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Oliveira M, Oliveira D, Lisboa C, Boechat JL, Delgado L. Clinical Manifestations of Human Exposure to Fungi. J Fungi (Basel) 2023; 9:jof9030381. [PMID: 36983549 PMCID: PMC10052331 DOI: 10.3390/jof9030381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Biological particles, along with inorganic gaseous and particulate pollutants, constitute an ever-present component of the atmosphere and surfaces. Among these particles are fungal species colonizing almost all ecosystems, including the human body. Although inoffensive to most people, fungi can be responsible for several health problems, such as allergic fungal diseases and fungal infections. Worldwide fungal disease incidence is increasing, with new emerging fungal diseases appearing yearly. Reasons for this increase are the expansion of life expectancy, the number of immunocompromised patients (immunosuppressive treatments for transplantation, autoimmune diseases, and immunodeficiency diseases), the number of uncontrolled underlying conditions (e.g., diabetes mellitus), and the misusage of medication (e.g., corticosteroids and broad-spectrum antibiotics). Managing fungal diseases is challenging; only four classes of antifungal drugs are available, resistance to these drugs is increasing, and no vaccines have been approved. The present work reviews the implications of fungal particles in human health from allergic diseases (i.e., allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization, thunderstorm asthma, allergic fungal rhinosinusitis, and occupational lung diseases) to infections (i.e., superficial, subcutaneous, and systemic infections). Topics such as the etiological agent, risk factors, clinical manifestations, diagnosis, and treatment will be revised to improve the knowledge of this growing health concern.
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Affiliation(s)
- Manuela Oliveira
- i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135 Porto, Portugal
- Ipatimup-Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho 45, 4200-135 Porto, Portugal
| | - Diana Oliveira
- CRN-Unidade de Reabilitação AVC, Centro de Reabilitação do Norte, Centro Hospitalar de Vila Nova de Gaia/Espinho, Avenida dos Sanatórios 127, 4405-565 Vila Nova de Gaia, Portugal
| | - Carmen Lisboa
- Serviço de Microbiologia, Departamento de Patologia, Faculdade de Medicina do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Serviço de Dermatologia, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE-Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - José Laerte Boechat
- CINTESIS@RISE-Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Luís Delgado
- CINTESIS@RISE-Centro de Investigação em Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Laboratório de Imunologia, Serviço de Patologia Clínica, Centro Hospitalar e Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Questionnaires or Serum Immunoglobulin G Testing in the Diagnosis of Hypersensitivity Pneumonitis among Patients with Interstitial Lung Disease. Ann Am Thorac Soc 2021; 18:130-147. [PMID: 32780584 DOI: 10.1513/annalsats.202005-419oc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Hypersensitivity pneumonitis (HP) results from exposure to a variety of stimuli, which are challenging to identify. Questionnaires and serum immunoglobulin G (IgG) testing are methods to identify potentially causative exposures.Objectives: To perform a systematic review to determine the usefulness of questionnaires and serum IgG testing in identifying exposures that may have caused HP.Methods: This systematic review informed an international, multidisciplinary panel that developed a clinical practice guideline on the diagnosis of HP for the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax. MEDLINE, the Cochrane Library, and EMBASE were searched from January 1946 to October 2019 for studies that used a questionnaire or serum IgG testing to identify exposures that may have caused HP. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to appraise the quality of the evidence.Results: Searches identified 1,141 and 926 potentially relevant articles for questionnaires and serum IgG testing, respectively. The full texts of 32 and 49 articles, respectively, were reviewed. Two observational studies for questionnaires and 15 accuracy studies for serum IgG testing were selected. Questionnaires were better at detecting potentially relevant exposures than clinical history (100% vs. 26%; risk ratio [RR], 3.80; 95% confidence interval [95% CI], 1.79-8.06) and serum IgG testing (100% vs. 63%; RR, 1.58; 95% CI, 1.12-2.23) but did not differ from serum IgG testing plus bronchial challenge testing (59% vs. 65%; RR, 0.90; 95% CI, 0.65-1.24). Longer, detailed questionnaires were more likely to lead to identification of potential exposures. Only 70% of potential exposures identified by questionnaires were subsequently confirmed by environmental testing. Serum IgG testing distinguished HP from healthy exposed and unexposed control subjects with high sensitivity (90% and 92%, respectively) and high specificity (91% and 100%, respectively) but did not distinguish HP as effectively from interstitial lung diseases (ILDs; sensitivity of 83% and specificity of 68%).Conclusions: Using a questionnaire may help clinicians identify potentially relevant exposures when evaluating a patient with newly identified ILD for HP. Serum IgG testing may also lead to identification of potentially relevant exposures, but its usefulness for distinguishing HP from other types of ILD is poor.
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Kawamoto Y, Oda S, Tanaka M. Antigen avoidance in people with hypersensitivity pneumonitis: A scoping review. Heart Lung 2021; 50:407-416. [PMID: 33621839 DOI: 10.1016/j.hrtlng.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/31/2020] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antigen avoidance (AA) is essential for people with hypersensitivity pneumonitis (HP). An intervention programme to promote continuous AA in people with HP will be the focus of future research. OBJECTIVES We systematically analysed the AA behaviour of people with HP, interventions of health-care providers to promote AA behaviour, clinical outcomes after AA, and evaluation methods after AA. METHODS We conducted a scoping review using six online databases and manual searches. Papers written in English or Japanese that reported cases on AA were selected. The extracted data were classified qualitatively. RESULTS In total 205 cases included in 109 eligible papers were examined. CONCLUSIONS This review clarified the fundamental evidence of AA in people with HP. These people required the continuous support of health-care providers to continue appropriate AA. This review highlighted four aspects that require further research to design interventions for promoting effective and continuous AA in people with HP.
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Affiliation(s)
- Yuko Kawamoto
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Sumika Oda
- Nursing Division, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan
| | - Makoto Tanaka
- Department of Critical and Invasive-Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
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Costabel U, Miyazaki Y, Pardo A, Koschel D, Bonella F, Spagnolo P, Guzman J, Ryerson CJ, Selman M. Hypersensitivity pneumonitis. Nat Rev Dis Primers 2020; 6:65. [PMID: 32764620 DOI: 10.1038/s41572-020-0191-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
Hypersensitivity pneumonitis (HP) is a complex syndrome caused by the inhalation of a variety of antigens in susceptible and sensitized individuals. These antigens are found in the environment, mostly derived from bird proteins and fungi. The prevalence and incidence of HP vary widely depending on the intensity of exposure, the geographical area and the local climate. Immunopathologically, HP is characterized by an exaggerated humoral and cellular immune response affecting the small airways and lung parenchyma. A complex interplay of genetic, host and environmental factors underlies the development and progression of HP. HP can be classified into acute, chronic non-fibrotic and chronic fibrotic forms. Acute HP results from intermittent, high-level exposure to the inducing antigen, usually within a few hours of exposure, whereas chronic HP mostly originates from long-term, low-level exposure (usually to birds or moulds in the home), is not easy to define in terms of time, and may occur within weeks, months or even years of exposure. Some patients with fibrotic HP may evolve to a progressive phenotype, even with complete exposure avoidance. Diagnosis is based on an accurate exposure history, clinical presentation, characteristic high-resolution CT findings, specific IgG antibodies to the offending antigen, bronchoalveolar lavage and pathological features. Complete antigen avoidance is the mainstay of treatment. The pharmacotherapy of chronic HP consists of immunosuppressive drugs such as corticosteroids, with antifibrotic therapy being a potential therapy for patients with progressive disease.
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Affiliation(s)
- Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany.
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Annie Pardo
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Dirk Koschel
- Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.,Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Josune Guzman
- General and Experimental Pathology, Ruhr-University, Bochum, Germany
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
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Ziegler K, Joest M, Turan N, Schmidt D, Rath PM, Steinmann J. Hypersensitivity pneumonitis of a bagpipe player: Fungal antigens as trigger? Med Mycol Case Rep 2019; 24:44-47. [PMID: 30989036 PMCID: PMC6447729 DOI: 10.1016/j.mmcr.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022] Open
Abstract
Here we present a 79-year old man with chronic hypersensitivity pneumonitis probably caused by fungal contamination of a bagpipe. Several samples were taken from the patient's bagpipe. Four potential fungal antigens (Exophiala phaeomuriformis, Kwoniella europaea, Pyrenochaeta unguis-hominis and Aureobasidium melanogenum) as potential trigger of hypersensitivity pneumonitis were identified. A serum ELISA test with Exophiala phaeomuriformis indicated reactivity. Cessation of playing the bagpipe and application of glucocorticoids lead to an improvement of the patient's symptoms.
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Affiliation(s)
- Katharina Ziegler
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Prof.-Ernst-Nathan Straße 1, 90419 Nuremberg, Germany
| | - Marcus Joest
- Allergologic-Immunologic Laboratory, Malteser Lung- and Allergy Center Bonn, Weberstraße 118, 53113 Bonn, Germany
| | - Nesrin Turan
- Clinic of Internal Medicine 3, Department of Pneumology, Paracelsus Medical University, Prof.-Ernst-Nathan Straße 1, 90419 Nuremberg, Germany
| | - Dirk Schmidt
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Peter-Michael Rath
- Institute of Medical Microbiology, University Hospital Essen, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany
| | - Joerg Steinmann
- Institute of Clinical Hygiene, Medical Microbiology and Infectiology, Paracelsus Medical University, Prof.-Ernst-Nathan Straße 1, 90419 Nuremberg, Germany
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Fattori A, Ohana M, Hirschi S, Kessler R, Santelmo N, Nathan N, Chenard MP, Raymond S, Legendre M, Calabrese F. A Nonsmoker Man in His 40s With a Diagnosis of Genetic-Related Idiopathic Pulmonary Fibrosis (Surfactant-Protein C Gene Mutation). Chest 2019; 155:e91-e96. [PMID: 30955586 DOI: 10.1016/j.chest.2018.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/05/2018] [Accepted: 12/24/2018] [Indexed: 11/29/2022] Open
Abstract
A nonsmoker man in his 40s underwent bilateral lung transplantation with a referral diagnosis of genetic-related idiopathic pulmonary fibrosis (IPF). The patient had no medical history in childhood and early adulthood, nor was there a family history of IPF. His nonsmoker father presented with lung cancer at 59 years of age. The patient was a professional brass instrument player; he had started playing at 9 years of age, and he was recently playing 3 to 4 h per day. He had a 7-year clinical history of chronic cough and shortness of breath. Bilateral fine crackles were present at clinical examination. There was no digital clubbing. Data had been collected since 2015: no clinical or immunologic signs of connective tissue disease were evident, including autoantibodies for myositis or anti-synthetase syndrome. Chest radiograph showed diffuse interstitial lung disease. Results of pulmonary function tests yielded a restrictive pattern with decreased FVC and decreased total lung capacity (69% and 47% of predicted, respectively). The FEV1/FVC ratio was 86%, and carbon monoxide transfer coefficient was 36% of predicted. BAL cellular analysis consisted of macrophages (66%), lymphocytes (19%; CD4+/CD8+ ratio, 0.16), neutrophils (10%), and eosinophils (5%).
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Affiliation(s)
- Antonin Fattori
- Department of Pathology, University of Strasbourg, Strasbourg, France
| | - Mickael Ohana
- Department of Radiology, University of Strasbourg, Strasbourg, France
| | - Sandrine Hirschi
- Department of Pneumology, University of Strasbourg, Strasbourg, France
| | - Romain Kessler
- Department of Pneumology, University of Strasbourg, Strasbourg, France
| | - Nicola Santelmo
- Department of Thoracic Surgery, University of Strasbourg, Strasbourg, France
| | - Nadia Nathan
- Department of Pediatric Pulmonology, Inserm UMR_S933, Armand-Trousseau Hospital, Paris, France
| | | | | | - Marie Legendre
- Sorbonne Université, Inserm and AP-HP, Inserm UMR_S933 and Genetics Department, Armand-Trousseau Hospital, Paris, France
| | - Fiorella Calabrese
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
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7
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Davidson J, McErlane J, Aljboor K, Barratt SL, Jeyabalan A, Medford ARL, Borman AM, Adamali H. Musical instruments, fungal spores and hypersensitivity pneumonitis. QJM 2019; 112:287-289. [PMID: 30649525 DOI: 10.1093/qjmed/hcz020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/03/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- J Davidson
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - J McErlane
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - K Aljboor
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - S L Barratt
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - A Jeyabalan
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - A R L Medford
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
| | - A M Borman
- UK National Mycology Reference Laboratory (MRL), Public Health England South-West, Southmead Hospital, Bristol, UK
| | - H Adamali
- North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol, UK
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8
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Soumagne T, Reboux G, Metzger F, Roussel S, Lefebvre A, Penven E, De Vuyst P, Thaon I, Dalphin JC. Fungal contamination of wind instruments: Immunological and clinical consequences for musicians. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 646:727-734. [PMID: 30059932 DOI: 10.1016/j.scitotenv.2018.07.284] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Playing a wind instrument is an increasingly reported cause of hypersensitivity pneumonitis. However, current knowledge about contamination of wind instruments by fungi and specific fungal sensitization is scarce. Therefore, we aimed: (i) to assess the current prevalence and type of fungal contamination of wind instruments, (ii) to identify potential risk factors associated with instrument contamination, and (iii) to evaluate the prevalence of sensitization to these fungi among musicians. MATERIAL AND METHODS Musicians from music schools in eastern France and who played a wind instrument were prospectively recruited (NCT01487850). The mouthpiece and the reed of their instrument were sampled to quantify the magnitude and type of fungi. Each subject had a physical examination, a mycological analysis of saliva and a blood sample in search of serum precipitins against the most frequent fungi isolated from instruments. The results were compared with those of 40 healthy non-exposed controls. RESULTS Forty musicians playing a wind instrument (bassoon, clarinet, oboe, saxophone) were included. (i) 95% of wind instruments were colonized by fungi, mainly with Phoma spp., Penicillium spp. and Rhodotorula mucilaginosa; (ii) absence of systematic drying of the instrument was a main contributing factor; (iii) serum precipitins were significantly more present in the musicians' sera than in control sera and were consistent with the fungi present in their instrument. CONCLUSION This study reveals a constant and specific fungal contamination among wind reed instruments with a significant sensitization among musicians, pleading in favour of regular instrument cleaning. Physicians should be aware of this possible source of antigenic exposure.
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Affiliation(s)
- Thibaud Soumagne
- Service de Pneumologie, Centre Hospitalier Universitaire de Besançon, Besançon, France; Service de Physiologie-Explorations Fonctionnelles, Centre Hospitalier Universitaire de Besançon, Besançon, France.
| | - Gabriel Reboux
- UMR-CNRS 6249 Chrono-environnement, Université de Franche-Comté, Besançon, France; Laboratoire de Mycologie, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France
| | - Flora Metzger
- Service de Pneumologie, Centre Hospitalier de Colmar, Colmar, France
| | - Sandrine Roussel
- UMR-CNRS 6249 Chrono-environnement, Université de Franche-Comté, Besançon, France
| | - Annick Lefebvre
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Emmanuelle Penven
- Université de Lorraine, CHRU-Nancy, Centre de Consultations de Pathologies Professionnelles, Nancy, France
| | - Paul De Vuyst
- Service de Pneumologie, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Thaon
- Université de Lorraine, CHRU-Nancy, Centre de Consultations de Pathologies Professionnelles, Nancy, France; Université de Lorraine, APEMAC, Nancy, France
| | - Jean-Charles Dalphin
- Service de Pneumologie, Centre Hospitalier Universitaire de Besançon, Besançon, France; UMR-CNRS 6249 Chrono-environnement, Université de Franche-Comté, Besançon, France
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Okoshi K, Minami T, Kikuchi M, Tomizawa Y. Musical Instrument-Associated Health Issues and Their Management. TOHOKU J EXP MED 2018; 243:49-56. [PMID: 28931767 DOI: 10.1620/tjem.243.49] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Playing musical instruments can bring joy to people, but can also cause a wide variety of health issues that range from mild disorders to potentially fatal conditions. Although sports medicine is an established medical subspecialty, relatively few studies have investigated the health issues associated with musical instruments. Here we present an overview of these health issues. These include infections due to microorganisms, allergic reactions, as well as mechanical injuries from sustained high pressures within the oral, mediastinal, thoracic, and abdominal cavities. For example, wind instruments can potentially harbor thousands of pathogenic organisms. If several players share the same instrument, these instruments present potential hazards in the spread of infections. A fatal case of hypersensitivity pneumonitis in a bagpiper is particularly noteworthy. Similarly, a case of gastrointestinal anthrax in an animal-hide drummer is a reminder of this rare but highly fatal disease. Although not fatal, hearing-related disorders, neuromuscular issues, musculoskeletal problems, and contact dermatitis are also very common among instrumentalists. This review aims to illuminate these under-recognized health issues by highlighting both the common conditions and the rare but fatal cases.
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Affiliation(s)
- Kae Okoshi
- Department of Surgery, The Japan Baptist Hospital
| | - Taro Minami
- Division of Pulmonary, Critical Care, and Sleep Medicine, Memorial Hospital of Rhode Island, The Warren Alpert Medical School of Brown University
| | - Masahiro Kikuchi
- Department of Otolaryngology-Head and Neck Surgery, Kobe City Medical Center General Hospital
| | - Yasuko Tomizawa
- Department of Cardiovascular Surgery, Tokyo Women's Medical University
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Chang HC, Lan CC, Wu YK, Su WL, Yang MC. Hypersensitivity pneumonitis due to unclean continuous positive airway pressure equipment. THE CLINICAL RESPIRATORY JOURNAL 2018; 12:1721-1724. [PMID: 29105305 DOI: 10.1111/crj.12735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/15/2017] [Indexed: 06/07/2023]
Abstract
Hypersensitivity pneumonitis is a potentially fatal immunological lung disease caused by occupational or environmental exposure to specific antigens. Here, we report on an obstructive sleep apnea patient whose hypersensitivity pneumonitis was aggravated because of the use of unclean continuous positive airway pressure equipment. This report shows that careful history taking is important when diagnosing hypersensitivity pneumonitis. Sleep specialists should be aware of the risks related to unclean continuous positive airway pressure equipment use, and obstructive sleep apnea patients should be instructed and monitored in the regular cleaning of their equipment.
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Affiliation(s)
- Hsu-Chao Chang
- Department of Radiology, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
| | - Chou-Chin Lan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
| | - Yao-Kuang Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
| | - Wen-Lin Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
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11
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Møller J, Hyldgaard C, Kronborg-White SB, Rasmussen F, Bendstrup E. Hypersensitivity pneumonitis among wind musicians - an overlooked disease? Eur Clin Respir J 2017; 4:1351268. [PMID: 28815004 PMCID: PMC5553096 DOI: 10.1080/20018525.2017.1351268] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 07/01/2017] [Indexed: 11/22/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is a complex pulmonary disorder mediated by the immune system and caused by various inhaled antigens against which the subject has previously been sensitized. In about 50% of the cases, the antigen is not identified. Identification and removal of the eliciting antigen is important for the prognosis. We report two cases of HP caused by molds and atypical mycobacteria isolated from wind instruments. We present the first case of HP caused by bassoon playing and another case of HP caused by molds in a trombone. HP caused by fungi and bacteria in wind instruments may be much more common than previously thought. HP caused by fungi and bacteria in wind instruments is probably underdiagnosed; this calls for more clinical attention when HP is suspected.
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Affiliation(s)
- Janne Møller
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Hyldgaard
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Finn Rasmussen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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12
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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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King J, Richardson M, Quinn AM, Holme J, Chaudhuri N. Bagpipe lung; a new type of interstitial lung disease? Thorax 2016; 72:380-382. [PMID: 27552781 DOI: 10.1136/thoraxjnl-2016-208751] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 06/09/2016] [Accepted: 06/27/2016] [Indexed: 11/03/2022]
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14
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Morell F, Villar A, Montero MÁ, Muñoz X, Colby TV, Pipvath S, Cruz MJ, Raghu G. Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study. THE LANCET RESPIRATORY MEDICINE 2013; 1:685-94. [PMID: 24429272 DOI: 10.1016/s2213-2600(13)70191-7] [Citation(s) in RCA: 257] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The clinical features of idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis can be indistinguishable; the need to eliminate occult environmental factors known to cause pulmonary fibrosis in patients suspected to have IPF during diagnostic evaluation is evident. We aimed to investigate occult, putative causes in the environments of patients diagnosed with IPF using tests beyond those conventionally used. METHODS In this case-cohort study, 60 consecutive patients diagnosed with IPF on the basis of the 2000 American Thoracic Society (ATS) and the European Respiratory Society (ERS) criteria were prospectively followed up every 4 months for 6 years between Jan 1, 2004, and Dec 31, 2009. At each visit a uniformly applied questionnaire was administered to these 60 patients to identify occult antigen exposure known to cause hypersensitivity pneumonitis. Patients underwent specific IgG determination, bronchoalveolar lavage, bronchial challenge testing with suspected antigens, and re-review of histopathological features in existing and subsequently obtained surgical lung biopsy samples and from lung explants. Specimens obtained from suspected sources from the patient's environment were subjected to cultures in microbiology laboratory. These clinical data and discussions among pulmonologists and radiologists familiar with IPF were used to confirm the diagnosis in accordance with 2011 ATS, ERS, Japanese Respiratory Society, and Latin American Thoracic Association guidelines; 46 of the 60 patients had IPF according to the 2011 guidelines, and our analyses in this study were focused on these 46 patients. FINDINGS 20 of the 46 (43%, 95% CI 29-58) patients with IPF according to 2011 guidelines had a subsequent diagnosis of chronic hypersensitivity pneumonitis: nine patients had positive bronchial challenge testing (eight of whom were also IgG positive and six of these patients also had surgical lung biopsy showing a pattern consistent with chronic hypersensitivity pneumonitis); seven were IgG positive plus had histopathology on surgical lung biopsy that was consistent with hypersensitivity pneumonitis; one was IgG positive plus had greater than 20% lymphocytes in bronchoalveolar lavage fluid; and three had findings on surgical lung biopsy that were consistent with subacute hypersensitivity pneumonitis (and IgG positive). Altogether, 29 of 46 patients diagnosed with IPF who had met the 2011 criteria had lung tissue available for histopathology (surgical lung biopsy in 28 patients and explanted lung in two patients, one of whom also had surgical biopsy) during the study period, and 16 of the 20 patients with chronic hypersensitivity pneumonitis had histopathological features on surgical lung biopsy that were consistent with this diagnosis. 26 of the 46 patients remained with a diagnosis of IPF. INTERPRETATION Almost half of patients diagnosed with IPF on the basis of 2011 criteria were subsequently diagnosed with chronic hypersensitivity pneumonitis, and most of these cases were attributed to exposure of occult avian antigens from commonly used feather bedding. Our results reflect findings in one centre with recognised expertise in chronic hypersensitivity pneumonitis, and further research and studies at other centres are warranted. FUNDING Fondo de Investigaciones Sanitarias; Fundació Privada Cellex; SEPAR 2010.
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Affiliation(s)
- Ferran Morell
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Palma de Mallorca, Spain.
| | - Ana Villar
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Palma de Mallorca, Spain
| | - María-Ángeles Montero
- Pathology Division, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Histopathology Department, Royal Brompton and Harefield Hospital NHS Foundation Trust, London, UK
| | - Xavier Muñoz
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Palma de Mallorca, Spain
| | - Thomas V Colby
- Laboratory Medicine-Pathology Department, Mayo Clinic, Scottsdale, AZ, USA
| | - Sudhakar Pipvath
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - María-Jesús Cruz
- Respiratory Medicine Department, Hospital Universitari Vall d'Hebron, Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Palma de Mallorca, Spain
| | - Ganesh Raghu
- Department of Medicine, University of Washington Medical Center, Seattle, WA, USA
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15
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Fishwick D. New occupational and environmental causes of asthma and extrinsic allergic alveolitis. Clin Chest Med 2013; 33:605-16. [PMID: 23153603 DOI: 10.1016/j.ccm.2012.07.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Asthma and extrinsic allergic alveolitis (EAA) remain prevalent respiratory diseases and the cause of a significant disease burden. This article reviews the recent occupational and environmental causes described for these conditions. Even over the limited time spam addressed by this article, novel agents and new data relating to already suggested causes have been described. Various types of work tasks or exposures are described that appear to cause both asthma and EAA. Isocyanates, the best example of dual potential to cause asthma and EAA are discussed, as is the new understanding of the role metal-working fluids play when causing respiratory diseases.
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Affiliation(s)
- David Fishwick
- Centre for Workplace Health, Health and Safety Laboratories, The University of Sheffield, Harpur Hill, Buxton, Derbyshire SK17 3JN, UK.
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16
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Agache IO, Rogozea L. Management of hypersensivity pneumonitis. Clin Transl Allergy 2013; 3:5. [PMID: 23374544 PMCID: PMC3585806 DOI: 10.1186/2045-7022-3-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 02/01/2013] [Indexed: 12/28/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is an interstitial lung disease due to a combined type III and IV reaction with a granulomatous inflammation, caused by cytotoxic delayed hypersensitivity lymphocytes, in a Th1/Th17 milieu, chaperoned by a deficient suppressor function of T regulatory cells. Skewing toward a Th2 phenotype is reported for chronic HP. Phenotypic expression and severity depends on environmental and/or host genetic and immune co-factors. The wide spectrum of causative antigens is continuously up-dated with new sources of airborne organic particles and drug-induced HP. The diagnosis requires a detailed history, measurement of environmental exposure, pulmonary function tests, imaging, detection of serum specific antibodies, broncho-alveolar lavage, antigen-induced lymphocyte proliferation, environmental or laboratory-controlled inhalation challenge and lung biopsy. Complete antigen avoidance is the best therapeutic measure, although very difficult to achieve in some cases. Systemic steroids are of value for subacute and chronic forms of HP, but do not influence long term outcome. Manipulation of the immune response in HP holds future promise.
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Affiliation(s)
- Ioana O Agache
- Theramed Medical Center, Spatarul Luca Arbore 16, 500112, Brasov, Romania.
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PATHOLOGIE INFECTIEUSE. IMAGERIE THORACIQUE 2013. [PMCID: PMC7156015 DOI: 10.1016/b978-2-294-71321-7.50016-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Ohshimo S, Bonella F, Guzman J, Costabel U. Hypersensitivity pneumonitis. Immunol Allergy Clin North Am 2012; 32:537-56. [PMID: 23102065 DOI: 10.1016/j.iac.2012.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Clinical manifestations of hypersensitivity pneumonitis may closely mimic other interstitial lung diseases, and the disease onset is usually insidious. High-resolution computed tomography and bronchoalveolar lavage are the sensitive and characteristic diagnostic tests for hypersensitivity pneumonitis. The relevant antigen to hypersensitivity pneumonitis cannot be identified in up to 20% to 30% of patients. Clinicians should be aware that hypersensitivity pneumonitis must be considered in all cases of interstitial lung disease, and a detailed environmental exposure history is mandatory.
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Affiliation(s)
- Shinichiro Ohshimo
- Department of Molecular and Internal Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Japan
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Abstract
Hypersensitivity pneumonitis (HP) is a complex syndrome caused by the inhalation of environmental antigens. Chronic HP may mimic other fibrotic lung diseases, such as idiopathic pulmonary fibrosis. Recognition of the antigen is important for diagnosis; avoidance of further exposure is critical for treatment. Fibrosis on biopsy or high-resolution computed tomography is a predictor of increased mortality. Additional research is needed to understand why the disease develops only in a minority of exposed individuals and why cases of chronic HP may progress without further antigen exposure.
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Affiliation(s)
- Ulrich Costabel
- Department of Pneumology/Allergy, Ruhrlandklinik, University Hospital, Essen, Germany.
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Affiliation(s)
- Craig R Rackley
- Division of Pulmonary and Critical Care, Department of Medicine, Duke University Medical Center, Durham, NC
| | - Eric B Meltzer
- Division of Pulmonary and Critical Care, Department of Medicine, Duke University Medical Center, Durham, NC.
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Metersky ML, Bean S. Throw Caution to the Wind Instruments: Response. Chest 2011. [DOI: 10.1378/chest.10-2870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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