title: Airway surface mycosis in chronic TH2-associated airway disease.
abstract: BACKGROUND
  Environmental fungi have been linked to TH2 cell-related airway inflammation and the TH2-associated chronic airway diseases asthma, chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP), and allergic fungal rhinosinusitis (AFRS), but whether these organisms participate directly or indirectly in disease pathology remains unknown.
  
  
  OBJECTIVE
  To determine the frequency of fungus isolation and fungus-specific immunity in patients with TH2-associated and non-TH2-associated airway disease.
  
  
  METHODS
  Sinus lavage fluid and blood were collected from sinus surgery patients (n = 118) including patients with CRSwNP, patients with CRS without nasal polyps, patients with AFRS, and non-CRS/nonasthmatic control patients. Asthma status was determined from medical history. Sinus lavage fluids were cultured and directly examined for evidence of viable fungi. PBMCs were restimulated with fungal antigens in an enzyme-linked immunocell spot assay to determine total memory fungus-specific IL-4-secreting cells. These data were compared with fungus-specific IgE levels measured from plasma by ELISA.
  
  
  RESULTS
  Filamentous fungi were significantly more commonly cultured in patients with TH2-associated airway disease (asthma, CRSwNP, or AFRS: n = 68) than in control patients with non-TH2-associated disease (n = 31): 74% vs 16%, respectively (P < .001). Both fungus-specific IL-4 enzyme-linked immunocell spot (n = 48) and specific IgE (n = 70) data correlated with TH2-associated diseases (sensitivity 73% and specificity 100% vs 50% and 77%, respectively).
  
  
  CONCLUSIONS
  The frequent isolation of fungi growing directly within the airways accompanied by specific immunity to these organisms only in patients with TH2-associated chronic airway diseases suggests that fungi participate directly in the pathogenesis of these conditions. Efforts to eradicate airway fungi from the airways should be considered in selected patients.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Tex.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Porter
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Konkuk University, Chungju Hospital, Chungbuk, Korea.
authors.forename: Dae Jun
authors.initials: DJ
authors.lastname: Lim
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Tex.
authors.forename: Zahida Khan
authors.initials: ZK
authors.lastname: Maskatia
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Tex.
authors.forename: Garbo
authors.initials: G
authors.lastname: Mak
authors.affiliation: Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Houston, Tex.
authors.forename: Chu-Lin
authors.initials: CL
authors.lastname: Tsai
authors.affiliation: Department of Otorhinolaryngolgy-Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Tex.
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Citardi
authors.affiliation: Department of Otorhinolaryngolgy-Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Tex.
authors.forename: Samer
authors.initials: S
authors.lastname: Fakhri
authors.affiliation: Department of Otorhinolaryngolgy-Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Tex; Center for Immunology and Autoimmune Diseases, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Medical School at Houston, Houston, Tex.
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Shaw
authors.affiliation: Department of Pathology, The University of Texas Health Science Center at San Antonio, San Antonio, Tex.
authors.forename: Annette
authors.initials: A
authors.lastname: Fothergil
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Tex; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Tex; Michael E. Debakey VA Center for Translational Research on Inflammatory Diseases, Houston, Tex.
authors.forename: Farrah
authors.initials: F
authors.lastname: Kheradmand
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Tex; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Tex; Michael E. Debakey VA Center for Translational Research on Inflammatory Diseases, Houston, Tex. Electronic address: dcorry@bcm.edu.
authors.forename: David B
authors.initials: DB
authors.lastname: Corry
authors.affiliation: Department of Otorhinolaryngolgy-Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Tex; Center for Immunology and Autoimmune Diseases, The Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases, University of Texas Medical School at Houston, Houston, Tex. Electronic address: Amber.U.Luong@uth.tmc.edu.
authors.forename: Amber
authors.initials: A
authors.lastname: Luong
mesh_terms: D000328:Adult; D000908:Antibodies, Fungal / Q000096:biosynthesis*; D000946:Antigens, Fungal / Q000276:immunology; D001230:Aspergillus / Q000276:immunology; D001249:Asthma / Q000150:complications / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D016022:Case-Control Studies; D002478:Cells, Cultured; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007249:Inflammation / Q000150:complications / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D015847:Interleukin-4 / Q000378:metabolism; D007963:Leukocytes, Mononuclear; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D009298:Nasal Polyps / Q000150:complications / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D012220:Rhinitis / Q000150:complications / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D012852:Sinusitis / Q000150:complications / Q000276:immunology / Q000382:microbiology* / Q000473:pathology; D018418:Th2 Cells / Q000276:immunology* / Q000382:microbiology / Q000473:pathology; D007507:Therapeutic Irrigation
chemical_list: D000908:Antibodies, Fungal; D000946:Antigens, Fungal; C508598:IL4 protein, human; D015847:Interleukin-4; D007073:Immunoglobulin E
keywords: Allergic; T(H)2-associated airway disease; airway; asthma; chronic rhinosinusitis; fungal; mycosis