Precipitating antibodies against organic dust antigens in human sera by counterimmunoelectrophoresis

Occurrence of farmer's lung disease is relevant to meteorological conditions: a 20-year follow-up field survey analysis

BACKGROUND

A field survey on farmer's lung disease (FLD) in a dairy farming community in the northernmost district of Japan has been in progress since 1978.

METHODS

The correlation between the number of FLD occurrences year by year and dairy farming conditions and meteorological data were compared.

RESULTS

Thirty-four FLD cases had occurred in a 20 years period. Average number of days below freezing during the harvest season the year prior to FLD occurrence were significantly smaller than other years (2.1 +/- 0.7 [SE] days, 4.6 +/- 0.7 days, P < 0.05, respectively). Average annual sum of the sunlight hours in the years before the years with FLD occurrence was significantly smaller than those without FLD occurrence (1457.1 +/- 114.0 hr, 1811.3 +/- 97.7 hr, P < 0.05, respectively) and was also significantly smaller for the sunlight hours during a harvest season (821.9 +/- 60.2 hr, 1023.2 +/- 52.7 hr, P < 0.05, respectively).

CONCLUSIONS

Temperature and sunlight hours closely associated with the FLD occurrence.

Serum KL-6 concentrations in dairy farmers

STUDY OBJECTIVES

Serum KL-6 (Krebs von den Lungen-6) has been recognized to be a marker for the activity of diffuse interstitial lung diseases. The purpose of the study is to evaluate serum KL-6 measurement as a marker for farmer's lung disease (FLD).

DESIGN

A cross-sectional survey of a cohort of dairy farmers. Retrospective measurement of KL-6 stored serum samples from those dairy farmers previously screened for FLD.

SETTING

University hospital screening project for FLD within a dairy-farming community in Japan.

PARTICIPANTS

Four hundred seventy-two dairy farmers were invited to attend a local clinic.

MEASUREMENTS AND RESULTS

We examined serum KL-6 concentrations in 272 farmers. Subjects were classified into three groups: (1) 5 farmers with FLD, (2) 30 farmers with positive serum precipitating antibodies to Saccharopolyspora rectivirgula and/or Thermoactinomyces vulgaris without FLD (Ab(+)), and (3) 237 farmers without these antibodies (Ab(-)). Serum KL-6 concentrations in the FLD group were significantly higher than those in the Ab(+) and the Ab(-) groups (1,263 +/- 288 [SEM], 328 +/- 57, and 207 +/- 6 U/mL, respectively, p < 0.001). Serum KL-6 concentrations in those with FLD were significantly higher than KL-6 concentrations from stored screening samples from the same individual when FLD was not diagnosed (1,263 +/- 288 and 419 +/- 209 U/mL, respectively, p < 0.05). Serum KL-6 concentrations of the Ab(+) group were significantly higher than those of the Ab(-) group (p < 0.001). In the Ab(+) group, farmers with high serum KL-6 concentrations had lower permeability coefficients than farmers with normal serum KL-6 concentrations (p < 0.05). These results may suggest that subclinical FLD can be detected in farmers with high KL-6 concentrations and precipitating antibodies.

CONCLUSION

Serum KL-6 concentration can be a useful marker for assessing the activity of FLD and may be able to be used to detect subclinical disease.

The medically important aerobic actinomycetes: epidemiology and microbiology

The aerobic actinomycetes are soil-inhabiting microorganisms that occur worldwide. In 1888, Nocard first recognized the pathogenic potential of this group of microorganisms. Since then, several aerobic actinomycetes have been a major source of interest for the commercial drug industry and have proved to be extremely useful microorganisms for producing novel antimicrobial agents. They have also been well known as potential veterinary pathogens affecting many different animal species. The medically important aerobic actinomycetes may cause significant morbidity and mortality, in particular in highly susceptible severely immunocompromised patients, including transplant recipients and patients infected with human immunodeficiency virus. However, the diagnosis of these infections may be difficult, and effective antimicrobial therapy may be complicated by antimicrobial resistance. The taxonomy of these microorganisms has been problematic. In recent revisions of their classification, new pathogenic species have been recognized. The development of additional and more reliable diagnostic tests and of a standardized method for antimicrobial susceptibility testing and the application of molecular techniques for the diagnosis and subtyping of these microorganisms are needed to better diagnose and treat infected patients and to identify effective control measures for these unusual pathogens. We review the epidemiology and microbiology of the major medically important aerobic actinomycetes.

Personal spore sampling and indirect immunofluorescent test for exploration of hypersensitivity pneumonitis due to mould spores

Sensitization to mould spores was investigated in six patients with hypersensitivity pneumonitis, eight patients with idiopathic lung fibrosis, and six healthy controls by immunodiffusion and immunofluorescent testing of personal spore samples. The new technique of personal spore sampling with the Burkard personal volumetric air sampler and indirect immunofluorescent test for detection of spore-specific IgG and IgM confirmed that five patients with hypersensitivity pneumonitis and four with lung fibrosis were actually exposed and sensitized to moulds. Personal spore sampling and subsequent immunofluorescent tests represent sensitive tools for detection of individual mould sensitization and air quality control.

Occurrence and significance of precipitating antibodies against thermophilic actinomycetes in the sera of dairy herd workers, Nangali, Delhi

The study was prompted by the lack of information on the role of thermophilic actinomycetes in hypersensitivity pneumonitis in India. It reports the occurrence of precipitating antibodies against clinically important thermophilic actinomycetes in the sera of a population sample of dairy herd workers, Nangali, Delhi. Of 112 workers investigated, 28 (25%) showed precipitins against Faenia rectivirgula, 4 (3.2%) against Saccharomonospora viridis, 2 against Thermoactinomyces thalpophilus and one each against T. vulgaris and T. sacchari. The results of enzyme-linked immunosorbent assay (ELISA) indicated that IgG antibody activity against F. rectivirgula was significantly higher in the symptomatic group than in the asymptomatic group (p less than 0.05) of workers and the controls (p less than 0.01). Significant difference in F. rectivirgula IgG activity was also obtained between the precipitin-positive symptomatic group and the precipitin-positive asymptomatic group (p less than 0.05). In strong contrast, the IgG antibody activity against T. thalpophilus was found to be uniformly low. A limited aeromicrobiological sampling of the dairy farm revealed S. viridis (55.8%) to be the commonest species followed by T. vulgaris (19.2%), T. thalpophilus (18.5%), F. rectivirgula (5%) and T. sacchari (1.5%). On the basis of suggestive clinical and laboratory findings, farmer's lung disease was suspected in four dairy herd workers. A comprehensive clinical evaluation including pulmonary function studies on the dairy herd workers and their long-term follow-up is indicated to determine the extent of respiratory morbidity caused by F. rectivirgula, S. viridis, T. thalpophilus, T. sacchari and T. vulgaris in India.

Five-year follow-up of Micropolyspora faeni antibody in smoking and nonsmoking farmers

To examine factors that influence changes in Micropolyspora faeni (MF) antibody titer in farmer's lung disease (FLD), we followed for 5 yr the prevalence of serum MF antibody and the epidemiologic factors (years on farm, hours in barn, and hay-handling time) among 92 dairy farmers in Hokkaido, Japan. The prevalence of MF antibody among nonsmokers was significantly higher than that among smokers: 27.1% versus 7.7% in 1979, 31.3% versus 2.9% in 1984. There was no remarkable change in overall prevalences of MF antibody between 1979 and 1984 (18.5 and 19.6%, respectively). However, out of 17 seropositive farmers, six (35%) became seronegative, and out of 75 seronegative farmers, seven (9.3%) became seropositive after 5 yr. The nonsmoking farmers who remained seronegative throughout the follow-up period were older and had worked longer on farms than the farmers with seroconversion. These results suggest that in addition to smoking habits, age and exposure time to MF influence the immune response to MF in dairy farmers. Out of 11 farmers who remained seropositive throughout the 5-yr period, two (18.2%) developed FLD. Therefore, continuously positive MF antibody is one of the risk factors in the development of FLD.

Human nail dust and precipitating antibodies to Trichophyton rubrum in chiropodists

The toe-nail dust produced in chiropodial practice causes allergic hypersensitivity and Trichophyton rubrum is the most common fungal cause of nail dystrophy. Use of drills and burrs to reduce the thickness of hyperkeratotic nails generates dust and chiropodists develop precipitins to T. rubrum. A survey into the prevalence of these antibodies in 11.2% of state-registered chiropodists is described and 14% of the profession estimated to have antibodies to T. rubrum. In response to a questionnaire 49% stated that toe-nail dust troubled them; complaints of nasal and eye symptoms were 72 and 41% respectively. In 384 chiropodists ventilatory function was tested with a vitalograph. Restrictive lung disease appears to be more common in chiropodists than other sedentary workers.

Immunological studies on Alternaria sensitivity. Use of crossed radioimmunoelectrophoresis, precipitins and enzyme-linked immunosorbent assay

Characterization of the immunological response to Alternaria in sensitive subjects is not complete. We used crossed radioimmunoelectrophoresis (CRIE) to identify antigens in Alternaria extracts reacting with IgE antibody in five patients with Alternaria-sensitive asthma, four with Alternaria-induced rhinitis, three non-allergic asthmatics, and three normal controls. All five Alternaria-asthma patients and three of four Alternaria-rhinitis patients showed IgE binding to a third antigen. These results suggest an analogy of Alternaria antigens with that found in ragweed pollen extracts, i.e. that IgE antibody is directed against more than one antigen. Using the enzyme-linked immunosorbent assay (ELISA), we found a significant difference (P less than 0.05, unpaired Student's t-test) in IgG binding between Alternaria-sensitive asthmatics and normal controls. There was no apparent difference in IgG binding between untreated Alternaria-sensitive asthmatics and those receiving high-dose immunotherapy.

Hypersensitivity pneumonitis and extrinsic asthma. An unusual association

A farmer who had no prior history of pulmonary disease developed tightness in the chest of rapid onset, shortness of breath, fever, and pulmonary infiltration while farming. The symptoms of his disease worsened with repeated exposure to the dusty farm field but remitted after each of five hospitalizations. Provocative challenge with inhalation of a water-soluble extract of dust from the field reproduced both asthmatic and pneumonitic features of the disease, while administration of corticosteroids clinically controlled the entire process. The data suggest a common cause for asthma and pneumonitis in this patient.

Precipitating antibodies in a midwest dairy farming population toward the antigens associated with farmer's lung disease

A survey of the frequency of precipitins to the antigens of the thermophilic actinomycetes and Aspergillus species was conducted on serum samples from 1,045 farmers obtained at a 3-day exposition on modern farm equipment and farming practices in central Wisconsin. Each farmer filled out a questionnaire including socioeconomic information, lung disease history, exposure history, and smoking history. Precipitins were detected by the double-diffusion method. The antigen panel included eight thermophilic actinomycetes species and a mixture of Aspergillus species. Precipitins were found in the sera of 93 famers (8.9%). The distribution of positive precipitins was: Micropolyspora faeni 63 (67.7%), Thermoactinomyces vulgaris 7 (7.5%), Thermomonospora viridis 2 (2.2%), M. faeni + T. viridis 16 (17.2%), M. faeni + T. vulgaris 1 (1.1%), Aspergillus species 4 (4.3%). Of all the parameters tested for in the questionnaire, those with positive serology differed significantly from the whole population only in that a higher proportion of the positives reported exposure to silo gas and illness after uncapping silos. Comparison of the size of the farm and the number of dairy cows in the state of Wisconsin with the population samples indicated that the sample population was skewed toward those with larger farms and larger dairy herds. This study confirms that a significant proportion of the farm population in Wisconsin does have precipitins to the microorganisms associated with farmer's lung disease. Follow-up studies to establish the relationship between the positive precipitin reactions to the presence of clinical disease are now under way.

Incidence of serum precipitins against organic-dust antigens in different populations by counterimmunoelectrophoresis

The incidence of serum antidust and antifungal precipitins was determined by counterimmunoelectrophoresis in 317 atopic and nonatopic subjects of three geographic areas (north central, southern, and western United States). The selected lyophilized crude antigens employed were from house dust, Micropolyspora faeni, Candida albicans, Alternaria tenuis, Aspergillus fumigatus, Puccinia coronata, Cantharellus cibarius, and Amborsia trifida. Antidust precipitins were detected with high frequency in atopic and nonatopic subjects of each geographic area (48 to 71 percent of different population subgroups). Precipitin reactions were generally intense and often multiple, in keeping with the marked heterogeneity of the crude dust antigen employed. Antidust precipitins were also present in serum fractions precipitated with ammonium sulfate and in IgG-rich fractions obtained by gel filtration (Sephadex G-200) and diethylaminoethyl-cellulose chromatography. Precipitins against crude somatic fungal and actinomycetic antigens were detected with considerably less frequency in all populations surveyed, considerably less frequency in all populations surveyed, and antiragweed precipitins were not detected. Our results suggest that prolonged environmental exposure to diverse, ubiquitous organic dusts results in a "normal" serum precipitating-antibody response. They also extend our previous finding of a high precipitin response against organic dusts in residents of the Gulf south area compared to other geographic areas.

Primary interaction between antibody and components of Alternaria. II. Antibodies in sera from normal, allergic, and immunoglobulin-deficient children

Antibodies in sera from normal, allergic, and immunoglobulin-deficient children were studied for binding to radiolabeled components of Alternaria tenuis. Significant binding levels were found in 103 of 105 sera from normal children. The levels were age-dependent, rising from a low point in the 7- to 12-month age group to adult levels by the age of 8 years. Levels of binding to two antigens, a culture filtrate derivative (125I-CLF) and a mycelial derivative (125-I-HS), were similar. Sera from asthmatic children with strong immediate skin test reactions to Alternaria extracts bound significantly higher levels of 125-I-CLF than did sera from allergic children with negative skin tests or from control children. Binding levels in sera from children with hypogammaglobulinemia were significantly less than binding levels in sera from normal children in any age group. Sera from children with selective IgA deficiency bound 125-I-CLF at normal levels. The almost universal occurrence of anti-Alternaria antibodies in children was partly explained by the finding of partial cross-reactivity and/or shared antigens among several fungal species, including A. tenuis, Stemphylium sp., Curvularia sp., and Aspergillus fumigatus. The biological significance of these antibodies is not clear, but the procedures described lend themselves to further investigations.