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11/91. Extrinsic allergic alveolitis induced by the yeast Debaryomyces hansenii.

    A 65-yr-old female developed cough, fever and dyspnoea following repeated exposure to a home ultrasonic humidifier. High-resolution computed tomography showed ground-glass opacity in both lung fields. Arterial blood gas analysis gave an oxygen tension of 8.38 kPa (63 Torr). Pulmonary function testing revealed restrictive ventilatory impairment with a reduction in the diffusing capacity. The diagnosis of extrinsic allergic alveolitis (EAA) was confirmed by radiographic findings, pathological evidence of alveolitis and reproductive development by a provocation test to the humidifier water. The yeast Debaryomyces Hansenii was the only microorganism cultured from the water of the humidifier. The double diffusion precipitating test and lymphocyte proliferative response was positive for an extract of D. Hansenii, providing evidence to incriminate this fungus. This is the first described case of EAA caused by D. Hansenii.
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12/91. Treatment of allergic alveolitis with methylprednisolone pulse therapy.

    We report on a 13-year-old-boy who had been admitted to our hospital for dyspnea, hypoxia, and pulmonary infiltrates. The diagnosis of allergic alveolitis was based on history (provocation by exposure), lung function tests, bronchoalveolar lavage, and transbronchial lung biopsy. No specific allergen could be identified. Five courses of methylprednisolone pulse therapy (15 mg/kg on three consecutive days) stabilized the patient with normalization of lung function and blood gas analysis. Between pulses the boy returned to his home on a farm without relapse. It is estimated that the effect of a single pulse lasted for at least 2-4 weeks. We conclude that pulse therapy can be used instead of continuous therapy in this rare disease in childhood.
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13/91. hypersensitivity pneumonitis induced by Shiitake mushroom spores.

    hypersensitivity pneumonitis due to the inhalation of Shiitake mushroom spores was demonstrated in a 38-year-old woman. Symptoms of cough, nausea and malaise, and clinical findings of cyanosis, bibasilar crackles, reduced lung volumes, hypoxemia, leukocytosis, elevated ESR, positive c-reactive protein, and bilateral diffuse reticulonodular shadows on chest roentgenogram improved after the patient was removed from exposure. Alveolitis was demonstrated by transbronchial lung biopsy, as well as an increase in lymphocytes in bronchoalveolar lavage. serum precipitins and specific IgG antibodies to an extract of Shiitake mushroom spores, but not to other common molds or mushroom body, were detected in serum. Provocative inhalation test with the extract of mushroom spores caused the same clinical symptoms and signs as experienced in the workroom. This is the first report of typical hypersensitivity pneumonitis induced by Shiitake mushroom spores. Mushroom spores as well as thermophilic actinomycetes must be considered a causative agents for mushroom worker's lung.
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keywords = exposure
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14/91. Localised alveolar-septal amyloidosis with hypersensitivity pneumonitis.

    Localised alveolar-septal amyloidosis has been thought irreversible. A woman exposed to the dust of sea-snail shells during the manufacture of nacre buttons had clinical and immunological features typical of hypersensitivity pneumonitis; however, transbronchial lung biopsy showed alveolar-septal amyloidosis. There was no evidence of other diseases known to be associated with amyloidosis, nor were amyloid deposits found in other organs. After a year without exposure to the antigen there was no trace of either pneumonitis or amyloidosis.
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ranking = 1
keywords = exposure
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15/91. Evaluation of hypersensitivity pneumonitis among workers exposed to metal removal fluids.

    hypersensitivity pneumonitis (HP) was identified among employees in an automobile parts manufacturing facility. Mycobacteria immunogenum (MI) was identified as a metal removal fluid (MRF) contaminant at this facility and had been identified as a contaminant in other facilities where HP had occurred. We therefore questioned whether measurement of MI-specific cell-mediated immunity would be associated with HP in this facility. We also questioned whether measures of cell-mediated immunity would be more informative about the presence of HP than evaluation of serum anti-MI antibody levels. Workers were categorized for exposure and disease status by questionnaire and review of medical records. Cell-mediated immunity to MI was assessed by measuring in vitro secretion of cytokines (interleukin 8, tumor necrosis factor alpha, and interferon-gamma) from peripheral blood mononuclear cells or anticoagulated whole blood induced by culture with MI antigen. serum antibodies against MI were also measured. Six study participants met our survey definition for HP and 48 did not. As has been reported for various agents causing HP, serum antibody levels against MI were increased in both exposed workers and workers with HP. serum antibodies did not distinguish between the two. When expressed as a percentage of secretion induced by lipopolysaccharide, MI induced a significant increase in interleukin-8 secretion in exposed participants' whole blood cultures. There were trends for increased MI-induced secretion of interferon-gamma by peripheral blood mononuclear cells from both exposed workers and workers with HP. However, these trends did not attain statistical significance. Thus, several measures of immunity to MI distinguished between exposed and unexposed workers but not between workers with and without HP. These evaluations of cell-mediated immunity were not more informative than measurement of serum antibodies. As was done at this facility, institution of a comprehensive safety and health plan for MRF is necessary to eliminate (or minimize) health effects related to occupational exposures in the machining environment.
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ranking = 49.628274136557
keywords = occupational exposure, exposure
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16/91. Familial presentation of occupational hypersensitivity pneumonitis caused by aspergillus-contaminated esparto dust.

    Esparto grass (Stipa tenacissima), which is commonly found in the Mediterranean area, has a wide variety of uses. Five plaster workers from the same family developed cough, dyspnea, malaise, and fever after exposure to the esparto fiber used in their work for the previous few years. They showed a significant decrease in symptoms when away from work. Precipitating antibodies against an esparto extract were found in the sera of all patients. Specific IgG antibodies against aspergillus fumigatus were detected. A. fumigatus was identified after microbiologic evaluation of esparto fiber samples. The dust derived from fungi-contaminated esparto fibers can cause hypersensitivity pneumonitis in exposed subjects. The causative antigen is A. fumigatus. When esparto fibers were strongly contaminated by fungi, all the workers developed a clinical picture compatible with hypersensitivity pneumonitis. The coincidental finding of an occupational and a familiar condition is unusual.
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17/91. minocycline-induced cell-mediated hypersensitivity pneumonitis.

    OBJECTIVE: To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis. DESIGN: Case study. SETTING: intensive care unit of a referral hospital. PATIENT: A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amoxicillin, and erythromycin. INTERVENTION: Sequential bronchoalveolar lavages after reexposure to minocycline and amoxicillin. MEASUREMENTS: Immunologic analysis of the phenotype and function of alveolar lymphocytes. RESULTS: Reexposure to minocycline but not to amoxicillin was followed by an interstitial pneumonitis. Sequential bronchoalveolar lavages showed a transient rise of eosinophils and neutrophils and a persistent alveolar lymphocytosis. Alveolar lymphocytes consisted predominantly of CD8 but also CD4 cells. Two CD8 lymphocyte subsets were identified: CD8 D44 cytotoxic T cells that increased rapidly after the drug was resumed and CD8 CD57 suppressor T cells that predominated 11 days after the drug's withdrawal. In-vitro assays showed the presence of a lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages. CONCLUSION: These results support the hypothesis of a central role of T lymphocytes in the pathogenesis of drug-related hypersensitivity pneumonitis.
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ranking = 3
keywords = exposure
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18/91. Extrinsic allergic alveolitis due to exposure to esparto dust.

    We here describe the case of a patient with a history of exposure to esparto grass for two and a half years, who presented with clinical symptoms, radiological signs, pulmonary function test and histological findings consistent with the diagnosis of hypersensitivity pneumonitis. signs and symptoms reappeared after re-exposure. There are few reports of stipatosis in the world literature.
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ranking = 6
keywords = exposure
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19/91. dapsone-induced hypersensitivity pneumonitis mimicking pneumocystis carinii pneumonia in a patient with AIDS.

    Interstitial pneumonitis, often related to infectious etiologies, occurs commonly in hiv-infected patients. However, hypersensitivity pneumonitis from noninfectious etiologies, including environmental stimuli or drug exposure, is an unusual etiology of interstitial pneumonitis in hiv-infected patients. We report a patient with AIDS who developed a dapsone-induced hypersensitivity pneumonitis mimicking pneumocystis carinii (PCP) pneumonia. We believe drug-induced hypersensitivity pneumonitis should be considered in the differential diagnosis of interstitial pneumonia in hiv-infected patients in whom infectious etiologies have been ruled out.
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ranking = 1
keywords = exposure
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20/91. Occupational hypersensitivity pneumonitis in a smelter exposed to zinc fumes.

    A smelter exposed to zinc fumes reported severe recurrent episodes of cough, dyspnea and fever. bronchoalveolar lavage showed a marked increase in lymphocytes count with predominance of CD8 t-lymphocytes. Presence of zinc in alveolar macrophages was assessed by analytic transmission electron microscopy. This is the first case of recurrent bronchoalveolitis related to zinc exposure in which the clinical picture and BAL results indicate a probable hypersensitivity pneumonitis.
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