Hypersensitivity pneumonitis caused by Fusarium napiforme in a home environment

Lee, S. K.; Kim, Sun Sin; Nahm, Dong Ho; Park, H. S.; Oh, Younjae; Park, K. J.; Kim, S. O.; Kim, S. J.

doi:10.1034/j.1398-9995.2000.00650.x

Cited by 43 publications

(18 citation statements)

References 15 publications

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“…Despite their large size, it has been hypothesized that Fusarium spores release small antigenic material that can reach the terminal alveoli, where an immunologic response results [2,12,13]. Different species of Fusarium have been isolated in a number of HP patients with exposures in both occupational and home settings [2,4,14,15,16,17], none of which were fatal. Our patient reported mild but recurrent symptoms of cough and dyspnea over a 3-year span, which were misinterpreted as asthma, while living unknowingly in his F. vasinfectum -contaminated mobile home.…”

Section: Discussionmentioning

confidence: 99%

Fatal Hypersensitivity Pneumonitis from Exposure to Fusarium vasinfectum in a Home Environment: A Case Report

Dickson

Tankersley

2015

Int Arch Allergy Immunol

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Background: Hypersensitivity pneumonitis (HP) is a rare, non-IgE-mediated inflammatory lung disease caused by inhalational exposure to various antigens found in occupational, avocational and home environments. The prognosis is favorable with early detection and prompt removal of the causative agent, and fatalities are unusual. We present a fatal case of HP caused by chronic exposure to Fusarium vasinfectum mold in the home. Case Report: A 37-year-old white male presented with a 6-month history of progressively worsening dyspnea, cough, weight loss and fatigue associated with the self-renovation of his water-damaged, mold-infested mobile home. Evaluation included a physical examination (hypoxia, inspiratory crackles and expiratory rhonchi), baseline pulmonary function testing (mixed obstructive/restrictive pattern), chest computed tomography (bronchiectasis, fibrosis and diffuse interstitial involvement), bronchoalveolar lavage (macrophages 20%, lymphocytes 28% and neutrophils 52%) and transbronchial biopsy (interstitial fibrosis and chronic inflammatory infiltrate). Mold culture from the home grew out F. vasinfectum. An Ouchterlony double diffusion technique documented high antibody titer to F. vasinfectum. Despite aggressive intravenous corticosteroid treatment, the patient's lung function declined to the extent that he could not be removed from ventilator support following an open lung biopsy, eventually resulting in death. Conclusion: This is the first reported case of fatal HP related to an acute exacerbation of a chronic form of HP following continuous and intense exposure to F. vasinfectum. Although uncommon, a high index of suspicion for HP is necessary in patients with progressive respiratory symptoms and known environmental antigen exposure. With early detection and prompt removal of the causative antigen, HP prognosis is generally favorable, but can progress to fatal disease with continued exposure.

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Section: Discussionmentioning

confidence: 99%

Fatal Hypersensitivity Pneumonitis from Exposure to Fusarium vasinfectum in a Home Environment: A Case Report

Dickson

Tankersley

2015

Int Arch Allergy Immunol

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“…Since most antigens are occupational, this disease has been mainly reported in adults chronically exposed in the work setting. However, hypersensitivity pneumonitis may develop in children especially as a consequence of exposure to household inhaled antigens [94][95][96][97][98][99]. Fan [100] reported that pigeon's lung is the most frequent form observed in children with HP.…”

Section: D2 Hypersensitivity Pneumonitismentioning

confidence: 99%

Bronchiolar Disorders In Childhood

Cazzato¹,

Bernardi²

2005

CPR

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Bronchiolitis is an inflammatory or fibrosing process that primarily affects the small airways, often sparing a considerable portion of the interstitium. Although acute bronchiolitis, mainly caused by viruses, is the most frequently recognized affliction of the bronchioles in the pediatric age group, diseases primarily located in the small, peripheral airways of the lung are reported in various clinical settings.Bronchiolar injury includes infection, collagen-vascular diseases, reaction to drugs, exposure to toxic fumes, and may follow organ or bone marrow transplantation. In addition, bronchiolar involvement may be seen in conditions that are more suggestive of an interstitial lung disease and it frequently accompanies diseases of the large airways.The purpose of this review is to provide a description of the spectrum of childhood bronchiolar disorders and the different clinical settings in which they occur. A summary of both the anatomic and histologic characteristics of small airways is given. A comprehensive description of the clinical presentation of bronchiolitis, functional impairment, and radiologic features is reported, with special emphasis on the role of high resolution computed tomography in the diagnosis of pediatric diffuse lung diseases and to the therapeutic options.

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“…Mold and Thermophilic actinomycete antigens also account for a significant number of HP cases among children [16][17][18][19][20][21][22]. Exposure often occurs in the home environment through spray water air conditioning systems or humidifiers.…”

Section: Epidemiologymentioning

confidence: 99%

Hypersensitivity Pneumonitis

Temprano¹,

Knutsen²,

Slavin³

2005

CPR

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Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is an immunological mediated hypersensitivity reaction to a variety of inhaled allergens that may cause an acute and subacute interstitial pneumonitis and may lead to a chronic end-stage lung disease. Though more common in adults, hypersensitivity pneumonitis needs to be considered in the differential diagnosis of interstitial pneumonitis in children. In children, the most common antigens are from residential exposure to birds, humidifiers and indoor molds. Clinical features are dependent upon stage of disease, and can include fevers, chills, cough, dyspnea, fatigue and weight loss. Physical examination often reveals rales, and dyspnea and hypoxemia are usually present. Routine laboratory testing demonstrates a moderately elevated erythrocyte sedimentation rate, leukocyte count, total IgG level and a positive rheumatoid factor. Though serum IgG antibodies are elevated to the inhaled antigen(s) in hypersensitivity pneumonitis, they may be present in asymptomatic exposed individuals. The immunopathogenesis involves cellular immunity to inhaled allergens, especially CD8+ cytotoxic T cells, multinucleated giant cells, and ultimately granulomas. The role of antigen-specific IgG antibodies is unclear, but may be involved in antibody-dependent-cellular-cytotoxicity (ADCC) and/or interaction with FcRγ on dendritic cells and monocytes that enhance a Th1 response. Pulmonary function studies demonstrate a restrictive pattern with a diffusion defect resulting in hypoxemia. Radiographic changes vary according to the stage of the disease and are best evaluated by high resolution computerized tomography. Bronchoalveolar lavage demonstrates a lymphocytosis with characteristic increase of CD8+ T cells and NK cells. However, recent literature suggests that the CD4+/CD8+ ratio may not be decreased in children as found in adults. Treatment of hypersensitivity pneumonitis is antigen avoidance and systemic corticosteroids, and prognosis depends on early recognition of the disease.

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Hypersensitivity pneumonitis caused by Fusarium napiforme in a home environment

Abstract: We should be aware that HP may be caused by F. napiforme in the home environment.

Cited by 43 publications

References 15 publications

Fatal Hypersensitivity Pneumonitis from Exposure to <b><i>Fusarium vasinfectum</i></b> in a Home Environment: A Case Report

Fatal Hypersensitivity Pneumonitis from Exposure to <b><i>Fusarium vasinfectum</i></b> in a Home Environment: A Case Report

Bronchiolar Disorders In Childhood

Hypersensitivity Pneumonitis

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