[Objective]The aim of the present study was to clarify the influence of sensitization to Bjerkandera adusta(B. adusta)on the clinical manifestation in patients with fungus-associated chronic cough(FACC).[Methods]Seventeen patients with FACC who underwent bronchoprovocation tests using an antigenic solution of B. adusta were selected from among 21 FACC patients. We compared the allergological findings and clinical characteristics of the FACC patients who showed a positive reaction to the bronchoprovocation test(Allergic fungal cough sensitized to B. adusta; AFC-Bj)with the remaining FACC patients(non AFC-Bj)retrospectively.[Results]The eleven patients with AFC-Bj had a median age of 52(range, 22-70)years, and 45.5% were female. The respective values for six patients with non AFC-Bj were 47.5(range, 36-60)years of age, and 33.3% were female. The positive ratios for an immediate cutaneous reaction(45.5%; p<0.05)and the lymphocyte stimulation test(63.6%; p<0.05)to B. adusta were found to be significantly higher in the AFC-Bj group than in the non AFC-Bj group. The total time required for complete remission of cough symptoms was longer(median 20, range 12-43 weeks; p=0.0009), and the recurrence ratio of coughing was more frequent in the AFC-Bj group in comparison to those in non AFC-Bj group(2, range 1-3 times and 0.5, range 0-1 times, respectively).[Conclusions]This study demonstrated that B. adusta, a basidiomycetous is an environmental fungus attracting attention because of its possible role in enhancing the cough severity of FACC patients via the sensitization to this fungus.
Thirty-nine Arthroderma vanbreuseghemii isolates identified by mating behavior were assayed to determine their ribosomal RNA gene internal transcribed spacer(ITS)region genotypes. Twenty-two isolates of mating type(+)and 4 of(-)showed the genotype of Trichophyton mentagrophytes var. interdigitale, 9 isolates of mating type(+)and 4 of(-)showed the genotype of A. vanbreuseghemii. Nine of 14 isolates with granular or asteroid colony morphology showed the genotype of T. mentagrophytes var. interdigitale. There was no relation between ITS genotype and morphology or mating type of the isolates. Isolates of T. mentagrophytes var. interdigitale genotype were shown to include non-sexually degenerate zoophilic strains with granular colony morphology as well as sexually and morphologically degenerate anthropophilic strains and may be just one genotype of a heterogeneous species, A. vanbreuseghemii.
Phylogenetic relationships among 34 isolates from 11 Trichophyton and 3 Arthroderma species were investigated using the nucleotide sequences from 4 DNA regions: internal transcribed spacers(ITS)1 and 2 including the 5.8S rRNA gene, and the actin(ACT), DNA topoisomerase(TOP)2 and glyceraldehyde-3-phosphate dehydrogenase(GPD)genes. All four phylogenetic trees showed that the 34 isolates can be divided into 3 clades, the Arthroderma simii, A. benhamiae and Trichophyton rubrum clades. The Shimodaira-Hasegawa test(SH test)revealed significant topological incongruities within the A. benhamiae and A. simii clades. Although branching patterns of the 3 clades were inconsistent among the four trees, the SH test did not support these differences except that the best tree topology according to ACT sequences was significantly rejected by the TOP data set. These results show that multiple gene analyses are necessary to more precisely understand the phylogenetic relationships among these fungi.
クロモブラストミコーシス（CBM）の主要な原因菌種Fonsecaea属は，近年分子系統解析により再検討され，F. pedorosoi, F. monophora, F. nubicaの３菌種が提唱されている．今回，その原因菌の形態学的同定が困難であったが，系統解析によりF. monophoraと同定することができた慢性重症型CBMの症例を報告する．患者は55歳のフィリピン出身の男性．ココナッツ農園で働いていた1973年ごろ，左下腿に小紅斑が出現．1999年に下腿部から大腿部にかけて皮疹が多発し，同年から2005年まで母国で治療し略治．2005年来日後，下腿の皮疹が再燃し，イトラコナゾールの内服を再開したが悪化してきたため当科を受診．2008年10月初診時，左下腿部に瘢痕型病変と周囲に腫瘤型病変を伴っていた．その病変の上部から大腿にかけて，多数の斑状瘢痕を認めた．腫瘤性病変からmuriform cellを確認，黒色真菌を分離した．集落は，はじめ炭粉状，後に短絨毛様となった．本分離株は顕微鏡所見による菌種同定が困難なため，リボソームRNA遺伝子internal transcribed spacer領域の塩基配列を解析し，F. monophora（DDBJ accession number AB566420）と同定した．治療はボリコナゾール内服とカイロによる温熱療法を併用し，６ヶ月後には腫瘤性病変は消退し，１年６ヶ月で瘢痕様紅斑を残し内服治療を終了した．瘢痕型は薬剤の到達が難しいため再発しやすく，治癒判定も難しいため，今後も経過観察が必要である．