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Suberosis: clinical study and new etiologic agents in a series of eight patients
Ferran Morell1, Alex Roger, María-Jesús Cruz
1Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain. fmorell@hg.vhebron.es
Background:
Penicillium frequentans is considered to be the causal agent of suberosis, hypersensitivity pneumonitis due to cork dust inhalation. Nevertheless, other fungi can colonize cork during its storage period in humid conditions. The aims of the study were to assess the etiologic role of several fungi and cork itself in the genesis of suberosis, and to review the clinical characteristics of patients with this disease.
Methods:
Eight patients with suberosis were studied. Chest radiography, high-resolution chest CT, pulmonary function testing, bronchofibroscopy with BAL and transbronchial biopsy, and delayed cutaneous hypersensitivity tests were performed. Fungal and suberin (cork that is culture negative for fungi) antigens were used for serum determination of specific IgG antibodies, immediate hypersensitivity specific skin tests, and specific bronchial challenge tests.
Results:
Serum specific IgG antibody determinations and specific skin tests against Aspergillus fumigatus and suberin demonstrated the capacity of both these antigenic extracts to induce an immunologic response. Positive specific bronchial challenge tests performed not only with P frequentans but also with A fumigatus, and cork itself were recorded in some patients for the first time in this disease. Dyspnea and cough were the most frequent symptoms. Clinical and functional improvement occurred after antigen avoidance.
Conclusions:
In addition to P frequentans, A fumigatus and cork dust itself may contribute to the development of suberosis.
Insights
Hypersensitivity pneumonitis, or suberosis, can be caused by Aspergillus fumigatus and cork dust, not just Penicillium frequentans. Avoiding these allergens improves patient symptoms and lung function.
Area of Science:
- Pulmonary Medicine
- Immunology
- Environmental Health
Background:
- Suberosis, a form of hypersensitivity pneumonitis, is traditionally linked to Penicillium frequentans from cork dust.
- Other fungi and cork itself may play a role in suberosis development under humid storage conditions.
Purpose of the Study:
- To investigate the etiologic role of various fungi and cork in suberosis.
- To review the clinical features of patients diagnosed with suberosis.
Main Methods:
- Studied eight patients with suberosis using imaging, pulmonary function tests, bronchoscopy, and biopsies.
- Assessed immune responses using serum IgG antibodies, skin tests, and bronchial challenge tests with fungal and suberin antigens.
Main Results:
- Both Aspergillus fumigatus and suberin antigens elicited immune responses.
- Bronchial challenge tests were positive for P. frequentans, A. fumigatus, and cork dust in some patients.
- Dyspnea and cough were common symptoms, improving with allergen avoidance.
Conclusions:
- Aspergillus fumigatus and cork dust, in addition to Penicillium frequentans, can contribute to suberosis.
- Identifying and avoiding causative allergens is crucial for managing suberosis.
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