3/11/16 Hypersensitivity Pneumonitis: environmental exposure investigation. Dr Kenneth Anderson Department of Respiratory Medicine University Hospital Crosshouse Kilmarnock Scotland President Elect Scottish Thoracic Society 25 years E&O lectures University of Glasgow Disclosures None Dr Kenneth Anderson, Consultant Physician March 2016 1 3/11/16 Gravimetric determination of dust and antigen exposure in pigeon breeders. G Morris, K Anderson, et al. Annals of Occup Hygiene 1994; 38(sup 1): 919-22 2 3/11/16 Anderson K, et al Thorax. 1988;43:798-800 K Anderson et al Thorax 1988; 43: 798-800 Case : 29yrs male non smoker athlete 6 months short of breath Cough initially dry then productive Fever; muscle ache; backache weight loss 15 kg end of working day bad, good on hols some crackles over lung fields K Anderson et al Thorax 1985;40:312-3 3 3/11/16 Serial Pulmonary Function 4 3/11/16 5 3/11/16 6 3/11/16 Hypersensitivity Pneumonitis ?? Survey symptoms Factory 1 n=40 Factory 2 n=17 chest tightness 15/250 13/22 headache 24/250 4/22 chills 17 -- 3 -- breathlessness 15 -- 1-- wheeze 11 -- 0 -- poor appetite 10 -- 0 -- weight loss 6 -- 0 -- fever 8 -- 13 -- tiredness 26 -- 0 – K Anderson MD thesis Univ Glasgow 1989 7 3/11/16 Thanks to Dr J Edwards, Cardiff Inhalational Fevers Humidifier fever Byssinosis Metal fume fever Grain workers Polymer fumes (smokers) Endotoxin Lake water fever Pulmonary mycotoxicosis Sump-bay fever 8 3/11/16 Sump-bay fever: inhalational fever associated with a biologically-contaminated water aerosol. K Anderson, et al Occup and Env Medicine 1996; 53:106-111. Sump-Bay Fever shivers ‘flu’ muscle aches, tiredness chest tightness shortness of breath, wheeze, cough headache well following day late afternoon evening 9 3/11/16 Sump-Bay Fever : endotoxin Glasgow tap water 23.90 dump sump 1055 main sump 1055 large pump drain funnel 938.4 small pump dead leg valve 29000 large pump oil sump dead area 57030 10 3/11/16 11 3/11/16 43 yr old male cheeseworker Short of breath walking upstairs Never smoked Blue cheese maker, Penicillium roqueforti Better off work, symptoms when back DLCO 45%, FVC 95%, FEV 92% Rarely reported syndrome. First case in UK. 5K artisan cheeseries in the UK. Environmental assessment of hypersensitivity pneumonitis in a Scottish cheesery.A Hamilton, MD Richardson, K Anderson. Scottish Thoracic Society. 2015 Aspergillosis in immunocompromised paediatric patients: associations with building hygiene, design and indoor air. K Anderson, et al Thorax 1996; 51: 256-61. 12 3/11/16 Pulmonary infiltration after home-renovation dust exposure : histopathology and microanalysis. K.Anderson, et al Thorax 1996; 51: 654-655. 13 3/11/16 Thanks to Charlie McSharry Ruth Adamson Phil Lynch Gavin Boyd Malcolm Richardson and about forty others. 14 .