Hypersensitivity pneumonitis is a pulmonary disease with symptoms of cough and dyspnea resulting from the inhalation of an antigen to which the subject has been previously sensitized,such as microbes,animal or plant proteins and certain chemicals that form haptens.The radiologic findings include diffuse ground-glass opacification,small centrilobular nodules,air trapping,fibrosis and emphysema.Bronchoalveolar lavage fluid reveals a lymphocyte alveolitis with CD4/CD8 decrease.The histopathologic process consists of chronic inflammation of the bronchi and peribronchiolar tissue,often with poorly defined granulomas.The diagnosis usually rests on a variable combination of findings from history,clinical manifestation,radiography,serology,bronchoalveolar lavage fluid and lung biopsy.Treatment includes avoiding the allergen and systemic corticosteroids.The long-term prognosis is usually good.

Key words: 
Hypersensitivity pneumonitis; Etiology; Clinical presentation; Diagnosis; Treatment

Hypersensitivity pneumonitis

The number of composting sites in Europe is rapidly increasing, due to efforts to reduce the fraction of waste destined for landfill, but evidence on possible health impacts is limited. This article systematically reviews studies related to bioaerosol exposures within and near composting facilities and associated health effects in both community and occupational health settings. Six electronic databases and bibliographies from January 1960 to July 2014 were searched for studies reporting on health outcomes and/or bioaerosol emissions related to composting sites. Risk of bias was assessed using a customized score. Five hundred and thirty-six papers were identified and reviewed, and 66 articles met the inclusion criteria (48 exposure studies, 9 health studies, 9 health and exposure studies). Exposure information was limited, with most measurements taken in occupational settings and for limited time periods. Bioaerosol concentrations were highest on-site during agitation activities (turning, shredding, and screening). Six studies detected concentrations of either Aspergillus fumigatus or total bacteria above the English Environment Agency’s recommended threshold levels beyond 250 m from the site. Occupational studies of compost workers suggested elevated risks of respiratory illnesses with higher bioaerosol exposures. Elevated airway irritation was reported in residents near composting sites, but this may have been affected by reporting bias. The evidence base on health effects of bioaerosol emissions from composting facilities is still limited, although there is sufficient evidence to support a precautionary approach for regulatory purposes. While data to date are suggestive of possible respiratory effects, further study is needed to confirm this and to explore other health outcomes.

https://www.tandfonline.com/doi/pdf/10.1080/10937404.2015.1009961

Exposures and Health Outcomes in Relation to Bioaerosol Emissions From Composting Facilities: A Systematic Review of Occupational and Community Studies

Endotoxins are lipopolysaccharides found in the outer membrane of most Gram-negative bacteria and cyanobacteria. Worker exposure to endotoxins has been shown in a number of work situations and is associated with both respiratory and systemic pathologies. The lack of an occupational exposure limit is mainly due to the absence of a standard protocol at the international level for sampling and analyzing airborne endotoxins. The bibliographic review in this article takes an exhaustive look at the current knowledge on measuring airborne endotoxins. It shows that, despite several reference documents at the international level, the methods used to measure endotoxin exposure differ considerably from one laboratory to another. Standardization is necessary to reduce interlaboratory variability and, ultimately, to improve the use of interstudy data. The bibliographic review presents the current status of standardization for airborne endotoxin measurement methods in the workplace and summarizes areas for further research. This article is both a reference document for all operators wishing to use such methods and a working document to build international consensus around the measurement of airborne endotoxins.

Measurement of endotoxins in bioaerosols at workplace: a critical review of literature and a standardization issue.

Indoor fungal contamination has been associated with a wide range of adverse health effects, including infectious diseases, toxic effects and allergies. The diversity of fungi contributes to the complex role that they play in indoor environments and human diseases. Molds have a major impact on public health, and can cause different consequences in hospitals, homes and workplaces. This review presents the methods used to assess fungal contamination in these various environments, and discusses advantages and disadvantages for each method in consideration with different health risks. Air, dust and surface sampling strategies are compared, as well as the limits of various methods are used to detect and quantify fungal particles and fungal compounds. In addition to conventional microscopic and culture approaches, more recent chemical, immunoassay and polymerase chain reaction (PCR)-based methods are described. This article also identifies common needs for future multidisciplinary research and developme...

Indoor fungal contamination: Health risks and measurement methods in hospitals, homes and workplaces

A large number of people work with garbage collection, and exposure to microorganisms is considered an occupational health problem. However, knowledge on microbial exposure at species level is limited. The aim of the study was to achieve knowledge on waste collectors' exposure to airborne inhalable fungal and bacterial species during waste collection with focus on the transport of airborne microorganisms into the truck cab. Airborne microorganisms were collected with samplers mounted in the truck cab, on the workers' clothes, and outdoors. Fungal and bacterial species were quantified and identified. The study showed that the workers were exposed to between 112 and 4.8×10(4) bacteria m(-3) air and 326 and 4.6×10(4) fungi m(-3) air. The personal exposures to bacteria and fungi were significantly higher than the concentrations measured in the truck cabs and in the outdoor references. On average, the fungal and bacterial concentrations in truck cabs were 111 and 7.7 times higher than outdoor reference measurements. In total, 23 fungal and 38 bacterial species were found and identified. Most fungal species belonged to the genus Penicillium and in total 11 Penicillium species were found. Identical fungal species were often found both in a personal sample and in the same person's truck cab, but concentrations were on average 27 times higher in personal samples. Concentrations of fungal and bacterial species found only in the personal samples were lower than concentrations of species also found in truck cabs. Skin-related bacteria constituted a large fraction of bacterial isolates found in personal and truck cab samples. In total, six Staphylococcus species were found. In outdoor samples, no skin-related bacteria were found. On average, concentrations of bacterial species found both in the truck cab and personal samples were 77 times higher in personal samples than in truck cab samples. In conclusion, high concentrations of fungi were found in truck cabs, but the highest concentrations were found in personal samples; fungal and bacterial species found in high concentrations in personal samples were also found in truck cabs, but in lower concentrations indicating that both fungi and bacteria are transported by the workers into the truck cab, and are subsequently aerosolized in the truck cab.

Waste Workers’ Exposure to Airborne Fungal and Bacterial Species in the Truck Cab and During Waste Collection

Aerosolisation of Escherichia coli and associated endotoxin using an improved bubbling bioaerosol generator

Bioaerosol concentrations were investigated in a totally indoor composting facility processing fermentable household and green wastes to assess their variability. Stationary samples were collected by filtration close to specific composting operations and then were analysed for cultivable mesophilic bacteria, thermophilic bacteria, mesophilic fungi, thermophilic fungi, endotoxins and total airborne bacteria (DAPI-staining). Indoor concentrations exceeded the background levels, between 500 and 5400 EU m−3 for endotoxins, 104 and 106 CFU m−3 for cultivable bacteria and generally below 105 CFU m−3 for airborne cultivable fungi. No significant (p > 0.05) differences were observed between the indoor composting operations. Successive 30 minute bioaerosol samples were collected to investigate the variation of cultivable mesophilic microorganisms over the work shift. Concentrations of mesophilic bacteria and fungi varied up to 1 log unit depending on the time at which they were collected in the day. Total airborne particles, counted using an optical particle counter, were present at up to 108 particles m−3 and several concentration peaks were noted. Values for total airborne bacteria were roughly 70-fold higher than cultivable bacteria. These results raise the question of the sampling strategy (duration of sampling; number of samples to be collected) used in similar studies. They provide new bioaerosol concentration data in a composting facility and suggest that the filtration sampling method might be a useful tool for exposure measurements in that occupational environment.

Documentation of bioaerosol concentrations in an indoor composting facility in France

The presence of actinomycetes in many workplaces and their role in the incidence of various respiratory symptoms remains poorly understood and underestimated. A sampling and culture-independent analysis method to measure airborne actinomycetes has yet to be developed and controlled bioaerosols are needed for laboratory investigations. In this article, the performances of a single-pass bubbling aerosolizer were characterized to evaluate the feasibility of generating actinomycetes from a liquid source and to confirm that viability of aerosolized entities was preserved. Six preparation protocols for liquid Thermoactinomycetes vulgaris cultures were compared in terms of culturable flora and total spores concentrations (culture and epifluorescence microscopy) and size distributions (optical counter and cascade impactor) of the bioaerosols generated. Using the best protocol, the generator's performances were then validated using three species: Thermoactinomyces vulgaris, Thermobifida fusca, and Streptomyces cal...

Véronique Koehler

Papers

Aerosolisation of Escherichia coli and associated endotoxin using an improved bubbling bioaerosol generator

Documentation of bioaerosol concentrations in an indoor composting facility in France

Generation of Actinomycetes Aerosols Containing Spores and Mycelium: Performances of a Liquid Bubbling Aerosolizer