Chronic Summer-type Hypersensitivity Pneumonitis Initially Misdiagnosed as Idiopathic Interstitial Pneumonia

Ohtani, Yoshio; Ochi, Junichi; Mitaka, Keiko; Takemura, Tamiko; Jinta, Torahiko; Kuramochi, Jin; Miyazaki, Yasunari; Inase, Naohiko; Yoshizawa, Yasuyuki

doi:10.2169/internalmedicine.47.0656

Cited by 15 publications

(7 citation statements)

References 16 publications

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“…A number of species colonise the skin, gastrointestinal, respiratory and urinary tracts of humans [2], [3], and superficial Trichosporon infections of immunocompetent individuals such as white piedra infections of the hair shaft are well documented [2], [3]. As well as superficial infections, repeated inhalation of Trichosporon arthroconidia can cause summer-type hypersensitivity pneumonitis (SHP) [4], [5], an immunologically induced lung disease. It is the most common form of hypersensitivity pneumonitis (HP) in Japan [4] and T. asahii is the most frequent cause of the disease [1], [3].…”

Section: Introductionmentioning

confidence: 99%

“…As well as superficial infections, repeated inhalation of Trichosporon arthroconidia can cause summer-type hypersensitivity pneumonitis (SHP) [4], [5], an immunologically induced lung disease. It is the most common form of hypersensitivity pneumonitis (HP) in Japan [4] and T. asahii is the most frequent cause of the disease [1], [3]. However, other fungi such as the basidiomycete yeast Cryptococcus may be responsible for SHP [6] and accurate identification of the causative species is necessary for appropriate treatment, which is challenging due to the number of different techniques required [7]–[10].…”

Section: Introductionmentioning

confidence: 99%

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Differentiation of the Emerging Human Pathogens Trichosporon asahii and Trichosporon asteroides from Other Pathogenic Yeasts and Moulds by Using Species-Specific Monoclonal Antibodies

Davies

Thornton

2014

PLoS ONE

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The fungal genus Trichosporon contains emerging opportunistic pathogens of humans, and is the third most commonly isolated non-candidal yeast from humans. Trichosporon asahii and T. asteroides are the most important species causing disseminated disease in immunocompromised patients, while inhalation of T. asahii spores is the most important cause of summer-type hypersensitivity pneumonitis in healthy individuals. Trichosporonosis is misdiagnosed as candidiasis or cryptococcosis due to a lack of awareness and the ambiguity of diagnostic tests for these pathogens. In this study, hybridoma technology was used to produce two murine monoclonal antibodies (MAbs), CA7 and TH1, for detection and differentiation of Trichosporon from other human pathogenic yeasts and moulds. The MAbs react with extracellular antigens from T. asahii and T. asteroides, but do not recognise other related Trichosporon spp., or unrelated pathogenic yeasts and moulds including Candida, Cryptococcus, Aspergillus, Fusarium, and Scedosporium spp., or the etiologic agents of mucormycosis. Immunofluorescence and Western blotting studies show that MAb CA7, an immunoglobulin G1 (IgG1), binds to a major 60 kDa glycoprotein antigen produced on the surface of hyphae, while TH1, an immunoglobulin M (IgM), binds to an antigen produced on the surface of conidia. The MAbs were used in combination with a standard mycological growth medium (Sabouraud Dextrose Agar) to develop an enzyme-linked immunosorbent assay (ELISA) for differentiation of T. asahii from Candida albicans and Cryptococcus neoformans in single and mixed species cultures. The MAbs represent a major advance in the identification of T. asahii and T. asteroides using standard mycological identification methods.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Differentiation of the Emerging Human Pathogens Trichosporon asahii and Trichosporon asteroides from Other Pathogenic Yeasts and Moulds by Using Species-Specific Monoclonal Antibodies

Davies

Thornton

2014

PLoS ONE

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“…The histopathological findings in chronic HP have been described recently, 4–7 but histological features overlap with other idiopathic interstitial pneumonias, especially idiopathic pulmonary fibrosis (IPF) 8,9 . Indeed, some cases diagnosed initially as IPF have been confirmed later to be chronic summer‐type HP 10,11 . Furthermore, the causative antigen can be difficult to determine 12 .…”

Section: Introductionmentioning

confidence: 99%

“…8,9 Indeed, some cases diagnosed initially as IPF have been confirmed later to be chronic summer-type HP. 10,11 Furthermore, the causative antigen can be difficult to determine. 12 Several studies have demonstrated good prognosis in patients with chronic HP showing patterns of non-specific interstitial pneumonia (NSIP) and organizing pneumonia (OP), but worse prognosis in those with the usual interstitial pneumonia (UIP) pattern.…”

Section: Introductionmentioning

confidence: 99%

Pathological differentiation of chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia

et al. 2012

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“…An epidemiologic survey for determining chronic HP cases among 36 Japanese cases [9] revealed that the proportion of patients with S-HP who developed chronic HP was smaller than that of the pa- [22] reported problems in the diagnoses of patients with chronic S-HP. They further cautioned that some cases with bird fancier's lung were misdiagnosed as idiopathic interstitial pneumonia (IIP) or chronic and insidious HP before referral to their institution [19][20][21][22]. The data shown in Figure 1 indicates that the patient group comprised 3 subgroups categorized in terms of the time elapsed from the onset of initial symptoms to the time of referral to our hospital.…”

Section: Discussionmentioning

confidence: 99%

Interaction between Primary Care Physicians and Specialists for Diagnosis and Management of Hypersensitivity Pneumonitis

Morii¹,

Yoshimori²,

Sudo³

et al. 2011

IJCM

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Objective: Hypersensitivity pneumonitis (HP) may be a complex syndrome rather than a single, uniform disease entity. The problems associated with HP treatment include a lack of awareness of primary care procedures and scarcity of recent information regarding HP. The main objective of this study was to investigate the problems in the interaction between primary care physicians and chest specialists. Data source: All available clinical records of cases at the Fukujuji Chest Hospital, Tokyo, between 1994 and 2005, supervised by specialists of a university hospital. Study selection: All cases suspected of HP during the period. Results: Nine cases were excluded because of insufficient records or because they did not satisfy the clinical criteria. Twenty-eight enrolled patients (14 men and 14 women; mean age, 53.0 years) were initially treated for respiratory infections by primary care physicians. The final HP types were summer-type (n = 18), bird fancier’s lung (n = 2), ventilation-related (n = 3), or undetectable antigen (n = 5). On the basis of the interval between the onset of initial symptoms and the time of referral to our hospital, the cases can be categorized into 3 groups, which may represent acute, subacute, and chronic HP. Conclusion: All patients initially received treatment on the basis of a different diagnosis at primary evaluation. We concluded that interaction between primary care physicians and chest specialists is essential for solving problems associated with the early diagnosis and adequate treatment of HP

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Chronic Summer-type Hypersensitivity Pneumonitis Initially Misdiagnosed as Idiopathic Interstitial Pneumonia

Abstract: The clinical features of chronic hypersensitivity pneumonitis (HP)

Cited by 15 publications

References 16 publications

Differentiation of the Emerging Human Pathogens Trichosporon asahii and Trichosporon asteroides from Other Pathogenic Yeasts and Moulds by Using Species-Specific Monoclonal Antibodies

Differentiation of the Emerging Human Pathogens Trichosporon asahii and Trichosporon asteroides from Other Pathogenic Yeasts and Moulds by Using Species-Specific Monoclonal Antibodies

Pathological differentiation of chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia

Interaction between Primary Care Physicians and Specialists for Diagnosis and Management of Hypersensitivity Pneumonitis

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