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Viegas C, Dias M, Pacífico C, Faria T, Clérigo A, Brites H, Caetano LA, Carolino E, Gomes AQ, Viegas S. Portuguese cork industry: filling the knowledge gap regarding occupational exposure to fungi and related health effects. Front Public Health 2024; 12:1355094. [PMID: 38915753 PMCID: PMC11195813 DOI: 10.3389/fpubh.2024.1355094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/07/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction The presence of the Penicillium section Aspergilloides (formerly known as Penicillium glabrum) in the cork industry involves the risk of respiratory diseases such as suberosis. Methods The aim of this study was to corroborate the predominant fungi present in this occupational environment by performing a mycological analysis of 360 workers' nasal exudates collected by nasal swabs. Additionally, evaluation of respiratory disorders among the cork workers was also performed by spirometry. Results Penicillium section Aspergilloides was detected by qPCR in 37 out of the 360 nasal swabs collected from workers' samples. From those, 25 remained negative for Penicillium sp. when using culture-based methods. A significant association was found between ventilatory defects and years of work in the cork industry, with those people working for 10 or more years in this industry having an approximately two-fold increased risk of having ventilatory defects compared to those working less time in this setting. Among the workers who detected the presence of Penicillium section Aspergilloides, those with symptoms presented slightly higher average values of CFU. Discussion Overall, the results obtained in this study show that working in the cork industry may have adverse effects on worker's respiratory health. Nevertheless, more studies are needed (e.g., using serological assays) to clarify the impact of each risk factor (fungi and dust) on disease etiology.
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Affiliation(s)
- Carla Viegas
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
| | - Marta Dias
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
| | - Cátia Pacífico
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Tiago Faria
- Centro de Ciências e Tecnologias Nucleares (C2TN), Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Anália Clérigo
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Hermínia Brites
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Liliana Aranha Caetano
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Elisabete Carolino
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Anita Quintal Gomes
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Susana Viegas
- H&TRC – Health and Technology Research Center, ESTeSL – Escola Superior de Tecnologia e Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, REAL, CCAL, NOVA University Lisbon, Lisbon, Portugal
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
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Cunha L, Lacomblez M. How can the work activity point of view inform territorial development projects? Work 2024; 77:391-404. [PMID: 38073360 DOI: 10.3233/wor-220374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND The heuristic potential of work activity-focused territory analyses has yet to be explored in depth. Instead of viewing territories as a product of their actors, the prevailing approaches rely on statistical indicators to view them "from above". OBJECTIVE To understand how work activity acts upon a territory and transforms it, and to discuss what the main indicators used to characterize territories reveal and conceal. METHODS Case studies led on two territories, each in a different industry. One on transportation in a sparsely populated "low density" area; the other in an industrial district, focusing on its "high activity rate" cork industry. In the first case, work activity analyses were led with drivers and mobility designers, including systematic observations and interviews, in the context of an endeavour to redesign a local transport network. In the second case, work activity analyses led among cork stopper choosers were followed with an integrative literature review of indicators about the cork industry and its health impacts. RESULTS This territory analysis highlights: (i) traces of bus drivers' work activity on the mitigation of inequalities in access to public transportation; (ii) "absent indicators" regarding cork choosers' work activity and its health impacts, stressing the existence of a development agenda for this territory focused on cork processing rather than on those who perform it. CONCLUSION Our analysis of territorialization processes through the lens of work activity signposts a path for research-action seeking to associate territorial development with improvements in the working conditions of citizen workers.
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Affiliation(s)
- Liliana Cunha
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
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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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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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Assessment and Management of Occupational Hypersensitivity Pneumonitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3295-3309. [PMID: 33161960 DOI: 10.1016/j.jaip.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
The diagnosis and treatment of occupational hypersensitivity pneumonitis (OHP) remain complex and challenging in the absence of diagnostic gold standards or clinical guidelines. This review provides an update of the recent literature regarding the different presentations of OHP and the diagnostic yield and value of the diagnostic tests currently available, which include occupational and medical history, laboratory tests (serum-specific immunoglobulins, environmental sampling), imaging, bronchoalveolar lavage, transbronchial biopsy, transbronchial cryobiopsy, surgical lung biopsy, and specific inhalation challenges. These tools provide a precise differential diagnosis within the framework of interstitial lung diseases. However, among the chronic fibrotic forms, distinguishing OHP from sarcoidosis, nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis remains a diagnostic challenge. Avoidance of exposure is pivotal for OHP management, whereas corticosteroids are fundamental in the pharmacological approach to this disease. In addition, studies describing the long-term benefits of immunosuppressive and antifibrotic agents have increased the use of these treatments in OHP.
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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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Morell F, Villar A, Ojanguren I, Muñoz X, Cruz MJ, Sansano I, Ramon MA, Raghu G. Hypersensitivity Pneumonitis and (Idiopathic) Pulmonary Fibrosis Due to Feather Duvets and Pillows. Arch Bronconeumol 2020; 57:87-93. [PMID: 32059824 DOI: 10.1016/j.arbres.2019.12.003] [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: 03/05/2019] [Revised: 11/11/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Exposure to feather bedding may be an unnoticed cause of hypersensitivity pneumonitis (HP) and idiopathic pulmonary fibrosis (IPF). Thus, an in-depth clinical study of the diagnosis of patients with suspected HP and IPF is required in order to determine their etiologies. The objective of the present study is to raise awareness of HP and pulmonary fibrosis due to exposure to feather bedding, and to study the prevalence and describe long-term outcomes. METHODS We describe a series of 33 patients diagnosed with HP and pulmonary fibrosis due to feather bedding exposure and followed over a 10-year period. The patients were from a subgroup of 127 individuals with HP undergoing in-depth evaluation using a diagnostic protocol at a regional referral center. RESULTS Eleven (33%) patients were clinically diagnosed with acute HP and 22 (67%) with chronic HP. Ten (45%) chronic HP patients showed a high resolution computed tomography (HRCT) pattern of usual interstitial pneumonia (UIP) with suspected IPF. The prevalence of HP was 6.2/100 000 feather bedding users (compared with 54.6 per 100 000 bird-breeders). The survival rates of patients over the 10-year period was 100% for acute HP and 64% for chronic HP. CONCLUSIONS In a series of HP patients, the diagnosis was attributed to feather bedding exposure in 26%. UIP pattern on HRCT was present in nearly half of the chronic cases. The survival of patients with chronic HP at ten years was 64%, despite avoiding further exposure.
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Affiliation(s)
- Ferran Morell
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Catalonia, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain.
| | - Ana Villar
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Catalonia, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Iñigo Ojanguren
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Catalonia, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Xavier Muñoz
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Catalonia, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - María Jesús Cruz
- Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Catalonia, Spain; Departament de Medicina, Universitat Autònoma de Barcelona (UAB), Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Irene Sansano
- Servei d'Anatomia Patològica, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Maria Antonia Ramon
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Catalonia, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Catalonia, Spain
| | - Ganesh Raghu
- Division of Pulmonary & Critical Care Medicine, University of Washington, Center for Interstitial Lung Disease, University of Washington, Seattle, USA
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Hypersensitivity pneumonitis: Main features characterization in a Portuguese cohort. Pulmonology 2019; 26:130-137. [PMID: 31672592 DOI: 10.1016/j.pulmoe.2019.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 01/30/2023] Open
Abstract
Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) which varies in prevalence across the world, depending on disease definition, diagnostic methods, exposure type and intensity, geographical environments, agricultural and industrial practices, and host risk factors. This study aimed to deepen knowledge about HP's clinical characteristics, diagnosis and functional and imaging features in a cohort of HP patients from the North of Portugal. To achieve this goal, a retrospective assessment of the clinical and diagnostic data was carried out, and patients were classified and compared according to disease presentation (acute, sub-acute and chronic HP forms). Of the 209 HP patients included (mean age 58.3 ± 16.0 years), 52.6% were female and 73.7% presented a chronic form. Most patients had prior exposure to birds (76.6%). Dyspnoea and cough were the most frequently experienced symptoms, but no statistically significant differences were found between groups (p = 0.089, p = 0.418, respectively). Fever was most common in acute HP form (p < 0.001). The most common patterns found in Chest CT were ground glass (p = 0.002) in acute/subacute presentation, and reticulation (p < 0.001) in chronic form, while mosaic attenuation, although was also frequently observed, no statistically significant differences were found between groups (p = 0.512). The most common functional pattern was restrictive (38% of patients, 73.7% with chronic HP form). Bronchoalveolar lavage lymphocytes were higher in acute and subacute forms although not reaching statistical significance (p = 0.072), with lowest CD4/CD8 ratio (p = 0.001) in acute forms. Thus, given the significant disease heterogeneity, further studies with different populations and ambient exposures are needed to achieve a better stratification of the exposure risk, to provide proper implementation of avoidance methods and a precise diagnostic and therapeutic approach.
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Hypersensitivity pneumonitis: Antigen diversity and disease implications. Pulmonology 2018; 25:97-108. [PMID: 30126802 DOI: 10.1016/j.pulmoe.2018.07.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/03/2018] [Accepted: 07/05/2018] [Indexed: 11/20/2022] Open
Abstract
Hypersensitivity pneumonitis (HP) is an immune-mediated syndrome triggered by inhalation of a wide variety of allergens, to which an individual has previously been sensitized. More than 200 agents responsible for the disease have already been identified; however, HP occurs only in a small number of individuals exposed to causal antigens. The present report provides an overview of the role of antigen role in HP, highlighting its diversity, research methods, and prevention strategies, as well as the impact on disease prognosis following elimination of antigen. HP is an underdiagnosed disease and, therefore, it is difficult to accurately estimate its incidence. Triggering antigens can be divided into six broad categories: bacteria, fungi, mycobacteria, animal and plant proteins, chemicals, and metals, represented by disease prototypes. The identification of causal antigen is a major challenge; it is impossible to obtain in about 30-60% of cases. The acute form of HP, with early detection and immediate eviction of causal antigen, tends to have an excellent prognosis. In the chronic form, partial recovery of disease is still possible; however, some cases tend to progress to fibrosis, even after removal from exposure. In conclusion, HP diagnosis should be based on a proactive search for potential antigen sources, although their identification is hampered by the lack of standardized methods of demonstrating the specific antigen sensitization. Antigen avoidance is a critical determinant in disease prognosis.
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Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity Pneumonitis: Perspectives in Diagnosis and Management. Am J Respir Crit Care Med 2017; 196:680-689. [PMID: 28598197 DOI: 10.1164/rccm.201611-2201pp] [Citation(s) in RCA: 259] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Martina Vasakova
- 1 Department of Respiratory Medicine, First Faculty of Medicine of Charles University, Thomayer Hospital Prague, Prague, Czech Republic
| | - Ferran Morell
- 2 Vall d'Hebron Institut de Recerca, Servei de Pneumología, Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Autonóma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Respiratoria, Barcelona, Catalonia, Spain
| | - Simon Walsh
- 3 King's College National Health Service Hospital Foundation Trust, Denmark Hill, London, United Kingdom
| | | | - Ganesh Raghu
- 5 Center for Interstitial Lung Diseases, University of Washington Medical Center, Seattle, Washington
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Ojanguren I, Cruz MJ, Villar A, Barrecheguren M, Morell F, Muñoz X. Utility of Exhaled Nitric Oxide Fraction for the Diagnosis of Hypersensitivity Pneumonitis. Lung 2015; 194:75-80. [DOI: 10.1007/s00408-015-9824-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/03/2015] [Indexed: 01/05/2023]
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Ojanguren I, Cruz MJ, Villar A, Sanchez-Ortiz M, Morell F, Munoz X. Changes in PH in exhaled breath condensate after specific bronchial challenge test in patients with chronic hypersensitivity pneumonitis: a prospective study. BMC Pulm Med 2015; 15:109. [PMID: 26420256 PMCID: PMC4589182 DOI: 10.1186/s12890-015-0100-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 09/10/2015] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to investigate the influence of the specific inhalation challenge (SIC) on changes of pH values in exhaled breath condensate (EBC) in patients with hypersensitivity pneumonitis (HP). Methods A prospective study of 85 patients with suspected HP, of whom 63 were diagnosed with HP due to exposure to avian or fungal antigens. In all cases, EBC samples were collected before and after completion of the SIC and pH values were determined. Results Taken as a whole, patients with HP did not present changes in EBC pH after SIC. However, considering only patients with exposure to molds, those diagnosed with HP had a significantly more acid pH post-SIC than those with another diagnosis (p = 0.011). This fact is not observed in patients exposed to bird’s antigens. A ROC curve showed that a reduction in EBC pH of 0.3 units or more after SIC in patients diagnosed with HP due to exposure to molds had a sensitivity of 30 % (CI: 12.8 to 54.3 %) and a specificity of 100 % (CI: 65.5 to 100 %). Conclusion EBC pH may be useful in interpreting SIC results in patients with HP, especially in those patients exposed to molds. Further studies are now required to test the validity of these proposals.
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Affiliation(s)
- I Ojanguren
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Catalonia, Spain
| | - M J Cruz
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Catalonia, Spain.,CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - A Villar
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Catalonia, Spain
| | - M Sanchez-Ortiz
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Catalonia, Spain
| | - F Morell
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Catalonia, Spain.,CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - X Munoz
- Servicio de Neumología, Departamento de Medicina, Hospital Universitario Vall d´Hebron, Universidad Autónoma de Barcelona, Catalonia, Spain. .,CIBER Enfermedades Respiratorias (Ciberes), Barcelona, Spain. .,Departamento de Biología Celular, Fisiología e Inmunología, Universidad Autónoma de Barcelona, Catalonia, Spain. .,Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 119, 08035, Barcelona, Spain.
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Cruz MJ, Alvarez-Simón D, Gómez-Olles S, Muñoz X. Estudios inmunológicos y pruebas de provocación bronquial específicas, técnicas esenciales para el diagnóstico de neumonitis por hipersensibilidad. Med Clin (Barc) 2014; 143:328-9. [DOI: 10.1016/j.medcli.2013.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 09/22/2013] [Accepted: 09/26/2013] [Indexed: 11/15/2022]
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Muñoz X, Sánchez-Ortiz M, Torres F, Villar A, Morell F, Cruz MJ. Diagnostic yield of specific inhalation challenge in hypersensitivity pneumonitis. Eur Respir J 2014; 44:1658-65. [PMID: 25142480 DOI: 10.1183/09031936.00060714] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Reliable methods are needed to diagnose hypersensitivity pneumonitis. The aim of the study was to establish the diagnostic yield of specific inhalation challenge (SIC) in patients with hypersensitivity pneumonitis. All patients with suspected hypersensitivity pneumonitis in whom SIC was performed (n=113) were included. SIC was considered positive when patients showed a decrease of >15% in forced vital capacity (FVC) or >20% in diffusing capacity of the lung for carbon dioxide, or a decrease of 10% to 15% in FVC accompanied by a temperature increase of 0.5°C within 24 h of inhalation of the antigen. SIC was positive to the agents tested in 68 patients: 64 received a diagnosis of hypersensitivity pneumonitis and SIC results were considered false-positive in the remaining four patients. In the SIC-negative group (n=45), 24 patients received a diagnosis of hypersensitivity pneumonitis and SIC results were considered false-negative, and 21 patients were diagnosed with other respiratory diseases. The sensitivity and specificity of the test were 72.7% and 84%, respectively. Having hypersensitivity pneumonitis caused by an antigen other than birds or fungi predicted a false-negative result (p=0.001). In hypersensitivity pneumonitis, positive SIC testing virtually confirms the diagnosis, whereas negative testing does not rule it out, especially when the antigenic sources are not birds or fungi.
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Affiliation(s)
- Xavier Muñoz
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain Dept of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mónica Sánchez-Ortiz
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
| | - Ferran Torres
- Biostatistics and Data Management Platform, IDIBAPS, Hospital Clinic, Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Villar
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
| | - Ferran Morell
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
| | - María-Jesús Cruz
- Pulmonology Service, Medicine Dept, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain CIBER Enfermedades Respiratorias (Ciberes), Spain
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Villar A, Muñoz X, Sanchez-Vidaurre S, Gómez-Ollés S, Morell F, Cruz MJ. Bronchial inflammation in hypersensitivity pneumonitis after antigen-specific inhalation challenge. Respirology 2014; 19:891-9. [PMID: 24890329 DOI: 10.1111/resp.12323] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 01/15/2014] [Accepted: 04/09/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study is to compare the inflammatory profile before and after specific inhalation challenge (SIC) in induced sputum from patients with hypersensitivity pneumonitis (HP) and to investigate whether different causal antigens define the resulting profile. METHODS A prospective study was conducted in 27 patients with HP: 15 patients due to exposure to birds (BHP) and 12 due to exposure to fungi (FHP), confirmed by SIC. Induced sputum was obtained before and/or 24 h after SIC. Cell types were determined by differential cell count using optical microscopy. Interferon-γ, interleukin (IL)-12p70, IL-2, IL-10, IL-8, IL-6, IL-4, IL-5, IL-1β, tumour necrosis factor (TNF)-α and TNF-β levels were measured in the supernatants. RESULTS Following SIC, higher sputum neutrophilia levels (P = 0.048) and an increase in IL-8 levels (P = 0.017) were found in patients with FHP than in those with BHP. FHP patients also showed increased IL-1β, IL12-p70 and IL5 levels (P = 0.011, P = 0.036 and P = 0.018, respectively) after SIC. In BHP, a trend towards increases in sputum eosinophils and TH2 cytokines (IL4, IL5) was seen following SIC (P = 0.059, P = 0.068 and P = 0.075 respectively). CONCLUSIONS This study shows that bronchial inflammation is present in patients with HP evidenced by increases in sputum neutrophils and eosinophils following exposure to the offending antigen during SIC.
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Affiliation(s)
- Ana Villar
- Department of Medicine, Pulmonology Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Network for Biomedical Research in Respiratory Disease (CIBER Enfermedades Respiratorias or CIBERES), Salud Carlos III Health Institute, Barcelona, Spain
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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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Abstract
PURPOSE OF REVIEW The diagnosis of hypersensitivity pneumonitis remains a dilemma because of the absence of any characteristic features able to distinguish it from other interstitial lung diseases. We analyze the current role of the specific inhalation challenge (SIC) in the diagnosis of this entity. RECENT FINDINGS Few descriptions of the use of SIC for the diagnosis of hypersensitivity pneumonitis have been published in recent years. In fact, hypersensitivity pneumonitis is still diagnosed on the basis of clinical criteria, as there is no agreement on the diagnostic utility of SIC. Two major reviews carried out in the past year have concluded that this test is not standardized and is usually unnecessary; however, a third study found that the test can indeed recreate the symptoms and functional abnormalities in the laboratory, and may therefore be of considerable use in the diagnosis of hypersensitivity pneumonitis. SUMMARY Hypersensitivity pneumonitis remains a diagnostic challenge. Given that the main cause of the disease is sensitization and hyper-responsiveness to specific antigens in susceptible individuals, SIC is an obvious candidate as the gold standard for diagnosis of this entity. The present review analyzes the reasons for the test's limited use, assesses its diagnostic utility, and proposes a basis for its standardization.
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Neumonitis por hipersensibilidad a isocianatos. Características clínico-radiológicas y de función pulmonar. Arch Bronconeumol 2013; 49:169-72. [DOI: 10.1016/j.arbres.2012.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 08/27/2012] [Accepted: 08/30/2012] [Indexed: 11/19/2022]
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Uranga A, Sánchez-Ortiz M, Morell F, Cruz MJ, Muñoz X. Hypersensitivity Pneumonitis Due to Isocyanates: Lung Function, Clinical and Radiological Characteristics. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.arbr.2012.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Zacharisen MC, Fink JN. Hypersensitivity Pneumonitis and Related Conditions in the Work Environment. Immunol Allergy Clin North Am 2011; 31:769-86, vii. [DOI: 10.1016/j.iac.2011.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hypersensitivity pneumonitis related to medium-density fiberboard. Arch Bronconeumol 2011; 48:29-31. [PMID: 21676517 DOI: 10.1016/j.arbres.2011.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 04/04/2011] [Accepted: 04/09/2011] [Indexed: 11/20/2022]
Abstract
Pneumonitis due to hypersensitivity to wood fiber is mainly associated with the fungus that colonizes it. We present the case of a male affected with hypersensitivity pneumonitis in which the agent implicated was medium-density fiberboard, an engineered product whose main component is pine wood fiber. The causal agent was identified by means of a specific bronchial provocation test.
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Weber RW. Aspergillus fumigatus. Ann Allergy Asthma Immunol 2010; 104:A3. [PMID: 20486323 DOI: 10.1016/j.anai.2010.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Richard W Weber
- National Jewish Health, 1400 Jackson Street Room J326, Denver, CO 80206, USA
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Hirschmann JV, Pipavath SNJ, Godwin JD. Hypersensitivity pneumonitis: a historical, clinical, and radiologic review. Radiographics 2010; 29:1921-38. [PMID: 19926754 DOI: 10.1148/rg.297095707] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most cases of hypersensitivity pneumonitis develop only after many years of inhaling allergens, which include microbes, animal or plant proteins, and certain chemicals that form haptens. The initial clinical presentation is either episodes of acute illness with dyspnea and prominent constitutional symptoms, such as fever, or an insidious onset of dyspnea, coughing, and weight loss, sometimes with superimposed acute episodes. The histopathologic process consists of chronic inflammation of the bronchi and peribronchiolar tissue, often with poorly defined granulomas and giant cells in the interstitium or alveoli. Fibrosis and emphysema may develop. The radiologic findings include diffuse ground-glass opacification, centrilobular ground-glass opacities, air trapping, fibrosis, lung cysts, and emphysema. The histologic and radiologic features in some cases may resemble those of usual interstitial pneumonia or nonspecific interstitial pneumonia. The diagnosis usually rests on a variable combination of findings from history, serology, radiography, lung biopsy, and bronchoalveolar lavage, which characteristically reveals a lymphocyte content of more than 30%, often with an increased CD4-to-CD8 ratio of T cells. Treatment includes avoiding the allergen, if possible, and, in severe cases, systemic corticosteroids. The long-term prognosis is usually good, but some patients develop severe respiratory insufficiency, and a few die of the disease.
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Villar A, Muñoz X, Cruz MJ, Morell F. Neumonitis por hipersensibilidad a Mucor sp. en un trabajador de la industria del corcho. Arch Bronconeumol 2009; 45:405-7. [DOI: 10.1016/j.arbres.2008.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Accepted: 07/30/2008] [Indexed: 11/28/2022]
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Sogo A, Morell F, Muñoz X. Neumonitis por hipersensibilidad en una planchadora. Arch Bronconeumol 2009; 45:258-9. [DOI: 10.1016/j.arbres.2008.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2008] [Revised: 06/30/2008] [Accepted: 07/07/2008] [Indexed: 10/21/2022]
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Abstract
Bird fancier's lung (BFL) is one of the most common types of hypersensitivity pneumonitis. Nevertheless, the criteria for diagnosing this condition are not standardized. The current study is an in-depth investigation into the clinical characteristics of BFL in the largest series examined for this purpose by a single group, to our knowledge, taking into account the acute, subacute, or chronic clinical presentation. From 1977 to 2003, BFL was diagnosed in 86 patients using a homogeneous protocol. Data from the clinical history and physical examination were analyzed, as well as the results from the following complementary examinations: laboratory analyses, specific serum IgG antibodies determination, chest X-ray, chest computed tomography (CT), pulmonary function testing, immediate hypersensitivity skin testing, delayed cutaneous hypersensitivity testing, bronchofibroscopy with bronchoalveolar lavage (BAL) and/or transbronchial biopsy, bronchial challenge testing, and surgical lung biopsy. In addition, clinical and epidemiologic characteristics were determined in a control group of 60 pigeon breeders who did not meet the diagnostic criteria of BFL. Eighty-six patients (21 men and 65 women) with a mean age of 47 years were studied. Seven (8%) patients were younger than 15 years of age at the time of the diagnosis. In 3 cases, the disease was caused by exposure to feather-filled bedding. Nearly 1 in 5 patients was diagnosed in the chronic phase of the disease. The mean diagnostic delay was 1.6 years overall, and 3.2 years in patients diagnosed in the chronic phase of the disease. Among the 17% of patients with chronic disease, the mean interval from initiation of exposure to diagnosis was 16 years, a higher value than in the acute or subacute presentation forms. Dyspnea and cough were the most common clinical symptoms (98% and 82%, respectively), and nearly 25% had grade III or IV dyspnea at diagnosis. Only 18% of patients experienced chest tightness, a symptom classically considered to be frequent in this condition. Erythrocyte sedimentation rate was elevated (>30 mm/h) in 44% of patients. Urinary calcium was elevated in 20% of patients. Angiotensin-converting enzyme was not elevated in any of the patients in which it was measured. Lactate dehydrogenase increases were found in 51% of patients. Specific IgG antibodies to avian antigens were documented in 92% of BFL patients, but also in 87% of pigeon breeder controls. The most frequent radiologic finding was an interstitial pattern in 79% of patients. Common chest CT features were ground glass areas (68%) and a mosaic pattern (61%); areas of emphysema were found in 7/41 (17%) patients, 5 of whom had never smoked. Two patients had a CT pattern of pulmonary fibrosis indistinguishable from idiopathic pulmonary fibrosis. Immediate hypersensitivity skin testing with bird sera and pigeon bloom was positive in 78% and 100% of BFL patients, respectively, and in 64% and 88% of control pigeon breeders, respectively. Almost one-third of the patients (29%) presented an anergic response on delayed cutaneous hypersensitivity testing. Restrictive ventilatory impairment was the most frequent functional pattern (77%), although 9% and 4% showed a pure obstructive and mixed pattern, respectively. The carbon monoxide diffusing capacity was decreased (<80% of the predicted value) in 85% of cases. Forty-one percent of patients had PaO2 <60 mm Hg at diagnosis when blood gas analysis was performed. Lymphocytosis (>20% lymphocytes) was documented in 83% of patients who underwent BAL, with a similar frequency in the 3 presentation forms: 70% acute, 89% subacute, and 85% chronic. In addition, inversion of the CD4/CD8 ratio (<1) was observed in 62% of the patients, but 38% of cases showed a CD4 predominance. The characteristic triad of histopathologic findings in hypersensitivity pneumonitis was found in only 9% of patients undergoing transbronchial biopsy, but at least 1 of these findings was seen in 69%. Surgical lung biopsy was undertaken in 14/86 (16%) patients; the complete triad was observed in 50% and at least 1 finding in 100%. In 54/86 (63%) patients, the diagnosis was confirmed by bronchial challenge testing, a test with a sensitivity of 92% and specificity of 100%. BFL is a potentially severe disease that can progress to respiratory failure secondary to pulmonary fibrosis or chronic obstructive pulmonary disease, as a form of chronic occupational respiratory disease. Respiratory symptoms in exposed patients, including children and adults who have only 1 pet bird at home, should raise the suspicion of BFL. Diagnosis in the chronic phase is frequent, and the delay to diagnosis was greatest in these cases. Elevated urinary calcium, lactate dehydrogenase, and erythrocyte sedimentation rate in a bird fancier may constitute a combined marker for suspected BFL. Chest CT frequently discloses emphysema and a pattern of idiopathic pulmonary fibrosis in some patients. An anergic response on delayed cutaneous hypersensitivity testing is not infrequent. The presentation with respiratory failure and the predominance of CD4 T lymphocytes in some patients' BAL are both remarkable. Lymphocytosis on BAL also persists in the chronic phase of the disease. Bronchial challenge testing has a high diagnostic yield, and surgical lung biopsy is not needed to reach the final diagnosis in the vast majority of cases.
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Affiliation(s)
- Ferran Morell
- From Servei de Pneumologia (FM, LR, XM) i Unitat d'Investigació en Pneumologia (MJC), Hospital Universitari Vall d'Hebron, Departament de Medicina, Universitat Auto`noma de Barcelona, Barcelona; CIBERES, (Ciber Enfermedades Respiratorias) Instituto de Salud Carlos III, Madrid, Spain; Servei de Pneumologia, Hospital Dos de Maig (AR) i Servei de Pneumologia, Hospital General de Catalunya (CM), Barcelona, Spain
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Merget R, Sander I, Rozynek P, Raulf-Heimsoth M, Bruening T. Occupational hypersensitivity pneumonitis due to molds in an onion and potato sorter. Am J Ind Med 2008; 51:117-9. [PMID: 18161826 DOI: 10.1002/ajim.20534] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A 42-year-old female non-smoking onion and potato sorter developed work-related shortness of breath, cough, fatigue and flu-like symptoms. The diagnosis of hypersensitivity pneumonitis was based on patchy infiltrates in both lungs on high resolution computed tomography and lymphocytosis of 71% in a bronchoalveolar lavage sample with a CD4/CD8 ratio of 0.4. Exposure cessation and initial corticosteroid therapy resulted in complete recovery. IgG antibodies to Penicillium species and Fusarium solani cultivated from samples from the patient's workplace were detected in the patient's serum and cross-reactivity was demonstrated within Penicillium species, but also between Penicillium species and Aspergillus fumigatus. We conclude that occupational hypersensitivity pneumonitis due to molds may develop in onion and potato sorters.
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Affiliation(s)
- R Merget
- BGFA-Research Institute of Occupational Medicine, German Social Accident Insurance, Ruhr-University, Bochum, Germany.
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Thaon I, Reboux G, Moulonguet S, Dalphin J. Les pneumopathies d’hypersensibilité en milieu professionnel. ARCH MAL PROF ENVIRO 2007. [DOI: 10.1016/s1775-8785(07)78223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Orriols Martínez R, Abu Shams K, Alday Figueroa E, Cruz Carmona MJ, Galdiz Iturri JB, Isidro Montes I, Muñoz Gall X, Quirce Gancedo S, Sastre Domínguez J. [Guidelines for occupational asthma]. Arch Bronconeumol 2006; 42:457-74. [PMID: 17040662 DOI: 10.1016/s1579-2129(06)60569-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Thaon I, Reboux G, Moulonguet S, Dalphin JC. Les pneumopathies d’hypersensibilité en milieu professionnel. Rev Mal Respir 2006; 23:705-25. [PMID: 17202974 DOI: 10.1016/s0761-8425(06)72084-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) is a granulomatous disease of the lungs due to immune reactions following chronic inhalation of organic dusts or chemicals especially encountered in the occupational environment. The main purpose of this review is to report current concepts regarding aetiologies, epidemiology, diagnosis, treatment as well as legal aspects of HP. STATE OF THE ART The following aspects will be focused: (1) increase in new etiological circumstances, especially occupational and news antigens, (2) for diagnosis, the major contribution of chest high resolution CT scan which often shows characteristic images but also recent developments in simple diagnostic criteria that may be used for an epidemiological approach, (3) importance of bronchial obstruction and even emphysema as a long term sequelae, finally (4) the possibility of continuing occupational activities in certain circumstances where preventive measures can be used. PERSPECTIVES The increasing knowledge of etiological agents and circumstances as well as the development of secondary and especially primary preventive measures should lead to reduce the frequency of this disease and of its medico-social consequences.
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Affiliation(s)
- I Thaon
- Service des Maladies Professionnelles, CHU de Besançon, France
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Merget R, Sander I, Rozynek P, Heinze E, Imoehl M, Raulf-Heimsoth M, Bruening T. Occupational immunoglobulin E-mediated asthma due to Penicillium camemberti in a dry-sausage packer. ACTA ACUST UNITED AC 2006; 76:109-11. [PMID: 17108671 DOI: 10.1159/000097137] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2006] [Accepted: 07/31/2006] [Indexed: 11/19/2022]
Abstract
A 62-year-old female sausage packer reported progressive work-related asthma, rhinitis and contact urticaria after contact to dry sausages refined by moulds. Whereas skin prick tests with commercial mould extracts were negative, the patient showed weak skin sensitization to a cultivated mould sample from a dry sausage. Specific immunoglobulin E antibodies to various moulds were demonstrated by ImmunoCAP and antibodies to the cultivated mould sample were demonstrated by enzyme allergosorbent test. The mould was identified by pheno- and genotyping as Penicillium camemberti. Five atopic controls did not show sensitization with the same tests. Crossreactivity of P. camemberti and Penicillium notatum was shown by enzyme allergosorbent inhibition tests. Although no challenge tests were considered due to the patient's airway obstruction, a diagnosis of allergic occupational asthma was made. We conclude that immunoglobulin E-mediated allergic occupational asthma due to moulds may occur in dry sausage packers.
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Affiliation(s)
- R Merget
- Research Institute for Occupational Medicine, Institutions for Statutory Accident Insurance and Prevention, Ruhr University, Bochum, Germany.
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Orriols Martínez R, Abu Shams K, Alday Figueroa E, Cruz Carmona MJ, Galdiz Iturri JB, Isidro Montes I, Muñoz Gall X, Quirce Gancedo S, Sastre Domínguez J. Normativa del asma ocupacional. Arch Bronconeumol 2006. [DOI: 10.1157/13092417] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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