Aerobiological analysis in a salami factory: a possible case of extrinsic allergic alveolitis by Penicillium camembertii

A 39-year-old man was hospitalized with a history of fatigue, dyspnoea and low grade fever which seemed to be related to his working environment. The patient was employed in a salami factory, working near the area where the salami are seasoned with fungal inocula. Chest X-ray showed diffuse initial changes of reticulonodular pattern that disappeared after a brief course of steroids therapy. Precipitating antibodies to Penicillium notatum and Aspergillus fumigatus were found both in plasma and bronchoalveolar lavage fluid. This, together with the finding of a lymphocytic alveolitis with CD4 sub(+) depletion and CD8 sub(+) increase, suggested the possibility of extrinsic allergic alveolitis of fungal aetiology. Qualitative and quantitative monitoring with an impinger of both the working and outside environment for aerial fungal concentration demonstrated a very high level of contamination (up to 1.14x10 sub(9) fungal propagules m sub(-3) of air) and an inside/outside ratio from 21 to about 2000. Penicillium camembertii was the most common species found in all the indoor sites (60-100% of the fungal load). The patients BALF and serum both displayed precipitating antibodies to P. camembertii from the powder used for the inoculum and the air samples. These results together with the patients working history gave some evidence of relationship between the indoor P. camembertii concentration and the patients symptoms.