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Falvo MJ, Sotolongo AM, Osterholzer JJ, Robertson MW, Kazerooni EA, Amorosa JK, Garshick E, Jones KD, Galvin JR, Kreiss K, Hines SE, Franks TJ, Miller RF, Rose CS, Arjomandi M, Krefft SD, Morris MJ, Polosukhin VV, Blanc PD, D'Armiento JM. Consensus Statements on Deployment-Related Respiratory Disease, Inclusive of Constrictive Bronchiolitis: A Modified Delphi Study. Chest 2023; 163:599-609. [PMID: 36343686 PMCID: PMC10154857 DOI: 10.1016/j.chest.2022.10.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The diagnosis of constrictive bronchiolitis (CB) in previously deployed individuals, and evaluation of respiratory symptoms more broadly, presents considerable challenges, including using consistent histopathologic criteria and clinical assessments. RESEARCH QUESTION What are the recommended diagnostic workup and associated terminology of respiratory symptoms in previously deployed individuals? STUDY DESIGN AND METHODS Nineteen experts participated in a three-round modified Delphi study, ranking their level of agreement for each statement with an a priori definition of consensus. Additionally, rank-order voting on the recommended diagnostic approach and terminology was performed. RESULTS Twenty-five of 28 statements reached consensus, including the definition of CB as a histologic pattern of lung injury that occurs in some previously deployed individuals while recognizing the importance of considering alternative diagnoses. Consensus statements also identified a diagnostic approach for the previously deployed individual with respiratory symptoms, distinguishing assessments best performed at a local or specialty referral center. Also, deployment-related respiratory disease (DRRD) was proposed as a broad term to subsume a wide range of potential syndromes and conditions identified through noninvasive evaluation or when surgical lung biopsy reveals evidence of multicompartmental lung injury that may include CB. INTERPRETATION Using a modified Delphi technique, consensus statements provide a clinical approach to possible CB in previously deployed individuals. Use of DRRD provides a broad descriptor encompassing a range of postdeployment respiratory findings. Additional follow-up of individuals with DRRD is needed to assess disease progression and to define other features of its natural history, which could inform physicians better and lead to evolution in this nosology.
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Affiliation(s)
- Michael J Falvo
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ.
| | - Anays M Sotolongo
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ; New Jersey Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - John J Osterholzer
- Pulmonary Section, Department of Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI; Division of Pulmonary and Critical Care, Department of Medicine, University of Michigan, Ann Arbor, MI
| | - Michelle W Robertson
- Airborne Hazards and Burn Pits Center of Excellence, Department of Veterans Affairs New Jersey Health Care System, East Orange, NJ
| | - Ella A Kazerooni
- Department of Radiology, University of Michigan, Ann Arbor, MI; Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Judith K Amorosa
- Department of Radiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; University Radiology Group, East Brunswick, NJ
| | - Eric Garshick
- Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, Boston, MA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA
| | - Kirk D Jones
- Department of Anatomic Pathology, University of California, San Francisco, CA
| | - Jeffrey R Galvin
- Department of Radiology and Nuclear Medicine (Chest Imaging), University of Maryland School of Medicine, Baltimore, MD
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV
| | - Stella E Hines
- Divisions of Occupational and Environmental Medicine and Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; VA Maryland Health Care System, Baltimore Veterans Affairs Medical Center, Baltimore, MD
| | - Teri J Franks
- Department of Pulmonary and Mediastinal Pathology, Joint Pathology Center, Department of Defense, Silver Spring, MD
| | - Robert F Miller
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Anschutz Medical Campus, Denver, CO
| | - Mehrdad Arjomandi
- Department of Anatomic Pathology, University of California, San Francisco, CA; Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA
| | - Silpa D Krefft
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO; Division of Pulmonary and Critical Care Medicine, Veterans Administration Eastern Colorado Health Care System, Aurora, CO; Division of Pulmonary and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Michael J Morris
- Pulmonary/Critical Care Service, Department of Medicine, Brooke Army Medical Center, JBSA-Sam Houston, Fort Sam Houston, TX
| | | | - Paul D Blanc
- Department of Anatomic Pathology, University of California, San Francisco, CA; Division of Occupational and Environmental Medicine, University of California, San Francisco, CA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jeanine M D'Armiento
- Center for LAM and Rare Lung Disease, Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY
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Guanidine-Containing Antifungal Agents against Human-Relevant Fungal Pathogens (2004-2022)-A Review. J Fungi (Basel) 2022; 8:jof8101085. [PMID: 36294650 PMCID: PMC9605545 DOI: 10.3390/jof8101085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022] Open
Abstract
The guanidine moiety is typically a highly basic group, and can be found in a wide variety of drugs, such as zanamivir (Relenza) and metformin (Fortamet), as well as in biologically active compounds for numerous disease areas, including central nervous system (CNS) diseases and chemotherapeutics. This review will focus on antifungal agents which contain at least one guanidine group, for the treatment of human-related fungal pathogens, described in the literature between 2004 and 2022. These compounds include small molecules, steroids, polymers, metal complexes, sesquiterpenes, natural products, and polypeptides. It shall be made clear that a diverse range of guanidine-containing derivatives have been published in the literature and have antifungal activity, including efficacy in in vivo experiments.
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Hariri LP, Flashner BM, Kanarek DJ, O'Donnell WJ, Soskis A, Ziehr DR, Frank A, Nandy S, Berigei SR, Sharma A, Mathisen D, Keyes CM, Lanuti M, Muniappan A, Shepard JAO, Mino-Kenudson M, Ly A, Hung YP, Castelino FV, Ott HC, Medoff BD, Christiani DC. E-Cigarette Use, Small Airway Fibrosis, and Constrictive Bronchiolitis. NEJM EVIDENCE 2022; 1:10.1056/evidoa2100051. [PMID: 37122361 PMCID: PMC10137322 DOI: 10.1056/evidoa2100051] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND Vaping, including the use of electronic cigarettes (e-cigarettes), has become increasingly prevalent, yet the associated long-term health risks are largely unknown. Given the prevalence of use, particularly among adolescents early in their lifespan, it is vital to understand the potential chronic pathologic sequelae of vaping. METHODS We present the cases of four patients with chronic lung disease associated with e-cigarette use characterized by clinical evaluation, with pulmonary function tests (PFTs), chest high-resolution computed tomography (HRCT), endobronchial optical coherence tomography (EB-OCT) imaging, and histopathologic assessment. RESULTS Each patient presented with shortness of breath and chest pain in association with a 3- to 8-year history of e-cigarette use, with mild progressive airway obstruction on PFTs and/or chest HRCT findings demonstrating evidence of air trapping and bronchial wall thickening. EB-OCT imaging performed in two patients showed small airway–centered fibrosis with bronchiolar narrowing and lumen irregularities. The predominant histopathologic feature on surgical lung biopsy was small airway–centered fibrosis, including constrictive bronchiolitis and MUC5AC overexpression in all patients. Patients who ceased vaping had a partial, but not complete, reversal of disease over 1 to 4 years. CONCLUSIONS After thorough evaluation for other potential etiologies, vaping was considered to be the most likely common causal etiology for all patients due to the temporal association of symptomatic chronic lung disease with e-cigarette use and partial improvement in symptoms after e-cigarette cessation. In this series, we associate the histopathologic pattern of small airway–centered fibrosis, including constrictive bronchiolitis, with vaping, potentially defining a clinical and pathologic entity associated with e-cigarette use. (Funded in part by the National Institutes of Health.)
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Affiliation(s)
- Lida P Hariri
- Department of Pathology, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Bess M Flashner
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David J Kanarek
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Walter J O'Donnell
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Alyssa Soskis
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Division of Pulmonary and Critical Care Medicine, Duke University Hospital, Durham, NC
| | - David R Ziehr
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Angela Frank
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sreyankar Nandy
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Sarita R Berigei
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amita Sharma
- Harvard Medical School, Boston
- Department of Radiology, Massachusetts General Hospital, Boston
| | - Douglas Mathisen
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Colleen M Keyes
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Michael Lanuti
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Ashok Muniappan
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | | | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Yin P Hung
- Department of Pathology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - Flavia V Castelino
- Harvard Medical School, Boston
- Division of Rheumatology, Massachusetts General Hospital, Boston
| | - Harald C Ott
- Harvard Medical School, Boston
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
| | - David C Christiani
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston
- Harvard T.H. Chan School of Public Health, Boston
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4
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Banks DE, Morris MJ. Inhalational Constrictive Bronchiolitis: The Evolution of our Understanding of this Disease. Lung 2021; 199:327-334. [PMID: 34415399 DOI: 10.1007/s00408-021-00466-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
The case definition of inhalational constrictive bronchiolitis (CB) has changed over the generations. We identify changes in the description of this illness over time associated with different exposures and present the natural history of CB in a case attributed to military burn pit exposure. The initial descriptions of this disease began with nitric acid spills and silage exposures. In these events, there was an acute exposure, typically a short-term resolution of the adverse respiratory events, and then a progression, leading to disability or a respiratory death. The life-saving role of corticosteroid therapy in this situation was recognized. War gas exposures of World War I and then Saddam Hussein's use of sulfur mustard gas in the Iran-Iraq War followed. More recently the findings associated with diacetyl exposure in commercial popcorn workers remained consistent with previously described presentations, but then the clinical presentation in troops returning from deployment to Southwest Asia was very different, yet with the same histologic findings. We recognize unreconciled disparities in the clinical, physiologic, and imaging presentation in those with inhalational bronchiolitis and acknowledge this as perhaps one of the difficult diagnoses in respiratory medicine.
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Affiliation(s)
- Daniel E Banks
- Orlando Veterans Administration Medical Center, Room 4H811, 13800 Veterans Way, Orlando, FL, 32827, USA.
| | - Michael J Morris
- Pulmonary and Critical Care Service, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA
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5
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Spirometric Abnormalities and Lung Function Decline in Current and Former Microwave Popcorn and Current Flavoring Manufacturing Workers. J Occup Environ Med 2021; 62:412-419. [PMID: 32510907 DOI: 10.1097/jom.0000000000001860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare spirometry results in microwave popcorn and flavoring manufacturing workers. METHODS We used NIOSH data on current and former microwave popcorn workers (MPWs) and surveillance data on flavoring manufacturing workers (FMWs). RESULTS Former MPW had higher prevalence of mixed and high severity abnormalities, some had excessive lung function drops. Current MPW had lowest occurrence of excessive lung function drops. FMW with excessive drops and spirometric abnormalities at last test had developed a restrictive pattern. Spirometric abnormalities and excessive drops were associated with work-related factors. CONCLUSION There was evidence of a healthy worker survivor effect in MPW. Importantly, removal from exposure did not always stabilize lung function decline indicating a need for continued monitoring. The development of a restrictive pattern should raise the level of suspicion for possible work-related disease in flavoring-exposed workers.
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Abstract
Occupational bronchiolitis is characterized by inflammation of the small airways, and represents a heterogeneous set of lung conditions that can occur following a range of inhalation exposures related to work. The most common clinical presentation includes insidious onset of exertional dyspnea and cough. Multiple reports in recent years have drawn attention to previously unrecognized risk factors for occupational bronchiolitis following exposures in several settings. Both current and past occupational exposures, including prior military deployment-related exposures, should be considered in patients undergoing evaluation for unexplained dyspnea. Diagnostic testing for potential bronchiolitis should include a thorough assessment of the small airways.
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7
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Heinzerling A, Armatas C, Karmarkar E, Attfield K, Guo W, Wang Y, Vrdoljak G, Moezzi B, Xu D, Wagner J, Fowles J, Dean C, Cummings KJ, Wilken JA. Severe Lung Injury Associated With Use of e-Cigarette, or Vaping, Products-California, 2019. JAMA Intern Med 2020; 180:861-869. [PMID: 32142111 PMCID: PMC7060503 DOI: 10.1001/jamainternmed.2020.0664] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE Since August 2019, more than 2700 patients have been hospitalized with e-cigarette, or vaping, product use-associated lung injury (EVALI) across the United States. This report describes the outbreak in California, a state with one of the highest case counts and with a legal adult-use (recreational) cannabis market. OBJECTIVE To present clinical characteristics and vaping product exposures of patients with EVALI in California. DESIGN, SETTING, AND PARTICIPANTS Case series describing epidemiologic and laboratory data from 160 hospitalized patients with EVALI reported to the California Department of Public Health by local health departments, who received reports from treating clinicians, from August 7 through November 8, 2019. EXPOSURES Standardized patient interviews were conducted to assess vaping products used, frequency of use, and method of product acquisition. Vaping products provided by a subset of patients were tested for active ingredients and other substances. MAIN OUTCOMES AND MEASURES Demographic and clinical characteristics, level of care, and outcomes of hospitalization were obtained from medical record review. RESULTS Among 160 patients with EVALI, 99 (62%) were male, and the median age was 27 years (range, 14-70 years). Of 156 patients with data available, 71 (46%) were admitted to an intensive care unit, and 46 (29%) required mechanical ventilation. Four in-hospital deaths occurred. Of 86 patients interviewed, 71 (83%) reported vaping tetrahydrocannabinol (THC)-containing products, 36 (43%) cannabidiol (CBD)-containing products, and 39 (47%) nicotine-containing products. Sixty-five of 87 (75%) THC-containing products were reported as obtained from informal sources, such as friends, acquaintances, or unlicensed retailers. Of 87 vaping products tested from 24 patients, 49 (56%) contained THC. Vitamin E or vitamin E acetate was found in 41 (84%) of the THC-containing products and no nicotine products. CONCLUSIONS AND RELEVANCE Patients' clinical outcomes and vaping behaviors, including predominant use of THC-containing products from informal sources, are similar to those reported by other states, despite California's legal recreational cannabis market. While most THC products tested contained vitamin E or vitamin E acetate, other underlying cause(s) of injury remain possible. The California Department of Public Health recommends that individuals refrain from using any vaping or e-cigarette products, particularly THC-containing products from informal sources, while this investigation is ongoing.
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Affiliation(s)
- Amy Heinzerling
- Center for Healthy Communities, California Department of Public Health, Richmond.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina Armatas
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Ellora Karmarkar
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.,Center for Infectious Diseases, California Department of Public Health, Richmond
| | - Kathleen Attfield
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Weihong Guo
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Yun Wang
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Gordon Vrdoljak
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Bahman Moezzi
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Dadong Xu
- Center for Environmental Health, California Department of Public Health, Richmond
| | - Jeff Wagner
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Jefferson Fowles
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Charity Dean
- Office of the Director, California Department of Public Health, Sacramento
| | - Kristin J Cummings
- Center for Healthy Communities, California Department of Public Health, Richmond
| | - Jason A Wilken
- Center for Healthy Communities, California Department of Public Health, Richmond.,Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia.,US Public Health Service Commissioned Corps, Rockville, Maryland
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Cummings KJ, Stanton ML, Kreiss K, Boylstein RJ, Park JH, Cox-Ganser JM, Virji MA, Edwards NT, Segal LN, Blaser MJ, Weissman DN, Nett RJ. Work-related adverse respiratory health outcomes at a machine manufacturing facility with a cluster of bronchiolitis, alveolar ductitis and emphysema (BADE). Occup Environ Med 2020; 77:386-392. [PMID: 32132182 DOI: 10.1136/oemed-2019-106296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 01/27/2020] [Accepted: 02/14/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Four machine manufacturing facility workers had a novel occupational lung disease of uncertain aetiology characterised by lymphocytic bronchiolitis, alveolar ductitis and emphysema (BADE). We aimed to evaluate current workers' respiratory health in relation to job category and relative exposure to endotoxin, which is aerosolised from in-use metalworking fluid. METHODS We offered a questionnaire and spirometry at baseline and 3.5 year follow-up. Endotoxin exposures were quantified for 16 production and non-production job groups. Forced expiratory volume in one second (FEV1) decline ≥10% was considered excessive. We examined SMRs compared with US adults, adjusted prevalence ratios (aPRs) for health outcomes by endotoxin exposure tertiles and predictors of excessive FEV1 decline. RESULTS Among 388 (89%) baseline participants, SMRs were elevated for wheeze (2.5 (95% CI 2.1 to 3.0)), but not obstruction (0.5 (95% CI 0.3 to 1.1)). Mean endotoxin exposures (range: 0.09-28.4 EU/m3) were highest for machine shop jobs. Higher exposure was associated with exertional dyspnea (aPR=2.8 (95% CI 1.4 to 5.7)), but not lung function. Of 250 (64%) follow-up participants, 11 (4%) had excessive FEV1 decline (range: 403-2074 mL); 10 worked in production. Wheeze (aPR=3.6 (95% CI 1.1 to 12.1)) and medium (1.3-7.5 EU/m3) endotoxin exposure (aPR=10.5 (95% CI 1.3 to 83.1)) at baseline were associated with excessive decline. One production worker with excessive decline had BADE on subsequent lung biopsy. CONCLUSIONS Lung function loss and BADE were associated with production work. Relationships with relative endotoxin exposure indicate work-related adverse respiratory health outcomes beyond the sentinel disease cluster, including an incident BADE case. Until causative factors and effective preventive strategies for BADE are determined, exposure minimisation and medical surveillance of affected workforces are recommended.
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Affiliation(s)
- Kristin J Cummings
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Marcia L Stanton
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randy J Boylstein
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Ju-Hyeong Park
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Jean M Cox-Ganser
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - M Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Nicole T Edwards
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Leopoldo N Segal
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Martin J Blaser
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - David N Weissman
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Randall J Nett
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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9
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Cummings KJ, Stanton ML, Nett RJ, Segal LN, Kreiss K, Abraham JL, Colby TV, Franko AD, Green FH, Sanyal S, Tallaksen RJ, Wendland D, Bachelder VD, Boylstein RJ, Park J, Cox‐Ganser JM, Virji MA, Crawford JA, Green BJ, LeBouf RF, Blaser MJ, Weissman DN. Severe lung disease characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE) in industrial machine-manufacturing workers. Am J Ind Med 2019; 62:927-937. [PMID: 31461179 DOI: 10.1002/ajim.23038] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. METHODS Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. RESULTS Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV1 = 44% predicted) and reduced diffusing capacity (mean = 53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. CONCLUSION This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention.
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Affiliation(s)
- Kristin J. Cummings
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Marcia L. Stanton
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Randall J. Nett
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Leopoldo N. Segal
- Department of MedicineNew York University School of Medicine New York New York
| | - Kathleen Kreiss
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Jerrold L. Abraham
- Department of PathologyState University of New York Upstate Medical University Syracuse New York
| | - Thomas V. Colby
- Department of Laboratory Medicine and PathologyMayo Clinic Scottsdale Arizona
| | - Angela D. Franko
- Department of Pathology and Laboratory MedicineUniversity of Calgary Calgary Alberta Canada
| | - Francis H.Y. Green
- Department of Pathology and Laboratory MedicineUniversity of Calgary Calgary Alberta Canada
| | - Soma Sanyal
- Department of PathologyState University of New York Upstate Medical University Syracuse New York
| | - Robert J. Tallaksen
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | | | | | - Randy J. Boylstein
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Ju‐Hyeong Park
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Jean M. Cox‐Ganser
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - M. Abbas Virji
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Judith A. Crawford
- Department of PathologyState University of New York Upstate Medical University Syracuse New York
| | - Brett James Green
- Health Effects Laboratory Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Ryan F. LeBouf
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
| | - Martin J. Blaser
- Department of MedicineNew York University School of Medicine New York New York
| | - David N. Weissman
- Respiratory Health Division, National Institute for Occupational Safety and HealthCenters for Disease Control and Prevention Morgantown West Virginia
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10
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Cummings KJ, Virji MA. The Long-Term Effects of Cleaning on the Lungs. Am J Respir Crit Care Med 2019; 197:1099-1101. [PMID: 29474796 DOI: 10.1164/rccm.201801-0138ed] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kristin J Cummings
- 1 Respiratory Health Division National Institute for Occupational Safety and Health Morgantown, West Virginia
| | - M Abbas Virji
- 1 Respiratory Health Division National Institute for Occupational Safety and Health Morgantown, West Virginia
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Reinero CR, Masseau I, Grobman M, Vientos-Plotts A, Williams K. Perspectives in veterinary medicine: Description and classification of bronchiolar disorders in cats. J Vet Intern Med 2019; 33:1201-1221. [PMID: 30982233 PMCID: PMC6524100 DOI: 10.1111/jvim.15473] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/21/2019] [Indexed: 01/20/2023] Open
Abstract
This Perspectives in Veterinary Medicine article seeks to define, describe putative causes, and discuss key diagnostic tests for primary and secondary bronchiolar disorders to propose a classification scheme in cats with support from a literature review and case examples. The small airways (bronchioles with inner diameters <2 mm), located at the transitional zone between larger conducting airways and the pulmonary acinus, have been overlooked as major contributors to clinical syndromes of respiratory disease in cats. Because the trigger for many bronchiolar disorders is environmental and humans live in a shared environment with similar susceptibility, understanding these diseases in pet cats has relevance to One Health. Thoracic radiography, the major imaging modality used in the diagnostic evaluation of respiratory disease in cats, has low utility in detection of bronchiolar disease. Computed tomography (CT) with paired inspiratory and expiratory scans can detect pathology centered on small airways. In humans, treatment of bronchiolar disorders is not well established because of heterogeneous presentations and often late definitive diagnosis. A review of the human and veterinary medical literature will serve as the basis for a proposed classification scheme in cats. A case series of cats with CT or histopathologic evidence of bronchiolar lesions or both, either as a primary disorder or secondary to extension from large airway disease or interstitial lung disease, will be presented. Future multi‐institutional and multidisciplinary discussions among clinicians, radiologists, and pathologists will help refine and develop this classification scheme to promote early and specific recognition and optimize treatment.
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Affiliation(s)
- Carol R Reinero
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri
| | - Isabelle Masseau
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri.,Department of Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, St-Hyacinthe, Quebec, Canada
| | - Megan Grobman
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri
| | - Aida Vientos-Plotts
- Department of Veterinary Medicine and Surgery, University of Missouri College of Veterinary Medicine, Columbia, Missouri
| | - Kurt Williams
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
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Wylie SL, Langlois D, Carey S, Nelson NC, Williams KJ. Constrictive Bronchiolitis Obliterans in a Dog. J Am Anim Hosp Assoc 2019; 55:e55201. [PMID: 30653359 DOI: 10.5326/jaaha-ms-6821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 2 yr old, neutered male rottweiler was evaluated for a chronic cough that had acutely worsened. Computed tomographic examination revealed a diffuse alveolar pattern in the right, middle, and left cranial lung lobes. Aerated parenchymal tissue was not observed in the left cranial lung lobe, and both lobes were markedly decreased in volume. Lobectomy of the right middle and left cranial lung lobes was performed. Histopathologic examination of both lungs identified alveolar collapse associated with marked chronic bronchial and bronchiolar luminal concentric fibrosis leading to reduced airway lumen diameter and bronchiolar destruction. The clinical signs and airway pathology were consistent with constrictive bronchiolitis obliterans. The dog remained stable for over 2 yr with glucocorticoid therapy and intermittent antimicrobics. Although the polypoid form of bronchiolitis obliterans has been described in cattle and occasionally in dogs, constrictive bronchiolitis obliterans has not been reported previously in veterinary species.
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Affiliation(s)
- Stacey Lynn Wylie
- From NorthStar VETS, Robbinsville, New Jersey (S.L.W.); Department of Small Animal Clinical Sciences (D.L., S.C.), and Department of Pathobiology and Diagnostic Investigation (K.J.W.), College of Veterinary Medicine, Michigan State University, East Lansing, Michigan; and College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (N.C.N.)
| | - Daniel Langlois
- From NorthStar VETS, Robbinsville, New Jersey (S.L.W.); Department of Small Animal Clinical Sciences (D.L., S.C.), and Department of Pathobiology and Diagnostic Investigation (K.J.W.), College of Veterinary Medicine, Michigan State University, East Lansing, Michigan; and College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (N.C.N.)
| | - Stephan Carey
- From NorthStar VETS, Robbinsville, New Jersey (S.L.W.); Department of Small Animal Clinical Sciences (D.L., S.C.), and Department of Pathobiology and Diagnostic Investigation (K.J.W.), College of Veterinary Medicine, Michigan State University, East Lansing, Michigan; and College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (N.C.N.)
| | - Nathan C Nelson
- From NorthStar VETS, Robbinsville, New Jersey (S.L.W.); Department of Small Animal Clinical Sciences (D.L., S.C.), and Department of Pathobiology and Diagnostic Investigation (K.J.W.), College of Veterinary Medicine, Michigan State University, East Lansing, Michigan; and College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (N.C.N.)
| | - Kurt J Williams
- From NorthStar VETS, Robbinsville, New Jersey (S.L.W.); Department of Small Animal Clinical Sciences (D.L., S.C.), and Department of Pathobiology and Diagnostic Investigation (K.J.W.), College of Veterinary Medicine, Michigan State University, East Lansing, Michigan; and College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (N.C.N.)
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13
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Park EJ, Park SJ, Kim S, Lee K, Chang J. Lung fibroblasts may play an important role in clearing apoptotic bodies of bronchial epithelial cells generated by exposure to PHMG-P-containing solution. Toxicol Lett 2018; 286:108-119. [DOI: 10.1016/j.toxlet.2018.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/26/2017] [Accepted: 01/02/2018] [Indexed: 02/04/2023]
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14
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Nett RJ, Cox-Ganser JM, Hubbs AF, Ruder AM, Cummings KJ, Huang YCT, Kreiss K. Non-malignant respiratory disease among workers in industries using styrene-A review of the evidence. Am J Ind Med 2017; 60:163-180. [PMID: 28079275 DOI: 10.1002/ajim.22655] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Asthma and obliterative bronchiolitis (OB) cases have occurred among styrene-exposed workers. We aimed to investigate styrene as a risk factor for non-malignant respiratory disease (NMRD). METHODS From a literature review, we identified case reports and assessed cross-sectional and mortality studies for strength of evidence of positive association (i.e., strong, intermediate, suggestive, none) between styrene exposure and NMRD-related morbidity and mortality. RESULTS We analyzed 55 articles and two unpublished case reports. Ten OB cases and eight asthma cases were identified. Six (75%) asthma cases had abnormal styrene inhalation challenges. Thirteen (87%) of 15 cross-sectional studies and 12 (50%) of 24 mortality studies provided at least suggestive evidence that styrene was associated with NMRD-related morbidity or mortality. Six (66%) of nine mortality studies assessing chronic obstructive pulmonary disease-related mortality indicated excess mortality. CONCLUSIONS Available evidence suggests styrene exposure is a potential risk factor for NMRD. Additional studies of styrene-exposed workers are warranted. Am. J. Ind. Med. 60:163-180, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Randall J. Nett
- Respiratory Health Division; Centers for Disease Control and Prevention (CDC); National Institute for Occupational Safety and Health (NIOSH); Morgantown West Virginia
| | - Jean M. Cox-Ganser
- Respiratory Health Division; Centers for Disease Control and Prevention (CDC); National Institute for Occupational Safety and Health (NIOSH); Morgantown West Virginia
| | - Ann F. Hubbs
- Health Effects Laboratory Division; National Institute for Occupational Safety and Health (NIOSH), CDC; Morgantown West Virginia
| | - Avima M. Ruder
- Division of Surveillance, Hazard Evaluations, and Field Studies; National Institute for Occupational Safety and Health (NIOSH), CDC; Cincinnati Ohio
| | - Kristin J. Cummings
- Respiratory Health Division; Centers for Disease Control and Prevention (CDC); National Institute for Occupational Safety and Health (NIOSH); Morgantown West Virginia
| | - Yuh-Chin T. Huang
- Division of Pulmonary and Critical Care Medicine; Duke University Medical Center; Durham North Carolina
| | - Kathleen Kreiss
- Respiratory Health Division; Centers for Disease Control and Prevention (CDC); National Institute for Occupational Safety and Health (NIOSH); Morgantown West Virginia
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15
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Falvo MJ, Helmer DA, Klein JC, Osinubi OY, Ndirangu D, Patrick-DeLuca LA, Sotolongo AM. Isolated diffusing capacity reduction is a common clinical presentation in deployed Iraq and Afghanistan veterans with deployment-related environmental exposures. CLINICAL RESPIRATORY JOURNAL 2016; 12:795-798. [DOI: 10.1111/crj.12552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/02/2016] [Accepted: 08/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Michael J. Falvo
- Department of Veterans Affairs New Jersey Health Care System; Airborne Hazards Center of Excellence - War Related Illness and Injury Study Center; East Orange NJ, USA
- Rutgers Biomedical and Health Sciences - New Jersey; Medical School; Newark NJ, USA
| | - Drew A. Helmer
- Department of Veterans Affairs New Jersey Health Care System; Airborne Hazards Center of Excellence - War Related Illness and Injury Study Center; East Orange NJ, USA
- Rutgers Biomedical and Health Sciences - New Jersey; Medical School; Newark NJ, USA
| | - Jacquelyn C. Klein
- Department of Veterans Affairs New Jersey Health Care System; Airborne Hazards Center of Excellence - War Related Illness and Injury Study Center; East Orange NJ, USA
| | - Omowunmi Y. Osinubi
- Department of Veterans Affairs New Jersey Health Care System; Airborne Hazards Center of Excellence - War Related Illness and Injury Study Center; East Orange NJ, USA
- Rutgers Biomedical and Health Sciences -; School of Public Health; Piscataway NJ, USA
| | - Duncan Ndirangu
- Department of Veterans Affairs New Jersey Health Care System; Airborne Hazards Center of Excellence - War Related Illness and Injury Study Center; East Orange NJ, USA
| | - Lydia A. Patrick-DeLuca
- Department of Veterans Affairs New Jersey Health Care System; Airborne Hazards Center of Excellence - War Related Illness and Injury Study Center; East Orange NJ, USA
| | - Anays M. Sotolongo
- Department of Veterans Affairs New Jersey Health Care System; Airborne Hazards Center of Excellence - War Related Illness and Injury Study Center; East Orange NJ, USA
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Holley AB, Sobieszczyk M, Perkins M, Cohee BM, Costantoth CB, Mabe DL, Liotta R, Abraham JH, Holley PR, Sherner J. Lung function abnormalities among service members returning from Iraq or Afghanistan with respiratory complaints. Respir Med 2016; 118:84-87. [DOI: 10.1016/j.rmed.2016.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/09/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
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17
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Bronchiolitis by Any Other Name: Describing Bronchiolar Disorders from Inhalational Exposures. Ann Am Thorac Soc 2016; 13:143-4. [PMID: 26730874 DOI: 10.1513/annalsats.201510-714le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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