Background
Prevalence
Causative agents
Antigen | Source | Disease |
---|---|---|
Microbes | ||
Alternaria species | Wood or wood pulp | Woodworker’s lung |
Aspergillus clavatus
| Moldy grains | Malt-worker’s lung |
Aspergillus species | Tobacco mold | Tobacco-worker’s lung |
Aspergillus species | Moldy malt | Malt-worker’s lung |
Aspergillus versicolor
| Animal bedding | Dog house disease |
Aureobasidium pullulans
| Moldy sequoia dust | Sequoiosis |
Aureobasidium species | Contaminated water | Sauna-taker’s disease |
Bacillus subtilis
| Detergent enzymes | Detergent-worker’s lung |
Botrytis cinerea
| Grape mold | Winegrower’s lung or Späetlase lung |
Candida albicans
| Saxophone mouthpiece | Sax lung |
Cephalosporium | Sewage | Sewage-worker’s lung |
Cryptostroma corticale
| Moldy maple bark | Maple bark–stripper’s lung |
Merulius lacrymans
| – | Dry rot lung |
Mixed amoeba, fungi, and bacteria | Cold mist and other humidifiers, air conditioners | Nylon plant or office worker’s or air conditioner’s lung, ventilation pneumonitis |
Mycobacterium avium
| Contaminated water | Hot tub lung |
Mycobacterium species, Gram negative bacilli | Metal-cutting fluid | Machine-worker’s lung |
Mucor stolonifer
| Paprika | Paprika-splitter’s lung |
Penicillium casei
| Cheese mold | Cheese-washer’s lung |
Penicillium chrysogenum
| Moldy wood dust | Woodworker’s lung |
Penicillium frequentans
| Moldy cork | Suberosis |
Saccharopolyspora rectivirgula (micropolyspora faeni) | Moldy hay | Farmer’s lung |
Thermoactinomyces vulgaris
| Moldy hay, compost | Farmer’s lung, mushroom-worker’s lung, composter’s lung |
Thermoactinomyces sacchari
| Sugar cane residue | Bagassosis |
Thermophilic actinomycetes
| Moldy plant materials | Farmer’s lung |
Trichosporon cutaneum | Mold in Japanese homes | Summer-type HP |
Animals | ||
Animal fur protein | Animal fur | Furrier’s lung |
Avian proteins | Bird excreta, blood, or feather | Bird-breeder’s lung, bird-fancier’s lung, pigeon-breeder’s lung |
Gerbil proteins | Gerbil | Gerbil-keeper’s lung |
Fish | Fish meal dust | Fishmeal-worker’s lung |
Mollusk shell protein | Mollusk shell dust | Oyster shell lung |
Ox and pork protein | Pituitary snuff | Pituitary snuff–taker’s lung |
Rat proteins | Rat urine or serum | Rodent-handler’s lung |
Silk worm larvae proteins | Silk worm larvae | Sericulturist’s lung |
Wheat weevil | Flour | Miller’s lung |
Plants | ||
Coffee | Coffee bean dust | Coffee-worker’s lung |
Lycoperdon species | Puffballs | Lycoperdonosis |
Soybean | Soybean hulls | Soybean-worker’s lung |
Chemicals | ||
Anhydrides | Plastics | Chemical-worker’s lung, plasticworker’s lung, epoxy-worker’s lung |
Bordeaux mixture | Vineyard fungicide | Vineyard-sprayer’s lung |
Isocyanates | Paints, plastics | Paint-refinisher’s lung |
Pauli’s reagent | – | Pauli’s reagent lung |
Pyrethrum | Insecticides | Insecticide lung |
Metals | ||
Cobalt | – | Hard metal lung disease |
Beryllium | – | Berylliosis |
Pathogenesis
Clinical presentation
Characteristics | Acute/subacute HP | Chronic HP |
---|---|---|
Exposure to causal antigen | Intermittent high-level exposure | Continuous low-level exposure |
Onset of symptoms | 2–9 h after exposure; may evolve to gradually increasing symptoms over days to weeks | Insidious, over weeks to months |
Nature of symptoms | Cough and dyspnea, but predominantly influenza-like symptoms | Progressive symptoms (dyspnea, cough, and weight loss), sometimes punctuated by intermittent attacks of symptoms or slowly increasing |
Physical signs | Fever | Inspiratory crackles; cyanosis; digital clubbing; cor pulmonale |
Outcome | Symptoms peak within 6–24 h after exposure, lasting hours to days. Symptoms recur on re-exposure and may progress to severe dyspnea | End-stage fibrotic disease and/or emphysema. Exacerbations may occur despite avoidance of exposure |