title: Dissociation between sensitizing and colonizing fungi in patients with allergic bronchopulmonary aspergillosis.
abstract: BACKGROUND
  Because allergic bronchopulmonary aspergillosis (ABPA) does not require the presence of Aspergillus fumigatus for diagnosis, serological and radiological findings without cultures usually confirm this condition.
  
  
  OBJECTIVE
  To determine which fungi colonize the airways of patients with definitive ABPA.
  
  
  METHODS
  We enrolled 11 patients (ages 57.5 ± 17.1 years; male: female, 4:7) with ABPA diagnosed by serological and radiological criteria. Fungi colonizing the airway were identified from mucous plugs that were naturally expectorated or obtained by fiberoptic bronchoscopy.
  
  
  RESULTS
  Aspergillus spp. (n = 8) was the most frequently isolated, followed by Schizophyllum commune (n = 4), Candida albicans (n = 2), Rhizopus oryzae (n = 1), and Penicillium spp. (n = 1). Among the Aspergillus spp., A. niger, A. terreus, and A. sydowii were more frequently isolated (total, n = 6) than A. fumigatus (n = 2). Many patients were sensitized with several fungi in addition to Aspergillus, which were dissociated with airway-colonizing fungi.
  
  
  CONCLUSIONS
  Multiple fungal species can colonize the airway, and dissociation between colonizing and sensitizing species frequently occurs in definitive ABPA. Considering the increased prevalence of azole-resistant Aspergillus spp., administering antifungal drugs that target A. fumigatus without identifying which fungal species colonize the airway might be problematic.
authors.affiliation: Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. hmatsuse@nagasaki-u.ac.jp
authors.forename: Hiroto
authors.initials: H
authors.lastname: Matsuse
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tsuchida
authors.forename: Susumu
authors.initials: S
authors.lastname: Fukahori
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kawano
authors.forename: Tomoya
authors.initials: T
authors.lastname: Nishino
authors.forename: Chizu
authors.initials: C
authors.lastname: Fukushima
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000276:immunology; D005260:Female; D005658:Fungi / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008875:Middle Aged; D012882:Skin Tests
chemical_list: D007073:Immunoglobulin E