Hypersensitivity Pneumonitis: Clinical Perspectives

2008 ◽  
Vol 132 (2) ◽  
pp. 195-198
Author(s):  
J. Mark Madison
Keyword(s):  
Bronchoalveolar Lavage ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Clinical Course ◽  
Disease Process ◽  
Data Sources ◽  
Chest Imaging ◽  
Laboratory Findings ◽  
Concise Review ◽  
Interstitial Disease

Abstract Context.—The clinical course of hypersensitivity pneumonitis (HSP) is highly variable and its diagnosis clinically challenging. Objective.—To provide a concise review of major clinical, radiographic, and laboratory findings that permits diagnosis of HSP from the standpoint of a clinician/pulmonologist. Data Sources.—Review of major contemporary and historical literature in combination with the author's experience and viewpoints. Conclusions.—The approach to the diagnosis of HSP is multidisciplinary. For patients being evaluated for unexplained dyspnea and cough and an unknown interstitial disease process, the initial evaluation should include detailed environmental and occupational histories with ancillary testing such as serology, chest imaging, inhalation challenges, and bronchoalveolar lavage, as indicated. In uncertain cases, lung biopsy is recommended.

scholarly journals Hypersensitivity pneumonitis: clinical, radiological and pathological profile of 103 patients from North India

2020 ◽  
Vol 90 (3) ◽  
Author(s):  
Raj Kumar ◽  
Sonam Spalgais ◽  
Vikrant Ranga
Keyword(s):  
Bronchoalveolar Lavage ◽  
Lung Disease ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Ground Glass Opacity ◽  
North India ◽  
Common Finding ◽  
Histopathological Diagnosis ◽  
Diffuse Lung Disease ◽  
Environmental Disease

Hypersensitivity pneumonitis (HP) is an interstitial lung disease, commonly occurring due to exposure to various inciting agent related to occupation. Few studies have shown that it can also occur without any occupation exposure. In this study we are presenting clinical, radiological and bronchoscopic finding of 103 HP patients. We retrospective analysis of 5½ years HP patient’s data from a chest institute of India. The diagnosis of HP was considered with following criteria: i) known exposure to an inciting antigen; ii) presence of respiratory symptoms; iii) radiologic evidence of diffuse lung disease; iv) no other identifiable cause; v) lung biopsy specimen that demonstrated features of HP; and vi) bronchoalveolar lavage lymphocytosis (≥30%). The mean ±SD age was 47±12.8 years; 67% were female. The common symptoms were cough (97%) and dyspnea (91%). History of exposure to inciting agent was present in 61% with pigeon exposure being the most common (56%). Majority of patients (86%) were having chronic symptoms for >6 months. On 6MWT oxygen desaturation >4% was seen in 57% patients. Centrilobular nodules (61%) and ground glass opacity (47.5%) were common finding on HRCT chest. Bronchoalveolar lavage (BAL) lymphocytosis >30% was present in 48.5% and histopathological diagnosis HP on transbronchial lung biopsy (TBLB) and/or endobronchial lung biopsy (EBLB) was in 50% patients. HP is exposure related environmental disease, as it can occur without any occupational history. Bronchoscopy with BAL and lung biopsy should do in all suspected cases to confirm diagnosis in our country as it is less invasive, day care procedure with less complication.

Multi-dimensional Visualisation of Laboratory Findings and Functional Test Results for Analysing the Clinical Course of Disease in Medicine

1995 ◽  
Vol 34 (03) ◽  
pp. 302-308 ◽  
Author(s):  
C. J. Luz ◽  
W. Giere ◽  
R. Lüdecke ◽  
D. Jonas ◽  
A. J. W. Goldschmidt
Keyword(s):  
Clinical Course ◽  
Test Results ◽  
Geometrical Figure ◽  
Laboratory Findings ◽  
Course Of Disease ◽  
Quantitative Examination ◽  
Ward Rounds ◽  
Patient’S History ◽  
Graphical Primitive ◽  
Computerized Medical Record

Abstract:The illustration of a patient’s history by a graphical primitive is discussed. Illustration technology is presented which simultaneously represents quantitative examination findings (e. g., laboratory values) and qualitative findings (e. g., from function diagnostics) by a single geometrical figure. Depending on the medical results, this figure takes on characteristic forms which can be identified as patterns typical for a specific disease. The procedure developed is integrated in a user interface which is implemented in the form of a computerized medical record for use on a pentop computer. This portable computer assists the physician during ward rounds, supplies additional, intelligence-based information, serves quality control, and streamlines working procedures making them more efficient.

scholarly journals Proteome Analysis of Bronchoalveolar Lavage Fluid in Chronic Hypersensitivity Pneumonitis

2012 ◽  
Vol 61 (1) ◽  
pp. 83-92 ◽  
Author(s):  
Tsukasa Okamoto ◽  
Yasunari Miyazaki ◽  
Ryutaro Shirahama ◽  
Meiyo Tamaoka ◽  
Naohiko Inase
Keyword(s):  
Bronchoalveolar Lavage ◽  
Hypersensitivity Pneumonitis ◽  
Bronchoalveolar Lavage Fluid ◽  
Proteome Analysis ◽  
Lavage Fluid ◽  
Chronic Hypersensitivity Pneumonitis

IDIOPATHIC HISTIOCYTOSIS

PEDIATRICS ◽  
1961 ◽  
Vol 28 (2) ◽  
pp. 307-327
Author(s):  
Harold A. Oberman
Keyword(s):  
Poor Prognosis ◽  
Soft Tissues ◽  
Clinical Course ◽  
Eosinophilic Granuloma ◽  
Disease Process ◽  
Foam Cells ◽  
Tissue Eosinophilia ◽  
Ultimate Outcome ◽  
Eosinophilic Granuloma Of Bone ◽  
Microscopic Findings

The clinical and pathologic aspects of 40 cases of eosinophilic granuloma of bone, Hand-Schüller-Christian disease and Letterer-Siwe disease have been reviewed. These cases were unified by a localized or generalized histiocytic proliferation. However, they could not be subdivided accurately on the basis of either clinical or microscopic findings. Histologically there was inconstant correlation of foam cells, tissue eosinophilia and fibrosis with clinical course. Nevertheless there was a suggestion that the presence of a homogeneous histiocytic infiltrate, with no eosinophils or foam cells, pointed to a poor prognosis, whereas the presence of large aggregates of eosinophils augured a more favorable course. With some exceptions, those patients presenting with disease confined to bone had little tendency toward dissemination, whereas those presenting with visceral on soft tissue lesions and generalized maculopapular skin eruptions usually died after a rapid course. Patients with skeletal and visceral or soft tissues lesions at onset had a variable outcome, with marked hepatomegaly and generalized cutaneous involvement being poor prognostic signs. It is concluded that these conditions probably represent various manifestations of a single disease process and that clinical assessment of rapidity of progression is the best guide to ultimate outcome.

Eosinophilic lung disease as a sequela of MSSA pneumonia

2021 ◽  
Vol 14 (3) ◽  
pp. e239304
Author(s):  
Syed Muhammad Zubair ◽  
Muhammad Zaid Hamid Hussain ◽  
Ali Bin Sarwar Zubairi
Keyword(s):  
Emergency Department ◽  
Staphylococcus Aureus ◽  
Bronchoalveolar Lavage ◽  
Complete Resolution ◽  
Lung Diseases ◽  
Disease Process ◽  
High Grade ◽  
Shortness Of Breath ◽  
High Grade Fever ◽  
Rare Group

Eosinophilic lung diseases are a rare group of lung disorders with multiple known and unknown aetiologies and the diagnosis is often challenging. We present a case of a young man who was admitted with pneumonia due to methicillin-sensitive Staphylococcus aureus and was discharged on antibiotics. He presented to the emergency department approximately 2 weeks after discharge with high-grade fever, cough and shortness of breath associated with serum and bronchoalveolar lavage eosinophilia. He was then treated with steroids with complete resolution of disease process.

scholarly journals High-resolution computed tomography and histopathological findings in hypersensitivity pneumonitis: a pictorial essay

2016 ◽  
Vol 49 (2) ◽  
pp. 112-116 ◽  
Author(s):  
Pedro Paulo Teixeira e Silva Torres ◽  
Marise Amaral Rebouças Moreira ◽  
Daniela Graner Schuwartz Tannus Silva ◽  
Roberta Rodrigues Monteiro da Gama ◽  
Denis Masashi Sugita ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Giant Cells ◽  
Clinical Findings ◽  
High Resolution Computed Tomography ◽  
Histopathological Findings ◽  
Pictorial Essay ◽  
Inflammatory Infiltrates

Abstract Hypersensitivity pneumonitis is a diffuse interstitial and granulomatous lung disease caused by the inhalation of any one of a number of antigens. The objective of this study was to illustrate the spectrum of abnormalities in high-resolution computed tomography and histopathological findings related to hypersensitivity pneumonitis. We retrospectively evaluated patients who had been diagnosed with hypersensitivity pneumonitis (on the basis of clinical-radiological or clinical-radiological-pathological correlations) and had undergone lung biopsy. Hypersensitivity pneumonitis is clinically divided into acute, subacute, and chronic forms; high-resolution computed tomography findings correlate with the time of exposure; and the two occasionally overlap. In the subacute form, centrilobular micronodules, ground-glass opacities, and air trapping are characteristic high-resolution computed tomography findings, whereas histopathology shows lymphocytic inflammatory infiltrates, bronchiolitis, variable degrees of organizing pneumonia, and giant cells. In the chronic form, high-resolution computed tomography shows traction bronchiectasis, honeycombing, and lung fibrosis, the last also being seen in the biopsy sample. A definitive diagnosis of hypersensitivity pneumonitis can be made only through a multidisciplinary approach, by correlating clinical findings, exposure history, high-resolution computed tomography findings, and lung biopsy findings.

scholarly journals The ability of clinical and laboratory findings to predict in-hospital death in patients with thrombotic thrombocytopenic purpura in an internal and emergency medicine department

2012 ◽  
pp. 269-273
Author(s):  
Filippo Pieralli ◽  
Antonio Mancini ◽  
Alberto Camaiti ◽  
Giancarlo Berni ◽  
Carlo Nozzoli
Keyword(s):  
Emergency Medicine ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Symptom Onset ◽  
Delayed Diagnosis ◽  
Disease Process ◽  
Hemodynamic Instability ◽  
Hospital Death ◽  
Laboratory Findings ◽  
Thrombocytopenic Purpura ◽  
Lactate Levels

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening syndrome characterized by microangiopathic anemia, thrombocytopenia, diffuse microvascular thrombosis, and ischemia. It is associated with very low levels of ADAMTS-13. Measurement of ADAMTS-13 levels is used for diagnostic and prognostic purposes, but in every-day clinical practice, this type of analysis is not always readily available. In this retrospective study, we evaluated prognostic value of clinical and laboratory findings in patients with TTP. Materials and methods: We retrospectively investigated patients with clinically diagnosed TTP treated in a unit of Internal and Emergency Medicine (1996-2007). Clinical and laboratory findings were collected and analyzed in order to assess their ability to predict in-hospital death. Results: Twelve patients were identified (mean age 59 + 22 years; 58% were women). Five (42%) died during the hospitalization, and the variables significantly associated with this outcome were: a delay between diagnosis and symptom onset (HR 1.36; 95% CI 1.04-1.78; p < 0.05); a higher severity score (HR 1.48; 95%CI 1,23-3.86; p < 0.05); hemodynamic instability with hypotension and/or shock (HR 3.35; 95%CI 3.02-9.26; p < 0.01); a higher schistocyte count on blood smear (HR 1.84; 95%CI 1.04-3.27; p < 0.05); and higher lactate values (HR 1.85; 95%CI 1.08- 3.16; p < 0.05). Conclusions: TTP is a rare and potentially fatal disease with protean manifestations. Delayed diagnosis after symptom onset is a major determinant of poor outcome. Hypotension and shock are also prognostically unfavourable. Laboratory evidence of cardiocirculatory compromise (i.e., elevated lactate levels) and extension of the disease process (i.e., schistocyte count > 3) are predictive of in-hospital death, independently of the hemodynamic profile on admission.

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