Farmer’s Lung Disease

Occupational lung disease is a lung disease or disorder that occurs due to the inhalation of dangerous particles, mist, vapors, or gases while a person is working. The materials accumulate in the respiratory tract or lungs. The type of lung disease that occurs depends on the size and type of the inhaled material. Substances that cause occupational lung disease are toxic materials called noksa. Noksa is a substance that can cause damage to the anatomical structure of body organs and cause respiratory tract function disorders. The lung disease that many farmers experience is often called farmer's lung disease (FLD). FLD is part of hypersensitivity pneumonitis (HP). HP, also known as extrinsic allergic alveolitis, is a group of lung diseases caused by the inhalation of various antigenic organic materials. The most common cause is exposure to agricultural biological dust derived from straw, mold spores, or other dust. HP can be a secondary reaction due to repeated and prolonged inhalation of specific antigens in sensitive individuals. Diagnosis of FLD is often inaccurate. Many of these cases are diagnosed as idiopathic interstitial lung disease. A complete anamnesis should be performed, especially regarding the history of exposure to moldy hay, previous work, and domestic animals, to determine the existence of a history of exposure to the antigen and to confirm the diagnosis.

Peculiarities of changes in a functional condition of pro-oxidant and antioxidant systems in guinea pigs’ lungs in experimental allergic alveolitis under the conditions of immobilization stress

We have analyzed the results of investigation of alterations in indices of pro-oxidant (conjugated diene and malondialdehyde) and antioxidant (superoxide dismutase, ceruloplasmin, catalase) systems in guinea pigs’ lungs in experimental allergic alveolitis in the dynamics of EAA development under the conditions of immobilization stress. The investigation was conducted on 62 female guinea pigs weighing 180-220 g, divided into 4 groups: I – intact guinea pigs (n=20), II – guinea pigs (n=14) with EAA under the conditions of IS (1st day); III – guinea pigs (n=14) with EAA under the conditions of IS (2nd day); IV – guinea pigs (n=14) with EAA under the conditions of IS (64th day). The results of experimental investigation showed that a significant increase in conjugated diene level in animals’ lungs was observed at all stages of EAA development under the conditions of immobilization stress as compared with control group, indicating activation of this marker. The same changes occurred with MDA content, indicating excessive accumulation of this lipid peroxidation product in lung tissue. Intensive synthesis of free radical compounds caused activation of some components of enzymatic system of antioxidant defense. In particular, a moderate decrease in superoxide dismutase activity in lung tissue is observed in response to increased level of LOPs at early stages of EAA and immobilization stress development as compared with the indices in intact animals. The same situation is observed with catalase and ceruloplasmin activity in the lungs of guinea pigs with modeled AA and IS.

Clinical Analysis of Transbronchial Cryobiopsy in Diagnosis of Diffuse Lung Disease

Background: Rapid advances in TBCB in recent years have allowed its gradual acceptance as a diagnostic method for DLD, and an alternative to surgical lung biopsy . However, the various guidelines have yet to provide clear recommendations for TBCB. This study investigated the diagnostic value of transbronchial cryobiopsy (TBCB) for identifying diffuse lung disease (DLD) .Methods: The clinical data was reviewed of 34 patients who showed initial signs of diffuse lung lesions, interstitial pneumonia, bronchial asthma, lung cancer/infection, or pulmonary alveolar proteinosis; and underwent TBCB from December 2018 to March 2021. The safety and effectiveness of TBCB in identifying the etiology of DLD was analyzed.Results: Clear pathomorphological diagnoses were obtained for 27 (79.4%) patients, based on clinical characteristics and pathology: pulmonary fibrosis, adenocarcinoma, alveolar proteinosis, extrinsic allergic alveolitis, tuberculous granulomatous inflammation, and interstitial pneumonia. Four (11.8%) patients required multi-disciplinary discussion for diagnostic confirmation (of diffuse lesions, interstitial pneumonia, and lung infection). The etiology of 3 cases remained unknown. The rate of DLD diagnosis via TBCB was 91.2% (31/34). Associated with the TBCB procedure, 9 (26.5%) patients developed pneumothorax (6 mild, 3 moderate), and 29 (85.3%) post-biopsy bleeding (all grade 1, requiring suction and compression, but no other intervention or surgery). The average hospitalization cost and length of stay were 7988 RMB (1233 USD) and 5.48 days, respectively.Conclusion: TBCB is safe, cost-effective, requires a short hospitalization, and the diagnostic confirmation rate for DLD is high.

HYPERSENSITIVITY PNEUMONITIS (EXOGENOUS ALLERGIC ALVEOLITIS) IN CHILDREN

А bibliographical review, based on domestic and foreign data, provides up-to-date information on hypersensitivity pneumonitis (HP, exogenous allergic alveolitis) in children. It presents the current data on epidemiology, etiology, pathogenesis, classification, clinical manifestation, diagnosis, therapy, prevention and prognosis of the disease. A computed tomographic semiotics of HP is described in full details in comparison with data on morphology and histopathological patterns of the disease. This review includes classification criteria for the disease for diagnosis of reliable, probable and possible HPs to be verified. Information on the treatment and prevention of the disease is presented in an evidence-based medicine context.

Pneumonite de Hipersensibilidade Crónica: evolução de um Caso Clínico

INTRODUCTION Hypersensitivity pneumonitis (PH) or extrinsic allergic alveolitis is an inflammatory interstitial lung disease caused by recurrent exposure to a variety of environmental and/ or occupational antigens by immunologically susceptible individuals. The differential diagnosis with other interstitial lung diseases (ILD) is stimulating, but essential for a correct approach and implementation of appropriate therapy. CASE REPORT We present a case of a 55-year-old female worker, non-smoker, with no important pathological personal history. She had professional exposure to multiple paints (Gouache; Acrylics; Watercolors; Oil) inherent in her profession as an art teacher since she was 23 years old. After 24 years of performing these functions, without the use of proper personal protective equipment (protective mask, gloves, goggles, appropriate uniform), she develops a persistent cough, dyspnoea and fatigue, motivating observation in pulmonology consultation. Taking into account clinical, radiological and laboratory elements, she presented suggestive alterations of interstitial pulmonary pathology, and the diagnosis of Chronic Hypersensitivity Pneumonitis was assumed in a Multidisciplinary Group Consultation later assumed and characterized as an Occupational Disease. In the follow-up, the causal agent of the disease was removed, having the worker been mobilized internally, assuming functions associated with school coordination, for which she was able to work. Since 2011 under immunosuppression therapy with Prednisolone, Azathioprine from July 2014 to August 2016 and Mycophenolate Mofetil since March 2019, having remained clinically and functionally stable until today, without the need for oxygen therapy. As complementary diagnostic tests it has a respiratory function in 2019: FEV1 51%; FVC 55%; 73% TLC. 33% DLCO; DLCO/VA: 51%. Chest CT with scattered, bilateral ground glass densification areas; some cystic images, bilaterally, corresponding to areas of bronchial ectasia/ fibrosis; traction bronchiectasis, mainly in the upper lobes and the middle lobe; reticulation areas in the anterior right pulmonary field; calcified granuloma in the lower right lobe and upper left lobe; infracentimetric nodularities at both apexes. DISCUSSION/ CONCLUSION Chronic HP is an irreversible disease. Removal of the disease-causing antigen and immunosuppressive therapy are the usual interventions in these cases. In this worker, once the relationship between the pathology and the causal agent of the disease was assumed, was assigned a definitive incapacity for the current job, having been replaced in another compatible activity within the same company. Thus, occupational health surveillance becomes essential in the prevention/ attenuation of this occupational disease.

Occupational Extrinsic Allergic Alveolitis in a poultry farmer

Hypersensitivity pneumonitis is a group of inflammatory interstitial lung diseases caused by hypersensitivity immune reactions to the inhalation of various antigens: fungal, bacterial, animal protein, or chemical sources, finely dispersed, with aerodynamic diameter <5μ, representing the respirable fraction. The national register for interstitial lung diseases records very few cases of hypersensitivity pneumonitis (extrinsec allergic alveolitis), a well defined occupational disease. Although not an eminently of occupational origin, the extrinsec allergic alveolitis can occur secondary to occupational exposure to organic substances (animal or insect proteins, bacteria, fungi) or inorganic (low molecular weight chemical compounds) and the occupational doctor is a key actor in the diagnosys. The disease has chronic evolution and exposure avoidance, as early as possible, has major prognostic influence. The occupational anamnesis remains the most important step and the occupational physician is the one in charge for monitoring and detection of the presence of respiratory symptoms in all employees with risk exposure. Next, we present the case of a farmer, without other comorbidities, who develops various respiratory and systemic diseases and manifestations due to repeated exposure to animal proteins and molds, in order to review the risk factors and the consequences of exposure in poultry farms.

Hypersensitivity pneumonitis complicated by acute respiratory viral infection

The article presents a clinical case of hypersensitivity pneumonitis complicated by a viral infection in a 72-year-old woman. The introductory part provides a concise literature review on the etiology, classification, frequency, and possible complications of hypersensitivity pneumonitis. The patient’s computed tomography (CT) lung scan showed bilateral interstitial lesions. The patient was diagnosed with idiopathic pulmonary fibrosis based on the clinical manifestations and radiological findings. The autopsy revealed morphological signs of hypersensitivity pneumonitis (obliterative bronchiolitis, moderate interstitial fibrosis with honey-combing, nonspecific interstitial pneumonia, giant multinucleated cells) and viral lung damage (exudative stage of acute respiratory distress syndrome with interalveolar edema, hyaline membranes lining the alveoli, pneumocyte desquamation, and ugly giant cells). Keywords: hypersensitivity pneumonitis, exogenous allergic alveolitis, viral infection, lungs