1/8. ARDS after double extrinsic exposure hypersensitivity pneumonitis.hypersensitivity pneumonitis or extrinsic allergic alveolitis is a lung disease due to T cell and macrophage activation with IgA, IgG or IgE immunocomplex tissue lesions following extrinsic exposure to organic or inorganic agents. We report a case of hypersensitivity pneumonitis (pigeon protein sensitized) with a second nosocomial exposure to aspergillus fumigatus proteins from a contaminated oxygen water humidifier: the second extrinsic exposure induced significant acute respiratory failure with ARDS. A pre-existing COPD syndrome requiring prolonged oxygen therapy (7 days) involved lung disease with delayed clinical diagnosis and therapy. Microbiological and mycological analysis of oxygen water humidifiers should be considered, especially for hypersensitivity pneumonitis patients, when a new inexplicable clinical impairment occurs.- - - - - - - - - - ranking = 1keywords = pneumonitis (Clic here for more details about this article) |
2/8. Two year follow-up of a garbage collector with allergic bronchopulmonary aspergillosis (ABPA).BACKGROUND: Separate collection of biodegradable garbage and recyclable waste is expected to become mandatory in some western countries. A growing number of persons engaged in garbage collection and separation might become endangered by high loads of bacteria and fungi. Case history and examination A 29 year old garbage collector involved in emptying so-called biological garbage complained of dyspnea, fever, and flu-like symptoms during work beginning in the summer of 1992. Chest x-ray showed streaky shadows near both hili reaching into the upper regions. IgE- and IgG-antibodies (CAP, Pharmacia, sweden) were strongly positive for aspergillus fumigatus with 90.5 kU/L and 186%, respectively. Total-IgE was also strongly elevated with 5430 kU/L. Bronchial challenge testing with commercially available aspergillus fumigatus extract resulted in an immediate-type asthmatic reaction. Two years later he was still symptomatic and antibodies persisted at lower levels. CONCLUSIONS: Our diagnosis was allergic bronchopulmonary aspergillosis (ABPA) including asthmatic responses as well as hypersensitivity pneumonitis (extrinsic allergic alveolitis) due to exposure to moldy household waste. A growing number of persons engaged in garbage collection and handling are exposed and at risk to develop sensitization to fungi due to exposure to dust of biodegradable waste. Further studies are necessary to show if separate collection of biodegradable waste increases the health risks due to exposure to bacteria and fungi in comparison to waste collection without separation.- - - - - - - - - - ranking = 0.14285714285714keywords = pneumonitis (Clic here for more details about this article) |
3/8. Fulminant invasive pulmonary aspergillosis in immunocompetent patients--a two-case report.Two cases of invasive aspergillosis (IA) in immunocompetent patients with a fulminant fatal outcome are reported. Both patients were elderly and had a history of chronic lung disease treated with prolonged inhaled corticosteroids and a short course of systemic corticosteroids. They presented with dyspnea and fever, their respiratory function deteriorated rapidly, and they died 7 days after admission. aspergillus fumigatus was cultured from respiratory samples. IA was confirmed in one case by necropsy that showed diffuse bilateral necrotizing pneumonitis and myocarditis. In the other case, IA diagnosis was established by thoracic CT scan plus detection of Aspergillus antigen in two blood samples. These two cases demonstrate that short-term corticosteroid therapy in immunocompetent patients with underlying chronic lung conditions is a risk factor for IA, and that its evolution can be fulminant.- - - - - - - - - - ranking = 0.14285714285714keywords = pneumonitis (Clic here for more details about this article) |
4/8. The many faces of pulmonary aspergillosis.The recognition of aspergillus in all its clinical disguises remains a challenge to clinicians in all fields of medicine. Fortunately, aspergillus has low pathogenicity for humans and requires very heavy inoculum of spores (aspergillary pneumonitis) in order to infect those whose pulmonary defense mechanisms, inherent structure, and physiology are intact. patients with problems from aspergillus may be seen in either inpatient or outpatient clinical practice. The patient with fibrotic or cavitary lung disease finds himself at risk to be colonized and develop an aspergilloma (fungus ball). Conservative therapy (that is, antibiotics, pulmonary hygiene) or simple observation is often all that is required. With significant hemoptysis, surgical removal could be definitive treatment; but these patients often have such compromised pulmonary function that alternative therapies like infusion of antifungal agents locally are tempting. Part of the problem of the patient with asthma or COPD may actually be secondary to hypersensitivity to aspergillus (ABPA), which exacerbates bronchospasm and adds "pulmonary infiltrates" to the underlying disease. The recognition of this entity and then the judicious use of corticosteroids to control the symptoms will stabilize the clinical course of the disease. The immunocompromised patient may be relatively free of pulmonary disease.; but aspergillus, waiting until cytotoxic agents, corticosteroids, granulocytopenia, broad-spectrum antibiotics, and previous pneumonias destroy the local lung defense mechanisms, will then attack with a vengeance. The resultant invasive pulmonary aspergillosis requires treatment with amphotericin b, along with its own inherent toxicity.- - - - - - - - - - ranking = 0.14285714285714keywords = pneumonitis (Clic here for more details about this article) |
5/8. Occupational hypersensitivity lung disease.A case of occupational hypersensitivity pneumonitis caused by an air conditioning unit is presented. aspergillus fumigatus and aureobasidium pullulans were cultured from this unit and antibodies to these organisms were found the patient's blood. The case shows that this disease may present in a very subtle form and may be diagnosed by a culture from the patient's environment and an easily performed blood precipitin test. The importance of searching for this type of lung disease and the need for obtaining precipitin tests are stressed.- - - - - - - - - - ranking = 0.14285714285714keywords = pneumonitis (Clic here for more details about this article) |
6/8. Case report: invasive pulmonary aspergillosis in a nonimmunosuppressed patient.A patient with no known underlying immunosuppressive disorder who developed invasive pulmonary aspergillosis is described. A review of the English literature revealed ten other presumably nonimmunosuppressed patients with invasive aspergillosis. All had evidence of necrotizing pneumonitis with frequent cavity formation. Nine of the 11 patients died without the diagnosis of aspergillosis having been entertained. invasive pulmonary aspergillosis does occur in the nonimmunosuppressed host and should be considered when an etiologic agent is not readily identified in a patient with rapidly progressive diffuse necrotizing pneumonitis.- - - - - - - - - - ranking = 0.28571428571429keywords = pneumonitis (Clic here for more details about this article) |
7/8. Multifactorial immunologic lung disease: a case report.BACKGROUND: Allergic asthma, allergic bronchopulmonary aspergillosis, and hypersensitivity pneumonitis are all forms of immunologically mediated lung disease. Recognition that more than one of these diseases may co-exist is necessary for proper patient management. OBJECTIVE: To report a case of extrinsic (cat) asthma, allergic bronchopulmonary aspergillosis, hypersensitivity pneumonitis, and potentially fatal asthma. Immunologic mechanisms and treatment of these diseases are discussed. methods: The study is a case report from a university hospital setting. serum precipitating antibodies against avian antigens were measured using gel-diffusion technique. serum IgE levels were measured and skin testing was performed to selected antigens. RESULTS: The patient had positive cutaneous reactivity to cat antigen and Aspergillus. serology for allergic bronchopulmonary aspergillosis and serum precipitating antibodies to finch extract were positive. Symptoms improved and prednisone requirements decreased after removal of finches. CONCLUSION: A case of cat asthma, potentially fatal asthma, allergic bronchopulmonary aspergillosis, and hypersensitivity pneumonitis is presented. Early recognition and treatment of multifactorial immunologic lung disease with avoidance measures and use of corticosteroids can prevent progressive respiratory damage.- - - - - - - - - - ranking = 0.42857142857143keywords = pneumonitis (Clic here for more details about this article) |
8/8. hypersensitivity pneumonitis resulting from aspergillus fumigatus in a greenhouse.A 57-y-old female who had cultivated vegetables in a plastic greenhouse developed a case of hypersensitivity pneumonitis from aspergillus fumigatus. This report exemplifies a potential hazard caused by a thermotolerant fungus, A. fumigatus, in a poorly constructed greenhouse.- - - - - - - - - - ranking = 0.71428571428571keywords = pneumonitis (Clic here for more details about this article) |