First Aid, Chapter 7 Hypersensitivity Disorders, Hypersensitivity Pneumonitis Flashcards
What are the Immunologic Lung Disease broad categories? What diseases fit within each category?
TH1
CD8: HP and COPD
CD4: granulomatous - TB, sarcoid, and berylliosis
TH2
Asthma, ABPA, pulmonary eosinophilia, HIV, and Graves’ disease
What are the 3 types of HP?
Acute, Subacute, Chronic
What are the features of acute HP with regard to symptoms, onset, recovery, and CT findings?
- Explosive respiratory symptoms
- Takes 4–6 hours
- Nonproductive cough
- Fever present
- Recovery spontaneous
- On HRCT: Normal or fleeting ground glass opacities seen
What are the features of subacute HP with regard to symptoms, onset, recovery, and CT findings?
- Progressive
- Slow onset
- Productive cough
- No systemic symptoms
- HRCT: Diffuse micronodules, air trapping, mild fibrosis
What are the features of chronic HP with regard to symptoms, onset, recovery, and CT findings?
- No explosive symptoms
- No fever
- Fibrotic lung
- Anorexia
- Weight loss
- Permanent damage likely
- HRCT: Ground-glass opacities, emphysema, honeycombing, and parenchymal micronodules
What is the antigen in Farmer’s lung? What is the source?
Antigen: Faenia rectivirgula or Micropolyspora faeni
Source: moldy hay and compost
What is the source of the HP antigen Thermoactinomyces vulgaris?
Bagassosis (moldy sugar cane)
What is the antigen in ventilation pneumonitis (humidifier/AC induced)?
Thermoactinomyces sacchari, Naegleria gruberi, or Acanthamoeba
What is the antigen in humidifier’s lung (cool mist humidifier)?
Bacillus cereus or Klebsiella oxytoca
What is the antigen in hot tub lung?
Mycobacterium avium intracellulare (MAI)
What is the antigen in malt worker’s lung (malt, tobacco, and soy)?
Aspergillus species
What is the antigen in cheese worker’s lung (moldy cheese?
Penicillium casei or P. roqueforti
What is the antigen in machine operator’s lung?
Pseudomonas, Acinetobacter, or Mycobacter
What is the antigen in bird fancier’s lung? What group has a good prognosis?
Avian proteins or Aspergillus species, kids have a good prognosis.
What is the antigen in detergent worker’s lung?
Bacillus Subtilis
What is the antigen in Woodworker’s lung?
Alternaria species
What is the antigen in winegrower’s lung?
Stachybotrys
What is the antigen in Air-conditioner lung?
Aureobasidium
What is the antigen in summer-type lung (Japan)?
Trichosporum cutaneum
What is the antigen in El NIno lung?
Pezizia
What is the antigen in Saxophonist’s lung?
Candida albicans
What is the antigen in basement shower lung?
Epicoccum nigricans
What is the antigen in wheat weevil lung?
Sitophilus
What is the antigen in paint finisher’s lung?
Toluene or toluene diisocyanate (TDI)
What is the antigen in chemical worker’s lung?
Diphenylmethane diisocyanate (MDI)
What is the antigen in epoxy resin worker’s lung?
Phthalic acid
What is the antigen in plastic worker’s lung?
Trimellitic anhydride
What are the diagnostic criteria for HP?
-HP symptoms
-Evidence of exposure (history and +IgG)
+ Radiograph of chest or high-resolution computed tomography (HRCT, reticular, nodular, or ground-glass opacities)
-Bronchoalveolar lavage (BAL) lymphocytosis > 20% (low CD4:CD8 ratio
What are the BAL findings in HP?
↑CD8 (CD4:CD8 20% ↑ neutrophils ↑ eosinophils >1% of WBCs in BAL are mast cells ↑ IgG, IgA, IgM ↑ hyaluronic acid
What are the lung biopsy findings in HP?
Noncaseating granulomas Mononuclear cell infiltrates of alveolar walls (lymphocytes, plasma cells) Foamy histiocytes in alveoli Giant cells
peribronchiolar fibrosis
What are the PFT findings in HP?
↓FEV1 after 4–6 hr of exposure
↓FVC after 4–6 hr of exposure
↓DLCO after 4–6 hr of exposure
What are the lab differences in asymptomatic vs. symptomatic HP?
Asymptomatic
CD4>CD8
Normal CD8 numbers
Normal IgM
Symptomatic
CD8>CD4
Low CD8
High IgM
What are drugs that can cause HP?
Mnemonic: A Boy Came From a Good Home to Make Nice Purple Sweets Amiodarone
Beta Blockers Chlorambucil, clozapine, cyclosporine
Fluoxetine
Gold
Heroin, HMG Co-A reductase inhibitors Methotrexate,
minocycline
Nitrofurantoin
Procarbazine
Sulfasalazine
What is Organic dust toxic syndrome (ODTS, pulmonary mycotoxicosis)
Noninfectious, febrile illness that occurs in workers after exposure to dust contaminated by bacterial and/or fungal spores (from inhalation of toxinproducing fungi-contaminated aerosols [i.e., grain, hay]) 30 to 50 times more common than HP; young patients; usually contracted in the summer months; complete recovery.
What is fire-eater’s lung?
Choking, coughing, respiratory symptoms from aspiration of the flammable petrochemicals used during the fire-eating demonstration. Fever and pleuritic chest pain also seen
What is humidifier fever?
Toxic alveolitis, recirculated water with endotoxin, chest tightness occurs 4–8 hours after exposure; resolves in hours
What is silo unloaders disease?
Acute exposure to NO2, leading to asphyxia (i.e., a farmer entering a silo)
What is byssinosis?
Dust inhalation of cotton, flax, and hemp; bronchoconstriction first day of exposure; tends to improve as the week goes on
In what percent of histiocytosis patients does pneumothorax occur?
10%
What cell is predominant in usual interstitial pneumonia (UIP)? What physical exam finding is typical?
Clubbing present and neutrophil predominant
What is occasional interstitial lung disease (ILD)?
Secondary to flock or nylon; lifeguarding at the pool, with endotoxin as the culprit
What is the most common type of HP?
Farmer’s lung
What is more common than farmer’s lung in farmers? How can you distinguish the two?
ODTS Organic dust toxic syndrome (nonimmunologic) up to 50 times more common. Farmer’s lung occurs after prolonged exposure, whereas ODTS occurs after a single highdose exposure.
What is the most common pathogen seen in contamination of water and ventilation systems?
MAI
Is smoking pathologic in HP? Why?
No, it is protective due to decreased antibody response to antigen in the lung.
What is the particle size of agents in HP?
Must be
What is the timing of the cells that are involved in HP?
Eosinophils and PMNs after a few hours, lymphocytes infiltrate after a few days and macrophages over months
What is the treatment of HP?
Avoidance of offending agent. Glucocorticoids in severe or persistent symptoms accelerate recovery. Use daily for 1–2 weeks and taper over next 2–4 week
