Lycoperdonosis
Encyclopedia
Lycoperdonosis is a respiratory disease
caused by the inhalation of large quantities of spore
s from mature puffball
s. It is classified as a hypersensitivity pneumonitis
(also called extrinsic allergic alveolitis)—an inflammation of the alveoli within the lung caused by hypersensitivity
to inhaled organic dusts. It is one of several types of hypersensitivity pneumonitis caused by different agents that have similar clinical features. Typical progression of the disease includes symptoms of a cold
hours after spore inhalation, followed by nausea
, rapid pulse, crepitant rales
(a sound like that made by rubbing hairs between the fingers, heard at the end of inhalation), and dyspnea
. Chest radiographs reveal the presence of nodules
in the lungs. The early symptoms presented in combination with pulmonary abnormalities apparent on chest radiographs may lead to misdiagnosis of the disease as tuberculosis
, histiocytosis
, or pneumonia
caused by Pneumocystis carinii. Lycoperdonosis is generally treated with corticosteroid
s, which decrease the inflammatory response; these are sometimes given in conjunction with antimicrobial
s.
The disease was first described in the medical literature in 1967 by R.D. Strand and colleagues in the New England Journal of Medicine
. In 1976, a 4-year-old was reported developing the disease in Norway after purposely inhaling a large quantity of Lycoperdon
spores to stop a nosebleed. Lycoperdon species are sometimes used in folk medicine
in the belief that their spores have haemostatic properties. A 1997 case report discussed several instances of teenagers inhaling the spores. In one severe case, the individual inhaled enough spores so as to be able to blow them out of his mouth. He underwent bronchoscopy
and then had to be on life support
before recovering in about four weeks. In another instance, a teenager spent 18 days in a coma, had portions of his lung removed, and suffered severe liver damage. In Wisconsin
, eight teenagers who inhaled spores at a party presented clinical symptoms such as cough, fever
, shortness of breath, myalgia
, and fatigue within a week. Five of the eight required hospitalization; of these, two required intubation
to assist in breathing. The disease is rare, possibly because of the large quantity of spores that need to be inhaled for clinical effects to occur. Lycoperdonosis also occurs in dogs; in the few reported cases, the animals had been playing or digging in areas known to contain puffballs. Known species of puffballs implicated in the etiology
of the published cases include the widespread Lycoperdon perlatum
(the "devil's snuff-box", L. gemmatum) and Calvatia gigantea, both of the Lycoperdaceae
family.
Respiratory disease
Respiratory disease is a medical term that encompasses pathological conditions affecting the organs and tissues that make gas exchange possible in higher organisms, and includes conditions of the upper respiratory tract, trachea, bronchi, bronchioles, alveoli, pleura and pleural cavity, and the...
caused by the inhalation of large quantities of spore
Spore
In biology, a spore is a reproductive structure that is adapted for dispersal and surviving for extended periods of time in unfavorable conditions. Spores form part of the life cycles of many bacteria, plants, algae, fungi and some protozoa. According to scientist Dr...
s from mature puffball
Puffball
A puffball is a member of any of several groups of fungus in the division Basidiomycota. The puffballs were previously treated as a taxonomic group called the Gasteromycetes or Gasteromycetidae, but they are now known to be a polyphyletic assemblage. The distinguishing feature of all puffballs is...
s. It is classified as a hypersensitivity pneumonitis
Hypersensitivity pneumonitis
Hypersensitivity pneumonitis is an inflammation of the alveoli within the lung caused by hypersensitivity to inhaled organic dusts. Sufferers are commonly exposed to the dust by their occupation or hobbies.-Pathophysiology:Hypersensitivity pneumonitis involves inhalation of an antigen...
(also called extrinsic allergic alveolitis)—an inflammation of the alveoli within the lung caused by hypersensitivity
Hypersensitivity
Hypersensitivity refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. These reactions may be damaging, uncomfortable, or occasionally fatal. Hypersensitivity reactions require a pre-sensitized state of the host. The four-group classification...
to inhaled organic dusts. It is one of several types of hypersensitivity pneumonitis caused by different agents that have similar clinical features. Typical progression of the disease includes symptoms of a cold
Common cold
The common cold is a viral infectious disease of the upper respiratory system, caused primarily by rhinoviruses and coronaviruses. Common symptoms include a cough, sore throat, runny nose, and fever...
hours after spore inhalation, followed by nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
, rapid pulse, crepitant rales
Rales
Crackles, crepitations, or rales are the clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation. They are often heard only with a stethoscope...
(a sound like that made by rubbing hairs between the fingers, heard at the end of inhalation), and dyspnea
Dyspnea
Dyspnea , shortness of breath , or air hunger, is the subjective symptom of breathlessness.It is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations...
. Chest radiographs reveal the presence of nodules
Nodule (medicine)
For use of the term nodule in dermatology, see Nodule In medicine, a nodule refers to a relatively hard, roughly spherical abnormal structure....
in the lungs. The early symptoms presented in combination with pulmonary abnormalities apparent on chest radiographs may lead to misdiagnosis of the disease as tuberculosis
Tuberculosis
Tuberculosis, MTB, or TB is a common, and in many cases lethal, infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis. Tuberculosis usually attacks the lungs but can also affect other parts of the body...
, histiocytosis
Histiocytosis
In medicine, histiocytosis refers to an excessive number of histiocytes, , and is typically used to refer to a group of rare diseases which share this as a characteristic...
, or pneumonia
Pneumocystis pneumonia
Pneumocystis pneumonia or pneumocystosis is a form of pneumonia, caused by the yeast-like fungus Pneumocystis jirovecii...
caused by Pneumocystis carinii. Lycoperdonosis is generally treated with corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s, which decrease the inflammatory response; these are sometimes given in conjunction with antimicrobial
Antimicrobial
An anti-microbial is a substance that kills or inhibits the growth of microorganisms such as bacteria, fungi, or protozoans. Antimicrobial drugs either kill microbes or prevent the growth of microbes...
s.
The disease was first described in the medical literature in 1967 by R.D. Strand and colleagues in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
. In 1976, a 4-year-old was reported developing the disease in Norway after purposely inhaling a large quantity of Lycoperdon
Lycoperdon
Lycoperdon is a genus of puffball mushrooms. The genus has a widespread distribution and contains about 50 species. In general, it contains the smaller species such as the pear shaped puffball and the gem studded puffball. Most of the time they grow from dead wood and if they grow through the...
spores to stop a nosebleed. Lycoperdon species are sometimes used in folk medicine
Folk medicine
-Description:Refers to healing practices and ideas of body physiology and health preservation known to a limited segment of the population in a culture, transmitted informally as general knowledge, and practiced or applied by anyone in the culture having prior experience.All cultures and societies...
in the belief that their spores have haemostatic properties. A 1997 case report discussed several instances of teenagers inhaling the spores. In one severe case, the individual inhaled enough spores so as to be able to blow them out of his mouth. He underwent bronchoscopy
Bronchoscopy
Bronchoscopy is a technique of visualizing the inside of the airways for diagnostic and therapeutic purposes. An instrument is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows the practitioner to examine the patient's airways for...
and then had to be on life support
Life support
Life support, in medicine is a broad term that applies to any therapy used to sustain a patient's life while they are critically ill or injured. There are many therapies and techniques that may be used by clinicians to achieve the goal of sustaining life...
before recovering in about four weeks. In another instance, a teenager spent 18 days in a coma, had portions of his lung removed, and suffered severe liver damage. In Wisconsin
Wisconsin
Wisconsin is a U.S. state located in the north-central United States and is part of the Midwest. It is bordered by Minnesota to the west, Iowa to the southwest, Illinois to the south, Lake Michigan to the east, Michigan to the northeast, and Lake Superior to the north. Wisconsin's capital is...
, eight teenagers who inhaled spores at a party presented clinical symptoms such as cough, fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, shortness of breath, myalgia
Myalgia
Myalgia means "muscle pain" and is a symptom of many diseases and disorders. The most common causes are the overuse or over-stretching of a muscle or group of muscles. Myalgia without a traumatic history is often due to viral infections...
, and fatigue within a week. Five of the eight required hospitalization; of these, two required intubation
Intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
to assist in breathing. The disease is rare, possibly because of the large quantity of spores that need to be inhaled for clinical effects to occur. Lycoperdonosis also occurs in dogs; in the few reported cases, the animals had been playing or digging in areas known to contain puffballs. Known species of puffballs implicated in the etiology
Etiology
Etiology is the study of causation, or origination. The word is derived from the Greek , aitiologia, "giving a reason for" ....
of the published cases include the widespread Lycoperdon perlatum
Lycoperdon perlatum
Lycoperdon perlatum, commonly known as the common puffball, warted puffball, gem-studded puffball or devil's snuff-box, is a species of puffball mushroom in the Agaricaceae family. A common species with a cosmopolitan distribution, it is a moderate-sized puffball with a round fruit body tapering to...
(the "devil's snuff-box", L. gemmatum) and Calvatia gigantea, both of the Lycoperdaceae
Lycoperdaceae
Lycoperdaceae is a family of approximately 150 fungi now known to lie in the Agaricales. Historically they were placed in their own order Lycoperdales. Members of the Lycoperdaceae family are known as the true puffballs. Unlike other types of fungi that hold spores in gills or teeth, puffballs...
family.