Bronchopulmonary Mycosis Research Articles

Bronchopulmonary mycoses. Pictorial review

Prevalence of bronchopulmonary mycosis (BPM) has dramatically increased during last decades due to increase of the number of patients’ with congen-ital and acquired immunodeficiencies or damages of broncs and lungs’ architectonics resulted from non-mycotic bronchopulmonary diseases, as well as significant improvements in diagnostics. Aim. To pres-ent latest data on BPM prevalence and clinical char-acteristics, and their diagnosis algorithms. Materials and methods. Data from 62 researches, reviews and clinical recommendations in Russian and International resources on BPM, are presented and analyzed. Results. Prevalence of BPM clinical forms (allergic, chronic, and invasive mycoses) associated with different diseases are discussed. Modern diagnostic algorithms of of dif-ferent BPM clinical forms are presented according to the latest clinical recommendations of international professional societies. Typical X-ray images and cases’ description of BPM clinical forms are used as illustra-tions. Conclusion. BPM diagnostic algorithms and evi-dence value-based diagnosis formulation presented in international recommendations are significant input in standardization of approaches to BPM diagnosis and eventually to its efficiency.

Improved IgG antibody diagnostics of hypersensitivity pneumonitis and pulmonary mycoses by means of newly evaluated serum antibody ranges and frequencies using IgG ImmunoCAP™

Summary Background The ranges of most human IgG antibodies against avian, microbial, and chemical antigens between their cut off values and their maximum values detected by IgG ImmunoCAP™ (Thermo Fisher Diagnostics, Freiburg, Germany) are not well known in pulmonary immune-mediated disorders. In addition, for many antigens it is not yet known how frequently their IgG antibodies appear in patients with these lung diseases. Therefore, we evaluated ranges and frequencies of these IgG antibodies. Methods The sera of 47,200 patients with suspected hypersensitivity pneumonitis (HP, extrinsic allergic alveolitis) or bronchopulmonary mycoses (mainly allergic bronchopulmonary aspergillosis [ABPA]), which were examined for 32 various IgG antibodies against birds, bacteria, molds, yeasts, and chemicals using the IgG ImmunoCAP™ assay, were evaluated retrospectively. Results We found a large spreading of the specific IgG ranges with maximum values from 26 mgA/l for Rhizopus nigricans up to 4640 mgA/l for pigeon. When the maximum values in the literature are also taken into account, the ranges of avian antibodies reach values up to 7280 mgA/l, the ranges of molds and yeasts up to 1707 mgA/l, of bacterial thermoactinomycetes up to 206 mgA/l, and of chemicals up to 139 mgA/l. The evaluated antibody ranges of the individual antigens can be used to decide whether a detected IgG antibody value is weakly, moderately or strongly positive. According to consistent evidence from numerous studies, a strongly positive antibody indicates HP or pulmonary mycosis more likely than a weakly positive antibody. It was found that the antigens of the highest maximum antibody levels—pigeon, budgerigar, parrot, Aspergillus fumigatus—are the causative agents of the most common immune-mediated lung diseases: bird breeder’s lung and pulmonary aspergillosis. Evaluation of the frequencies of eight major IgG antibodies of HP revealed the following rates: pigeon 28%, Aspergillus fumigatus 25%, budgerigar 23%, Penicillium chrysogenum 11%, Saccharopolyspora rectivirgula 7%, Acremonium kiliense 6%, Aureobasidium pullulans 5%, and Thermoactinomyces vulgaris 2%. Conclusion This study is the first to evaluate the ranges not only of avian and Aspergillus fumigatus antigens, as has been done up to now, but also of antibodies against 24 other environmental antigens. Quantification of IgG antibodies regarding their specific ranges can help to improve the serodiagnostics of immune-mediated lung diseases. In the lower ranges IgG antibodies are mainly physiological, while higher ranges correlate with the mentioned diseases as HP and ABPA/allergic bronchopulmonary mycoses (ABPM). The determined frequencies of the eight HP antibodies can be helpful in establishing HP screening tests.

Allergic bronchopulmonary mycosis in a child caused by Paecilomyces lilacinus

The article discusses the problem of allergic bronchopulmonary mycoses, which occur in children much more often than they are diagnosed. Their treatment is a challenge, and the prognosis is very problematic. In addition to the most frequent cause of Aspergillus, allergic bronchopulmonary mycoses can be caused by various fungi. The clinical example demonstrates the difficulty of diagnosing and treating a child with allergic bronchopulmonary mycosis caused by a rare type of filamentous fungi Paecilomyces lilacinus.

Asthma phenotypes and their impact on treatment

Patients with asthma can have varying characteristics, and therefore they need different treatments. Knowing asthma phenotypes can aid practice nurses to better understand how to best manage their patients' condition, as Aleksandra Gawlik-Lipinski describes Asthma is characterised by the presence of a wheeze, a cough, breathlessness, tightness in the chest and various levels of airway obstruction ( Chapman et al, 2014 , British Thoracic Society and Scottish Intercollegiate Guidelines Network, 2016 ). There is diversity among asthma patients and it was in the final decade of twentieth century that asthma was categorised into phenotypes ( Wenzel, 2012a ). A phenotype is an observable manifestation of the interaction between an individual's genotype and their environment ( Marieb and Hoehn, 2012 ). Traditionally, phenotypes are based on clinical, molecular and individual characteristics, designed to recognise different treatment requirements among asthma patients and deliver targeted therapy ( Chung et al, 2014 ). Apart from inhaled corticosteroids, eosinophilic, early- and late-onset asthma phenotypes benefit from leukotriene receptor antagonists (LTRAs) and monoclonal anti-immunoglobin E therapy; obesity-related, non-eosinophilic phenotype from weight management; and allergic bronchopulmonary mycoses from antifungal treatment ( Haldar et al, 2008 ; Moore et al, 2010 ; Wenzel, 2012b ). The treatments of early-onset, non-eosinophilic phenotype with LTRAs ( Bacci et al, 2006 ; Paggiaro and Bacci, 2011 ) and the neutrophilic phenotype solely with macrolide antibiotics ( Wenzel, 2012b ) continue to be debated.

Allergic bronchopulmonary aspergillosis in Japan: A nationwide survey

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) is an allergic pulmonary disease characterized by a hypersensitivity reaction to Aspergillus species colonizing the airways. The clinical characteristics of ABPA may differ depending on genetic and environmental background. We performed a nationwide survey to determine the clinical characteristics of ABPA in Japan. MethodsIn 2013, a questionnaire on physician-diagnosed ABPA/allergic bronchopulmonary mycosis was sent to 903 medical centers specializing in respiratory or allergic diseases. Cases fulfilling the following criteria were categorized as possible ABPA-central bronchiectasis (ABPA-CB): 1) presence of specific serum immunoglobulin E (IgE) antibodies or a positive skin reaction to Aspergillus, and 2) bronchiectasis or mucoid impaction in the central bronchi. ResultsOf 499 physician-diagnosed cases reported by 132 clinical centers, 358 cases met the criteria for possible ABPA-CB. Median age of ABPA-CB onset was 57 (interquartile range, 44–68) years; later-onset disease, developing ≥50 years of age, accounted for 66% of the cases and was associated with female sex, delayed onset of asthma, and lower levels of serum IgE. A third of the patients (120 patients, 34%) exhibited low levels of serum total IgE (<1000 IU/mL). Aspergillus species were isolated from sputum in 126/213 cases (59%), and Schizophyllum commune was identified in 12 (6%) patients. During the course of the treatment, ABPA recurred in 169 (48%) cases. ConclusionsThis nationwide survey identified several unique clinical characteristics of ABPA in Japan, such as late-onset, relatively lower serum IgE levels, and frequent recurrences/flares.

A retrospective study of patients with a delayed diagnosis of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis

This study was designed to aid health care providers in better understanding the need for earlier recognition of allergic bronchopulmonary aspergillosis/allergic bronchopulmonary mycosis (ABPA/ABPM). Patients with a confirmed diagnosis of ABPA/ABPM after evaluation in the Department of Respiratory Medicine of Zhongshan Hospital affiliated to Fudan University between March 2003 and January 2013 were analyzed retrospectively. Clinical signs and symptoms, previous diagnoses and potential diagnostic errors, serologic tests and chest computed tomography (CT) were reviewed and compiled. Seventy patients were diagnosed with ABPA/ABPM in which 52 were misdiagnosed or underdiagnosed. The median total serum IgE level was 2574 IU/mL, ranging from 338 to 31527 IU/mL. Fifty-eight of the 70 patients were tested for specific IgE (sp-IgE) in which 57 were positive to Aspergillus fumigatus and 48 were positive to Penicillium. Twelve of the 70 patients did not undergo sp-IgE testing but allergy skin test, and all were positive to A. fumigatus. The two most common abnormalities found on chest CT exams were central bronchiectasis (CB) and mucus plugs in 48 and 20 patients, respectively. The time from first hospital visit to confirmation of diagnosis for ABPA/ABPM-CB (48/70) was longer than that of ABPA/ABPM-seropositive type (S; 22/70; 30.8 ± 9.81 m versus 9.3 ± 3.55 m; p = 0.044). Prior diagnoses antecedent to our diagnostic conformation included 13 patients with bronchial asthma, 12 with bronchiectasis, and 19 with pneumonia. Only 18 patients were correctly first diagnosed with ABPA/ABPM. ABPA/ABPM is not an uncommon complication accompanying underlying chronic diseases, most notably bronchial asthma and cystic fibrosis. Patients who present with poorly controlled disease, especially with recurrent pulmonary infiltrates, demand the attention of a specialist, the sooner the better to minimize the likelihood of more severe, persistent, and ultimately irreversible pathological changes in large airways. Early treatment of oral corticosteroid with or without antifungal therapy can improve the prognosis. Early testing for ABPA/ABPM along with careful ongoing follow-up is imperative and necessary to prevent or forestall significant future morbidity.

Molecular Characterization and In Vitro Antifungal Susceptibility Profile of Schizophyllum commune, an Emerging Basidiomycete in Bronchopulmonary Mycoses

Schizophyllum commune (n = 30) showed lowest geometric mean MICs of isavuconazole (0.19 μg/ml), itraconazole (0.2 μg/ml), voriconazole (0.24 μg/ml), and amphotericin B (0.29 μg/ml) and high geometric mean MICs of fluconazole (19.39 μg/ml) and flucytosine (17.28 μg/ml). Five cases (of 8) of allergic bronchopulmonary mycosis that were treated with itraconazole had no recrudescence after 6 to 24 months of follow-up. One case each of invasive pulmonary mycosis and fungal ball were treated successfully with voriconazole and itraconazole.

Eosinophils Contribute to IL-4 Production and Shape the T-Helper Cytokine Profile and Inflammatory Response in Pulmonary Cryptococcosis

Susceptibility to infection with Cryptococcus neoformans is tightly determined by production of IL-4. In this study, we investigated the time course of IL-4 production and its innate cellular source in mice infected intranasally with C. neoformans. We show that pulmonary IL-4 production starts surprisingly late after 6 weeks of infection. Interestingly, in the lungs of infected mice, pulmonary T helper (Th) cells and eosinophils produce significant amounts of IL-4. In eosinophil-deficient ΔdblGATA mice, IL-33 receptor-expressing Th2s are significantly reduced, albeit not absent, whereas protective Th1 and Th17 responses are enhanced. In addition, recruitment of pulmonary inflammatory cells during infection with C. neoformans is reduced in the absence of eosinophils. These data expand previous findings emphasizing an exclusively destructive effector function by eosinophilic granulocytes. Moreover, in ΔdblGATA mice, fungal control is slightly enhanced in the lung; however, dissemination of Cryptococcus is not prevented. Therefore, eosinophils play an immunoregulatory role that contributes to Th2-dependent susceptibility in allergic inflammation during bronchopulmonary mycosis.

Severe bronchiectasis.

Bronchiectasis is primarily the result of airway injury and remodeling attributable to recurrent or chronic inflammation and infection. The underlying etiologies include autoimmune diseases, severe infections, genetic abnormalities, and acquired disorders. Recurrent airway inflammation and infection may also be the result of allergic or immunodeficiency states such as allergic bronchopulmonary mycoses or HIV/AIDS. Bronchiectasis should be included in the differentiation diagnosis of any patient with chronic respiratory complaints such as cough and sputum production. Early clinical manifestations may be subtle. Hallmarks of severe bronchiectasis include fetid breath, chronic cough, and sputum production. The associated chronic respiratory infections and airway sepsis are punctuated by episodes of acute exacerbation. Prompt recognition and treatment of bronchiectasis may allow for prevention of disease progression and irreversible loss of lung function. This review of severe non-cystic fibrosis bronchiectasis describes the current pathophysiology, clinical presentations, and management of bronchiectasis. We review how impaired airway clearance and the inability to resolve infection and inflammation creates a vicious cycle of recurrent injury. The common clinical features of bronchiectasis and findings are presented and illustrated by radiographic images. The common species and significance of various organisms often recovered from the distal airways including: tuberculous and environmental mycobacteria, aspergillus, and bacteria such as Pseudomonas aeruginosa will be covered. Management strategies including sputum surveillance, sputum clearance, antimicrobial therapy including antifungal and antimyobacterial agents as well as the evidence for the use of inhalational and anti-inflammatory therapies such as corticosteroids are also discussed. Recommendations for the work-up and therapy of complications including hemoptysis and respiratory failure are presented.

Odontogenous Maxillary Sinusitis Due to Candida Albicans: Report of a Case

Mycotic infections of the external ear, nasal, buccal and pharyngeal cavities are well known and often diagnosed by the otorhinolaryngologists. Mycoses of the paranasal sinuses, on the contrary, have attracted limited attention in this field. This may be assumed from the relative scarcity of the reported cases as compared to the large number of similar cases of the lower respiratory tract (bronchopulmonary mycoses). Schubert in 1885 was the first to describe a fungus infection of the nasal cavity. In 1892, MacKenzie2for the first time described a mycotic maxillary sinusitis which followed a tooth extraction and was due to aspergillus fumigatus. Cases of frontal sinus mycoses were reported by Batt4in 1941 and Bergqvist5in 1945. Other cases of maxillary sinusitis were reported by Dunn6in 1896, Harmer7in 1911 and 1913, Tilley8in 1914, and Adams9in 1933. Kelly10in 1934