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Clinical characteristics and outcomes of hypersensitivity pneumonitis: a population-based study in China. Chin Med J (Engl) 2019; 132:1283-1292. [PMID: 31021982 PMCID: PMC6629344 DOI: 10.1097/cm9.0000000000000256] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Backgrounds: Hypersensitivity pneumonitis (HP) is an immune-mediated interstitial lung disease (ILD) that develops in response to the inhalation of various antigens. The clinical pathologies are very complex and undetermined. The clinical features and outcomes of HP have not been fully elucidated. The aim of this study was to analyze the incidence, clinical features, and outcomes of HP patients and construct a simple clinical model for diagnosing chronic HP (CHP). Methods: The cohort study included 101 patients with HP admitted to the Nanjing Drum Tower Hospital from January 2009 to December 2017. The patients were categorized into acute HP (AHP, n = 72) and CHP (n = 29) groups according to the updated international criteria. The clinical, imaging, treatment, and follow-up data were retrospectively reviewed. All patients were followed up until December 31, 2017. Statistical analysis was performed, and a clinical scoring system for CHP was constructed by SPSS 20.0 software. Results: The incidence of HP was 2.4% in ILD inpatients in our center. Patients in the CHP group were older (t = −2.212, P = 0.029), had more smokers (χ2 = 8.428, P = 0.004), and longer duration of symptoms (t = −4.852, P < 0.001) than those in the AHP group. Weight loss, crackles, digital clubbing, and cyanosis were more common in the CHP group than those in the AHP group (χ2 = 5.862, P < 0.001; χ2 = 8.997, P = 0.003; χ2 = 11.939, P = 0.001; and χ2 = 4.025, P = 0.045, respectively). On chest high-resolution computed tomography (HRCT), reticular patterns, traction bronchiectasis, and accompanying honeycombing were more common in CHP cases than those in AHP cases (χ2 = 101.000, P < 0.001; χ2 = 32.048, P < 0.001; and χ2 = 36.568, P < 0.001, respectively). The clinical scoring system for CHP was established based on the clinical variables (age [A], duration of symptoms [D], smoking history [S], unidentified exposure [U], and chest HRCT [C]; ADSUC) (area under the curve 0.935, 95% confidence interval: 0.883–0.987, P < 0.001). Eleven patients (15.3%) in the AHP group developed CHP, and unidentified exposure was an independent risk factor for the progression of disease (P = 0.038). The survival of patients with CHP, smoking history, unidentified antigens and fibrosis on Chest HRCT were significantly worse (P = 0.011, P = 0.001, P = 0.005, and P = 0.011, respectively) by Kaplan-Meier analysis. Cox multivariate regression analysis revealed that unidentified exposure and total lung volume (TLC pred%) were independent prognostic predictors for HP patients (P = 0.017 and P = 0.017, respectively). Conclusions: The clinical features and outcomes of the CHP patients differ from those of the AHP patients. ADSUC is a simple and feasible clinical model for CHP. Unidentified exposure is an independent risk factor for the progression of AHP to CHP. Unidentified exposure and a low baseline TLC pred% are independent predictors for survival in HP patients.
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Barber CM, Burge PS, Feary JR, Parfrey H, Renzoni EA, Spencer LG, Walters GI, Wiggans RE. Identifying causation in hypersensitivity pneumonitis: a British perspective. BMJ Open Respir Res 2019; 6:e000469. [PMID: 31803475 PMCID: PMC6890382 DOI: 10.1136/bmjresp-2019-000469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/10/2019] [Accepted: 11/03/2019] [Indexed: 11/16/2022] Open
Abstract
Background Establishing whether patients are exposed to a ‘known cause’ is a key element in both the diagnostic assessment and the subsequent management of hypersensitivity pneumonitis (HP). Objective This study surveyed British interstitial lung disease (ILD) specialists to document current practice and opinion in relation to establishing causation in HP. Methods British ILD consultants (pulmonologists) were invited by email to take part in a structured questionnaire survey, to provide estimates of demographic data relating to their service and to rate their level of agreement with a series of statements. A priori ‘consensus agreement’ was defined as at least 70% of participants replying that they ‘Strongly agree’ or ‘Tend to agree’. Results 54 consultants took part in the survey from 27 ILD multidisciplinary teams. Participants estimated that 20% of the patients in their ILD service have HP, and of these, a cause is identifiable in 32% of cases. For patients with confirmed HP, an estimated 40% have had a bronchoalveolar lavage for differential cell counts, and 10% a surgical biopsy. Consensus agreement was reached for 25 of 33 statements relating to causation and either the assessment of unexplained ILD or management of confirmed HP. Conclusions This survey has demonstrated that although there is a degree of variation in the diagnostic approach for patients with suspected HP in Britain, there is consensus opinion for some key areas of practice. There are several factors in clinical practice that currently act as potential barriers to identifying the cause for British HP patients.
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Affiliation(s)
| | - P Sherwood Burge
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
| | - Jo R Feary
- Department of Occupational Lung Disease, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Helen Parfrey
- Cambridge ILD Service, Royal Papworth Hospital NHSFT, Cambridge, UK
| | - Elizabeth A Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Lisa G Spencer
- Liverpool Interstitial Lung Disease Service, University Hospital Aintree, Liverpool, UK
| | - Gareth I Walters
- Birmingham Regional NHS Occupational Lung Disease Service, Birmingham Chest Clinic, Birmingham, UK
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Forced Oscillation Technique and Small Airway Involvement in Chronic Hypersensitivity Pneumonitis. Arch Bronconeumol 2019; 55:519-525. [DOI: 10.1016/j.arbres.2019.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/22/2018] [Accepted: 01/29/2019] [Indexed: 11/21/2022]
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Walters GI, Mokhlis JM, Moore VC, Robertson AS, Burge GA, Bhomra PS, Burge PS. Characteristics of hypersensitivity pneumonitis diagnosed by interstitial and occupational lung disease multi-disciplinary team consensus. Respir Med 2019; 155:19-25. [DOI: 10.1016/j.rmed.2019.06.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/12/2022]
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Epidemiology of Hypersensitivity Pneumonitis among an Insured Population in the United States: A Claims-based Cohort Analysis. Ann Am Thorac Soc 2019; 15:460-469. [PMID: 29236517 DOI: 10.1513/annalsats.201704-288oc] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Hypersensitivity pneumonitis is a complex lung disease resulting from repeated inhalation of a variety of antigens. Limited data exist regarding its epidemiology. OBJECTIVES To describe the trends in the annual incidence and prevalence of hypersensitivity pneumonitis in the United States. METHODS We developed novel claims-based coding algorithms to identify hypersensitivity pneumonitis, chronic hypersensitivity pneumonitis, and fibrotic hypersensitivity pneumonitis cases using the 2004 to 2013 MarketScan Commercial and Medicare Supplemental healthcare claims databases. Algorithm validity and reliability were assessed with clinical data from National Jewish Health. We calculated yearly cumulative incidence and prevalence overall and by age. For the subgroup with vital status, Kaplan-Meier methods were used to analyze survival stratified by evidence of fibrosis. RESULTS We identified 7,498 cases that met our hypersensitivity pneumonitis definition over the 10-year study period, including 3,902 with chronic hypersensitivity pneumonitis and 1,852 with fibrotic hypersensitivity pneumonitis. On the basis of the clinical-radiological adjudication of the validation sample, 38 cases (95%) were confirmed as hypersensitivity pneumonitis. The mean age was 52 years, and 58% were women. The 1-year prevalence rates for hypersensitivity pneumonitis ranged from 1.67 to 2.71 per 100,000 persons, and 1-year cumulative incidence rates ranged from 1.28 to 1.94 per 100,000 persons. The prevalence increased with age, ranging from 0.95 per 100,000 among 0- to 9-year-olds to 11.2 per 100,000 among those aged 65 years and older. Between 56 and 68% of hypersensitivity pneumonitis cases in each year were classified as chronic hypersensitivity pneumonitis (prevalence, 0.91-1.70 per 100,000 persons; cumulative incidence, 0.63-1.08 per 100,000 persons). Fewer had fibrotic hypersensitivity pneumonitis (prevalence, 0.41-0.80 per 100,000 persons; cumulative incidence: 0.29-0.43 per 100,000 persons). Most cases (74%) were classified as unspecified hypersensitivity pneumonitis. Older age, male sex, and fibrosis were associated with higher mortality rates in unadjusted analyses. CONCLUSIONS Using U.S. administrative claims-based data, we developed an algorithm with a high sensitivity and specificity for hypersensitivity pneumonitis. Between 2004 and 2013, hypersensitivity pneumonitis was more common among women and those older than 65 years. Most cases were classified as chronic hypersensitivity pneumonitis. Approximately one-fourth met our criteria for fibrotic hypersensitivity pneumonitis, which was associated with a higher mortality rate.
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Frequency of goose and duck down causation of hypersensitivity pneumonitis within an 80-patient cohort. Ann Allergy Asthma Immunol 2019; 123:201-207. [PMID: 31042573 DOI: 10.1016/j.anai.2019.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND A variety of antigens have been identified as causative of hypersensitivity pneumonitis (HP), which is characterized by inflammation to the lung parenchyma that is induced by exposure. Goose and duck down (GDD) bedding is often overlooked by physicians as a potential cause, yet the use of GDD has markedly increased in recent years, paralleling an increased frequency of reports of GDD-induced HP. OBJECTIVE To determine the frequency of GDD as the causative antigen in patients with HP who use bedding that contains GDD. METHODS Patients referred with a working diagnosis of HP underwent a detailed environmental history. Those who were using GDD were asked to remove it as an avoidance procedure. Signs, symptoms, spirometry, and inflammatory markers were followed up at weekly intervals for up to 1 month to determine the effect of remediation. RESULTS Eighty patients with HP were seen during an 8-year period. Thirty-two patients (40%) were using GDD bedding. Of these 32 patients, 12 (37.5% of those exposed and 15% of the total HP population experienced remission (or nonprogression) of disease by simply avoiding GDD bedding. Eleven (92%) of these 12 patients were female. In patients with GDD-induced HP, lung biopsy patterns were varied. CONCLUSION Approximately one-third of patients with HP, who slept with GDD, had persistent improvement or remission with simple avoidance. The higher incidence of GDD-induced HP in females may be hormonal and/or sociocultural related. Lung biopsy findings were across the spectrum of histopathologic patterns. Avoidance-challenge techniques were effective in confirming diagnoses and causation and mitigating the need for additional remediation.
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Bellanger AP, Reboux G, Rouzet A, Barrera C, Rocchi S, Scherer E, Millon L. Hypersensitivity pneumonitis: A new strategy for serodiagnosis and environmental surveys. Respir Med 2019; 150:101-106. [PMID: 30961934 DOI: 10.1016/j.rmed.2019.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 01/08/2023]
Abstract
We propose a strategy for serodiagnosis of hypersensitivity pneumonitis (HP): 1) question patients about their private or occupational activity, or visit him on site; 2) select panels of six somatic specific antigens appropriate for each type of exposure; 3) and use ELISA to test concomitantly two recombinant antigens highly specific to Farmer's lung, Metalworking-fluid HP, and for Bird fancier's lung. The serodiagnosis provides an immunological argument that may complete radiological, functional lung exploration and clinical features; 4) If the serodiagnosis is negative but the suspicion of HP is strong, a microbial analysis of the patient's specific exposure is conducted; 5) "A la carte" antigens are produced from the microorganisms isolated in the patient's environment sample and tested; 6) Finally, the patient may be asked to undergo a specific inhalation challenge with the offending antigens in a safety cabin, or to avoid his usual environment for a few days.
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Affiliation(s)
- Anne-Pauline Bellanger
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, France
| | - Gabriel Reboux
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, France.
| | - Adeline Rouzet
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, France
| | - Coralie Barrera
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, France
| | - Steffi Rocchi
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, France
| | - Emeline Scherer
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, France
| | - Laurence Millon
- Department of Parasitology Mycology, University Hospital of Besançon, UMR/CNRS 6249 Chrono-Environnement Research Team, University of Bourgogne- Franche-Comté, France
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Singh S, Collins BF, Sharma BB, Joshi JM, Talwar D, Katiyar S, Singh N, Ho L, Samaria JK, Bhattacharya P, Chaudhari S, Singh T, Pilania K, Pipavath S, Ahuja J, Chetambath R, Ghoshal AG, Jain NK, Gayathri Devi HJ, Kant S, Koul P, Dhar R, Swarnakar R, Katiyar SK, Jindal A, Mangal DK, Singh V, Raghu G. Hypersensitivity pneumonitis: Clinical manifestations - Prospective data from the interstitial lung disease-India registry. Lung India 2019; 36:476-482. [PMID: 31670294 DOI: 10.4103/lungindia.lungindia_263_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Multiple environmental factors are associated with development of hypersensitivity pneumonitis (HP), and diagnostic algorithms for the diagnosis of HP have been proposed in recent perspectives. Aims We analyzed the data of patients with HP from interstitial lung disease (ILD)-India registry. The analysis was performed to (1) find the prevalence of HP, (2) reclassify HP as per a recently proposed classification criterion to assess the level of diagnostic certainty, and (3) identify the causative agents for HP. Setting and Designs This was a prospective multicenter study of consecutive, consenting adult patients with new-onset ILD from 27 centers across India (March 2012-April 2015). Materials and Methods The diagnoses were based on prespecified working clinical criteria and multidisciplinary discussions. To assess strength of diagnosis based on available clinical information, patients with HP were subclassified into definite HP, HP with high level of confidence, and HP with low level of confidence using a recent classification scheme. Results Five hundred and thirteen of 1084 patients with new-onset ILD were clinically diagnosed with HP and subclassified as HP with high level of confidence (380, 74.1%), HP with low level of confidence (106, 20.7%), and definite HP (27, 5.3%). Exposures among patients with HP were birds (odds ratios [OR]: 3.52, P < 0.001), air-conditioners (OR: 2.23, P < 0.001), molds (OR: 1.79, P < 0.001), rural residence (OR: 1.64, P < 0.05), and air-coolers (OR: 1.45, P < 0.05). Conclusions About 47.3% of patients with new-onset ILD in India were diagnosed with HP, the majority of whom were diagnosed as HP with a high level of confidence. The most common exposures were birds, cooling devices, and visible molds.
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Affiliation(s)
- Sheetu Singh
- Department Chest and Tuberculosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Bridget F Collins
- Department of Medicine, Center for Interstitial Lung Diseases, University of Washington, Seattle, WA 98195, USA
| | - Bharat B Sharma
- Department of Medicine, SMS Medical College, Jaipur, Rajasthan, India
| | - Jyotsana M Joshi
- Department of Pulmonary Medicine, Topiwala National Medical College and BYL Nair Hospital, Mumbai, Maharashtra, India
| | - Deepak Talwar
- Department of Pulmonary and Sleep Care Medicine, Metro Multispeciality Hospital, Noida, Uttar Pradesh, India
| | - Sandeep Katiyar
- Department of Respiratory Medicine, Chest Care Centre, Kanpur, Uttar Pradesh, India
| | - Nishtha Singh
- Department of Pulmonary Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Lawrence Ho
- Department of Medicine, Center for Interstitial Lung Diseases, University of Washington, Seattle, WA 98195, USA
| | - Jai K Samaria
- Department of Chest Disease, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Parthasarthi Bhattacharya
- Department of Respiratory Medicine, Institute of Pulmocare and Research, Kolkata, West Bengal, India
| | - Sudhir Chaudhari
- Department of Tuberculosis and Respiratory Diseases, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Tejraj Singh
- Research Division, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Khushboo Pilania
- Department of Radiodiagnosis, Jankharia Imaging, Mumbai, Maharashtra, India
| | - Sudhakar Pipavath
- Department of Radiology, Center for Interstitial Lung Diseases, University of Washington, Seattle, WA 98195, USA
| | - Jitesh Ahuja
- Department of Radiology, Center for Interstitial Lung Diseases, University of Washington, Seattle, WA 98195, USA
| | - Ravindran Chetambath
- Department of Pulmonary Medicine, Calicut Medical College, Kozhikode, Kerala, India
| | - Aloke G Ghoshal
- National Allergy Asthma Bronchitis Institute, Kolkata, West Bengal, India
| | - Nirmal K Jain
- Department of Respiratory Medicine, Jain Chest Care Center, Jaipur, Rajasthan, India
| | - H J Gayathri Devi
- Department of Respiratory Medicine, MS Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Surya Kant
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Parvaiz Koul
- Department of Internal and Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Raja Dhar
- Department of Pulmonology and Critical Care, Fortis Hospital, Kolkata, West Bengal, India
| | - Rajesh Swarnakar
- Department of Pulmonology and Respiratory Medicine, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Subodh K Katiyar
- Department of Respiratory Medicine, Chest Care Centre, Kanpur, Uttar Pradesh, India
| | - Arpita Jindal
- Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
| | | | - Virendra Singh
- Department of Pulmonary Medicine, Asthma Bhawan, Jaipur, Rajasthan, India
| | - Ganesh Raghu
- Department of Medicine, Center for Interstitial Lung Diseases, University of Washington, Seattle, WA 98195, USA
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Interstitial Lung Disease and Pulmonary Fibrosis: A Practical Approach for General Medicine Physicians with Focus on the Medical History. J Clin Med 2018; 7:jcm7120476. [PMID: 30477216 PMCID: PMC6306719 DOI: 10.3390/jcm7120476] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 12/26/2022] Open
Abstract
Interstitial lung disease (ILD) and pulmonary fibrosis comprise a wide array of inflammatory and fibrotic lung diseases which are often confusing to general medicine and pulmonary physicians alike. In addition to the myriad of clinical and radiologic nomenclature used in ILD, histopathologic descriptors may be particularly confusing, and are often extrapolated to radiologic imaging patterns which may further add to the confusion. We propose that rather than focusing on precise histologic findings, focus should be on identifying an accurate etiology of ILD through a comprehensive and detailed medical history. Histopathologic patterns from lung biopsy should not be dismissed, but are often nonspecific, and overall treatment strategy and prognosis are likely to be determined more by the specific etiology of ILD rather than any particular histologic pattern. In this review, we outline a practical approach to common ILDs, highlight important aspects in obtaining an exposure history, clarify terminology and nomenclature, and discuss six common subgroups of ILD likely to be encountered by general medicine physicians in the inpatient or outpatient setting: Smoking-related, hypersensitivity pneumonitis, connective tissue disease-related, occupation-related, medication-induced, and idiopathic pulmonary fibrosis. Accurate diagnosis of these forms of ILD does require supplementing the medical history with results of the physical examination, autoimmune serologic testing, and chest radiographic imaging, but the importance of a comprehensive environmental, avocational, occupational, and medication-use history cannot be overstated and is likely the single most important factor responsible for achieving the best possible outcomes for patients.
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Collins BF, McClelland RL, Ho LA, Mikacenic CR, Hayes J, Spada C, Raghu G. Sarcoidosis and IPF in the same patient-a coincidence, an association or a phenotype? Respir Med 2018; 144S:S20-S27. [DOI: 10.1016/j.rmed.2018.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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Dias OM, Baldi BG, Ferreira JG, Cardenas LZ, Pennati F, Salito C, Carvalho CRR, Aliverti A, Pereira de Albuquerque AL. Mechanisms of exercise limitation in patients with chronic hypersensitivity pneumonitis. ERJ Open Res 2018; 4:00043-2018. [PMID: 30151370 PMCID: PMC6104296 DOI: 10.1183/23120541.00043-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/05/2018] [Indexed: 01/02/2023] Open
Abstract
Small airway and interstitial pulmonary involvements are prominent in chronic hypersensitivity pneumonitis (cHP). However, their roles on exercise limitation and the relationship with functional lung tests have not been studied in detail. Our aim was to evaluate exercise performance and its determinants in cHP. We evaluated maximal cardiopulmonary exercise testing performance in 28 cHP patients (forced vital capacity 57±17% pred) and 18 healthy controls during cycling. Patients had reduced exercise performance with lower peak oxygen production (16.6 (12.3–19.98) mL·kg−1·min−1versus 25.1 (16.9–32.0), p=0.003), diminished breathing reserve (% maximal voluntary ventilation) (12 (6.4–34.8)% versus 41 (32.7–50.8)%, p<0.001) and hyperventilation (minute ventilation/carbon dioxide production slope 37±5 versus 31±4, p<0.001). All patients presented oxygen desaturation and augmented Borg dyspnoea scores (8 (5–10) versus 4 (1–7), p=0.004). The prevalence of dynamic hyperinflation was found in only 18% of patients. When comparing cHP patients with normal and low peak oxygen production (<84% pred, lower limit of normal), the latter exhibited a higher minute ventilation/carbon dioxide production slope (39±5.0 versus 34±3.6, p=0.004), lower tidal volume (0.84 (0.78–0.90) L versus 1.15 (0.97–1.67) L, p=0.002), and poorer physical functioning score on the Short form-36 health survey. Receiver operating characteristic curve analysis showed that reduced lung volumes (forced vital capacity %, total lung capacity % and diffusing capacity of the lung for carbon dioxide %) were high predictors of poor exercise capacity. Reduced exercise capacity was prevalent in patients because of ventilatory limitation and not due to dynamic hyperinflation. Reduced lung volumes were reliable predictors of lower performance during exercise. Besides significant small airway involvement, reduced exercise capacity is due to ventilatory limitation and not due to dynamic hyperinflation in chronic hypersensitivity pneumonitishttp://ow.ly/Ou9230kSBQz
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Affiliation(s)
- Olívia Meira Dias
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Bruno Guedes Baldi
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Jeferson George Ferreira
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Letícia Zumpano Cardenas
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Caterina Salito
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Carlos Roberto Ribeiro Carvalho
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - André Luis Pereira de Albuquerque
- Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sâo Paulo, Sâo Paulo, Brazil
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Adams TN, Newton CA, Batra K, Abu-Hijleh M, Barbera T, Torrealba J, Glazer CS. Utility of Bronchoalveolar Lavage and Transbronchial Biopsy in Patients with Hypersensitivity Pneumonitis. Lung 2018; 196:617-622. [PMID: 29959521 DOI: 10.1007/s00408-018-0139-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Making the diagnosis of HP is challenging due to a lack of consensus criteria and variability of both pathologic and radiographic findings. The purpose of this retrospective study was to determine the diagnostic utility of the combination of BAL lymphocyte count and TBBX in patients with HP. METHODS We conducted a retrospective cohort study of all patients with a MDD diagnosis of HP at a single center. RESULTS 155 patients were included in the study. 49% of patients who underwent BAL had a lymphocyte count > 20, 42% had a lymphocyte count > 30, and 34% had lymphocyte count > 40%. The median BAL lymphocyte count was higher in inflammatory HP compared to fibrotic HP. The addition of TBBX to BAL significantly increased the diagnostic yield regardless of the BAL lymphocyte cutoff used. The yield of bronchoscopy with TBBX and BAL when a lymphocyte count > 40% was used as a cutoff was 52%. CONCLUSIONS Our study suggests that the combination of TBBX with BAL significantly increases the likelihood that the procedure will provide adequate additional information to allow a confident MDD diagnosis of HP and may reduce the need for SLB in the diagnostic workup of HP.
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Affiliation(s)
- Traci N Adams
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA.
| | - Chad A Newton
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Kiran Batra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Muhanned Abu-Hijleh
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Tyonn Barbera
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
| | - Jose Torrealba
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Craig S Glazer
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75219, USA
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Bhattacharyya P, Dasgupta S, Paul M, Saha D, Sengupta S, Bhattacharyya PP. High-resolution computerized tomography changes in diffuse parenchymal lung disease from chronic hypersensitivity pneumonitis related to bird antigen. Lung India 2018; 35:215-219. [PMID: 29697078 PMCID: PMC5946554 DOI: 10.4103/lungindia.lungindia_293_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: Chronic hypersensitivity pneumonitis (HP) is the most common cause of diffuse parenchymal lung disease (DPLD) in India. There is no data regarding the avian antigen exposure-associated DPLD from the country. Methods: Chronic HP from exposure to avian antigen was diagnosed when the high resolution computerized tomography (HRCT) showed features for HP and was supported by the history of exposure to pigeons, the presence of precipitin antibodies (IgG) to avian antigen in high titre with negative rheumatoid factor, antinuclear antibody, and no clinical clue for a collagen vascular disease. The HRCT changes were noted on Likert scale (0–5) in terms of affection of peripheral and/or axial involvement, reticulation, honeycombing, haze, mosaic, traction bronchiectasis, pleural reactions, features of pulmonary hypertension, and air cysts. Cardiomegaly and independent cardiac chamber enlargement were also recorded. Results: The lower lobes were predominantly (65.6%) affected with similar frequency (78.1) of peripheral and axial parenchymal affection. The parenchymal changes in HRCT were haze or ground-glass opacity (100%), mosaic appearance (93.75%), reticulations (68.75%), traction bronchiectasis (34.3%), air cysts (21.8%), and honeycombing (9.37%). Pleural reactions, though not described so far, were found in 50% of cases. Features of pulmonary hypertension (87.5%), cardiomegaly (50%), left and right atrial enlargement (81.2% and 78.1%), and right ventricular enlargement (31.2%) were the common echocardiography findings. Conclusion: Chronic HP from avian exposure shows predominantly lower lobe involvement with haze, reticulation, features of pulmonary hypertension, and pleural reactions as common HRCT findings. The likelihood of pulmonary hypertension appears high and although honeycombing is often present, the classical UIP pattern has not been found.
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Affiliation(s)
| | - Sanjukta Dasgupta
- Research Scholar, School of Medical Science and Technology, IIT Kharagpur, West Bengal, India
| | - Mintu Paul
- Department of Parenchymal Lung Disease, Institute of Pulmocare and Research, Kolkata, West Bengal, India
| | - Dipanjan Saha
- Department of Parenchymal Lung Disease, Institute of Pulmocare and Research, Kolkata, West Bengal, India
| | - Sayoni Sengupta
- Department of Parenchymal Lung Disease, Institute of Pulmocare and Research, Kolkata, West Bengal, India
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Baqir M, White D, Ryu JH. Emphysematous changes in hypersensitivity pneumonitis: A retrospective analysis of 12 patients. Respir Med Case Rep 2018; 24:25-29. [PMID: 29977751 PMCID: PMC6010618 DOI: 10.1016/j.rmcr.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 02/04/2023] Open
Abstract
Introduction Emphysema is most commonly associated with smoking but also occurs in hypersensitivity pneumonitis (HP). The aim of this study was to further explore this relationship. Methods A retrospective, computer-assisted search was performed to identify patients with HP seen at Mayo Clinic in Rochester, Minnesota, from January 1997 through February 2014. Demographic, clinical, and imaging features were analyzed. Patients were excluded if they had a smoking history of 10 pack-years or more. Results Twelve patients (9 males) with HP and computed tomographic evidence of emphysema were identified. Ten were never smokers and 2 were ex-smokers. The median age at diagnosis was 47 (range, 29-77) years; median symptom duration was 2.2 (range, 0.2-13.4) years. The most common presenting symptoms were dyspnea (83%) and cough (67%). On pulmonary function testing, 6 patients (50%) had a restrictive defect, 2 (17%) had airflow obstruction, and 4 (33%) had an isolated reduction in diffusing capacity of lung for carbon monoxide. The severity of emphysema ranged from mild to severe to focal bullae. All patients had chronic hypersensitivity pneumonitis (CHP). Centrilobular emphysema was most commonly seen with coexistent paraseptal emphysema in 5 patients.Emphysema was most frequent in the upper lung but could be seen in any lobe. Conclusion Emphysema can occur in patients with CHP independently of smoking history and exposure to specific types of antigens. Emphysematous changes seem to progress at a slower pace compare to reticulations/fibrosis.
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Affiliation(s)
- Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
- Corresponding author. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
| | - Darin White
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Screening for Lung Cancer: Incidental Pulmonary Parenchymal Findings. AJR Am J Roentgenol 2018; 210:503-513. [DOI: 10.2214/ajr.17.19003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Abstract
There are possibly millions of mold species on earth. The vast majority of these mold spores live in harmony with humans, rarely causing disease. The rare species that does cause disease does so by triggering allergies or asthma, or may be involved in hypersensitivity diseases such as allergic bronchopulmonary aspergillosis or allergic fungal sinusitis. Other hypersensitivity diseases include those related to occupational or domiciliary exposures to certain mold species, as in the case of Pigeon Breeder's disease, Farmer's lung, or humidifier fever. The final proven category of fungal diseases is through infection, as in the case of onchomycosis or coccidiomycosis. These diseases can be treated using anti-fungal agents. Molds and fungi can also be particularly important in infections that occur in immunocompromised patients. Systemic candidiasis does not occur unless the individual is immunodeficient. Previous reports of "toxic mold syndrome" or "toxic black mold" have been shown to be no more than media hype and mass hysteria, partly stemming from the misinterpreted concept of the "sick building syndrome." There is no scientific evidence that exposure to visible black mold in apartments and buildings can lead to the vague and subjective symptoms of memory loss, inability to focus, fatigue, and headaches that were reported by people who erroneously believed that they were suffering from "mycotoxicosis." Similarly, a causal relationship between cases of infant pulmonary hemorrhage and exposure to "black mold" has never been proven. Finally, there is no evidence of a link between autoimmune disease and mold exposure.
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Miller R, Allen TC, Barrios RJ, Beasley MB, Burke L, Cagle PT, Capelozzi VL, Ge Y, Hariri LP, Kerr KM, Khoor A, Larsen BT, Mark EJ, Matsubara O, Mehrad M, Mino-Kenudson M, Raparia K, Roden AC, Russell P, Schneider F, Sholl LM, Smith ML. Hypersensitivity Pneumonitis A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2018; 142:120-126. [DOI: 10.5858/arpa.2017-0138-sa] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ross Miller
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Timothy Craig Allen
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Roberto J. Barrios
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mary Beth Beasley
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Louise Burke
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Philip T. Cagle
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Vera Luiza Capelozzi
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Yimin Ge
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Lida P. Hariri
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Keith M. Kerr
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Andras Khoor
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Brandon T. Larsen
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Eugene J. Mark
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Osamu Matsubara
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mitra Mehrad
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Mari Mino-Kenudson
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Kirtee Raparia
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Anja Christiane Roden
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Prudence Russell
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Frank Schneider
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Lynette M. Sholl
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
| | - Maxwell Lawrence Smith
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Drs Miller, Barrios, Cagle, and Ge); the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen); the Department of Pathology, Mount Sinai Medical Center, New York, New York (Dr Beasley); the Department of Histopathology, Cork University Hospital, Cork, Ireland (Dr Burke); the Department of Pathology, University of São Paulo, São Paulo, Brazil (Dr Capelozzi); the Department of
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Ryerson CJ, Corte TJ, Lee JS, Richeldi L, Walsh SLF, Myers JL, Behr J, Cottin V, Danoff SK, Flaherty KR, Lederer DJ, Lynch DA, Martinez FJ, Raghu G, Travis WD, Udwadia Z, Wells AU, Collard HR. A Standardized Diagnostic Ontology for Fibrotic Interstitial Lung Disease. An International Working Group Perspective. Am J Respir Crit Care Med 2017; 196:1249-1254. [PMID: 28414524 DOI: 10.1164/rccm.201702-0400pp] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Christopher J Ryerson
- 1 Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada.,2 St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Tamera J Corte
- 3 Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,4 University of Sydney, Sydney, Australia
| | - Joyce S Lee
- 5 Department of Medicine, University of Colorado Denver, Aurora, Colorado
| | - Luca Richeldi
- 6 Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Simon L F Walsh
- 7 Department of Radiology, King's College Hospital National Health Service Foundation Trust, London, United Kingdom
| | | | - Jürgen Behr
- 9 Department of Internal Medicine V, Ludwig Maximilians University, Munich, Germany.,10 Asklepios Clinics, Gauting, Germany.,11 Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | - Vincent Cottin
- 12 Department of Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, University of Lyon, Lyon, France
| | - Sonye K Danoff
- 13 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevin R Flaherty
- 14 Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - David J Lederer
- 15 Department of Medicine, Columbia University, New York, New York
| | - David A Lynch
- 16 Department of Radiology, National Jewish Health, Denver, Colorado
| | | | - Ganesh Raghu
- 18 Department of Medicine, University of Washington, Seattle, Washington
| | - William D Travis
- 19 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zarir Udwadia
- 20 Hinduja Hospital and Research Centre, Mumbai, India.,21 Breach Candy Hospital, Mumbai, India
| | - Athol U Wells
- 22 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom; and
| | - Harold R Collard
- 23 Department of Medicine, University of California San Francisco, San Francisco, California
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Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. Am J Respir Crit Care Med 2017; 196:680-689. [PMID: 28598197 DOI: 10.1164/rccm.201611-2201pp] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Martina Vasakova
- 1 Department of Respiratory Medicine, First Faculty of Medicine of Charles University, Thomayer Hospital Prague, Prague, Czech Republic
| | - Ferran Morell
- 2 Vall d'Hebron Institut de Recerca, Servei de Pneumología, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autonóma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratoria, Barcelona, Catalonia, Spain
| | - Simon Walsh
- 3 King's College National Health Service Hospital Foundation Trust, Denmark Hill, London, United Kingdom
| | | | - Ganesh Raghu
- 5 Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, Washington
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Jee AS, Jo HE, Corte TJ. Hypersensitivity pneumonitis: A protean and challenging disease. Respirology 2017; 22:1489-1490. [PMID: 28851038 DOI: 10.1111/resp.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/07/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Adelle S Jee
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Helen E Jo
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Tamera J Corte
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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CT findings associated with survival in chronic hypersensitivity pneumonitis. Eur Radiol 2017; 27:5127-5135. [DOI: 10.1007/s00330-017-4936-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/01/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
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Tseng HJ, Henry TS, Veeraraghavan S, Mittal PK, Little BP. Pulmonary Function Tests for the Radiologist. Radiographics 2017; 37:1037-1058. [DOI: 10.1148/rg.2017160174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hsiang-Jer Tseng
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Travis S. Henry
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Srihari Veeraraghavan
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
| | - Brent P. Little
- From the Department of Radiology and Imaging Sciences (H.J.T., P.K.M., B.P.L.) and Department of Medicine (S.V.), Emory University, 1364 Clifton Rd NE, Suite D125A, Atlanta, GA 30322; and Department of Radiology and Biomedical Imaging, University of California–San Francisco, San Francisco, Calif (T.S.H.)
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Abstract
Despite the ubiqitous nature of Mycobacterium avium complex (MAC) organisms in the environment, relatively few of those who are infected develop disease. Thus, some degree of susceptibility due to either underlying lung disease or immunosuppression is required. The frequency of pulmonary MAC disease is increasing in many areas, and the exact reasons are unknown. Isolation of MAC from a respiratory specimen does not necessarily mean that treatment is required, as the decision to treatment requires the synthesis of clinical, radiographic, and microbiologic information as well as a weighing of the risks and benefits for the individual patient. Successful treatment requires a multipronged approach that includes antibiotics, aggressive pulmonary hygiene, and sometimes resection of the diseased lung. A combination of azithromycin, rifampin, and ethambutol administered three times weekly is recommend for nodular bronchiectatic disease, whereas the same regimen may be used for cavitary disease but administered daily and often with inclusion of a parenteral aminoglycoside. Disseminated MAC (DMAC) is almost exclusively seen in patients with late-stage AIDS and can be treated with a macrolide in combination with ethambutol, with or without rifabutin: the most important intervention in this setting is to gain HIV control with the use of potent antiretroviral therapy. Treatment outcomes for many patients with MAC disease remain suboptimal, so new drugs and treatment regimens are greatly needed. Given the high rate of reinfection after cure, one of the greatest needs is a better understanding of where infection occurs and how this can be prevented.
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Woge MJ, Ryu JH, Moua T. Diagnostic implications of positive avian serology in suspected hypersensitivity pneumonitis. Respir Med 2017; 129:173-178. [PMID: 28732828 DOI: 10.1016/j.rmed.2017.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/27/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The diagnostic evaluation of patients with interstitial lung disease (ILD) often involves serologic assessment for identifiable causes such as hypersensitivity pneumonitis (HP). While not on its own defining of HP, precipitin serologies are often obtained to support clinical suspicion if other findings are inconclusive. We studied the clinical relevance of positive avian serology in patients undergoing ILD evaluation. MATERIAL AND METHODS We identified individuals with positive avian serology (>53.3 mg/L) and undifferentiated ILD seen at our institution over a three-year period. Clinical, laboratory, pathologic, and radiologic findings were evaluated for consensus HP diagnosis by two expert pulmonologists, blinded to presenting serology levels. RESULTS Ninety-one ILD subjects with positive avian serology were identified; mean age was 62.7 ± 15.3 years with a slight male predominance (56%). Forty-nine (54%) received a consensus HP diagnosis. Those with HP had higher mean avian serology titer (95.0 ± 38.7 mg/L vs. 68.3 ± 16.7, (P < 0.0001). Never-smokers also had higher titers compared to prior or active smokers (P = 0.0008). Positive avian protein exposure (P < 0.0001, OR 21.3 (6.4-87)), DLCO% (P = 0.04, unit OR 0.96 (0.92-0.99)), and increasing serology titer (P < 0.015, unit OR 1.03 [1.01-1.06]) were independent predictors of HP diagnosis. CONCLUSION Among patients with positive avian serology, those with higher titers were more likely to have HP diagnosis. Nonsmokers also manifested higher titers compared to those with smoking history. These results may guide the usage and interpretation of avian serology screening in the initial assessment of suspected HP.
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Affiliation(s)
- Matthew J Woge
- Department of Pathology, Mayo Clinic, Rochester, United States
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, United States
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, United States.
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Kouranos V, Jacob J, Nicholson A, Renzoni E. Fibrotic Hypersensitivity Pneumonitis: Key Issues in Diagnosis and Management. J Clin Med 2017; 6:jcm6060062. [PMID: 28617305 PMCID: PMC5483872 DOI: 10.3390/jcm6060062] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022] Open
Abstract
The diagnosis of hypersensitivity pneumonitis (HP) relies on the clinical evaluation of a number of features, including a history of significant exposure to potentially causative antigens, physical examination, chest CT scan appearances, bronchoalveolar lavage lymphocytosis, and, in selected cases, histology. The presence of fibrosis is associated with higher morbidity and mortality. Differentiating fibrotic HP from the idiopathic interstitial pneumonias can be a challenge. Furthermore, even in the context of a clear diagnosis of fibrotic HP, the disease behaviour can parallel that of idiopathic pulmonary fibrosis in a subgroup, with inexorable progression despite treatment. We review the current knowledge on the diagnosis, management, and prognosis of HP with particular focus on the fibrotic phenotype.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, Sydney Street, SW3 6NP London, UK.
| | - Joseph Jacob
- Department of Radiology, Royal Brompton Hospital, London, UK.
| | - Andrew Nicholson
- Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College, London, UK.
| | - Elizabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, Sydney Street, SW3 6NP London, UK.
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76
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D'souza RS, Donato A. Hypersensitivity pneumonitis: an overlooked cause of cough and dyspnea. J Community Hosp Intern Med Perspect 2017. [PMID: 28638572 PMCID: PMC5473193 DOI: 10.1080/20009666.2017.1320202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is an immune-mediated pulmonary disorder involving inflammation of the lung interstitium, terminal bronchioles, and alveoli caused by the immune response to the inhalation of an offending environmental airborne agent. It can manifest as exertional dyspnea, fatigue, weight loss, and progressive respiratory failure if left untreated. Because of its protean features, it can be misdiagnosed as other common obstructive lung conditions such as asthma. If triggers are not avoided, it can progress to irreversible pulmonary fibrosis. In this article, we present the case of a 51-year-old male who presented to our hospital with recurrent bouts of dyspnea and cough, initially diagnosed as an asthma exacerbation. He received a final diagnosis of HP after investigation of his workplace revealed airborne spores and surface molds from multiple fungal species, serology revealed eosinophilia, and computed tomography showed bronchiectasis. Avoidance of occupational exposure resulted in significant improvement of his respiratory symptoms after two months. Abbreviations: HP: Hypersensitivity pneumonitis
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Affiliation(s)
- Ryan S D'souza
- Department of Medicine, Reading Hospital, West Reading, PA, USA.,Adult Medical Genetics Program and Division of Cardiology, University of Colorado Denver, Denver, CO, USA
| | - Anthony Donato
- Department of Medicine, Reading Health System, Reading, PA, USA
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77
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Jacob J, Bartholmai BJ, Egashira R, Brun AL, Rajagopalan S, Karwoski R, Kokosi M, Hansell DM, Wells AU. Chronic hypersensitivity pneumonitis: identification of key prognostic determinants using automated CT analysis. BMC Pulm Med 2017; 17:81. [PMID: 28472939 PMCID: PMC5418678 DOI: 10.1186/s12890-017-0418-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 04/22/2017] [Indexed: 01/08/2023] Open
Abstract
Background Chronic hypersensitivity pneumonitis (CHP) has a variable disease course. Computer analysis of CT features was used to identify a subset of CHP patients with an outcome similar to patients with idiopathic pulmonary fibrosis (IPF). Methods Consecutive patients with a multi-disciplinary team diagnosis of CHP (n = 116) had pulmonary function tests (FEV1, FVC, DLco, Kco, and a composite physiologic index [CPI]) and CT variables predictive of mortality evaluated by analysing visual and computer-based (CALIPER) parenchymal features: total interstitial lung disease (ILD) extent, honeycombing, reticular pattern, ground glass opacities, pulmonary vessel volume (PVV), emphysema, and traction bronchiectasis. Mean survival was compared between both CHP and IPF patients (n = 185). Results In CHP, visual/CALIPER measures of reticular pattern, honeycombing, visual traction bronchiectasis, and CALIPER ILD extent were predictive of mortality (p < 0 · 05) on univariate analysis. PVV was strongly predictive of mortality on univariate (p < 0 · 0001) and multivariate analysis independent of age, gender and disease severity (represented by the CPI [p < 0 · 01]). CHP patients with a PVV threshold >6 · 5% of the lung had a mean survival (35 · 3 ± 6 · 1 months; n = 20/116 [17%]) and rate of disease progression that closely matched IPF patients (38 · 4 ± 2 · 2 months; n = 185). Conclusions Pulmonary vessel volume can identify CHP patients at risk of aggressive disease and a poor IPF-like prognosis. Electronic supplementary material The online version of this article (doi:10.1186/s12890-017-0418-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joseph Jacob
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
| | | | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga-City, Japan
| | - Anne Laure Brun
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Srinivasan Rajagopalan
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, MN, USA
| | - Ronald Karwoski
- Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, Rochester, MN, USA
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - David M Hansell
- Department of Radiology, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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Abstract
Hypersensitivity pneumonitis (HP) may be a challenging diagnosis given the wide variability of its clinical, radiographic, and pathologic manifestations. A multidisciplinary approach to diagnosis is critical in maintaining a high specificity for HP. An in-depth knowledge of all 3 arms of the multidisciplinary approach helps clinicians, radiologists, and pathologists interpret their own findings in the context of the entire presentation. In some cases, the combination of clinical findings (ie, an identifiable exposure) and typical findings on high-resolution computed tomography is considered diagnostic of HP, and pathologic confirmation is not necessary. As many as 50% of patients do not have a clear exposure, however. These patients may be difficult to distinguish from idiopathic disorders. In these cases, high-resolution computed tomography and pathology are the primary data points that may suggest the correct diagnosis. The goal of this paper is to discuss recent advances in HP and to present the spectrum of clinical, radiographic, and pathologic findings.
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79
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Pereira CA, Gimenez A, Kuranishi L, Storrer K. Chronic hypersensitivity pneumonitis. J Asthma Allergy 2016; 9:171-181. [PMID: 27703382 PMCID: PMC5036552 DOI: 10.2147/jaa.s81540] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Hypersensitivity pneumonitis (HSP) is a common interstitial lung disease resulting from inhalation of a large variety of antigens by susceptible individuals. The disease is best classified as acute and chronic. Chronic HSP can be fibrosing or not. Fibrotic HSP has a large differential diagnosis and has a worse prognosis. The most common etiologies for HSP are reviewed. Diagnostic criteria are proposed for both chronic forms based on exposure, lung auscultation, lung function tests, HRCT findings, bronchoalveolar lavage, and biopsies. Treatment options are limited, but lung transplantation results in greater survival in comparison to idiopathic pulmonary fibrosis. Randomized trials with new antifibrotic agents are necessary.
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Affiliation(s)
| | - Andréa Gimenez
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Lilian Kuranishi
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
| | - Karin Storrer
- Pulmonology Postgraduate, Federal University of São Paulo, São Paulo, Brazil
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80
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Magee AL, Montner SM, Husain A, Adegunsoye A, Vij R, Chung JH. Imaging of Hypersensitivity Pneumonitis. Radiol Clin North Am 2016; 54:1033-1046. [PMID: 27719974 DOI: 10.1016/j.rcl.2016.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The management of hypersensitivity pneumonitis (HP) depends on early identification of the disease process, which is complicated by its nonspecific clinical presentation in addition to variable and diverse laboratory and radiologic findings. HP is the result of exposure and sensitization to myriad aerosolized antigens. HP develops in the minority of antigenic exposures, and conversely has been documented in patients with no identifiable exposure, complicating the diagnostic algorithm significantly. Prompt diagnosis and early intervention are critical in slowing the progression of irreversible parenchymal damage, and additionally in preserving the quality of life of affected patients.
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Affiliation(s)
- Andrea L Magee
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA.
| | - Steven M Montner
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA
| | - Aliya Husain
- Department of Pathology, The University of Chicago, 5841 South Maryland Avenue, #6101, Chicago, IL 60637, USA
| | - Ayodeji Adegunsoye
- Department of Pathology, The University of Chicago, 5841 South Maryland Avenue, #6101, Chicago, IL 60637, USA
| | - Rekha Vij
- Department of Pulmonology & Critical Care, The University of Chicago, 5841 South Maryland Avenue, MC6076, Chicago, IL 60637, USA
| | - Jonathan H Chung
- Department of Radiology, The University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL 60637, USA
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81
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Factors associated with positive inhalation provocation test results in subjects suspected of having chronic bird-related hypersensitivity pneumonitis. Respir Investig 2016; 54:454-461. [PMID: 27886857 DOI: 10.1016/j.resinv.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chronic bird-related hypersensitivity pneumonitis (BRHP) is often misdiagnosed as other interstitial lung diseases. While the utility of the inhalation provocation test (IPT) has been reported, the test is not commonly performed. In this study, we aimed to identify significant clinical variables associated with positive inhalation provocation test results in subjects suspected of having chronic BRHP. This would help clinicians decide whether to perform IPT in patients suspected of having chronic BRHP in real-life practice. METHODS We retrospectively evaluated 107 patients who underwent the IPT for suspected chronic BRHP. We used the IPT as the gold standard diagnostic tool for chronic BRHP. RESULTS Specific antibodies against pigeon dropping extract were documented in 52% of the IPT-positive patients but also in 38% of the IPT-negative patients (p=0.172). By using the logistic regression model, three significant predictors of IPT results were identified as follows: (1) a history of raising birds (odds ratio [OR] 3.112), (2) exposure to birds from the surrounding environment (OR 7.321), (3) white blood cell count (×102/μl; OR 0.959). CONCLUSIONS This study demonstrates that current or past exposure to avian antigens is a positive predictor of positive IPT results in patients suspected of having chronic BRHP.
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82
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Quirce S, Vandenplas O, Campo P, Cruz MJ, de Blay F, Koschel D, Moscato G, Pala G, Raulf M, Sastre J, Siracusa A, Tarlo SM, Walusiak-Skorupa J, Cormier Y. Occupational hypersensitivity pneumonitis: an EAACI position paper. Allergy 2016; 71:765-79. [PMID: 26913451 DOI: 10.1111/all.12866] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2016] [Indexed: 12/14/2022]
Abstract
The aim of this document was to provide a critical review of the current knowledge on hypersensitivity pneumonitis caused by the occupational environment and to propose practical guidance for the diagnosis and management of this condition. Occupational hypersensitivity pneumonitis (OHP) is an immunologic lung disease resulting from lymphocytic and frequently granulomatous inflammation of the peripheral airways, alveoli, and surrounding interstitial tissue which develops as the result of a non-IgE-mediated allergic reaction to a variety of organic materials or low molecular weight agents that are present in the workplace. The offending agents can be classified into six broad categories that include bacteria, fungi, animal proteins, plant proteins, low molecular weight chemicals, and metals. The diagnosis of OHP requires a multidisciplinary approach and relies on a combination of diagnostic tests to ascertain the work relatedness of the disease. Both the clinical and the occupational history are keys to the diagnosis and often will lead to the initial suspicion. Diagnostic criteria adapted to OHP are proposed. The cornerstone of treatment is early removal from exposure to the eliciting antigen, although the disease may show an adverse outcome even after avoidance of exposure to the causal agent.
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Affiliation(s)
- S. Quirce
- Department of Allergy; Hospital La Paz Institute for Health Research (IdiPAZ) and CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - O. Vandenplas
- Department of Chest Medicine; Centre Hospitalier Universitaire de Mont-Godinne; Université Catholique de Louvain; Yvoir Belgium
| | - P. Campo
- Unidad de Gestión Clínica Allergy-IBIMA; Hospital Regional Universitario; Málaga Spain
| | - M. J. Cruz
- Pulmonology Service; Hospital Universitari Vall d'Hebron; Universitat Autonoma de Barcelona; Barcelona Spain
- CIBER de Enfermedades Respiratorias (CIBERES); Barcelona Spain
| | - F. de Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital; Fédération de Médecine Translationnelle de Strasbourg; Strasbourg University; Strasbourg France
| | - D. Koschel
- Fachkrankenhaus Coswig GmbH Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thorax- und Gefäßchirurgie; Coswig Germany
| | - G. Moscato
- Department of Public Health, Experimental and Forensic Medicine; University of Pavia; Pavia Italy
| | - G. Pala
- Occupational Physician's Division; Local Health Authority of Sassari; Sassari Italy
| | - M. Raulf
- IPA Institute for Prevention and Occupational Medicine of the German Social Accident Insurance; Institute of the Ruhr-Universität Bochum; Bochum Germany
| | - J. Sastre
- Department of Allergy; Fundación Jiménez Díaz, and CIBER de Enfermedades Respiratorias (CIBERES); Madrid Spain
| | - A. Siracusa
- Formerly Department of Clinical and Experimental Medicine; University of Perugia; Perugia Italy
| | - S. M. Tarlo
- Department of Medicine and Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
- Respiratory Division Toronto Western Hospital; Gage Occupational and Environmental Health Unit; St Michael's Hospital; Toronto ON Canada
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases and Toxicology; Nofer Institute of Occupational Medicine; Lodz Poland
| | - Y. Cormier
- Centre de Pneumologie; Institut Universitaire de Cardiologie et de Pneumologie de Québec; Université Laval; Québec City QC Canada
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Cramer C, Schlünssen V, Bendstrup E, Stokholm ZA, Vestergaard JM, Frydenberg M, Kolstad HA. Risk of hypersensitivity pneumonitis and interstitial lung diseases among pigeon breeders. Eur Respir J 2016; 48:818-25. [PMID: 27230447 DOI: 10.1183/13993003.00376-2016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/24/2016] [Indexed: 11/05/2022]
Abstract
We studied the risk of hypersensitivity pneumonitis and other interstitial lung diseases (ILDs) among pigeon breeders.This is a retrospective follow-up study from 1980 to 2013 of 6920 pigeon breeders identified in the records of the Danish Racing Pigeon Association. They were compared with 276 800 individually matched referents randomly drawn from the Danish population. Hospital based diagnoses of hypersensitivity pneumonitis and other ILDs were identified in the National Patient Registry 1977-2013. Stratified Cox regression analyses estimated the hazard ratios (HR) of hypersensitivity pneumonitis and other ILDs adjusted for occupation, residence and redeemed prescription of medication with ILDs as a possible side-effect. Subjects were censored at death, emigration or a diagnosis of connective tissue disease.The overall incidence rate of ILD was 77.4 per 100 000 person-years among the pigeon breeders and 50.0 among the referents. This difference corresponded to an adjusted HR of 1.56 (95% CI 1.26-1.94). The adjusted HRs of hypersensitivity pneumonitis and other ILDs for pigeon breeders were 14.36 (95% CI 8.10-25.44) and 1.33 (95% CI 1.05-1.69), respectively.This study shows an increased risk of ILD among pigeon breeders compared with the referent population. Protective measures are recommended even though ILD leading to hospital contact remains rare among pigeon breeders.
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Affiliation(s)
- Christine Cramer
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Vivi Schlünssen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark Department of Public Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Zara Ann Stokholm
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Frydenberg
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, Aarhus, Denmark
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84
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Jacobs MR, Jacobs RL. Environmental challenge: An effective approach for diagnosis and remediation of exacerbations of hypersensitivity pneumonitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:537-8. [DOI: 10.1016/j.jaip.2015.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/19/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
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Saukkonen K, Sharma A, Mark EJ. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 8-2016. A 71-Year-Old Man with Recurrent Fevers, Hypoxemia, and Lung Infiltrates. N Engl J Med 2016; 374:1077-85. [PMID: 26981938 DOI: 10.1056/nejmcpc1505680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kai Saukkonen
- From the Departments of Pulmonary and Critical Care (K.S.), Radiology (A.S.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Pulmonary and Critical Care (K.S.), Radiology (A.S.), and Pathology (E.J.M.), Harvard Medical School - both in Boston
| | - Amita Sharma
- From the Departments of Pulmonary and Critical Care (K.S.), Radiology (A.S.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Pulmonary and Critical Care (K.S.), Radiology (A.S.), and Pathology (E.J.M.), Harvard Medical School - both in Boston
| | - Eugene J Mark
- From the Departments of Pulmonary and Critical Care (K.S.), Radiology (A.S.), and Pathology (E.J.M.), Massachusetts General Hospital, and the Departments of Pulmonary and Critical Care (K.S.), Radiology (A.S.), and Pathology (E.J.M.), Harvard Medical School - both in Boston
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86
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Chronic hypersensitivity pneumonitis: important considerations in the work-up of this fibrotic lung disease. Curr Opin Pulm Med 2016; 21:171-7. [PMID: 25584937 DOI: 10.1097/mcp.0000000000000137] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Chronic hypersensitivity pneumonitis is increasingly recognized as an important mimic of other fibrotic lung diseases. This review will summarize recent data regarding the importance and difficulty of determining causative exposures both for accurate diagnosis and prognosis, and describe the expanded pathologic spectrum of the disease, the effects of fibrosis on prognosis and challenges in the diagnostic evaluation. RECENT FINDINGS Several recent publications show the potential pathologic patterns induced by chronic hypersensitivity pneumonitis are broader than the classic triad of bronchiolitis, interstitial infiltrates and granulomas. Other pathologic patterns include nonspecific interstitial pneumonia, usual interstitial pneumonia, organizing pneumonia, bronchiolitis and airway centric fibrosis. Detecting a causative antigen in fibrotic hypersensitivity pneumonitis is challenging but critically important both for accurate diagnosis and improved prognosis. The prognosis in hypersensitivity pneumonitis worsens in the presence of fibrosis, but it remains significantly better than idiopathic pulmonary fibrosis. SUMMARY Hypersensitivity pneumonitis is increasingly recognized as an important cause of fibrotic interstitial lung disease. Hypersensitivity pneumonitis demonstrates a remarkable tendency to mimic other idiopathic interstitial pneumonias. A detailed exposure history remains a cornerstone of diagnosis and management.
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87
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Dalpiaz G, Piolanti M. Non-infectious Parenchymal Lung Disease. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7121959 DOI: 10.1007/174_2016_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acute dyspnea is a common presenting complaint in the emergency room, emergency medicine and intensive care. It may have a cardiovascular or a non-cardiovascular origin, the latter including pulmonary parenchymal diseases. Depending on the cause, it may be associated with fever, cough, hemoptysis, and/or chest pain, with a duration of symptoms that can range from hours to days. Prompt identification of the underlying cause of acute dyspnea is essential in guiding appropriate therapy and management, as patients may rapidly progress to acute respiratory failure. Evaluation with chest radiography is vital for initial assessment and may reveal diffuse parenchymal abnormalities, which may require further assessment with computed tomography (HRCT). Acute non-infectious parenchymal lung diseases are often overlooked and may be under-diagnosed. Their diagnosis requires the evaluation, along with the HRCT pattern, of the clinical and laboratory features and of the bronchoalveolar lavage. Biopsy may be necessary in more complex cases. Although the most frequent cause of diffuse non-infectious parenchymal lung involvement is acute hydrostatic pulmonary edema, there is a wide variety of diseases that may be encountered, including acute drug toxicity, hypersensitivity pneumonitis (HP), acute respiratory distress syndrome (ARDS) and diffuse alveolar hemorrhage (DAH). In trauma patients, fat embolism syndrome (FES) must be taken into account. Acute respiratory failure is an eventuality that can occur during the course of chronic lung diseases (UIP for example), which may have been unknown until then.
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88
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Ojanguren I, Cruz MJ, Villar A, Barrecheguren M, Morell F, Muñoz X. Utility of Exhaled Nitric Oxide Fraction for the Diagnosis of Hypersensitivity Pneumonitis. Lung 2015; 194:75-80. [DOI: 10.1007/s00408-015-9824-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/03/2015] [Indexed: 01/05/2023]
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89
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Barber CM, Wiggans RE, Bradshaw LM, Fishwick D. Serial peak flow measurements in allergic alveolitis. Occup Med (Lond) 2015; 65:505-6. [PMID: 26240129 PMCID: PMC4522513 DOI: 10.1093/occmed/kqv099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
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90
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Barber CM, Wiggans RE, Fishwick D. Impaired quality of life in chronic hypersensitivity pneumonitis. Chest 2015; 147:e230. [PMID: 26033140 DOI: 10.1378/chest.15-0198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Ruth E Wiggans
- Centre for Workplace Health, Health and Safety Laboratory. Buxton, England
| | - David Fishwick
- Centre for Workplace Health, Health and Safety Laboratory. Buxton, England
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91
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Pulmonary Function Abnormalities in Regard to Age at the Time of Diagnosis of Hypersensitivity Pneumonitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 861:75-84. [DOI: 10.1007/5584_2015_137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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92
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Dickson SD, Tankersley MS. Fatal Hypersensitivity Pneumonitis from Exposure to Fusarium vasinfectum in a Home Environment: A Case Report. Int Arch Allergy Immunol 2015; 166:150-3. [PMID: 25871746 DOI: 10.1159/000377631] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypersensitivity pneumonitis (HP) is a rare, non-IgE-mediated inflammatory lung disease caused by inhalational exposure to various antigens found in occupational, avocational and home environments. The prognosis is favorable with early detection and prompt removal of the causative agent, and fatalities are unusual. We present a fatal case of HP caused by chronic exposure to Fusarium vasinfectum mold in the home. CASE REPORT A 37-year-old white male presented with a 6-month history of progressively worsening dyspnea, cough, weight loss and fatigue associated with the self-renovation of his water-damaged, mold-infested mobile home. Evaluation included a physical examination (hypoxia, inspiratory crackles and expiratory rhonchi), baseline pulmonary function testing (mixed obstructive/restrictive pattern), chest computed tomography (bronchiectasis, fibrosis and diffuse interstitial involvement), bronchoalveolar lavage (macrophages 20%, lymphocytes 28% and neutrophils 52%) and transbronchial biopsy (interstitial fibrosis and chronic inflammatory infiltrate). Mold culture from the home grew out F. vasinfectum. An Ouchterlony double diffusion technique documented high antibody titer to F. vasinfectum. Despite aggressive intravenous corticosteroid treatment, the patient's lung function declined to the extent that he could not be removed from ventilator support following an open lung biopsy, eventually resulting in death. CONCLUSION This is the first reported case of fatal HP related to an acute exacerbation of a chronic form of HP following continuous and intense exposure to F. vasinfectum. Although uncommon, a high index of suspicion for HP is necessary in patients with progressive respiratory symptoms and known environmental antigen exposure. With early detection and prompt removal of the causative antigen, HP prognosis is generally favorable, but can progress to fatal disease with continued exposure.
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Affiliation(s)
- Scott D Dickson
- Department of Allergy and Immunology, 56th MDG/SGOMA, Luke Air Force Base, Glendale, Ariz., USA
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93
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Donato J, Phillips CT, Gaffney AW, VanderLaan PA, Mouded M. A case of hypercalcemia secondary to hot tub lung. Chest 2015; 146:e186-e189. [PMID: 25451359 DOI: 10.1378/chest.14-0350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a diffuse granulomatous lung disease resulting from inhalation of an antigen to which an individual has been previously sensitized. Hot tub lung is an increasingly common form of HP associated with inhalation of water aerosols containing Mycobacterium avium complex organisms that contaminate hot tub water. Granulomatous lung disorders, most classically sarcoidosis, have been associated with unregulated 1-α-hydroxylase expression by macrophages present in the granulomas, causing conversion of 25-OH-vitamin D to the active form of vitamin D, 1,25(OH)2 vitamin D, and, thus, hypercalcemia. To our knowledge, this is the first confirmed case of hypercalcemia secondary to elevated 1,25(OH)2 vitamin D levels associated with HP.
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Affiliation(s)
- Jessica Donato
- Department of Medicine, Beth Israel Deaconness Medical Center
| | | | - Adam W Gaffney
- Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconness Medical Center
| | | | - Majd Mouded
- Department of Pulmonary and Critical Care Medicine, Beth Israel Deaconness Medical Center; Department of Pulmonary Medicine, Harvard Vanguard Medical Associates, Boston, MA
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94
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Validation of Inhalation Provocation Test in Chronic Bird-Related Hypersensitivity Pneumonitis and New Prediction Score. Ann Am Thorac Soc 2015; 12:167-73. [DOI: 10.1513/annalsats.201408-350oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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95
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Castonguay MC, Ryu JH, Yi ES, Tazelaar HD. Granulomas and giant cells in hypersensitivity pneumonitis. Hum Pathol 2015; 46:607-13. [PMID: 25694347 DOI: 10.1016/j.humpath.2014.12.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/29/2014] [Accepted: 12/03/2014] [Indexed: 11/17/2022]
Abstract
Hypersensitivity pneumonitis (HP) is an immunologically mediated form of diffuse lung disease, with histopathologic features that include cellular bronchiolitis, interstitial pneumonia, poorly formed granulomas, isolated multinucleated giant cells (MNGCs), organizing pneumonia, and interstitial fibrosis. This study describes the clinical and histopathologic findings in a retrospective series of 40 consecutive patients diagnosed with HP at the Mayo Clinic in Rochester, MN, between 1997 and 2011. Because the literature indicates that granulomas and MNGCs are located in the interstitium, particular attention was given to their distribution. Of the 40 patients, 33 underwent surgical lung biopsy and 7 underwent lung transplantation. Thirty-eight (95%) patients had interstitial pneumonia; 37 (93%), cellular bronchiolitis; 32 (80%), nonnecrotizing granulomas; 31 (78%), isolated MNGCs; 34 (85%) organizing pneumonia, and 31 (78%); interstitial fibrosis. In 27 cases, the granulomas were within airspaces; and in 26, they were interstitial. In 25 cases, MNGCs were within airspaces; and in 24, they were interstitial. In 3 (8%) cases, both granulomas and MNGCs were seen only within airspaces. Interstitial fibrosis was centrilobular in 22 cases, resembled usual interstitial pneumonia in 18 cases, and resembled nonspecific interstitial pneumonia in 11 cases. The "classic triad" of bronchiolitis, interstitial pneumonia, and granulomas was seen in 29 (73%) cases and was most frequent in biopsy than explant specimens (P = .004). This study confirms that granulomas and MNGCs are not confined to the pulmonary interstitium in HP.
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Affiliation(s)
- Mathieu C Castonguay
- Department of Pathology and Laboratory Medicine, Capital District Health Authority, Halifax, Nova Scotia, B3H 1 V8, Canada
| | - Jay H Ryu
- Division of Pulmonology and Critical Care Medicine, Mayo Clinic, Rochester, MN, 55905, USA
| | - Eunhee S Yi
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Henry D Tazelaar
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, 85259, USA.
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96
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Suhara K, Miyazaki Y, Okamoto T, Yasui M, Tsuchiya K, Inase N. Utility of immunological tests for bird-related hypersensitivity pneumonitis. Respir Investig 2015; 53:13-21. [PMID: 25542599 DOI: 10.1016/j.resinv.2014.08.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/09/2014] [Accepted: 08/11/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND The reaction of specific antibodies and sensitized lymphocytes to antigens is important in hypersensitivity pneumonitis (HP). However, there are no known studies evaluating the utility of the lymphocyte proliferation test (LPT) or specific antibodies to avian antigens in diagnosing bird-related HP. In this study, we examined the sensitivity and specificity of these two tests. METHODS Patients with acute bird-related HP (n=10), chronic bird-related HP (n=35), acute summer-type HP (n=14), and other interstitial pneumonia (IP) (n=76) were evaluated. The optimal cutoff values were determined by receiver operating curve (ROC) analyses of specific antibodies in serum and bronchoalveolar lavage fluid (BALF), and by conducting the LPT on mononuclear cells in peripheral blood and BALF. RESULTS The sensitivity and specificity of the antibodies were 80-100% and 92-100% in acute bird-related HP, and 26-79% and 73-93% in chronic bird-related HP, respectively. The sensitivity and specificity of the LPT were 50-100% and 100% in acute bird-related HP, and 46% and 91% in chronic bird-related HP, respectively. CONCLUSIONS Specific antibodies and the LPT are quite useful for diagnosing acute bird-related HP. The presence of specific antibodies in BALF and the results of LPT with peripheral blood mononuclear cells are particularly useful for diagnosing chronic bird-related HP.
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Affiliation(s)
- Kozo Suhara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Tsukasa Okamoto
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Makito Yasui
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Kimitake Tsuchiya
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Naohiko Inase
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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97
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98
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Ramirez RM, Jacobs RL. Hypersensitivity pneumonitis by Fusarium vasinfectum in a home environment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:483-4. [DOI: 10.1016/j.jaip.2014.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/19/2014] [Accepted: 04/04/2014] [Indexed: 11/30/2022]
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99
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Greer AM, Matthay MA, Kukreja J, Bhakta NR, Nguyen CP, Wolters PJ, Woodruff PG, Fahy JV, Shin JS. Accumulation of BDCA1⁺ dendritic cells in interstitial fibrotic lung diseases and Th2-high asthma. PLoS One 2014; 9:e99084. [PMID: 24915147 PMCID: PMC4051692 DOI: 10.1371/journal.pone.0099084] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 04/09/2014] [Indexed: 01/03/2023] Open
Abstract
Dendritic cells (DCs) significantly contribute to the pathology of several mouse lung disease models. However, little is known of the contribution of DCs to human lung diseases. In this study, we examined infiltration with BDCA1+ DCs of human lungs in patients with interstitial lung diseases or asthma. Using flow cytometry, we found that these DCs increased by 5∼6 fold in the lungs of patients with idiopathic pulmonary fibrosis or hypersensitivity pneumonitis, which are both characterized by extensive fibrosis in parenchyma. The same DC subset also significantly increased in the lung parenchyma of patients with chronic obstructive pulmonary disease, although the degree of increase was relatively modest. By employing immunofluorescence microscopy using FcεRI and MHCII as the specific markers for BDCA1+ DCs, we found that the numbers of BDCA1+ DCs also significantly increased in the airway epithelium of Th2 inflammation-associated asthma. These findings suggest a potential contribution of BDCA1+ DCs in human lung diseases associated with interstitial fibrosis or Th2 airway inflammation.
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Affiliation(s)
- Alexandra M. Greer
- Department of Microbiology and Immunology, Sandler Asthma Basic Research Center, University of California San Francisco, San Francisco, California, United States of America
| | - Michael A. Matthay
- Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, California, United States of America
| | - Jasleen Kukreja
- Division of Cardiothoracic Surgery, University of California San Francisco, San Francisco, California, United States of America
| | - Nirav R. Bhakta
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Christine P. Nguyen
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Paul J. Wolters
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - John V. Fahy
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Jeoung-Sook Shin
- Department of Microbiology and Immunology, Sandler Asthma Basic Research Center, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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100
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Kambouchner M, Levy P, Nicholson AG, Schubel K, Magois E, Feuillet S, Valeyre D, Bernaudin JF, Nunes H. Prognostic relevance of histological variants in nonspecific interstitial pneumonia. Histopathology 2014; 65:549-60. [DOI: 10.1111/his.12415] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Pierre Levy
- Département de Santé Publique; AP-HP; Hôpital Tenon; Université Pierre et Marie Curie Paris 6; Paris France
| | - Andrew G Nicholson
- Department of Histopathology; Royal Brompton and Harefield NHS Foundation Trust and NHLI Division; Imperial College London; London UK
| | - Kirsten Schubel
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
| | - Eline Magois
- Service de Pneumologie; Hôpital d'Amiens; Université de Picardie Jules Verne; Amiens France
| | - Séverine Feuillet
- Service de Pneumologie; AP-HP Hôpital Saint-Louis; Hôpital Saint Louis; Université Paris Diderot; Sorbonne Paris Cité; Paris France
| | - Dominique Valeyre
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
- Université Paris 13; Sorbonne Paris Cité; Paris France
| | - Jean-François Bernaudin
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
- Service d' Anatomie Pathologique; AP-HP Hôpital Tenon; Université Pierre et Marie Curie Paris 6; Paris France
| | - Hilario Nunes
- Service de Pneumologie; AP-HP; Hôpital Avicenne; Bobigny France
- Université Paris 13; Sorbonne Paris Cité; Paris France
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