Suberosis is a type of hypersensitivity pneumonitis usually caused by the fungus Penicillium glabrum (formerly called Penicillium frequentans) from exposure to moldy cork dust. Chrysonilia sitophilia, Aspergillus fumigatus, uncontaminated cork dust, and Mucor macedo may also have significant roles in the pathogenesis of the disease. Cause
Cork is often harvested from the cork oak (Quercus suber) and stored in slabs in a hot and humid environment until covered in mold. Cork workers may be exposed to organic dusts in this process, leading to this disease. Diagnosis
Chest radiography, high-resolution chest CT, pulmonary function testing, bronchofibroscopy with BAL and transbronchial biopsy, delayed cutaneous hypersensitivity tests, fungal and suberin antigen testing, immediate hypersensitivity specific skin tests, and specific bronchial challenge tests can all be used for diagnosis. Chest radiography can show fine miliary mottling. Obtaining a history of antigen exposure and asking about symptoms (e.g. dyspnea, cough) can also be useful. Treatment
Avoidance of antigen exposure is beneficial. History
Vinte-e-Um Mendes first reported respiratory disease in Portuguese cork workers in 1947 at the Portuguese Medical Reunion. Cancella dAbreu first described the disease in 1955. See also
Hypersensitivity pneumonitis

References
Further reading
Cancella de Abreu, LC (1955) On a special kind of pneumoconiosis: the suberosis [in Portuguese]. Med Contemp 73,235-243


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Pathophysiology
The symptoms of CAP are the result of lung infection by microorganisms and the response of the immune system to the infection. Mechanisms of infection are different for viruses and other microorganisms. Viruses
Up to 20 percent of CAP cases can be attributed to viruses. The most common viral causes are influenza, parainfluenza, human respiratory syncytial virus, human metapneumovirus and adenovirus. Less common viruses which may cause serious illness include chickenpox, SARS, avian flu and hantavirus.Typically, a virus enters the lungs through the inhalation of water droplets and invades the cells lining the airways and the alveoli. This leads to cell death; the cells are killed by the virus or they self-destruct. Further lung damage occurs when the immune system responds to the infection. White blood cells, particularly lymphocytes, activate chemicals known as cytokines which cause fluid to leak into the alveoli. The combination of cell destruction and fluid-filled alveoli interrupts the transportation of oxygen into the bloodstream. In addition to their effects on the lungs, many viruses affect other organs. Viral infections weaken the immune system, making the body more susceptible to bacterial infection, including bacterial pneumonia. Bacteria and fungi
Although most cases of bacterial pneumonia are caused by Streptococcus pneumoniae, infections by atypical bacteria such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila can also cause CAP. Enteric gram-negative bacteria, such as Escherichia coli and Klebsiella pneumoniae, are a group of bacteria that typically live in the large intestine; contamination of food and water by these bacteria can result in outbreaks of pneumonia.