Curvularia lunata
Summary
Curvularia lunata (Cochliobolus lunatus) is a ubiquitous mold of the Order Pleosporales, mostly found in plant materials and soil worldwide. It is a known plant and human pathogen. The particles causing allergic reactions are spores found in the environment.
Asthma, allergic rhinitis, allergic Bronchopulmonary Mycosis and allergic fungal sinusitis are the main clinical presentations of C. lunata allergy. This mold is also able to cause opportunistic disease. Cross reactivity with other molds, especially if taxonomically close, may occur.
Epidemiology
Worldwide distribution
Allergic diseases associated with Curvularia lunata have been described in many countries, including across South East Asia (Malaysia and Singapore), Japan, North America, Australia and India.
Route Of Exposure
Main
Inhalation of spores.
Clinical Relevance
Allergic rhinitis
In a study of 9,923 patients with a history of asthma, allergic rhinitis (AR) or atopic dermatitis (AD), sensitization to C. lunata (determined by skin-prick tests) significantly increased the risk of both asthma and AR, but not AD. The study also showed that C. lunata hypersensitivity was correlated with higher frequency of wheezing episodes, probability of attending a clinic and exacerbation of asthma symptoms.
Other diseases
A 25-year old patient with a history of bronchial asthma presented with a productive cough lasting several months; C. lunata was diagnosed as the cause of the allergic bronchopulmonary mycosis. This infection has also been described in two patients from an Australian report.
Curvularia lunata was frequently isolated from patients diagnosed with allergic fungal sinusitis (AFS).
C. lunata can also cause disease in immunocompromised patients and was described as the cause of a fatal cerebral infection in a 21-year old immunocompetent patient with a history of asthma.
Diagnostics
Main methods
Personal volumetric petri plate sampler.
Measures
The concentrations of Curvularia spp. spores ranged between 78-246 CFU/
The presence of allergen-specific antibodies is usually determined by skin prick tests (SPTs) and serology for IgE. In a study carried out in atopic subjects, the incidence of mold allergy was 44%, with C. lunata one of the most frequently identified mold agents. In another study of 150 patients, SPT reactions to C. lunata allergens in patients with respiratory allergies varied in positivity, with 34% of patients showing mild to moderately positive reactions, 10.7% showing moderately positive reactions and 2% showing highly positive skin reactions. In the same study, the serum of SPT+ (positive) patients was tested by ELISA for the presence of IgE specific for the fungal antigens that caused the positive skin reactions. This showed 69.2% concordance for C. lunata antigens when comparing the skin-prick tests and the ELISA in vitro immunoassay.
Prevention And Therapy
Allergen immunotherapy
Immunotherapy is currently not recommended for patients allergic to molds, due to complexities of the allergens and patient co-allergies.
Prevention strategies
Avoidance is difficult to achieve, due to the wide range of environments in which C. lunata can be found.
Cross-Reactivity
Cross-reactivity has been demonstrated to other molds. In a study carried out on 668 serum samples from patients which who had previously recorded at least one IgE positivity to fungal antigens, associations were observed between the patterns of IgE sensitization and fungal phylogenetic relationships. Using a panel of 17 fungal extracts including C. lunata, some samples were only positive to one fungal species, whereas many were multi-sensitized. The results suggest that the associations are likely due to antigen cross-reactivity between fungal species, not uncommon in more closely related species. Cross-reactivity was also demonstrated in immunoblots with an Epicoccum purpurascens 33.5 kDa allergen, Epi p 1. An Alternaria alternata antigen, Alt a 1, has been demonstrated to show reactivity to specific serum of all species of the Pleosporaceae family. C. lunata cytochrome c, a 12kDa protein, showed cross-reactivity with other fungal allergens.
References
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