1/39. A pediatric case of pigeon breeder's disease in nova scotia. Pigeon breeder's disease has been reported sporadically in the pediatric population since it was first described in children in 1967. Because of its infrequent occurrence in children, a high level of suspicion is often required before a diagnosis is made. A case of pigeon breeder's disease in a child in nova scotia, where the disease is virtually unseen or at least unrecognized, is described. The need for prompt recognition of the condition is paramount because its complications may be irreversible. ( info) |
2/39. Bird fanciers' lung: a case report. The clinical course of a case of bird fanciers' lung is described along with the considerations that are important in the management of this form of hypersensitivity pneumonitis. Diagnostic parameters, therapeutic considerations, and environmental issues are discussed in the context of the current literature. ( info) |
3/39. 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. ( info) |
| A 65-year-old pigeon breeder who presented with acute hypersensitivity pneumonitis refused to give up contact with pigeons and her lung disease, which had initially improved in hospital in response to removal from pigeons, progressed to chronic interstitial fibrosis. bronchoalveolar lavage lymphocytes fell from 50.0% of total cells in December 1986 to 27.1% in February 1990. The ratio of CD4 /CD8 lymphocytes shifted from 0.43 to 1.47. Furthermore, IL-6 and TNF-alpha were elevated initially and were much higher at the second time point. These data pointed to the importance of CD4 lymphocytes, IL-6 and TNF-alpha in the development of pulmonary fibrosis. ( info) |
5/39. B-lymphocyte aggregates in alveoli from a child with hypersensitivity pneumonitis (bird breeders lung). BACKGROUND: hypersensitivity pneumonitis is an interstitial lung disease mediated through a patient's immunologic response to a variety of inhaled organic dusts. Studies of the cellular components of lavage fluid from patients with this disease show marked increases of CD8 suppressor/cytotoxic t-lymphocytes. OBJECTIVE: In this study, we identified, in addition to the expected suppressor T-cells and natural killer cells, follicle-like aggregates of B-cells in the lung interstitium of an affected patient. methods: The patient was an 11-year-old non-asthmatic, Caucasian male who presented with a 4-month history of progressive dyspnea, cough, and fever. The home contained nine cockatiel and two doves. Admission pulmonary functions revealed a restrictive pattern with diminished diffusion capacity. Prior to a diagnosis, the patient underwent bronchoalveolar lavage and transbronchial biopsy. serum precipitins were eventually positive to pigeon (which cross-reacts with dove) droppings. The symptoms resolved after a prolonged course of prednisone. RESULTS: Analysis of bronchoalveolar lavage lymphocyte population revealed a predominance of CD8 cells (50%) with 85% expressing the activation marker HLA-DR. The percentage of CD4 and CD56 were 32% and 16%, respectively. The transbronchial biopsy revealed CD20 follicle-like aggregates within the lung interstitium. CONCLUSIONS: The histopathologic findings confirm that in hypersensitivity pneumonitis, the predominant immune response is an infiltrate of CD8 T cells. The presence of B cell aggregates, however, may indicate that the local synthesis of antibody may be involved in an antibody-dependent cellular cytotoxic mechanism. ( info) |
6/39. A hazard of Christmas: bird fancier's lung and the Christmas tree. A lady with alveolitis due to her budgerigar developed recurrent symptoms when exposed to allergen left on her artificial Christmas tree. ( info) |
7/39. A family with extrinsic allergic alveolitis caused by wild city pigeons: A case report. We describe a family in which the mother died of unresolved lung disease and whose 5 children, some of whom had previous signs of asthma, were subsequently affected by extrinsic allergic alveolitis caused by contact with wild city pigeon antigens. The children received systemic corticosteroids for 1 month and inhaled steroids for 24 months, while antigen exposure was reduced as much as feasible. This was followed by a quick clinical recovery and a slow normalization of chest radiographs and pulmonary function indices, especially of diffusion capacity, during a follow-up of 24 months. Because pigeon-breeder's lung caused by free-roaming city pigeons has not been previously described, it remains unclear whether this family developed the disease because of high antigen exposure or because of increased susceptibility. None of the supposedly high-risk human leukocyte antigen types were found in the children. Whether human leukocyte antigen B7 in 1 child played a role in the course of the illness remains speculative. It is unknown to what extent pigeon-breeder's lung caused by nondomestic birds remains undetected and misdiagnosed as difficult or steroid-resistant asthma. The question remains whether free-roaming city pigeons are indeed a public health risk. We suggest that atypical outdoor antigens be considered in all patients with nonresolving chest disease or therapy-resistant asthma. ( info) |
8/39. Unusual case of diagnosis of pigeon breeder's hypersensitivity pneumonitis with ventilation-perfusion lung scan. The authors describe a patient thought to have pulmonary embolism. Results of a perfusion scan were normal, but Tc-99m DTPA aerosol ventilation lung scan showed, in successive views, decreased activity of the deposited aerosol. The lung Tc-99m DTPA clearance was measured and was markedly increased. This suggested possible hypersensitivity pneumonitis, which was later confirmed as pigeon breeder's disease. The decreased activity observed on the DTPA ventilation scan must be directed toward increased lung clearance and its measurement. ( info) |
9/39. Subacute hypersensitivity pneumonitis in an hiv infected patient receiving antiretroviral therapy. Abnormal pulmonary immune response to various antigens can lead to hypersensitivity pneumonitis. This disease has not previously been reported in hiv infected patients. This case report describes an hiv infected woman who developed subacute hypersensitivity pneumonitis in response to bird exposure. The disease manifested itself only after the patient experienced an improvement in her CD4 positive T lymphocyte count secondary to antiretroviral therapy. This case emphasises the need to consider non-hiv associated diseases in patients with hiv and suggests that diseases in which host immune response plays an essential role in pathogenesis may become more prevalent in hiv infected patients receiving effective antiretroviral therapy. ( info) |
10/39. Pigeon breeder's lung in childhood: varied clinical picture at presentation. Extrinsic allergic alveolitis occurs rarely in childhood. We present 5 cases and briefly review the literature regarding this condition in the pediatric population. This report includes all cases (n = 5) of extrinsic allergic alveolitis known to have occurred in childhood on malta. All cases were males, and were initially misdiagnosed as having other respiratory illnesses or mental disturbances. The diagnosis was based on a history of exposure to birds, clinical findings, positive avian precipitins, a restrictive defect on pulmonary function tests, and a suggestive chest X-ray appearance. All were treated with high-dose oral steroids for 3-4 weeks, with excellent response. Although these patients appear to have suffered no long-term sequelae, delayed diagnosis can lead to irreversible pulmonary fibrosis. The diagnosis of extrinsic allergic alveolitis should be entertained early in the differential diagnosis of children presenting with unusual respiratory symptoms and signs. ( info) |