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Kespohl S, Warfolomeow I, Merget R, Brüning T, Raulf M. Hypersensitivity pneumonitis due to metal working fluids: detection of specific IgG antibodies to microbial antigens. Respir Physiol Neurobiol 2023:104107. [PMID: 37451418 DOI: 10.1016/j.resp.2023.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/18/2023]
Abstract
Occupational exposure to microbially contaminated metal working fluids (MWF) can cause hypersensitivity pneumonitis (HP). An important step in the diagnosis of HP is to identify the triggering antigen by detection of corresponding specific IgG antibodies (sIgG). As commercial sIgG tests are currently not available, protein antigens were prepared from MWF-workplace samples and from MWF-typical bacterial isolates. In 57% of suspected HP-cases (n= 30) elevated sIgG concentrations were measured to at least one MWF-relevant antigen, of which Mycobacterium immunogenum was most prominent (88%), followed by Pseudomonas oleovorans and Pseudomonas spec (82% each), MWF-antigen mix and Pseudomonas alcaliphila (65% each). Elevated sIgG concentrations to other microorganisms were measured to Micropolyspora faeni (82%) and Aureobasidium pullulans (77%). Correlation of sIgG values of all tested microbial antigens showed a significant relationship of MWF-antigen mixture to Pseudomonas antigens, but a low correlation to moulds. These newly prepared MWF-antigens are useful tools for the diagnosis of patients with suspected MWF-HP and are available for further investigations.
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Affiliation(s)
- Sabine Kespohl
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany.
| | - Isabell Warfolomeow
- German Social Accident Insurance Institution for the Woodworking and Metalworking Industries, BGHM, Mainz
| | - Rolf Merget
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
| | - Monika Raulf
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bochum, Germany
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Petnak T, Moua T. Exposure assessment in hypersensitivity pneumonitis: a comprehensive review and proposed screening questionnaire. ERJ Open Res 2020; 6:00230-2020. [PMID: 33015147 PMCID: PMC7520171 DOI: 10.1183/23120541.00230-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
Hypersensitivity pneumonitis is an immune-mediated inflammatory lung disease characterised by the inhalation of environmental antigens leading to acute and chronic lung injury. Along with suggestive clinical and radiological findings, history and timing of suspected antigen exposure are important elements for diagnostic confidence. Unfortunately, many diagnoses remain tentative and based on vague and imprecise environmental or material exposure histories. To date, there has not been a comprehensive report highlighting the frequency and type of environmental exposure that might lead to or support a more systematic approach to antigen identification. We performed a comprehensive literature review to identify and classify causative antigens and their associated environmental contexts or source materials, with emphasis on the extent of the supportive literature for each exposure type. Eligible publications were those that reported unique inciting antigens and their respective environments or contexts. A clinical questionnaire was then proposed based on this review to better support diagnosis of hypersensitivity pneumonitis when antigen testing or other clinical and radiological variables are inconclusive or incomplete.
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Affiliation(s)
- Tananchai Petnak
- Division of Pulmonary and Critical Care Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Bellanger AP, Morisse-Pradier H, Reboux G, Scherer E, Pramil S, Dominique S, Millon L. Hypersensitivity pneumonitis in a cystic fibrosis patient. Occup Med (Lond) 2019; 69:632-634. [PMID: 31504833 DOI: 10.1093/occmed/kqz115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a chronic inflammatory lung disease caused by repeated inhalation of antigenic substances. We present a case of metalworking fluids (MWFs)-HP sensitized to Pseudomonas oleovorans in a cystic fibrosis patient. This case illustrates that HP diagnosis remains challenging, especially in patients with another pulmonary disease, and that serodiagnosis contributes to identifying the precise microorganism involved. It also demonstrates that P. oleovorans is an important secondary aetiological agent in MWF-HP, less known than Mycobacterium immunogenum.
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Affiliation(s)
- A P Bellanger
- Parasitology Mycology Department, Jean Minjoz University Hospital, Besançon, France.,Chrono-Environment UMR/CNRS 6249, University of Bourgogne Franche-Comté, Besançon, France
| | | | - G Reboux
- Parasitology Mycology Department, Jean Minjoz University Hospital, Besançon, France.,Chrono-Environment UMR/CNRS 6249, University of Bourgogne Franche-Comté, Besançon, France
| | - E Scherer
- Parasitology Mycology Department, Jean Minjoz University Hospital, Besançon, France
| | - S Pramil
- Pneumology Department, Rouen University Hospital, Rouen, France
| | - S Dominique
- Pneumology Department, Rouen University Hospital, Rouen, France
| | - L Millon
- Parasitology Mycology Department, Jean Minjoz University Hospital, Besançon, France.,Chrono-Environment UMR/CNRS 6249, University of Bourgogne Franche-Comté, Besançon, France
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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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Abstract
PURPOSE OF REVIEW This review summarises the clinical knowledge of hypersensitivity pneumonitis in workers exposed to aerosols of metalworking fluid, reviewing published outbreaks and clinical cases. RECENT FINDINGS Metalworking fluid exposure has become the commonest recognised cause of occupational hypersensitivity pneumonitis, having been rare before 2000. There are many possible agents in the metalworking fluid which may be the cause of disease including bacteria, mycobacteria, fungae, biocides, emulsifiers, reodorants and dissolved chrome and cobalt. Causes are likely to be different in different outbreaks. Mycobacteria growing in the metalworking fluid have generated immune responses in some workers, but their role in disease causation is not yet established. Many outbreaks have been identified in large workplaces using common sumps. It is not possible to prevent microbial contamination of metalworking fluids in use. Disease prevention should focus on stopping inhalation of aerosols, particularly by re-engineering to remove recirculation.
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Affiliation(s)
- P Sherwood Burge
- Occupational Lung disease Unit, Birmingham Heartlands Hospital, Birmingham, B905SS, UK.
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Bellanger AP, Lignon T, Godet Y, Rognon B, Reboux G, Gbaguidi-Haore H, Borg C, Millon L. Fungal peptides from pneumonitis hypersensitivity etiologic agents are able to induce specific cellular immune response. J Immunol Methods 2016; 440:67-73. [PMID: 27876506 DOI: 10.1016/j.jim.2016.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Hypersensitivity pneumonitis (HP) is an immunoallergic disease due to chronic exposure to high quantities of different microorganisms such as Mycobacterium immunogenum (Mi), a mycobacterium, and Lichtheimia corymbifera (Lc), a filamentous fungus. It has recently been demonstrated that the protein DLDH (dihydrolipoyl dehydrogenase), is common to these microorganisms. This study aimed to investigate the immune potential of overlapping peptide pools covering the MiDLDH and LcDLDH. EXPERIMENTAL DESIGN A selection of 34 peptides, from the MiDLDH and LcDLDH, able to interact with Major Histocompatibility Complex (MHC) 1 and MHC 2, was obtained using three different epitope prediction websites. By means of ELISPOT assays, we compared the frequency of Interferon gamma (IFNγ) secreting peripheral blood mononuclear cells (PBMC) after stimulation with overlapping peptide pools. Tests were performed using cells from 35 healthy blood donors. RESULTS One peptide pool containing five peptides from MiDLDH and able to interact with MHC 2 induced a marked IFNγ specific immune response (Pool F, p<0.001, Wilcoxon signed-rank test). CONCLUSION This study demonstrated that peptides from microorganisms involved in HP were able to induce a high IFNγ specific immune response after stimulation of PBMCs from healthy blood donors which could be useful to develop an effective prevention strategy.
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Affiliation(s)
- Anne-Pauline Bellanger
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon, France; Parasitology-Mycology Department, Besançon University Hospital, Besançon, France.
| | - Thibaud Lignon
- Parasitology-Mycology Department, Besançon University Hospital, Besançon, France
| | - Yann Godet
- INSERM Unit 1098, University of Franche-Comté, Besançon, France
| | - Bénédicte Rognon
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon, France
| | - Gabriel Reboux
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon, France; Parasitology-Mycology Department, Besançon University Hospital, Besançon, France
| | | | - Christophe Borg
- INSERM Unit 1098, University of Franche-Comté, Besançon, France
| | - Laurence Millon
- Chrono-Environnement CNRS 6249 Research Team, Franche-Comté University, Besançon, France; Parasitology-Mycology Department, Besançon University Hospital, Besançon, France
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Chandra H, Lockey J, Yadav JS. Novel antigens of Mycobacterium immunogenum relevant in serodiagnosis of occupational hypersensitivity pneumonitis in machinists. Ann Allergy Asthma Immunol 2015; 114:525-6. [PMID: 25863449 DOI: 10.1016/j.anai.2015.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/24/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Harish Chandra
- Division of Environmental Genetics and Molecular Toxicology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - James Lockey
- Division of Occupational and Environmental Medicine, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jagjit S Yadav
- Division of Environmental Genetics and Molecular Toxicology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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