Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global overview.

Allergic bronchopulmonary mycosis (ABPM) is a hypersensitivity-mediated disease of worldwide distribution. We reviewed 143 reported global cases of ABPM due to fungi other than aspergilli. The commonest etiologic agent was Candida albicans, reported in 60% of the cases, followed by Bipolaris species (13%), Schizophyllum commune (11%), Curvularia species (8%), Pseudallescheria boydii species complex (3%) and rarely, Alternaria alternata, Fusarium vasinfectum, Penicillium species, Cladosporium cladosporioides, Stemphylium languinosum, Rhizopus oryzae, C. glabrata, Saccharomyces cerevisiae and Trichosporon beigelii. India accounted for about 47% of the globally reported cases of ABPM, attributed predominantly to C. albicans, followed by Japan (16%) where S. commune predominates, and the remaining one-third from the USA, Australia and Europe. Notably, bronchial asthma was present in only 32% of ABPM cases whereas its association with development of allergic bronchopulmonary aspergillosis (ABPA) is known to be much more frequent. The cases reviewed herein revealed a median IgE value threefold higher than that of ABPA, suggesting that the etiologic agents of ABPM incite a stronger immunological response than that by aspergilli in ABPA. ABPM is currently underdiagnosed, warranting comprehensive basic and clinical studies in order to elucidate its epidemiology and to devise a more effective therapy.

In vitro antifungal susceptibility profiles and genotypes of 308 clinical and environmental isolates of Cryptococcus neoformans var. grubii and Cryptococcus gattii serotype B from north-western India.

Cryptococcus neoformans and Cryptococcus gattii are aetiological agents of cryptococcosis, a major opportunistic systemic mycosis of increasing global importance. This study reports the antifungal susceptibility profiles of clinical and environmental isolates of C. neoformans var. grubii, genotype VNI/AFLP1 (n = 246), and C. gattii serotype B, genotype VGI/AFLP4 (n = 62), originating from patients and environmental sources in north-western India. All of the C. neoformans var. grubii and C. gattii isolates were mating type α. Using the broth microdilution method, both species were found to be susceptible to the antifungals tested except for two clinical C. neoformans var. grubii isolates that were resistant to 5-flucytosine (MIC >64 µg ml⁻¹). Data on the geometric mean of MICs revealed that C. gattii was significantly less susceptible than C. neoformans var. grubii to fluconazole, itraconazole and voriconazole (P<0.0001). In addition, the MIC90 of C. gattii was twofold higher than that of C. neoformans var. grubii for fluconazole, itraconazole and voriconazole. However, no statistically significant difference in susceptibility of the two Cryptococcus species was observed against amphotericin B and 5-flucytosine. Furthermore, the environmental C. neoformans var. grubii isolates were significantly less susceptible to fluconazole, itraconazole and 5-flucytosine (P<0.0001) than the clinical isolates. A continued surveillance of antifungal susceptibility of clinical and environmental strains of C. neoformans and C. gattii is desirable to monitor the emergence of any resistant strains in order to ensure more successful therapy of cryptococcosis.