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Case 46
Published in Edward Schwarz, Tomos Richards, Cases of a Hollywood Doctor, 2019
Edward Schwarz, Tomos Richards
Old Macdonald, a local farmer of pigs, cows, sheep, chickens and horses, presents to your GP practice. He was recently seen in the respiratory clinic for follow up for his pulmonary fibrosis. He recounts that years ago he was given a diagnosis of extrinsic allergic alveolitis and the nurse said this was caused by ‘farmer’s lung.’ He has been reading on the internet that this is due to inhaling mouldy hay. He was told in the recent clinic follow up that his spirometry showed a restrictive pattern and he wants to know what this means. On examination, his saturations are 95% in room air, he has clubbing of his fingers and fine inspiratory crackles can be heard throughout the chest.
B
Published in Anton Sebastian, A Dictionary of the History of Medicine, 2018
Bird-Breeders’ Lung A disease with symptoms resembling farmers’ lung, described amongst bird breeders around the 1950s. It was shown to be due to antigenic properties of the excreta of budgerigars and pigeons by F.E. Hargreave, J. Pepys and others in 1966.
Rural diseases
Published in Jim Cox, Iain Mungall, Rural Healthcare, 2017
Farmer’s lung is a hypersensitivity pneumonitis or extrinsic allergic alveolitis following exposure to mouldy hay on which thermophilic actinomycetes (e.g. Micropolyspora faeni) have grown. For the purposes of compensation, it is recognised as an industrial disease. When disturbed, mouldy hay releases clouds of millions of spores. A recent report from Canada has identified further possible antigens, Penicillium brevicompactum and Penicillium alevicolor, which are responsible for a farmer’s lunglike condition that can progress to fatal pulmonary fibrosis.
Current and emerging techniques for the diagnosis of hypersensitivity pneumonitis
Published in Expert Review of Respiratory Medicine, 2018
Thibaud Soumagne, Jean Charles Dalphin
This classification, which still remains the gold standard, has many limitations. It is generally misunderstood and therefore often misused in the literature. Indeed, many authors associated the acute form to the severe form, whereas in the minds of the working group led by Richerson in 1988, the severe form that leads to respiratory failure is the subacute form. In addition, the chronic form encompasses very different situations. Indeed, there are residual nonprogressive chronic forms and active chronic forms in which the disease worsens according to alveolitis outbreaks. It is worth noting that this classification is based on clinical features and was suggested before the use of computed tomography of the chest to describe HP. Finally, it is now known that these chronic forms can correspond not only to classical pulmonary fibrosis but also to pulmonary emphysema with or without airway obstruction regardless of the type of exposure [13,14]. Indeed, emphysematous chronic HP has been neglected and has probably gone unnoticed despite high prevalence in farmer’s lung disease.
Pediatric Hypersensitivity Pneumonitis: Clinicopathologic Characteristics of Two Cases with Fungal Triggers
Published in Fetal and Pediatric Pathology, 2022
Catherine Gonsalves, Dima Ezmigna, Archana Shenoy
Hypersensitivity pneumonitis (HP) is an inflammatory lung disease caused by a combination of immune complex-mediated (type III) and cell-mediated/delayed (type IV) hypersensitivity reactions to inhaled antigens [1]. The inciting agents are usually of organic avian or plant origins. HP is relatively uncommon in children, but its true incidence is probably underestimated due to underdiagnosis [2, 3]. The most common inciting agents for HP in children are avian antigens, which are present in bird feathers or feces [4]. On the other hand, HP due to fungal antigens (i.e. farmer’s lung) is infrequently reported in children.