attention should be given to nonpathogenic free living amoebae as causative agents of hypersensitivity pneumonitis.