Chest
Volume 124, Issue 3, September 2003, Pages 1145-1152
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Occupational and Environmental Lung Disease
Suberosis: Clinical Study and New Etiologic Agents in a Series of Eight Patients

https://doi.org/10.1378/chest.124.3.1145Get rights and content

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.

Section snippets

Study Population

Eight patients (five women) with a mean age (± SD) of 36.8 ± 9 years (range, 26 to 57 years) who fulfilled diagnostic criteria for suberosis10 were retrospectively studied. All but one of the patients received a diagnosis at our occupational respiratory disease unit between 1982 and 2000. The other patient (case 6) received a diagnosis in 1982.6 At the time of diagnosis, all patients were actively working in cork manufacturing industries in the province of Gerona (Catalonia) and all presented

Clinical Data and Test Results

Clinical data and test results are shown in Table 1. At the time of diagnosis, the patients had presented symptoms for a mean of 2.6 years (range, 0.5 to 5 years). Characteristically, symptoms began halfway through the working day or at the end of the evening shift and remitted or improved at weekends or during holidays. Evolution was highly favorable in all patients after a mean antigen avoidance period of 14.2 months (range, 4 to 26 months); 50% of patients (cases 1, 4, 6, and 8) remained

Discussion

The present work describes the clinical, analytic, and radiologic features, as well as immunologic test responses of a well-characterized group of patients with suberosis, and is one of very few articles published to date on this subject. The study shows that besides P frequentans, A fumigatus, and cork itself, uncontaminated by fungi, may participate in the etiopathogenesis of suberosis in some patients.

The etiology of cork dust-induced hypersensitivity pneumonitis has been attributed to the

ACKNOWLEDGMENT

We thank Christine O’Hara for English translation of the manuscript, and María-Dolores Untoria, a member of the nursing staff, for laboratory analysis.

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  • Cited by (0)

    This study was financed in part by grant FISS 90/0941, and Red Respira (Instituto Carlos III. Fis RTYC-C03/11), SEPAR.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

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