Hypersensitivity pneumonitis

Girard, M; and, Y. Lacasse; Cormier, Yvon

doi:10.1111/j.1398-9995.2009.01949.x

Cited by 114 publications

(102 citation statements)

References 131 publications

(130 reference statements)

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“…Among the well-documented proposals for diagnostic criteria, serological tests are not always given the same weight (11,18). Indeed, the presence of precipitins in a healthy farmer does not predict an increased risk of FLD (4,10).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Three Antigenic Extracts of Eurotium amstelodami in Serological Diagnosis of Farmer's Lung Disease

Roussel

Reboux

Rognon

et al. 2010

Clin Vaccine Immunol

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In France and Finland, farmer's lung disease (FLD), a hypersensitivity pneumonitis common in agricultural areas, is mainly caused by Eurotium species. The presence of antibodies in patients' serum is an important criterion for diagnosis. Our study aimed to improve the serological diagnosis of FLD by using common fungal particles that pollute the farm environment as antigens. Fungal particles of the Eurotium species were observed in handled hay. A strain of Eurotium amstelodami was grown in vitro using selected culture media; and antigen extracts from sexual (ascospores), asexual (conidia), and vegetative (hyphae) forms were made. Antigens were tested by enzyme-linked immunosorbent assay (ELISA), which was used to test for immunoglobulin G antibodies from the sera of 17 FLD patients, 40 healthy exposed farmers, and 20 nonexposed controls. The antigens were compared by receiver operating characteristic analysis, and a threshold was then established. The ascospores contained in asci enclosed within cleistothecia were present in 38% of the hay blades observed; conidial heads of aspergillus were less prevalent. The same protocol was followed to make the three antigen extracts. A comparison of the results for FLD patients and exposed controls showed the area under the curve to be 0.850 for the ascospore antigen, 0.731 for the conidia, and 0.690 for the hyphae. The cutoffs that we determined, with the standard deviation for measures being taken into account, showed 67% for sensitivity and 92% for specificity with the ascospore antigen. In conclusion, the serological diagnosis of FLD by ELISA was improved by the adjunction of ascospore antigen.Eurotium amstelodami is known to cause hypersensitivity pneumonitis (HP), of which farmer's lung disease (FLD) is a common form (24,29). Eurotium species, widely isolated from hay harvested in several European countries (22, 30), constitute a major etiological agent of the disease in France and Finland (13,26). Thus far, the diagnosis of HP has most often relied on an array of unspecific clinical symptoms and signs developed in an appropriate setting and the demonstration of interstitial markings on chest radiographs, serum antibodies against offending antigens, a lymphocytic alveolitis on bronchoalveolar lavage (BAL), and the granulomatous reaction on lung biopsy specimens (17, 21). Enzyme-linked immunosorbent assay (ELISA) is one of the techniques that can be used to look for specific serum antibodies (6). Although ELISA indicates significantly higher immunoglobulin G antibody levels in patients with FLD than in control groups, no clear threshold has been established due to an extreme variability in the results that have been obtained (6,25). The antigens used in most studies derive from the sonication of crude fungi.E. amstelodami can be found in any one of three forms (sexual, asexual, or vegetative), and the one that is predominant in the agricultural environment is not known to date. Sexual reproduction is characterized by the production of cleistothecia containing asci wit...

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Section: Discussionmentioning

confidence: 99%

Comparison of Three Antigenic Extracts of Eurotium amstelodami in Serological Diagnosis of Farmer's Lung Disease

Roussel

Reboux

Rognon

et al. 2010

Clin Vaccine Immunol

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“…od ekspozycji) obserwuje się w BALF zwiększoną liczbę neutrofilów. Kilka dni po ekspozycji można stwierdzić w BALF limfocyty B, mastocyty, plazmocyty, wysokie stężenie immunoglobulin M, G i A oraz wolnych łańcuchów lekkich immunoglobulin [15,20]. Charakterystyczny dla AZPP wynik BALF to: wzrost całkowitej liczby komórek z przewagą limfocytów T (> 50%), szczególnie jeśli jednocześnie stwierdza się powyżej 3% neutrofilów i powyżej 1% mastocytów [21].…”

Section: Inhalacyjne Testy Prowokacyjneunclassified

“…Charakterystyczny dla AZPP wynik BALF to: wzrost całkowitej liczby komórek z przewagą limfocytów T (> 50%), szczególnie jeśli jednocześnie stwierdza się powyżej 3% neutrofilów i powyżej 1% mastocytów [21]. Odsetek limfocytów w BALF może pozostawać podwyższony u chorych z AZPP przez wiele lat, nawet po zaprzestaniu ekspozycji [20]. U osób eksponowanych, ale bez objawów klinicznych także stwierdza się podwyższony odsetek limfocytów w BALF.…”

Section: Inhalacyjne Testy Prowokacyjneunclassified

“…Dawki proponowane pacjentom, oparte jedynie na opinii ekspertów, wynoszą 20-50 mg prednizolonu na dobę przez ok. 2-4 do 6 tygodni. Niższe dawki mogą być proponowane w przypadkach, w których możliwe jest istotne ograniczenie ekspozycji na antygen wywołujący objawy choroby, natomiast przy jej całkowitym wyeliminowaniu leczenie nie zawsze jest konieczne [20].…”

Section: Zapobieganie I Leczenieunclassified

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Hypersensitivity pneumonitis: Diagnostic criteria, treatment, prognosis and prevention

Jędrych¹,

Szturmowicz²,

Bestry³

et al. 2016

Med Pr

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StreszczenieAlergiczne zapalenie pęcherzyków płucnych (AZPP) jest chorobą wywoływaną wdychaniem środowiskowych antygenów, najczę-ściej rozpoznawaną wśród rolników i hodowców ptaków. Rozpoznanie opiera się na stwierdzeniu objawów klinicznych (kaszel i duszność) u osoby narażonej na kontakt z antygenem oraz na wykazaniu w tomografii komputerowej płuc o wysokiej rozdzielczości (TKWR) charakterystycznego obrazu -obustronnych mozaikowatych obszarów zacienień typu matowej szyby z predylekcją do pól środkowych i dolnych, i/lub słabo odgraniczonych guzków środkowej części zrazika, a także cech pułapki powietrznej, lepiej widocznych w fazie wydechowej badania. Taki obraz TKWR najczęściej stwierdzany jest w podostrej postaci AZPP. Pomocne w ustaleniu rozpoznania jest badanie płynu z płukania oskrzelowo-pęcherzykowego (broncho-alveolar lavage fluid -BALF), w którym stwierdza się zwiększenie całkowitej liczby komórek z przewagą limfocytów T (> 50%), szczególnie jeśli towarzyszy mu wzrost liczby neutrofilów (> 3%) i mastocytów (> 1%). Prawidłowy wynik BALF na ogół wyklucza AZPP, chyba że jest to schył-kowe stadium włóknienia. W ustaleniu rozpoznania jest pomocne wykazanie obecności swoistych przeciwciał precypitujących w surowicy chorego. W przypadkach niepewnych rozstrzygający jest wynik badania histopatologicznego materiału z biopsji płu-ca. Za rozpoznaniem AZPP przemawia obecność małych, słabo uformowanych ziarniniaków, bez cech martwicy, po wykluczeniu innych chorób ziarniniakowych. W leczeniu AZPP najważniejsze jest przerwanie narażenia na antygen. Stosowanie glikokortykosteroidów przynosi szybką poprawę, zwłaszcza w leczeniu ostrych objawów, ale długofalowa skuteczność tych leków jest niepewna. Rokowanie jest na ogół dobre, jeśli zostanie przerwane narażenie na antygen. W niektórych przypadkach dochodzi jednak do postępującego włóknienia płuc, co może prowadzić do ciężkiej niewydolności oddechowej. Med. Pr. 2016;67(4):517-527 Słowa kluczowe: alergiczne zapalenie pęcherzyków płucnych, diagnostyka, leczenie, rokowanie, tomografia komputerowa płuc o wysokiej rozdzielczości, BALF AbstractHypersensitivity pneumonitis (HP) is caused by inhalation of environmental antigens. Farmers and bird keepers are most frequently affected by this desease. The HP diagnosis is based on clinical symptoms (cough, dyspnea) in a person exposed to environmental antigens, and the presence of characteristic changes in high resolution chest computed tomography (HRCT) (bilateral, mosaic, ground glass opacities in the middle and lower lung zones, ill-defined centrilobular nodules and the sign of air-trapping on expiration). This type of HRCT pattern is most frequently found in the patients with subacute HP. Bronchioloalveolar lavage fluid (BALF) examination is helpful in establishing the HP diagnosis, when the increased total number of cells, with the predominance of T lymphocytes (> 50%), and the increased number of neutrophils (> 3%) and mastocytes (> 1%) are found. The presence of specific serum precipitins increases the likelihood of HP. In case...

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“…11 This disease likely shares features with hypersensitivity pneumonitis, also referred to as extrinsic allergic alveolitis, that refers to a bronchoalveolitis caused by repeated inhalation of specific antigens and, in part, involves a combination of type III and type IV reactions. 5,11 Hypersensitivity pneumonitis poses a significant occupational hazard to mushroom workers who are chronically exposed to mushroom spores; however, most reported cases of lycoperdonosis occurred after a single large inhalation, rather than repeated exposure. 10,12 The limited understanding of the nature of the inflammation in lycoperdonosis makes selection of therapeutics difficult.…”

mentioning

confidence: 99%

Lycoperdonosis in Two Dogs

et al. 2010

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Abstract. Lycoperdonosis is a rare respiratory disease that results from the inhalation of spores released from the Lycoperdon (puffball) mushroom. In the present study, 2 cases of confirmed canine lycoperdonosis are described. The first case presented to the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, and the second case was submitted for postmortem examination to the University of Tennessee Veterinary Teaching Hospital. Both dogs presented in respiratory distress, and owners reported that the dogs had been playing or digging in areas with puffball mushrooms prior to the onset of clinical signs. In the initial case, thoracic radiographs revealed a diffuse interstitial and multifocal alveolar pulmonary pattern. Despite aggressive medical treatment and mechanical ventilation, the dog continued to worsen and was euthanized. Postmortem examination revealed firm lung lobes and enlarged tracheobronchial lymph nodes. Histologically, there was a severe diffuse histiocytic and pyogranulomatous bronchointerstitial pneumonia. Throughout the lung and lymph nodes, most commonly within macrophages, were round, 3-5 mm in diameter, Gomori methenamine silver-positive structures, consistent with Lycoperdon spores. An approximately 750-base pair DNA fragment was amplified from lung of both cases by polymerase chain reaction using primers specific to yeast ribosomal DNA, and the sequence of the fragment was determined to be most closely related to Lycoperdon pyriforme. Importantly, reexamination of an endotracheal wash from the initial case revealed intrahistiocytic spores, suggesting that airway sampling may assist in diagnosing lycoperdonosis.

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Hypersensitivity pneumonitis

Cited by 114 publications

References 131 publications

Comparison of Three Antigenic Extracts of Eurotium amstelodami in Serological Diagnosis of Farmer's Lung Disease

Comparison of Three Antigenic Extracts of Eurotium amstelodami in Serological Diagnosis of Farmer's Lung Disease

Hypersensitivity pneumonitis: Diagnostic criteria, treatment, prognosis and prevention

Lycoperdonosis in Two Dogs

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