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.

Comparison of immunodiffusion and enzyme linked immunosorbent assay for antibodies to four Aspergillus species.

Antigenic extracts were prepared from Aspergillus fumigatus, A niger, A flavus and A terreus for use in enzyme linked immunosorbent assay (ELISA) and immunodiffusion (ID) tests for Aspergillus antibodies to determine whether the use of antigenic extracts from species other than A fumigatus increased the sensitivity of the ELISA. ELISA titres correlated well with positive ID tests. Patient titres by ELISA were significantly higher than control titres for all species. Patient titres to A niger were also significantly higher than titres to the other species. Total number of ID bands to A fumigatus correlated significantly with anti-A fumigatus ELISA titres. It is concluded that the use of antigenic extracts from species other than A fumigatus improves the sensitivity of the ELISA.

Allergic bronchopulmonary disease caused by Curvularia lunata and Drechslera hawaiiensis.

Three patients who developed bronchoceles caused by fungi other than Aspergillus sp are described. The first patient presented for investigation of a lesion at the right hilum on chest radiograph and a raised blood eosinophil count. A bronchogram showed complete block of the apical segmental bronchus which at operation was shown to be caused by inspissated material. The second patient was investigated because of a cough productive of plugs of sputum and irregular opacities in both upper zones on chest radiograph and a raised blood eosinophil count. This only cleared after one month on high dose oral prednisone therapy. The third patient with a previous history of left lingular pneumonia and bronchiectasis of the lingular segment of the left upper lobe was investigated three years later for right basal shadowing and a raised blood eosinophil count. The radiograph cleared after one month on high dose oral prednisone treatment. The aetiological agents in these cases were dematiaceous hyphomycetes, fungi ubiquitous in nature, and also agents of plant disease. The causal fungi, Curvularia lunata and Drechslera hawaiiensis, have on a few occasions been reported as causing human disease but in cases quite dissimilar to the three reported here. Septate branching dematiaceous mycelium was consistently seen in the clinical material and isolated from successive sputum specimens from each patient. Immunodiffusion tests from the third patient gave positive results for both fungi. Intraperitoneal inoculations of C lunata and D. hawaiiensis into Swiss white mice proved the pathogenicity of these isolates.