Fungal Exposure and Sarcoidosis

Title: Fungal Exposure and Sarcoidosis
Author(s): G. Doran1; M. Nugdallah1; L. Davidson1; E Murtagh1; SC Donnelly2; P Minnis1
Institution: 1Interstitial Lung Disease Service, Respiratory Medicine, Antrim Area Hospital, Bush Road 2Department of Medicine, Trinity Centre for Health Sciences, Tallaght Hospital, Tallaght, Dublin, Ireland
Poster: Click to view poster
Category: Lung Cancer/CF/ILD/Surgery
Abstract: Possible initiation triggers of pulmonary sarcoidosis are intriguing. Particular attention has previously focused on M. tuberculosis and P. acnes.1+2There is limited literature in the role of fungi in the development of sarcoidosis, however it often complicates fibrotic disease. We examined cohorts of well-characterised patients from Leinster and Ulster. Both cohorts were similar in terms of demographics, mode of presentation, physiological impairment and need for treatment.
The Leinster cohort consisted of 338 individuals identified from a historical database and those attending clinic and managed by a single physician. 47 patients were enrolled prospectively, at the time of assessment, after undergoing skin prick testing (SPT) and were followed up for a median of 40 months. Of the patients who were positive 74% reacted to Grass, 48% to D Pteronyssinus and 26% to Aspergillus or mould mix. Positive SPTs had reduced uptake of standard therapy OR 0.21 (0.07-0.62), p =0.0051.
The Ulster cohort consisted of 242 patients attending a single specialised clinic. Serum aspergillus titres were available for 72. There was no significant difference in titre level when stratified for CXR stage (Figure 1). Initial analysis documented no significant correlation between systemic inflammation as measured by ESR and aspergillus titre (Rho -0.073).
There was no signal from this large group of individuals with sarcoidosis to suggest that Aspergillus drives sarcoidosis in terms of radiological disease severity or systemic inflammation but a suggestion that it may correlate to reduced treatment need.

1. Gupta D, Agarwal R et al. Molecular evidence for the role of mycobacteria in sarcoidosis: a meta-analysis. Eur Respir J. (2007) 30:508-16.