Allergic Bronchopulmonary Fungal Disease Research Articles

The pulmonary pathology of illicit drug and substance abuse

Illicit substance abuse causes diverse pulmonary manifestations that relate to specific agents as well as their mode of delivery, chronicity of use, and the presence of additives. The major categories of substances are cannabinoids, stimulants, and narcotics. The pulmonary effects of marijuana smoking include alveolar macrophage exudation, epithelial remodelling of airways, allergic bronchopulmonary fungal disease, and barotrauma. Inhalation of alkaloidal cocaine may also trigger pulmonary haemorrhage and haemosiderosis, interstitial pneumonia and fibrosis, eosinophilic pneumonia or exacerbations of asthma, in addition to epithelial remodelling and barotrauma. Life-threatening oedema is an important pulmonary complication of intravenous narcotic use. Foreign body emboli, angiothrombosis, and pulmonary hypertension result from intravenous injection of oral pharmaceutical tablets. A variety of tablet fillers—including talc, cornstarch, microcrystalline cellulose, and crospovidone—are discernible histologically. Panacinar emphysema or massive fibrosis are infrequent complications of this practice. Among all categories of substances there is broad overlap of associated lung pathology.

Allergic Bronchopulmonary Fungal Disease Caused by Saccharomyces cerevisiae

We describe a patient who presented with dry cough, low‐grade fever, and focal patchy shadow of pulmonary infiltrates. Remarkably, the prospective etiological agent, Saccharomyces cerevisiae was purely and repeatedly cultured from her sputum. Allergic bronchopulmonary mycosis (ABPM) was diagnosed based on clinical, serological, and pathological criteria. Although the patient described here satisfied only three of the criteria, the conclusion that the allergic bronchopulmonary disease in our case was induced by S. cerevisiae was made based on the following evidence: 1) S. cerevisiae was repeatedly isolated from the patient's sputum, 2) anti‐S. cerevisiae antibody was detected in her serum, and 3) bronchoprovocation test to S. cerevisiae antigen was positive. We present here a case of allergic bronchopulmonary fungal disease caused by S. cerevisiae antigen.

Allergic bronchopulmonary aspergillosis: disease pattern in central Arabia.

Despite a high prevalence of asthma in Saudi Arabia, allergic bronchopulmonary aspergillosis (ABPA) has not been reported. We reviewed the medical records in a large university hospital in Saudi Arabia where thousands of asthmatics are being followed up. Over a 9-year period starting January 1986, the diagnosis of ABPA was made in 10 patients only. Delay in diagnosis was common and in some patients the disease was confused with fungal pneumonia, tuberculosis or tumours. Aspergillus fumigatus was isolated from one patient only and different Aspergillus species were cultured from respiratory secretions of the others. Corticosteroids were uniformly effective in all patients with active disease. Low humidity may account for this apparent rarity of ABPA, although it is possible that some cases are overlooked. Further work is needed on the prevalent fungi in the Arabian environment and their potential health effects and particularly on the prevalence of allergic bronchopulmonary fungal disease.

The use of bronchofiberscopy for diagnosis of allergic bronchopulmonary aspergillosis.

To assess the use of bronchofiberscopy for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA), we retrospectively analyzed bronchofiberscopic and pathologic findings of specimens obtained by bronchofiberscopy in 8 patients who met the British criteria for ABPA. Two of the 8 patients completely met Rosenberg's primary criteria for ABPA, while the remaining 6 lacked only 1 or 2 immunologic and radiographic conditions of the criteria. Bronchofiberscopic inspection revealed the presence of mucus plugs in all patients. Pathologic examination of plug specimens obtained by suction from 6 of 7 of these patients showed that the plugs consisted of allergic mucin containing fungal hyphae, diagnostic of ABPA. Bronchofiberscopy appears to be a useful tool in the diagnosis of ABPA, if immunologic and radiographic findings are not typical of ABPA. This bronchofiberscopic method is easily applicable for diagnosing allergic bronchopulmonary fungal disease (ABPFD) in addition to ABPA.

Unusual aspects of allergic bronchopulmonary fungal disease: Report of two cases due to Curularia organisms associated with allergic fungal sinusitis

We report two cases of allergic bronchopulmonary fungal disease (ABPFD) caused by Curvularia sp and associated with allergic fungal sinusitis (AFS). Curvularia lunata was cultured in one case and Curvularia senegalensis was cultured in the other. Based on these cases and a review of the literature, we discuss unusual clinical and pathologic features that can occur in ABPFD. Unusual clinical aspects of ABPFD include associated AFS, absence of asthma, progression to Churg-Strauss angiitis and granulomatosis, concomitant hypersensitivity pneumonitis, and underlying cystic fibrosis. Atypical pathologic features that may occur in ABPFD include follicular bronchiolitis, xanthomatous bronchiolitis, limited tissue invasion, fungus balls, and association with unusual fungi. Prominent follicular bronchiolitis and xanthomatous bronchiolitis were misleading histologic features in one of our cases and led to a delay in recognition of the diagnosis. Both patients presented primarily with AFS; ABPFD was detected subsequently. This suggests that a small subset of patients with AFS may be at risk for ABPFD. The goal of this review is to increase awareness of unusual clinical and pathologic manifestations of ABPFD. It is hoped that this will result in accurate diagnosis and proper therapy, especially for patients who present with atypical features. Unusual fungal species should be considered in patients who have clinical findings compatible with ABPFD but who do not demonstrate immunologic reactivity to Aspergillus sp, especially Aspergillus fumigatus. In addition, ABPFD should be considered in patients with AFS who develop new pulmonary lesions.

Allergic bronchopulmonary fungal disease caused by Bipolaris and Curvularia

Allergic bronchopulmonary fungal disease (ABPFD) usually manifests in asthmatics as allergic bronchopulmonary aspergillosis. In a few instances other fungi have been implicated. Serological testing in Western Australia between 1979 and 1986 revealed precipitins to Bipolaris and Curvularia species in 40 of 503 patients tested. Eight of these were patients with ABPFD due to Bipolaris and/or Curvularia and are reported here. Geographical location appeared to be significant as seven of eight of those with ABPFD (and at least 18 of 40 with positive serology) were living in the more remote and sub-tropical northern part of the state. ABPFD due to fungi other than Aspergillus species may be more common than previously recognised and further epidemiological assessment is warranted.

Fungal diseases of the sinuses

With recent advances in medicine, fungal diseases are becoming not only better understood, but also increasingly important in the management of patients with paranasal sinus disease. Fungal sinus diseases run the gamut from allergic fungal rhinitis and allergic fungal sinusitis, through fungus balls, to invasive and fulminant fungal sinusitis. Allergic fungal sinusitis may be thought of as the sinus counterpart of allergic bronchopulmonary fungal disease. Patients typically are first seen with chronic sinusitis. They may be atopic, and the peripheral blood often shows elevated IgE levels and absolute eosinophil counts. Such patients may be managed conservatively, requiring only surgical drainage and corticosteroid therapy. Fungus balls are typified by the so-called "aspergilloma." Although patients often have some predisposing factor, such as local tissue hypoxia or massive fungal exposure, most patients are not immunocompromised. Fungus balls may be treated with the traditional Caldwell-Luc operation or with newer endoscopic procedures. Invasive or fulminant fungal sinusitis generally occurs in immunosuppressed patients and merits aggressive surgical excision and debridement, as well as systemic chemotherapy, usually amphotericin B. In this article, we review fungal disease of the paranasal sinuses and present findings from our review of patients with chronic sinusitis.

Mixed allergic bronchopulmonary fungal disease due to Pseudallescheria boydii and Aspergillus.

A 24 year old asthmatic woman with mixed allergic bronchopulmonary fungal disease due to Pseudallescheria boydii and Aspergillus is reported. No previous cases due to P boydii have been described. This patient provides evidence that fungi other than Aspergillus species may cause the condition.

The structure of bronchial plugs in mucoid impaction, bronchocentric granulomatosis and asthma.

The structure of bronchial plugs was examined in 12 lobectomy specimens from patients with bronchocentric granulomatosis and mucoid impaction, two bronchial biopsies from patients with mucoid impaction, sections from one post-mortem showing evidence of mucoid impaction and bronchocentric granulomatosis as well as aspergilloma with tissue invasion and from post-mortems on eight patients who had died during a persisting exacerbation of their asthma. In both mucoid impaction and asthma eosinophils were arranged in layers within the mucus, but the pattern of lamination was different in the two groups. In asthma the layers of eosinophils appeared as whorls and eddies. In mucoid impaction the lamination was parallel to the circumference of the plug and the eosinophils were tightly compacted and appeared degenerate; fungal elements were found in all cases and were more readily seen among the eosinophils than in the mucus. The histological appearance of even small fragments of such plugs is diagnostic of allergic bronchopulmonary fungal disease with mucoid impaction. In all our cases bronchocentric granulomatosis appears to have been a complication of allergic bronchopulmonary aspergillosis with mucoid impaction. The clusters of inspissated eosinophils so typical of the peripheral lesion of bronchocentric granulomatosis appear to be fragments of the mucus plugs formed in the larger bronchi.

Allergic bronchopulmonary fungal disease without clinical asthma.

During a retrospective survey of patients with pulmonary shadows and blood eosinophilia between the years 1965 and 1980, 42 patients were found with allergic bronchopulmonary fungal disease. Eleven of these had no clinical evidence of asthma. Three of these 11 had hypersensitivity to fungi other than Aspergillus sp. In the absence of asthma there was some difficulty in making a diagnosis, particularly where collapse of the upper lobe occurred in middle-aged or elderly patients and bronchogenic carcinoma was presumed responsible. We suggest that the term allergic bronchopulmonary aspergillosis be replaced by allergic bronchopulmonary fungal disease, the diagnosis be considered in patients with lung disease and blood eosinophilia even in the absence of asthma, and a wider range of fungal allergens be used for skin and precipitin tests.