1/25. Allergic alveolitis due to herb dust exposure. We report an episode of allergic alveolitis in a female farmer due to massive exposure to organic dust contaminated with microorganisms during threshing of herbs (thyme). The patient's medical history, the results of exposure test, inhalation challenge, and bronchoalveolar lavage suggested the diagnosis of allergic alveolitis ( info) |
2/25. Coeliac disease with farmers' lung. Two patients with allergic alveolitis due to mouldy hay antigens (farmer's lung) were shown to have malabsorption due to coeliac disease. As similar associations have been found with other alveolar diseases, this association is probably not fortuitous and further population screening should be done. ( info) |
| A severe attack of farmer's lung developed in a dairy farmer after a workplace challenge. The patient showed full recovery after corticosteroid therapy. If a workplace challenge is considered necessary in the diagnosis of farmer's lung, care should be taken to avoid unnecessarily heavy exposure to the offending antigens. ( info) |
| A study of farmer's lung (FL) disease was carried out in 197 subjects engaged in farming and having respiratory complaints of varying duration. It revealed that 13.2% of the subjects had precipitating antibodies against thermophilic actinomycetes, with Faenia rectivirgula (Micropolyspora faeni) alone accounting for 85% of the positive reactions. Precipitating antibodies against thermoactinomyces vulgaris and T. thalpophilus were observed only in 1.5% and 0.5% of the subjects, respectively. Two subjects concomitantly demonstrated F. rectivirgula and T. vulgaris-specific serum precipitins. Sixty (30%) of the subjects related their respiratory symptoms to exposure to wheat straw/thresher's dust or other vegetable substrata in the working environment. Based upon a suggestive clinical history, roentgenography, pulmonary function studies and demonstration of serum precipitins against F. rectivirgula, FL was diagnosed in 4 subjects whose salient features are presented and discussed. To the best of our knowledge, this is the first authentic report on FL from india. A comprehensive epidemiological survey is indicated to determine the prevalence of FL in different geo-climatic regions of the country. ( info) |
5/25. Complete clarification of a case of farmer's lung. The diagnostic curriculum to clarify a case of farmer's lung in a fibrotic stage is presented, including clinical functional tests, X-ray, analysis of cellular elements recovered from bronchioalveolar lavage, determination of precipitating antibodies in the circulation, histological and immunohistological studies of transbronchial lung biopsies. The patient had precipitating antibodies against several species of hay molds, especially Micropolyspora faeni, and immune complex deposition in the lung. Elution experiments on frozen sections of the lung biopsies and subsequent administration of patient's serum- or mold antigen-specific antibodies combined with appropriate serum absorption experiments allowed the identification of the relevant antigen, i.e. M. faeni, in the deposited immune complexes. The immunohistological analysis of extracellular matrix components revealed an interstitial increase in procollagen and collagen type i and an even more pronounced augmentation of procollagen type III and fibronectin, i.e. a constellation characteristic for a chronic, active lung fibrosis that developed on the basis of an immune complex disease. ( info) |
6/25. Riding-school lung? Allergic alveolitis in an 11-year-old girl. farmer's lung is a rural disease, caused by inhalation of airborne moulds and actinomycetes in the environment (farms). We describe to our knowledge the first case of farmer's lung in an 11-year-old girl briefly exposed to Thermophilic actinomycetes at a riding-school. ( info) |
7/25. Reactive airways dysfunction syndrome presenting as a reversible restrictive defect. A 25-year-old farm worker developed acute bronchopneumonia after heavy exposure to a respiratory irritant in a silo. He recovered from the acute episode but then experienced chronic dyspnea and fatigue. Pulmonary function testing showed small lung volumes with a normal ratio of 1 s forced expiratory volume/forced vital capacity (restrictive defect). This defect improved markedly with bronchodilator treatment and changed to a mixed obstructive/restrictive defect with methacholine challenge. We believe that this is an example of the reactive airways dysfunction syndrome manifested by a restrictive rather than obstructive defect. constriction of airways at the bronchiole or alveolar duct level is the most likely cause of the syndrome. ( info) |
8/25. farmer's lung in infants and small children. A boy and a girl, 10 weeks and 3 years of age, respectively, were admitted to our department with low temperature, dry cough, fatigue and weight loss. In both patients pulmonary x-rays showed diffuse, bilateral, micronodular infiltrations, and sparse signs of fibrosis. serum IgG and blood eosinophils were abnormally high. After a stay in hospital for 3 weeks, the patients recovered slowly. However, after a few days at home, they were readmitted with the same symptoms. family histories revealed that the children lived on farms with huge grain magazines and dryers, where moist grain and straw were stored. Massive amounts of mould spores were cultured from the residential areas, and, in addition, the male patient had an elevated titer to Micropolyspora faeni and the female patient, elevated titers to thermoactinomyces vulgaris, Micropolyspora faeni, aspergillus fumigatus and alternaria alternans. The patients and their families moved from the farms and, for approximately a year, have been without lung symptoms. Farmer's disease in infants and small children is extremely rare. However, the incidence may be increasing due to the tendency in latter years to decentralize grain dryers and store moist grain and straw in big magazines, often close to residential areas. ( info) |
9/25. The distribution of pulmonary shadowing in farmer's lung. Reports of the radiological features in farmer's lung are inconsistent. We have reviewed clinical and radiological findings in eight patients with farmer's lung in the acute and sub-acute phases. In the acute phase the main feature is transient widespread diffuse shadowing of air space consolidation. In the sub-acute phase, the predominant feature is fine nodular shadowing tending to involve either the upper half or upper two-thirds of the lungs with relative sparing of the basal segments. This is in accordance with both the pathophysiological behaviour of the inhaled particulate antigen and the subsequent distribution of pulmonary changes in chronic farmer's lung. ( info) |
| bronchoalveolar lavage (BAL) was performed in order to reveal inflammatory immune processes during inhalation provocation test in a patient with farmer's lung disease. Three hours after inhalation challenge the patient showed dyspnea and an increase in body temperature to 38.9 degrees C, restrictive and obstructive impairment, and a decrease in peripheral lymphocytes from, 2.8 x 10(3)/mm3 to 1.8 x 10(3)/mm3, although peripheral granulocytes increased from 4.4 x 10(3)/mm3 to 10.3 x 10(3)/mm. BAL fluid at that time showed increases in lymphocytes, granulocytes and macrophage, as well as proteins and complements, compared with that before the inhalation test. These findings indicate that with inhalation challenge in a patient with farmer's lung disease, inflammation increases vascular permeability while protein loss is followed by an increase in lymphocytes, granulocytes and macrophage; the lymphocytes migrate to the lung from peripheral blood. ( info) |