barbecue java barcode generator 25 Selected causes of hypersensitivity pneumonitis in Objective-C

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Table 9 25 Selected causes of hypersensitivity pneumonitis
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Disease Farmer s lung Antigen Micropolyspora faeni, Thermoactinomyces vulgaris Thermophilic actinomycetes Source Moldy hay
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Humidifier lung
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Contaminated humidifiers, heating systems, or air conditioners Bird serum and excreta
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Bird fancier s lung ( pigeonbreeder s disease ) Bagassosis
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Thermoactinomyces sacchari and T vulgaris Graphium, Aureobasidium, and other fungi Cryptostroma (Coniosporium) corticale Same as farmer s lung Penicillium frequentans Bacillus subtilis enzyme
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Moldy sugar cane fiber (bagasse) Moldy redwood sawdust Rotting maple tree logs or bark Moldy compost Moldy cork dust Enzyme additives
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Sequoiosis
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Maple bark stripper s disease Mushroom picker s disease Suberosis Detergent worker s lung
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Pulmonary Disorders
noncaseating granulomas in the interstitium and air spaces A subacute hypersensitivity pneumonitis syndrome (15% of cases) has been described that is characterized by the insidious onset of chronic cough and slowly progressive dyspnea, anorexia, and weight loss Chronic respiratory insufficiency and the appearance of pulmonary fibrosis on radiographs may occur after repeated exposure to the offending agent Surgical lung biopsy is occasionally necessary for diagnosis Diffuse fibrosis is the hallmark of the subacute and chronic phases Treatment of hypersensitivity pneumonitis consists of identification of the offending agent, avoidance of further exposure, and, in severe acute or protracted cases, oral corticosteroids (prednisone, 05 mg/kg daily as a single morning dose, tapered to nil over 4 6 weeks) Change in occupation is often unavoidable
Jacobs RL et al Hypersensitivity pneumonitis: beyond classic occupational disease-changing concepts of diagnosis and management Ann Allergy Asthma Immunol 2005 Aug;95 (2):115 28 [PMID: 16136760] Lacasse Y et al Clinical diagnosis of hypersensitivity pneumonitis Am J Respir Crit Care Med 2003 Oct 15;168(8):952 8 [PMID: 12842854]
CMDT 2008
with symptoms subsiding later in the week Repeated exposure leads to chronic bronchitis
4 Toxic Lung Injury
Toxic lung injury from inhalation of irritant gases is discussed in the section on smoke inhalation Silo-filler s disease is acute toxic high-permeability pulmonary edema caused by inhalation of nitrogen dioxide encountered in recently filled silos Bronchiolitis obliterans is a common late complication, which may be prevented by early treatment of the acute reaction with corticosteroids Extensive exposure to silage gas may be fatal
5 Lung Cancer
Many industrial pulmonary carcinogens have been identified, including asbestos, radon gas, arsenic, iron, chromium, nickel, coal tar fumes, petroleum oil mists, isopropyl oil, mustard gas, and printing ink Cigarette smoking acts as a cocarcinogen with asbestos and radon gas to cause bronchogenic carcinoma Asbestos alone causes malignant mesothelioma Almost all histologic types of lung cancer have been associated with these carcinogens Chloromethyl methyl ether specifically causes small cell carcinoma of the lung
3 Obstructive Airway Disorders
Occupational pulmonary diseases manifested as obstructive airway disorders include occupational asthma, industrial bronchitis, and byssinosis
6 Pleural Diseases
Occupational diseases of the pleura may result from exposure to asbestos (see above) or talc Inhalation of talc causes pleural plaques that are similar to those caused by asbestos Benign asbestos pleural effusion occurs in some asbestos workers and may cause chronic blunting of the costophrenic angle on chest radiograph
A Occupational Asthma
It has been estimated that from 2% to 5% of all cases of asthma are related to occupation Offending agents in the workplace are numerous; they include grain dust, wood dust, tobacco, pollens, enzymes, gum arabic, synthetic dyes, isocyanates (particularly toluene diisocyanate), rosin (soldering flux), inorganic chemicals (salts of nickel, platinum, and chromium), trimellitic anhydride, phthalic anhydride, formaldehyde, and various pharmaceutical agents Diagnosis of occupational asthma depends on a high index of suspicion, an appropriate history, spirometric studies before and after exposure to the offending substance, and peak flow rate measurements in the workplace Bronchial provocation testing may be helpful in some cases Treatment consists of avoidance of further exposure to the offending agent and bronchodilators, but symptoms may persist for years after workplace exposure has been terminated
7 Other Occupational Pulmonary Diseases
Occupational agents are also responsible for other pulmonary disorders These include berylliosis, an acute or chronic pulmonary disorder related to exposure to beryllium, which is absorbed through the lungs or skin and widely disseminated throughout the body Acute berylliosis is a toxic, ulcerative tracheobronchitis and chemical pneumonitis following intense and severe exposure to beryllium Chronic berylliosis, a systemic disease closely resembling sarcoidosis, is more common Chronic pulmonary beryllium disease is thought to be an alveolitis mediated by the proliferation of beryllium-specific helperinducer T cells in the lung Exposure to beryllium now occurs in machining and handling of beryllium products and alloys Beryllium miners are not at risk for berylliosis Beryllium is no longer used in fluorescent lamp production, which was a source of exposure before 1950
Balmes J et al American Thoracic Society Statement Occupational contribution to the burden of airway disease Am J Respir Crit Care Med 2003 Mar 1;167(5):787 97 [PMID: 12598220] Glazer CS et al Occupational interstitial lung disease Clin Chest Med 2004 Sep;25(3):467 78 [PMID: 15331187] Kim JS et al Imaging of nonmalignant occupational lung disease J Thorac Imaging 2002 Oct;17(4):238 60 [PMID: 12362064]
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