Acremonium kiliense

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Code: m202
Latin name: Acremonium kiliense / Cephalosporium acremonium
Source material: Spores and mycelium
Family: Moniliacea

Cephalosporium is one of the most common airborne fungi genera.

Mould

A mould, which may result in allergy symptoms in sensitised individuals.

Allergen Exposure

Cephalosporium is one of the most common airborne fungi genera. Acremonium kiliense (Cephalosporium acremonium) is a soil-inhabiting imperfect fungi of the family Moniliacea, order Moniliales. (1)

A. kiliense, a fungus that exists environmentally as saprophytes (a saprophytic fungus), often leads to opportunistic infections. It is characterised by light microscopy as a Gram-positive microorganism with septate hyphae.

Hyalohyphomycosis is a group of fungal infections caused by fungi characterised by hyaline septate hyphae, and can infect both immunocompetent and immunocompromised patients. It may be difficult to distinguish between a pathogenic and a contaminant fungus because many such agents can assume clinical significance, depending on circumstances. (2)

A. kiliense is also an endophytic fungus, and may be associated with crops such as fennel, lettuce, chicory and celery. (3)

Some species are the source of a group of antibiotics: broad-spectrum penicillinase-resistant drugs including cephalexin, cephaloridine, cephaloglycin, and cephalothin. (1)

Allergen Description

No allergens have been characterised.

An alkaline protease has been isolated from A. kiliense (4, 5, 6) which may have allergenic potential, as do other alkaline protease antigens isolated from other fungi.

Potential Cross-Reactivity

No published data is found.

Clinical Experience

IgE-mediated reactions

Anecdotal evidence suggests that Acremonium kiliense may induce symptoms of hypersensitivity in sensitised individuals, including asthma, allergic alveolitis and hypersensitivity pneumonitis. (7, 8, 9) However, few studies have been reported to date; it is possible that the allergy occurs more frequently than has been reported.

In a Mexican study, the frequency of Cephalosporium sensitivity was 16% in a group of 101 patients with allergic bronchial asthma. (7) Precipitating antibodies to C. acremonium have been found in patients with allergic alveolitis (8) and hypersensitivity pneumonitis. (9, 10, 11)

Other reactions

Though in the past generally considered to be minimally invasive, genus Acremonium has been responsible for eumycotic mycetomas and focal lesions such as dermatophytoses, kerion, onicomycoses, keratitis and mycetomas in otherwise healthy (immunocompetent) individuals. (2, Cited in 12) It may cause any of pneumonia, arthritis, osteomyelitis, endocarditis, peritonitis, meningitis or sepsis in immunodeficient patients, especially in the presence of risk factors such as prosthesis, catheters, immunosuppressive therapy and anatomic disorders.(12) It is also increasingly being implicated in systemic fungal diseases. (2)

Immunodeficient patients are more susceptible to infections, including chronic granulomatous disease – a rare inherited phagocyte immunodeficiency, characterised by serious recurrent infections that can begin during the first year of life. (12)

In a USA study, the most common anatomic sites in which Acremonium isolates were found were the respiratory tract (41.3%), nails (10.7%) and the eye (9.3%). (13)

Compiled by Dr Harris Steinman.

References

  1. Al Doory Y, Domson JF. Mould Allergy. Philadelphia, 1984.
  2. Das S, Saha R, Dar SA, Ramachandran VG. Acremonium species: a review of the etiological agents of emerging hyalohyphomycosis. Mycopathologia 2010;170(6):361-75.
  3. D'Amico M, Frisullo S, Cirulli M. Endophytic fungi occurring in fennel, lettuce, chicory, and celery – commercial crops in southern Italy. Mycol Res 2008;112(Pt 1):100-7.
  4. Van Heyningen S. An alkaline protease from Acremonium kiliense. Specificity, kinetics, and effect of pH. Eur J Biochem 1972;28(3):432-7.
  5. Van Heyningen S. An alkaline protease from Acremonium kiliense. The enzyme protein and its properties in solutions of urea and sodium dodecylsulphate. Eur J Biochem 1972;27(3):436-42.
  6. Van Heyningen S, Secher DS. A new alkaline protease from Acremonium kiliense. Biochem J 1971;125(4):1159-60.
  7. Martinez Ordaz VA, Rincon Castaneda CB, Lopez Campos C, et al. Cutaneous hypersensitivity in patients with bronchial asthma in La Comarca Lagunera. [Spanish] Rev Alerg Mex 1997;44(6):142-5.
  8. Velcovsky HG, Graubner M. Allergic alveolitis following inhalation of mould spores from pot plant earth (author's transl). [German] Dtsch Med Wochenschr 1981;106(4):115-20.
  9. Suda T, Sato A, Ida M, Gemma H, Hayakawa H, Chida K. Hypersensitivity pneumonitis associated with home ultrasonic humidifiers. Chest 1995;107(3):711-7.
  10. Popp W, Braun O, Zwick H, Rauscher H, Ritschka L, Flicker M. Detection of antigen-specific antibodies on lung tissue in a patient with hypersensitivity pneumonitis. Virchows Arch A Pathol Anat Histopathol 1988;413(3):223-6.
  11. Patterson R, Fink JN, Miles WB, Basich JE, Schleuter DB, Tinkelman DG, Roberts M. Hypersensitivity lung disease presumptively due to Cephalosporium in homes contaminated by sewage flooding or by humidifier water. J Allergy Clin Immunol 1981;68(2):128-32.
  12. Pastorino AC, Menezes UP, Marques HH, Vallada MG, Cappellozi VL, Carnide EM, Jacob CM. Acremonium kiliense infection in a child with chronic granulomatous disease. Braz J Infect Dis 2005;9(6):529-34.
  13. Perdomo H, Sutton DA, García D, Fothergill AW, Cano J, Gené J, Summerbell RC, Rinaldi MG, Guarro J. Spectrum of clinically relevant Acremonium species in the United States. J Clin Microbiol 2011;49(1):243-56.

 

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.