A Real-World Multicenter Retrospective Observational Study on Polish Experience with Nintedanib Therapy in Patients with Idiopathic Pulmonary Fibrosis: The PolExNIB Study

Nintedanib is a disease-modifying agent licensed for the treatment of IPF. Data on Polish experience with nintedanib in IPF are lacking. The present study aimed to describe the safety and efficacy profiles of nintedanib in a large real-world cohort of Polish patients with IPF. This was a multicenter, retrospective, observational study of IPF patients treated with nintedanib between March 2018 and October 2021. Data collection included baseline clinical characteristics, results of pulmonary function tests (PFTs), and a six-minute walk test (6MWT). Longitudinal data on PFTs, 6MWT, adverse drug reactions (ADRs), and treatment persistence were also retrieved. A total of 501 patients (70% male) with a median age of 70.9 years (IQR 65-75.7) were included in this study. Patients were followed on treatment for a median of 15 months (7-25.5). The majority of patients (66.7%) were treated with the full recommended dose of nintedanib and 33.3% of patients were treated with a reduced dose of a drug. Intermittent dose reductions or drug interruptions were needed in 20% of patients. Over up to 3 years of follow-up, pulmonary function remained largely stable with the minority experiencing disease progression. The most frequent ADRs included diarrhea (45.3%), decreased appetite (29.9%), abdominal discomfort (29.5%), weight loss (32.1%), nausea (20.8%), fatigue (19.2%), increased liver aminotransferases (15.4%), and vomiting (8.2%). A total of 203 patients (40.5%) discontinued nintedanib treatment due to diverse reasons including ADRs (10.2%), death (11.6%), disease progression (4.6%), patient's request (6.6%), and neoplastic disease (2.2%). This real-world study of a large cohort of Polish patients with IPF demonstrates that nintedanib therapy is safe, and is associated with acceptable tolerance and disease stabilization. These data support the findings of previously conducted clinical trials and observational studies on the safety and efficacy profiles of nintedanib in IPF.

Spontaneous pneumomediastinum as a complication of COVID-19

In December 2019, an atypical form of severe pneumonia emerged in Wuhan in China's Hubei province, which in February 2020 was named COVID-19. The disease may have features of interstitial pneumonia and severe respiratory failure requiring intensive oxygen therapy. Spontaneous pneumomediastinum is a rare pathological condition with air in the mediastinum outside the trachea, oesophagus and bronchi. It is potentially life-threatening complication of both invasive and non-invasive mechanical ventilation. There have been reports that it may complicate the course of interstitial lung disease in the course of COVID-19. The report describes two cases of young patients who spontaneously developed this complication. Immediate diagnose is important in order to applicate adequate procedures.

Guidelines of the Polish Respiratory Society on the Diagnosis and Treatment of Progressive Fibrosing Interstitial Lung Diseases Other than Idiopathic Pulmonary Fibrosis

The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.

How much do we know about genetic predisposition of hypersensitivity pneumonitis?

INTRODUCTION AND OBJECTIVE

Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by iterative inhalation of various environmental agents. The clinical presentation is variable, acute HP commonly presents an inflammatory response, whereas the development and clinical consequences in chronic HP may be similar to IPF (idiopathic pulmonary fibrosis). The aim of the study is to present the latest discoveries regarding the genetic predisposition of HP.

MATERIAL AND METHODS

The appropriate scientific literature was reviewed and analyzed.

RESULTS

Studies have discovered relevant gene polymorphisms in HP, including polymorphisms in the major histocompatibility complex in the metalloproteinases genes. The length of the peripheral blood leukocyte telomere has been investigated and discovered to be important. Recently, the need to study miRNAs in ILD (interstitial lung disease) has been highlighted.

CONCLUSIONS

Exposed HP developed only in some people and a genetic susceptibility significantly increases the risk. Further more current studies on large groups of patients are needed to learn more about the genetic predisposition and risk factors of HP.

Timber-colonizing gram-negative bacteria as potential causative agents of respiratory diseases in woodworkers

Occurrence

Gram-negative bacteria occur commonly in the inner tissues of stored coniferous and deciduous timber, showing a marked variation in numbers. The greatest maximal numbers are found in the sapwood of coniferous timber. The common constituents of the Gram-negative biota are potentially pathogenic species of Enterobacteriaceae family of the genera Rahnella, Pantoea, Enterobacter, and Klebsiella. The air of wood-processing facilities is polluted with the wood-borne Gram-negative bacteria and produced by them endotoxin, as demonstrated worldwide by numerous studies.

Effects

There are three potential pathways of the pathogenic impact of wood-borne Gram-negative bacteria on exposed woodworkers: allergic, immunotoxic, and infectious. Allergic impact has been underestimated for a long time with relation to Gram-negative bacteria. Hopefully, the recent demonstration of the first documented case of hypersensitivity pneumonitis (HP) in woodworkers caused by Pantoea agglomerans which developed in extremely large quantities in birch sapwood, would speed up finding of new wood-related cases of HP caused by Gram-negative bacteria. The second pathway is associated with endotoxin, exerting strong immunotoxic (excessively immunostimulative) action. It has been demonstrated that endotoxin is released into wood dust in the form of nano-sized microvesicles, by peeling off the outer membrane of bacteria. Endotoxin microvesicles are easily inhaled by humans together with dust because of small dimensions and aerodynamic shape. Afterwards, they cause a nonspecific activation of lung macrophages, which release numerous inflammatory mediators causing an inflammatory lung reaction, chest tightness, fever, gas exchange disorders, and bronchospasm, without radiographic changes. The resulting disease is known as “Organic Dust Toxic Syndrome” or “toxic pneumonitis.” The potential third pathway of pathogenic impact is infection. The suspected species is Klebsiella pneumoniae that may occur commonly in wood dust; however, until now this pathway has not been confirmed.

Conclusion

Summarizing, Gram-negative bacteria-inhabiting timber should be considered, besides filamentous fungi and actinobacteria, as important risk factors of occupational disease in woodworkers that could be either HP with allergenic background or toxic pneumonitis elicited by endotoxin.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-021-01829-1.

COVID 19 - Possible interrelations with respiratory comorbidities caused by occupational exposure to various hazardous bioaerosols. Part II. Clinical course, diagnostics, treatment and prevention

INTRODUCTION AND OBJECTIVE

The course of COVID-19 caused by the SARS-CoV-2 may be aggravated by bioaerosols containing other viruses, bacteria, and fungi, occurring mainly in the occupational environment. Hence, the diagnostics and treatment of COVID-19 should address such a possibility in the anamnesis, treatment and final recommendations for avoiding of adverse exposure.

ABBREVIATED DESCRIPTION OF THE STATE OF KNOWLEDGE

As SARS-CoV-2 attacks primarily the respiratory system and the severe manifestation of COVID-19 is interstitial pneumonia, diagnostics should include the following clinical and laboratory examinations: chest X-ray; high resolution computed tomography (HRCT); pulmonary function tests; arterial-blood gas test; genetic tests for the presence of SARS-CoV-2, in the future with the use of highly specific and sensitive nano-based biosensors; tests for the presence of specific immunity against the antigens of microorganisms causing other infectious or allergic pulmonary diseases (in the case of anamnestic indications). Because an universally accepted treatment for COVID-19 does not exist, the hitherto prescribed antiviral and immune-modulating drugs should be used be with caution. In many cases, a better alternative could be a safe supportive therapy, such as supplementation of the diet with probiotics, prebiotics, vitamins and microelements.

SUMMARY

The most important preventive measures against COVID-19 should include: vaccination; the use of filter or surgical masks; disinfection and sterilization; maintaining of well-functioning ventilation and air conditioning systems; reduction of the community air pollution which has been identified as an important factor increasing the COVID-19 severity. In the choice of preventive measures, the above should be considered for their potential efficacy against other bioaerosols as potential disease-aggravating agents.

COVID 19 - Possible interrelations with respiratory comorbidities caused by occupational exposure to various hazardous bioaerosols. Part I. Occurrence, epidemiology and presumed origin of the pandemic

The occupational bioaerosols containing viruses, bacteria, fungi, microbial toxins and plant or animal particles, may evoke infectious, allergic or immunotoxic diseases which may co-exist as comorbidities with COVID-19 and exacerbate the course of disease. They include hypersensitivity pneumonitis (HP) caused mostly by bacteria, fungi, and particles containing animal proteins, and immunotoxic diseases such as organic dust toxic syndrome (ODTS) and byssinosis, caused mostly by bacterial and fungal toxins. The two most probable scenarios of possible interrelations between these three comorbidities (CM) and COVID-19 are: 1) 'Triggering' - when infection with SARS-CoV-2 triggers severe CM after bioaerosol exposure; 2) 'Reverse triggering' when exposure to bioaerosol exacerbates a symptomless or mild course of COVID-19, and evokes a severe disease. The occupations mostly endangered by COVID-19 as the result of exposure to SARS-CoV-2 bioaerosol, or to other bioaerosols which may exacerbate this disease, include: health care workers, social workers, breeders of fur animals, slaughterhouse workers, workers engaged in the processing and selling of seafood, and probably also agricultural workers, mainly in the developing countries. The authors present a hypothesis for the origin of the present pandemic. It assumes that a mild form of the present SARS-CoV-2 that is supposedly circulating among the Chinese population in the eastern part of the country, mutated under the influence of as yet unknown factor(s) present in the Chinese seafood markets, probably component(s) of bioaerosols, into the virulent and highly contagious form, known as the present SARS-CoV-2, under a scenario similar to that the authors have named 'Reverse triggering'.

Pantoea agglomerans chronic exposure induces epithelial-mesenchymal transition in human lung epithelial cells and mice lungs

Pantoea agglomerans is gram-negative bacteria widely distributed in nature. It predominates in inhalable dust from grain, herbs, and flax, and was identified as the most important cause of hypersensitivity pneumonitis (HP) in eastern Poland. To better understand the molecular mechanism of HP development studies focused on the interactions between P. agglomerans and alveolar epithelial cells as well as lung tissue with particular emphasis on the epithelial-mesenchymal transition (EMT). The studies were conducted on human normal lung epithelial NL20 cells and mice strain C57BL/6J. Cells and mice underwent chronic exposure to saline extract of P. agglomerans (SE-PA). Morphological changes were evaluated under light microscopy, the concentration of fibrosis markers was examined by the ELISA method, while the expression of genes involved in EMT was evaluated by RealTime PCR. During incubation with SE-PA epithelial cells underwent conversion and assumed fibroblast phenotype characterized by a decrease in epithelial cells markers (CDH1, CLDN1, JUP) and increase in mesenchymal cells markers (FN1, VIM, CDH2). Mice lungs collected after 14 days of SE-PA treatment revealed inflammation with marked lymphocytes infiltration. The intensified inflammatory process accompanied by increased proliferation of fibrous connective tissue was noted in mice lungs after 28 days of SE-PA exposure. Histological changes correlated with an increase of fibrosis markers (hydroxyproline, collagens), downregulation of epithelial markers (Cdh1, Cldn1, Jup, Ocln) and upregulation of myofibroblasts markers (Acta2, Cdh2, Fn1, Vim). Obtained results revealed SE-PA ability to induce EMT in human lung epithelial cells and mice lung tissue, with the scale of changes proportional to the time of treatment.

Thiram - Toxic inhalational lung injury

INTRODUCTION

Thiram, a fungicides, is widely used on seeds and as foliar agent on turf, vegetables and fruit. It is also used in the rubber industry as a vulcanization accelerator. When absorbed through the respiratory system, it is rapidly metabolised to dimethylthiocarbamate and carbon disulphide, causing noxious effects. A brief review is presented of the literature, centering on the interesting case of a 45-year-old woman admitted to the hospital suffering from acute respiratory failure.

RESULTS

Computer tomography in angiographic option (angio-CT) showed an extensive, irregular area of ground glass in both upper lobes and apical segments of the lower lobes of the lungs. A significant enlargement of both atria was also described. There was no improvement after cardiac treatment and patient was transferred to the pulmonary department where she was succesfully treated with systemic glucocortycosteroids. The patient remains under the supervision of the pulmonary out-patient department.

Acute hypersensitivity pneumonitis in woodworkers caused by inhalation of birch dust contaminated with Pantoea agglomerans and Microbacterium barkeri

CASE DESCRIPTION

Five workers (2 males and 3 females) employed in a furniture factory located in eastern Poland developed hypersensitivity pneumonitis (HP) after the pine wood used for furniture production was replaced by birch wood. All of them reported onset of respiratory and general symptoms (cough, shortness of breath, general malaise) after inhalation exposure to birch dust, showed crackles at auscultation, ground-glass attenuations in HRCT examination, and lymphocytosis in the BAL examination. The diagnosis of acute HP was set in 4 persons and the diagnosis of subacute HP in one.

IDENTIFICATION OF SPECIFIC ALLERGEN

Samples of birch wood associated with evoking disease symptoms were subjected to microbiological analysis with the conventional and molecular methods. Two bacterial isolates were found to occur in large quantities (of the order 10⁸ CFU/g) in examined samples: Gram-negative bacterium of the species Pantoea agglomerans and a non-filamentous Gram-positive actinobacterium of the species Microbacterium barkeri. In the test for inhibition of leukocyte migration, 4 out of 5 examined patients showed a positive reaction in the presence of P. agglomerans and 2 in the presence of M. barkeri. Only one person showed the presence of precipitins to P. agglomerans and none to M. barkeri. In the inhalation challenge, which is the most relevant allergological test in the HP diagnostics, all patients reacted positively to P. agglomerans and only one to M. barkeri. The results indicate that P. agglomerans developing in birch wood was the main agent causing HP in the workers exposed to the inhalation of dust from this wood, while the etiologic role of M. barkeri is probably secondary.

CONCLUSION

The results demonstrate that apart from fungi and filamentous actinobacteria, regarded until recently as causative agents of HP in woodworkers, Gram-negative bacteria and non-filamentous actinobacteria may also elicit disease symptoms in the workers processing wood infected with large amounts of these microorganisms. The results obtained also seem to indicate that cellular-mediated reactions are more significant for causing disease symptoms compared to those that are precipitin-mediated.

[Hypersensitivity pneumonitis and idiopathic pulmonary fibrosis - case report]

Hypersensitivity pneumonitis (HP), called extrinsic allergic alveolitis, is a syndrome characterized by diffuse inflammation of lung parenchyma and airways in response to the inhalation of antigens to witch the patient has been previously sensitized. The clinical presentation of HP have been categorized as acute, subacute and chronic. The patient with chronic HP may lack a history of acute episodes and usually reports the insidious onset of cough, dyspnoea, fatigue, and weight los. Idiopathic pulmonary fibrosis (IPF) is a type of lung disease that results in scarring (fibrosis) of the lungs for an unknown reason. Symptoms of IPF are the same as in chronic hypersensitivity pneumonitis and differentiation may be difficult. We present a case of patient with chronic HP, in whom the course of the end stage of the disease mimic acute exacerbations idiopathic pulmonary fibrosis.

The quality of life of farmers with chronic obstructive pulmonary disease (COPD)

Introduction and objective. COPD is a medical state characterized by chronically poor airflow, and typically worsens over time. Farmers have an increased risk of COPD because of being exposed to ammonia, hydrogen sulfide, inorganic dust, and organic dust. The quality of life of the ill depends on biomedical as well as psychosocial factors, the impact of which has not been a frequent subject of studies among COPD patients. The aim of the study was to indicate the factors that have negative and positive influence on the quality of life of farmers suffering from COPD. Materials and method. The study was conducted among 84 farmers treated for COPD in the Department of Pneumology, Oncology and Allergology of the Medical University in Lublin, Poland. The differences between the farmers concerned: severity of the disease, level of education and income, frequency of smoking tobacco and drinking alcohol, kinds of support they receive from their families, and the level of depression and anxiety experienced by the patients. Results. The study revealed that most patients suffered from depressive and anxiety disorders, and the level of depression higher among the patients who smoked more. Lack of family support had significant influence on exacerbation of the patient's depressive and anxiety symptoms. Patients who had recently experienced a critical situation presented with more severe COPD symptoms, lower quality of life and a higher level of depression. Higher income of the patients had positive influence on their quality of life. Farmers addicted to alcohol suffered from a higher level of anxiety.

Middle age enhances expression of innate immunity genes in a female mouse model of pulmonary fibrosis

The lungs are highly sensitive to tissue fibrosis, with a clear age-related component. Among the possible triggers of pulmonary fibrosis are repeated inhalations of fine organic particles. How age affects this response, is still far from being fully understood. We examined the impact of middle-age on gene expression in pulmonary fibrosis, using the novel "inhalation challenge set" mouse model. Our results demonstrate that the response of female mice to exposure of Pantoea agglomerans extract primarily involves various immune-related pathways and cell-cell/cell-extracellular matrix interactions. We found that middle-age had a strong effect on the response to the P. agglomerans-induced lung fibrosis, featured by a more rapid response and increased magnitude of expression changes. Genes belonging to innate immunity pathways (such as the TLR signaling and the NK-cell mediated cytotoxicity) were particularly up-regulated in middle-aged animals, suggesting that they may be potential targets for the treatment of pulmonary fibrosis caused by inhalations of organic particles. Our analysis also highlights the relevance of the "inhalation challenge set" mouse model to lung aging and related pathology.

Pantoea agglomerans: a mysterious bacterium of evil and good. Part III. Deleterious effects: infections of humans, animals and plants

Pantoea agglomerans, a bacterium associated with plants, is not an obligate infectious agent in humans. However, it could be a cause of opportunistic human infections, mostly by wound infection with plant material, or as a hospital-acquired infection, mostly in immunocompromised individuals. Wound infection with P. agglomerans usually follow piercing or laceration of skin with a plant thorn, wooden splinter or other plant material and subsequent inoculation of the plant-residing bacteria, mostly during performing of agricultural occupations and gardening, or children playing. Septic arthritis or synovitis appears as a common clinical outcome of exogenous infection with P. agglomerans, others include endophthalmitis, periostitis, endocarditis and osteomyelitis. Another major reason for clinical infection with P. agglomerans is exposure of hospitalized, often immunodeficient individuals to medical equipment or fluids contaminated with this bacterium. Epidemics of nosocomial septicemia with fatal cases have been described in several countries, both in adult and paediatric patients. In most cases, however, the clinical course of the hospital-acquired disease was mild and application of the proper antibiotic treatment led to full recovery. Compared to humans, there are only few reports on infectious diseases caused by Pantoea agglomerans in vertebrate animals. This species has been identified as a possible cause of equine abortion and placentitis and a haemorrhagic disease in dolphin fish (Coryphaena hippurus). P. agglomerans strains occur commonly, usually as symbionts, in insects and other arthropods. Pantoea agglomerans usually occurs in plants as an epi- or endophytic symbiont, often as mutualist. Nevertheless, this species has also also been identified as a cause of diseases in a range of cultivable plants, such as cotton, sweet onion, rice, maize, sorghum, bamboo, walnut, an ornamental plant called Chinese taro (Alocasia cucullata), and a grass called onion couch (Arrhenatherum elatius). Some plant-pathogenic strains of P. agglomerans are tumourigenic, inducing gall formation on table beet, an ornamental plant gypsophila (Gypsophila paniculata), wisteria, Douglas-fir and cranberry. Recently, a Pantoea species closely related to P. agglomerans has been identified as a cause of bacterial blight disease in the edible mushroom Pleurotus eryngii cultivated in China. The genetically governed determinants of plant pathogenicity in Pantoea agglomerans include such mechanisms as the hypersensitive response and pathogenicity (hrp) system, phytohormones, the quorum-sensing (QS) feedback system and type III secretion system (T3SS) injecting the effector proteins into the cytosol of a plant cell.

Pantoea agglomerans: a mysterious bacterium of evil and good. Part IV. Beneficial effects

Pantoea agglomerans, a gammaproteobacterium of plant origin, possesses many beneficial traits that could be used for the prevention and/or treatment of human and animal diseases, combating plant pathogens, promotion of plant growth and bioremediation of the environment. It produces a number of antibiotics (herbicolin, pantocins, microcin, agglomerins, andrimid, phenazine, among others) which could be used for combating plant, animal and human pathogens or for food preservation. Japanese researchers have demonstrated that the low-molecular-mass lipopolysaccharide of P. agglomerans isolated by them and described as 'Immunopotentiator from Pantoea agglomerans 1 (IP-PA1)' reveals the extremely wide spectrum of healing properties, mainly due to its ability for the maintenance of homeostasis by macrophage activation. IP-PA1 was proved to be effective in the prevention and treatment of a broad range of human and animal disorders, such as tumours, hyperlipidaemia, diabetes, ulcer, various infectious diseases, atopic allergy and stress-induced immunosuppression; it also showed a strong analgesic effect. It is important that most of these effects could be achieved by the safe oral administration of IP-PA1. Taking into account that P. agglomerans occurs commonly as a symbiont of many species of insects, including mosquitoes transmitting the Plasmodium parasites causing malaria, successful attempts were made to apply the strategy of paratransgenesis, in which bacterial symbionts are genetically engineered to express and secrete anti-Plasmodium effector proteins. This strategy shows prospects for a successful eradication of malaria, a deadly disease killing annually over one million people, as well as of other vector-borne diseases of humans, animals and plants. Pantoea agglomerans has been identified as an antagonist of many plant pathogens belonging to bacteria and fungi, as a result of antibiotic production, competition mechanisms or induction of plant resistance. Its use as a biocontrol agent permits the decrease of pesticide doses, being a healthy and environmental-friendly procedure. The application of the preparations of this bacterium efficiently protects the stored pome, stone and citrus fruits against invasion of moulds. P. agglomerans strains associated with both rhizosphere and plant tissues (as endophytes) efficiently promote the growth of many plants, including rice and wheat, which are the staple food for the majority of mankind. The promotion mechanisms are diverse and include fixation of atmospheric nitrogen, production of phytohormones, as well as degradation of phytate and phosphate solubilizing which makes the soil phosphorus available for plants. Accordingly, P. agglomerans is regarded as an ideal candidate for an environmental-friendly bioinoculant replacing chemical fertilizers. It has been documented that the Pantoea strains show biodegradation activity on various chemical pollutants of soil and water, including petroleum hydrocarbons and toxic metals. P. agglomerans prevents the penetration of harmful industrial contaminants into deeper parts of soil by biofilm formation, and has an ability to produce hydrogen from waste. Thus, this bacterium appears as a valuable bioremediator which, in some cases, may be acquired as a cheap form of energy. In conclusion, in spite of the proven pathologic role of P. agglomerans in causing occupational diseases of allergic and/or immunotoxic background and accidental infections, the beneficial traits of this species, and of related species of Pantoea genus, are of great value for potential use in many areas of biotechnology. Hence, any restrictions on the use of these organisms and their products should be declined, providing safety precautions at work with the Pantoea biopreparations are maintained.

Impact of I/D polymorphism of ACE gene on risk of development and course of chronic obstructive pulmonary disease

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) affects more than 10% of the world's population over 40 years of age. The main exogenous risk factor is cigarette smoking; however, only 20% of smokers develop COPD, indicating that some other factors, e.g. genetic, may play an important role in the disease pathogenesis. Recent research indicates that ACE (angiotensin-converting enzyme) may be a susceptibility gene for asthma or COPD. The aim of our study was to determine the influence of I/D (insertion/deletion) polymorphism of the ACE gene (AluYa5, rs4646994) on the risk and course of COPD.

MATERIAL AND METHODS

We investigated ACE I/D polymorphism in 206 COPD and 165 healthy Caucasian subjects.

RESULTS

In the generalized linear model (GLZ) analysis of the influence of selected factors on presence of COPD we found a significant independent effect for male sex (repeatedly increases the risk of COPD, OR = 7.7, p = 0.049), as well as smoking or lower body mass index, but only in combination with older age (OR = 0.96, p = 0.003 and OR = 1.005, p = 0.04 respectively). Interestingly, analysis of factors which may influence the risk of a higher number of exacerbations demonstrated that occurrence of DD genotype, but only in men, is associated with a lower risk (OR = 0.7, p = 0.03) of this complication.

CONCLUSIONS

We suggest that ACE may not be a susceptibility gene for the origin of COPD but a disease-modifying gene. Since the impact of I/D polymorphism of the ACE gene on COPD risk is moderate or negligible, other molecular changes, that will help predict the development of this disease, should still be sought.

Pantoea agglomerans: a mysterious bacterium of evil and good. Part II--Deleterious effects: Dust-borne endotoxins and allergens--focus on grain dust, other agricultural dusts and wood dust

Pantoea agglomerans, a Gram-negative bacterium developing in a variety of plants as epiphyte or endophyte is particularly common in grain and grain dust, and has been identified by an interdisciplinary group from Lublin, eastern Poland, as a causative agent of work-related diseases associated with exposure to grain dust and other agricultural dusts. The concentration of P. agglomerans in grain as well as in the settled grain and flour dust was found to be high, ranging from 10(4)-10(8) CFU/g, while in the air polluted with grain or flour dust it ranged from 10(3)-10(5) CFU/m(3) and formed 73.2-96% of the total airborne Gram-negative bacteria. The concentration of P. agglomerans was also relatively high in the air of the facilities processing herbs and other plant materials, while it was lower in animal farms and in wood processing facilities. Pantoea agglomerans produces a biologically-potent endotoxin (cell wall lipopolysaccharide, LPS). The significant part of this endotoxin occurs in dusts in the form of virus-sized globular nanoparticles measuring 10-50 nm that could be described as the 'endotoxin super-macromolecules'. A highly significant relationship was found (R=0.804, P=0.000927) between the concentration of the viable P. agglomerans in the air of various agricultural and wood industry settings and the concentration of bacterial endotoxin in the air, as assessed by the Limulus test. Although this result may be interfered by the presence of endotoxin produced by other Gram-negative species, it unequivocally suggests the primary role of the P. agglomerans endotoxin as an adverse agent in the agricultural working environment, causing toxic pneumonitis (ODTS). Numerous experiments by the inhalation exposure of animals to various extracts of P. agglomerans strains isolated from grain dust, including endotoxin isolated with trichloroacetic acid (LPS-TCA), endotoxin nanoparticles isolated in sucrose gradient (VECN), and mixture of proteins and endotoxin obtained by extraction of bacterial mass in saline (CA-S), showed the ability of these extracts to evoke inflammatory and fibrotic changes in the lungs, to stimulate alveolar macrophages to produce superoxide anion (O2(-)), interleukin-1 (IL-1) and chemotactic factors for other macrophages and neutrophils, and to increase the pulmonary concentrations of toll-like receptors and chemokines. The most potent properties showed the CA-S which may be attributed to the allergenic properties of P. agglomerans proteins enhanced by the presence of the autologous endotoxin. The results of these experiments are in accord with the clinical studies which revealed a high reactivity of the agricultural and grain industry workers to allergenic extracts of P. agglomerans, and the presence in these populations of hypersensitivity pneumonitis and asthma cases caused by this bacterium. P. agglomerans has been also identified as a potential causative agent of allergic dermatitis in farmers and of allergic pulmonary disorders in cattle. In conclusion, similar to the cotton industry, also in the grain industry and in agriculture, Pantoea agglomerans should be regarded as one of the major causative agents of work-related diseases, caused by the adverse effects of protein allergens and endotoxin produced by this bacterium.

Cathelicidin related antimicrobial peptide, laminin, Toll-like receptors and chemokines levels in experimental hypersensitivity pneumonitis in mice

INTRODUCTION

Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by unresolved inflammation and tissue repair pathologies triggered by repeated organic dust exposure. The aim of the study was to investigate changes in levels of the cathelicidin related antimicrobial peptide (CRAMP), laminin (LAM-A1), selected Toll-like receptors (TLR) and chemokines in experimental HP in mice.

MATERIALS AND METHODS

Three and 18-month-old female C57BL/6J mice underwent inhalations of the saline extract of Pantoea agglomerans cells, Gram-negative bacterium common in organic dust and known for its pathogenic impact. The inhalations were repeated daily (28 days). ELISA was used for measuring in lung tissue homogenates concentration of CRAMP, LAM-A1, TLR2, TLR4, TLR8, CXCL9 (chemokine [C-X-C motif] ligand) and CXCL10.

RESULTS

Levels of TLR2, TLR4 and CXCL9 were significantly higher in both young and old mice lungs already after 7 days of inhalations, while significant increase of LAM-A1 and CXCL10 was noted after 28 days, compared to untreated samples. TLR8 level was significantly augmented only in young mice. Only CRAMP level significantly declined. Significantly higher TLR8 and CXCL9 concentration in untreated samples were noted in old animals compared to young ones.

CONCLUSION

Significant alterations of the examined factors levels indicate their role in HP pathogenesis.

Age influence on mice lung tissue response to Aspergillus fumigatus chronic exposure

INTRODUCTION AND OBJECTIVE

Exposure to conidia of Aspergillus fumigatus was described as a causative factor of a number of the respiratory system diseases, including asthma, chronic eosinophilic pneumonia, hypersensitivity pneumonitis and bronchopulmonary aspergillosis. The study investigates the effects of the repeated exposure to A. fumigatus in mice pulmonary compartment. Our work tackles two, so far insufficiently addressed, important aspects of interaction between affected organism and A. fumigatus: 1) recurrent character of exposure (characteristic for pathomechanism of the abovementioned disease states) and 2) impact of aging, potentially important for the differentiation response to an antigen.

MATERIALS AND METHODS

In order to dissect alterations of the immune system involved with both aging and chronic exposure to A. fumigatus, we used 3- and 18-month-old C57BL/6J mice exposed to repeated A. fumigatus inhalations for 7 and 28 days. Changes in lung tissue were monitored by histological and biochemical evaluation. Concentration of pro- and anti-inflammatory cytokines in lung homogenates was assessed by ELISA tests.

RESULTS AND CONCLUSIONS

Our study demonstrated that chronic inflammation in pulmonary compartment, characterized by the significant increase of proinflammatory cytokines (IL1, IL6, IL10) levels, was the dominant feature of mice response to repeated A. fumigatus inhalations. The pattern of cytokines' profile in the course of exposure was similar in both age groups, however in old mice the growth of the cytokines' levels was more pronounced (especially in case of IL1).

Pantoea agglomerans: a marvelous bacterium of evil and good.Part I. Deleterious effects: Dust-borne endotoxins and allergens - focus on cotton dust

The ubiquitous Gram-negative bacterium Pantoea agglomerans (synonyms: Enterobacter agglomerans, Erwinia herbicola) is known both as an epiphytic microbe developing on the surface of plants and as an endophytic organism living inside the plants. The bacterium occurs also abundantly in plant and animal products, in the body of arthropods and other animals, in water, soil, dust and air, and occasionally in humans. From the human viewpoint, the role of this organism is ambiguous, both deleterious and beneficial: on one side it causes disorders in people exposed to inhalation of organic dusts and diseases of crops, and on the other side it produces substances effective in the treatment of cancer and other diseases of humans and animals, suppresses the development of various plant pathogens, promotes plant growth, and appears as a potentially efficient biofertilizer and bioremediator. P. agglomerans was identified as a predominant bacterium on cotton plant grown all over the world, usually as an epiphyte, rarely as pathogen. It is particularly numerous on cotton bract after senescence. During processing of cotton in mills, bacteria and their products are released with cotton dust into air and are inhaled by workers, causing respiratory and general disorders, usually defined as byssinosis. The most adverse substance is endotoxin, a heteropolymer macromolecule present in the outermost part of the cell wall, consisting of lipopolysaccharide (LPS) as a major constituent, phospholipids and protein. The numerous experiments carried out in last quarter of XXth century on laboratory animals and human volunteers supported a convincing evidence that the inhaled endotoxin produced by P. agglomerans causes numerous pathologic effects similar to those elicited by cotton dust, such as influx of free lung cells into airways and activation of alveolar macrophages which secrete mediators (prostaglandins, platelet-activating factor, interleukin-1, tumor necrosis factor) that cause accumulation of platelets in pulmonary capillaries initiating an acute and chronic inflammation resulting in endothelial cell damage and extravasation of cells and fluids into the lung interstitium. These changes cause bronchoconstriction, the decrement of lung function expressed as reduction of forced expiratory volume in one second (FEV1) and/or diffusion capacity, increase in the airway hyperreactivity and subjective symptoms such as fever, airway irritation and chest tightness. The conclusions from these experiments, performed mostly 2-3 decades ago, did not loose their actuality until recently as so far no other cotton dust component was identified as a more important work-related hazard than bacterial endotoxin. Though also other microbial and plant constituents are considered as potential causative agents of byssinosis, the endotoxin produced by Pantoea agglomerans and other Gram-negative bacteria present in cotton dust is still regarded as a major cause of this mysterious disease.

Relationship between concentrations of microbiological agents in the air of agricultural settings and occurrence of work-related symptoms in exposed persons

For assessment of the dose-response relationship between concentrations of microbial agents in the air of various agricultural settings and occurrence of work-related symptoms in exposed workers, a meta-analysis of the results obtained in 1994-2007 on the territory of eastern Poland was performed. The studies on the airborne concentrations of total culturable microorganisms, mesophilic bacteria, Gram-negative bacteria, thermophilic actinomycetes, fungi, and bacterial endotoxins, as well as on the frequency of work-related respiratory and general symptoms in the exposed workers, were carried out at grain, thyme, valerian, flax, and hop handling on farms, in cow barns, piggeries, horse stables and in a modern hatchery. The airborne concentrations of the total microorganisms were in the range of 9.2-1236.5 × 10(3) CFU/m(3) , of the total mesophilic bacteria 3.5-1225.8 × 10(3) CFU/m(3) , of Gram-negative bacteria 0.0- 46.2 × 10(3) CFU/m(3) , of thermophilic actinomycetes 0.0-7.1 × 10(3) CFU/m(3) , of fungi 2.1-77.9 × 10(3) CFU/m(3) , and of bacterial endotoxin 0.00925-429.55 µg/m(3) . The frequency of work-related symptoms ranged between 21.7-63.8%. In a meta-analysis for assessment of the correlations between the log-transformed concentrations of airborne microbial agents and the occurrence of work-related symptoms, the multiple regression test was applied. Statistically significant correlations were found between the occurrence of work-related symptoms and the concentration of total airborne microorganisms (R=0.748555; P=0.020317), mesophilic bacteria (R=0.7573; P=0.029548), Gram-negative bacteria (R=0.835938; P=0.019129), and endotoxins (R=0.705356; P=0.03378). The correlations between the concentrations of thermophilic actinomycetes and fungi, on one side, and frequency of work-related symptoms on the other, did not attain the threshold of significance (P=0.087049 and P=0.062963, respectively). Results of the meta-analysis confirm harmful health effects of the total airborne microorganisms, total airborne mesophilic bacteria, airborne Gram-negative bacteria, and airborne bacterial endotoxin on the occupationally-exposed agricultural workers, and indicate a need for the establishment of internationally recognized occupational exposure limits for these microbial agents.

Age influence on hypersensitivity pneumonitis induced in mice by exposure to Pantoea agglomerans

Hypersensitivity pneumonitis (HP) represents the immunologically mediated lung disease induced by repeated inhalations of a wide variety of certain finely dispersed organic antigens. In susceptible subjects, these inhalations provoke a hypersensitivity reaction characterized by intense inflammation of the terminal bronchioles, the interstitium and the alveolar tree. The inflammation often organizes into granulomas and may progress to pulmonary fibrosis. Our previous work indicated that cell extract of gram-negative bacteria Pantoea agglomerans (SE-PA) causes, in young C57BL/6J mice, pulmonary changes that are very similar to the clinical manifestations of HP in men. The purpose of presented studies was to describe the response of mice immune system while exposed to SE-PA. Particular attention was paid to examine the age influence on SE-PA induced inflammation and fibrosis in lung tissue. We used 3- and 18-month-old C57BL/6J mice. Lung samples were collected from untreated mice and animals exposed to harmful agent for 7 and 28 days. HP development was monitored by histological and biochemical evaluation. Using ELISA tests, we examined concentration of pro- and anti-inflammatory cytokines in lung homogenates. Our study demonstrated again that SE-PA provokes in mice changes typical for the clinical picture of HP, and that successive stages of disease (acute, subacute and chronic) might be obtained by modulation of time exposure. Furthermore, we found that animals' age at the time of sensitization influences the nature of observed changes (cytokine expression pattern) and the final outcome (reaction intensity and scale of fibrosis).

Relationship between COPD and lower socioeconomic status in farmers from South-Eastern Poland (Lublin region)

INTRODUCTION

Lower socioeconomic status is considered to be an independent risk factor of chronic conditions, such as chronic obstructive pulmonary disease (COPD). COPD, one of the major public health problems worldwide, is a chronic inflammatory lung disease of a multifactorial background. COPD morbidity in rural areas has been higher than in urban settings, as apart from the major causative factor, tobacco smoking, the burden of this disease in rural environments is also connected to additional occupational factors (organic dusts). The management of chronic diseases seems to be particularly difficult in rural areas. The aim of the study was to analyze the socioeconomic status of farmers suffering from COPD in comparison to healthy farmers.

METHODS

Thirty farmers with COPD and 34 healthy farmers from the Lublin region (Poland) were investigated based on the area of land they possessed (an indicator used in the health insurance system in Poland to classify farmers). The farmers from five rural communes were selected by general practitioners. Statistical analysis was performed by non-parametric Mann-Whitney U-test for the differences between area of farms. The p < 0.05 level was considered as significant.

RESULTS

Area of land (median: 1.5 ha, 25th-75th percentile: 1.0-4.0) owned by farmers with COPD was significantly lower than area of farms belonging to healthy farmers (median: 7.0 ha, 25th-75th percentile: 3.0-10.0) (p < 0001, Mann-Whitney U-test).

CONCLUSIONS

In rural areas individuals with COPD are characterized by significantly lower socioeconomic status than healthy persons. COPD is a major health problem, especially in rural areas, which may indicate that policy-makers should consider addressing equity in COPD management in rural areas.

Cathelicidin LL-37 in bronchoalveolar lavage and epithelial lining fluids from healthy individuals and sarcoidosis patients

Sarcoidosis is a granulomatous disease of unknown etiology most often characterized by pulmonary manifestations. Changes in an innate immune system, involving antimicrobial peptides, have been noted during the course of pulmonary sarcoidosis. This study focuses on the level of LL-37 peptide, the only human cathelicidin, additionally characterized by a wide range of pleiotropic activities, in pulmonary sarcoidosis. A cross-sectional study was conducted in groups of 32 patients with sarcoidosis and 12 healthy individuals. Bronchoalveolar lavage fluid (BALF) sampling, followed by LL-37 measurements by mass spectrometry combined with previous immunoaffinity purification, was performed. Based on urea levels, concentrations of LL-37 in epithelial lining fluid (ELF) were calculated. The levels of LL-37 peptide in BALF samples derived from patients with pulmonary sarcoidosis (median: 17.45 pg/ml, 25th-75th percentile: 8.05-28.33 pg/ml) were significantly higher compared to the healthy group (median: 6.38 pg/ml, 25th-75th percentile: 4.90-11.55 pg/ml) (U Mann-Whitney test, p=0.04). Assessment of LL-37 in ELF confirmed the differences across the groups that were observed in BALF. The level of LL-37 in patients with sarcoidosis (median: 2.25 ng/ml, 25th-75th percentile: 1.03-5.06 ng/ml) was again higher compared to healthy individuals (median: 0.62 ng/ml, 25th-75th percentile: 0.43-2.17 ng/ml) (p=0.06, Mann-Whitney U test). The results of this study demonstrate that the level of LL-37 peptide is elevated in pulmonary compartment affected by sarcoidosis. This might have a meaning in the pathomechanism of the disease, especially taking into consideration versatile activity of human cathelicidin revealed in numerous experimental studies during the last years.

Cathelicidin LL-37 in bronchoalveolar lavage and epithelial lining fluids from COPD patients and healthy individuals

Innate immunity is currently under scope of interest concerning its role in the development of chronic obstructive pulmonary disease (COPD). Antimicrobial peptides constitute a potent part of this fast response system. Here, we focus on the role of a specific antimicrobial peptide, the only human cathelicidin, the pleiotropic LL-37 peptide, in the development of COPD under clinical conditions. A cross-sectional study was conducted in groups of 43 patients with COPD (previously classified according to GOLD) and 12 healthy individuals. Bronchoalveolar lavage fluid (BALF) sampling, followed by LL-37 measurements by mass spectrometry combined with previous immunoaffinity purification, was performed. Based on urea levels, concentrations of LL-37 in epithelial lining fluid (ELF) were calculated. Additionally, an antimicrobial assay of growth inhibition of two bacterial species, often involved in COPD development mechanisms, by purchased LL-37 was conducted. Altogether, 55 BALF samples were analyzed. LL-37 levels were significantly higher in BALF from patients in early stages of COPD (GOLD I-II) compared to BALFs from healthy individuals. The same was true for ELF. Cathelicidin’s concentration was significantly lower in both BALF and ELF from patients in advanced COPD (GOLD III-IV). The significantly elevated LL-37 levels both in BALF and ELF in patients with COPD at stage GOLD I-II together with reduced levels in advanced (COPD stage III-IV) further supports the innate immunity involvement in COPD pathology and suggests a profound change in non-specific immunity during the disease progression.

Mouse model of hypersensitivity pneumonitis after inhalation exposure to different microbial antigens associated with organic dusts

The aim of this study was to reproduce in laboratory conditions hypersensitivity pneumonitis (HP) pathogenesis in a new animal model predictive of the human response, and to select the microbial antigen associated with organic dust that exerts the strongest pathogenic effect on the respiratory organ. To achieve this goal, mice of the strain C57BL/6J prone to fibrosis were exposed for 1 hour daily up to 28 days to the inhalation of aerosols of each of the 5 microbial components of organic dusts whose conjunction with the occurrence of HP has been confirmed by numerous authors: Pantoea agglomerans saline extract (SE), P. agglomerans microvesicle-bound endotoxin, Saccharopolyspora rectivirgula SE, Aspergillus fumigatus SE, saline extract of dust from a grain sample overgrown with S. rectivirgula and Thermoactinomyces vulgaris, and a saline solvent (PBS) was used as a control. Exposure of the animals to organic dust components was conducted using a novel inhalation challenge set. Lung samples were collected from untreated mice and from mice exposed for 7 and 28 days, and examined by digitalized histopathology and biochemistry for the presence of inflammatory changes and fibrosis. P. agglomerans SE appeared to be the sole antigen which evoked a statistically significant fibrosis and a significant increase of hydroxyproline in the lungs of mice exposed for 28 days to this extract, both compared to the mice untreated and to those exposed to the solvent. P. agglomerans SE also evoked the strongest and statistically significant inflammatory response in the lungs of the mice, both after 7 and 28 days of exposure. After 7 days, significant inflammatory changes were also found in mice exposed to A. fumigatus SE, and after 28 days in mice exposed to all antigens. In conclusion, our results allow us to define a useful animal model of HP which can be a supplement for now commonly used bleomycin model. This model should comprise: present set of instruments for inhalation, mice of the line C57BL/6J and the saline extract of P. agglomerans as the antigen. For a better understanding of the presented results, a detailed study covering immunological investigations, focused on the mechanism of antigen action, are needed.

Cathelicidin LL-37, granzymes, TGF-beta1 and cytokines levels in induced sputum from farmers with and without COPD

The cathelicidin LL-37 is an antimicrobial and lipopolysaccharide neutralizing peptide, possessing pro-inflammatory, tissue repair and remodeling activities. Recent reports indicate that the progression of COPD might be connected with increased levels of LL-37. The numerous experimental data show the potential role of LL-37 in the response to the exposure to organic dust (containing lipopolysaccharide and microorganisms) which is one of the major COPD causative factors. This work strives to further prove the role of LL-37 in the development of COPD. A cross-sectional study was conducted in 30 farmers in the early stages of COPD according to GOLD, 36 healthy farmers and 16 healthy urban dwellers. Collection of induced-sputum samples and lung function testing were conducted before and after work. The quantification of the LL-37 in sputum samples was performed by mass spectrometry and radioisotope techniques. Levels of granzymes A and B, IL-8, IFN-gamma and TGF-beta1 in sputum were measured by ELISA technique. Statistical analysis was conducted by Kruskal-Wallis and Mann-Whitney U tests. Significantly higher levels of LL-37 were observed in sputum samples from farmers with COPD compared to healthy individuals. The concentration of LL-37 in sputum from farmers was significantly higher compared to urban dwellers. The same was true for both granzymes A and B. The results of this study suggest that LL-37 and granzymes A and B may add to the development of COPD. The results suggest also their role in an organism's response to organic dust exposure.

Occupational exposure to organic dust, microorganisms, endotoxin and peptidoglycan among plants processing workers in Poland

The objective of present work was to determine and compare the components of bioaerosol in several sectors of plant processing industries. The study was conducted in 10 facilities engaged in herb and grain processing, flax threshing, grain storing, baking, and cereals production. The air samples were taken on glass fibre filters with an AS-50 sampler. We determined the concentrations of airborne microorganisms, dust, endotoxin and peptidoglycan. Total concentrations of viable airborne microorganisms ranged from 0.18-861.4 x 10(3) cfu/m(3). The highest levels of microbial contamination of the air were observed at flax farms, in grain elevators and in a herb processing plant. Gram-positive bacteria and fungi were detected at all sampling sites and their median concentrations were respectively 18.1 x 10(3) cfu/m(3) and 0.66 x 10(3) cfu/m(3). The concentration of Gram-negative bacteria ranged from 0.0-168.0 x 10(3) cfu/m(3). The concentration of thermophilic actinomycetes ranged from 0.0-1.45 x 10(3) cfu/m(3). Qualitatively, Gram-positive bacteria constituted 23-93% of the total microbial count. The most common species were: Staphylococcus spp., Curtobacterium pusillum, Rhodococcus fascians, Aureobacterium testaceum, Sanguibacter keddieii, Microbacterium spp., and Bacillus spp. Gram-negative bacteria formed 0-48% of the total count. The species Pantoea agglomerans dominated in all examined air samples. Fungi constituted 2.5-76.9% of the total microbial count. Among them, Penicillium spp., Mucor spp., Alternaria spp., Aspergillus niger, and Aspergillus spp. were found. The dust concentration ranged from 0.18-86.9 mg/m(3). The concentration of endotoxin was large and ranged from 0.0041-1562.6 microg/m(3). Muramic acid, the chemical marker of peptidoglycan, was detected in 9 out of 13 (69.2%) collected samples. The concentration of peptidoglycan ranged from 1.93-416 ng/m(3). A highly significant correlation was found between the individual components of bioaerosol determined in this study. The concentration of endotoxin was correlated with the concentration of Gram-negative bacteria, total microorganisms, and peptidoglycan (R>0.9, p<0.001). The concentration of peptidoglycan was correlated with the concentration of Gram-positive bacteria, Gram-negative bacteria, and total microorganisms (R>0.9, p<0.001).

Respiratory disorders in two workers of customs depositories occupationally exposed to mouldy tobacco

Work-related respiratory symptoms, including dyspnoea, cough, fever, tiredness and malaise, were recorded in two customs officers employed in 2 depositories of confiscated cigarettes, of which one showed signs of dampness. Microbiological sampling of the air and the cigarettes stored in a damp depository revealed the presence of potentially pathogenic fungi and bacteria and the biochemical markers of bacterial lipopolysaccharide and fungal biomass. The Penicillium species (P. simplicissimum, P. inflatum, P. commune) dominated in the damp depository, while in the other one Aspergillus fumigatus was prevalent. The patients under study did not show a specific sensitization to microbial allergens in the precipitin test, the test for inhibition of leukocyte migration and the bronchial provocation challenge, except for a weak reaction to fungal allergens in the test for inhibition of leukocyte migration. Moreover, one patient responded with subjective symptoms after exposure to inhalation of increased doses of Penicillium simplicissimum antigen. Both cases were diagnosed as a specific form of organic dust toxic syndrome (ODTS). It is hypothesized that the symptoms were evoked most probably by the non-specific action of low molecular fungal metabolites, such as mycotoxins or VOCs (volatile organic compounds), with the possible contribution of bacterial endotoxin. However, as there is no a direct proof to support this presumption, and the effects of nicotine and other tobacco constituents cannot be excluded, further studies are needed to elucidate etiopathogenesis of the disorders associated with the exposure to stored tobacco.

Health effects of exposure to organic dust in workers of a modern hatchery

The aim of the presented study was to determine the health status of workers occupationally exposed to moderate amounts of organic dust, employed in a modern hatchery with an efficient ventilation system. A group of 32 hatchery workers was examined. As a reference group, 50 urban dwellers not exposed to any kind of organic dust were examined. All people were interviewed for the presence of work-related symptoms and subjected to physical and spirometric examinations. Blood sera were examined for the presence of precipitins against 13 antigens associated with organic dust, and for the presence of total and chicken-specific No significant differences were found between the spirometric values in the group of hatchery workers and the reference group. Positive precipitin reactions were noted mostly with the antigens of Gram-negative bacteria associated with organic dust. The frequencies of positive reactions to antigens of Escherichia coli and Acinetobacter baumannii in hatchery workers were significantly greater compared to the reference group (p<0.05). Precipitin reactions to Gram-positive non-branching bacteria, actinomycetes, fungi and birdactions to antigens of Escherichia coli and Acinetobacter baumannii in hatchery workers were significantly greater compared to the reference group (p<0.05). Precipitin reactions to Gram-positive non-branching bacteria, actinomycetes, fungi and bird protein, were rare or absent. The mean concentration of total IgE in sera of hatchery workers was nearly 3 times greater compared to the reference group, and the difference proved to be statistically significant (p<0.05). No specific IgE antibodies against chicken feathers were detected in the blood of hatchery workers and referents. In conclusion, the examined hatchery workers showed a moderate frequency of work-related symptoms, no decline in lung function and low reactivity to most microbial and bird protein allergens. These results suggest that the effects of exposure to organic dust in workers of modern hatcheries with an efficient ventilation system are less compared to the workers of poultry farms, such as broiler or egg laying houses.

Respiratory effects of exposure to dust from herbs

A group of 150 people occupationally exposed to dust from herbs were examined. As a reference group, 50 urban dwellers, not exposed to any kind of organic dust were examined. People were subjected to routine physical examination and to lung function examinations with the LUNGTEST 500 spirometer (MES, Kraków, Poland). The spirometric values of the forced expiratory volume in one second (FEV (1)), vital capacity (VC) and FEV(1)/VC were recorded before and after work. Physical chest examination revealed pathological crepitations in 10 people (6.7 %). The mean baseline spirometric values in the study and reference groups did not show significant differences compared to the normal values. In the herb workers exposed to organic dust the post-shift decrease of all analysed spirometric values was noted. The post-shift decrease of some spirometric values (VC, VC % of normal values) was highly significant (p < 0.01). There was evidenced of a significant positive correlation between the age of examined people and decrease of VC and FEV(1) values. In 12 exposed workers the decrease of FEV(1) or FEV(1) % of normal values higher than 15 % was noted. 50 % of these workers cultivated thyme (Thymus vulgaris L.). This may suggest that dust from herbs, especially thyme dust, may cause acute airway obstruction. In the group showing significant decrease of FEV(1)/FEV(1) % of normal values ( > 15 %) the frequency of reported respiratory work-related symptoms (83.3 %) was higher than in the rest of exposed group (61.5 %). In conclusion, occupational exposure to dust from herbs may cause harmful effects on the respiratory system among herb processing workers. This indicates the need for use of prophylactic measures in this professional group, the more so as number of people occupationally exposed to dust from herbs is growing.

Health effects of exposure to herb dust in valerian growing farmers

The aim of the present study was to determine the health status of farmers cultivating valerian (Valeriana officinalis L.) and occupationally exposed to dust from this plant. A group of 75 valerian growing farmers were examined. As a reference group, 50 urban dwellers, not exposed to any kind of organic dust were examined. All people were interviewed for the presence of work-related symptoms and subjected to physical and spirometric examinations. Skin prick tests were conducted with 4 microbial antigens associated with organic dust and 3 herbal extracts, precipitin tests with 12 microbial antigens and 4 herbal extracts and tests for specific inhibition of leukocyte migration with 4 microbial antigens. 30.7 % of the valerian farmers reported occurrence of work-related symptoms. No significant differences were found between the spirometric values in the group of valerian farmers and the reference group. Valerian farmers showed a low frequency of positive skin reactions to all tested antigens (0-4.0 %), not significantly greater compared to reference group. The frequency of positive precipitin reactions to the antigen of Gram-negative bacterium Pantoea agglomerans was very high in valerian farmers (45.5 %) with 3-fold concentrated sera and significantly greater compared to the reference group (p < 0.001). The positive precipitin response of valerian farmers to other microbial and herbal antigens was much lower or absent and did not show any difference compared to reference group. In the test for specific inhibition of leukocyte migration, the highest frequencies of positive reactions in valerian farmers were noted with Pantoea agglomerans and Saccharopolyspora rectivirgula (15.0 % each), in both cases significantly greater compared to reference group (p < 0.05). In conclusion, the farmers growing valerian showed a moderate frequency of work-related symptoms and low reactivity to most microbial and herbal allergens. They exhibited an increased immunologic response to Gram-negative bacterium Pantoea agglomerans which appears to be the most important risk factor associated with valerian dust.

Immunologic reactivity to work-related airborne allergens in people occupationally exposed to dust from herbs

A group of 150 people occupationally exposed to dust from herbs were examined. The examined group consisted of 47 thyme farmers, 32 chamomile farmers, 31 sage farmers and 40 workers of herbs processing industry. As a reference group, 50 urban dwellers, not exposed to any kind of organic dust, were examined. Skin prick tests and precipitin tests were conducted with, respectively, 4 and 11 microbial antigens associated with organic dust. Both skin and precipitin tests were also conducted with herbal extracts of chamomile and sage. Precipitin tests were carried out with sera not concentrated and sera 3-fold concentrated. Tests for inhibition of leukocyte migration (MIF) were also conducted with 4 microbial antigens. People occupationally exposed to dust from herbs showed a higher frequency of positive skin reactions to microbial antigens compared to the reference group. The results of precipitin test also revealed greater reactivity to the environmental microbial antigens in the examined group, compared to the reference group. The highest frequency of positive results was noted with the antigen of Pantoea agglomerans (30.6 % with sera not concentrated and 48.3 % with sera 3-fold concentrated) - the difference compared to the reference group (12.0 %) was highly significant (p < 0.01). The frequencies of positive results of MIF test in the examined group were high with all antigens tested: Arthrobacter globiformis (12.6 %), Pantoea agglomerans (11.1 %), Saccharopolyspora rectivirgula (17.0 %), Aspergillus fumigatus (13.3 %), and, compared to the reference group with no positive result for any antigen, all the differences were significant (p < 0.05). In conclusion, the frequency of positive allergological reactions to airborne microorganisms was high in people occupationally exposed to dust from herbs and suggests a potential role of microbial allergens in the pathogenesis of work-related health disorders among herb workers. The risk of sensitization seems to be greatest among thyme farmers, who showed the highest positive response. The results confirmed the particular allergenic importance of Gram-negative bacterium Pantoea agglomerans.

Differences in clinical test results of patients with bronchial asthma and living environment. Research in rural and urban areas in the eastern part of Poland

The objective of the research was to evaluate immunological and clinical parameters in bronchial asthma patients from rural and urban areas in the east part of Poland. The study comprised 55 subjects reporting from November 2001 to January 2002 at the Pulmonary Department in order to have the disease diagnosed or to continue the treatment. The type of symptoms was determined on the basis of the standardized questionnaire. The patients were subjected to spirometry and skin prick tests. Blood eosinophil number as well as total and specific IgE levels were also evaluated. Significant (p<0.05) disturbances in respiratory parameters were found in 23% of patients living in the city and in 50% of subjects from the rural area. The level of IgE against grass pollens was significantly (p<0.01) higher in urban residents. The level of IgE against house dust was similar in both groups. Our study shows important differences between clinical manifestation of asthma in rural and inner-city patients and indicates that different aetiology may play an important role in asthma development.

Acute allergy reaction after posterior sub-Tenon's triamcinolone injection in the treatment of intermediate uveitis in the asthmatic patient

We report the case of a 21-year-old female patient afflicted with atopic asthma admitted to hospital in order to diagnose and treat bilateral uveitis. After diagnostic examination: serological tests for Candida and Aspergillus antigens, analysis of direct vitreous preparation and of culture searching for fungal and bacterial etiology, tests for antinuclear antibodies and for boreliosis, the diagnosis of idiopathic intermediate uveitis (pars planitis) were made. Routine treatment with Polcortolon in sub-Tenon's triamcinolone injection was applied. It resulted in acute allergic reaction characterized by blepharedema and chemosis. Hydrocortisone, Clemastin, Zyrtec, Calcium and locally Dexamethasone and Emadine in drops instilled to conjunctival sac were administered resulting in symptom disappearance.

Health effects of exposure to thyme dust in a group of thyme growing farmers

Medical examinations were performed in a group of 47 thyme farmers from eastern Poland while threshing thyme (Thymus vulgaris). As a reference group 63 urban dwellers were examined not exposed to organic dusts. The examinations included an interview concerning the occurrence of respiratory disorders and work-related symptoms, physical examination, lung function tests, skin prick tests with four microbial allergens and agar-gel precipitation tests with 12 antigens. 63.8% of thyme handling farmers reported occurrence of work-related symptoms while threshing thyme. The most common complaints were: blocking of the nose (reported by 18 farmers--38.3%), dry cough (14 persons--29.8%) and general weakness (13 persons--27.7%). The mean spirometric values in the farmers group were within a normal range and did not show a significant post-work decline. The farmers showed positive skin reactions to microbial antigens in the range of 4.3-14.9%, and a frequency of positive precipitin reactions 0-56.5%. The reference group responded to most allergens with a significantly lower frequency of positive results compared to the examined group. In conclusion, thyme farmers engaged in threshing this herb represent a group of elevated professional risk because of high incidence of work-related symptoms and common occurrence of positive skin and precipitin reactions to bacterial and fungal allergens associated with organic dust.

Evaluation of the effectiveness of short-term smoking cessation treatment in patients of the Pulmonary Department, Medical University of Lublin

From August to December 2001 antinicotine program was performed in the Pulmonary Department of the Medical University of Lublin in order to achieve smoking cessation of hospitalized patients, their families and other people coming to the ambulatory during the "open door" days. The usefulness of the smoker's registration in a specialist ambulatory and effectiveness of specialist advice was analyzed. Three hundred ninety persons were examined and given advice. One hundred thirty-four patients (34.4%) were included in the study during hospitalization, 256 (65.5%) during open door action and from patients' families. Fifty-eight (14.9%) persons had Zyban prescribed, 23 (5.9%) nicotine replacement medications. 183 persons came for control visit (46.9%). One hundred and one subjects resist nonsmoking within the month after first visit. In all of them CO concentration in the expired air was normal. This made patients' declaration more objective. Consciousness of tobacco smoking harmfulness and activities taken to quit smoking seem to rise among the Lublin region population. Accessibility of spirometric tests in the screening diagnosis of COPD, one of the main tobacco-related diseases, rises as well. A specialist plays the main role in motivating the patient to smoking cessation. He shows the patient benefits of such an activity during diagnostic and therapeutic process, keeps essential control and supports psychologically. The family doctor has to play a similar role. There is considerable relative effectiveness of short-term antinicotine treatment. Hospitalization favors resisting smoking, especially when the hospital is a tobacco smoke free zone.

Health effects of inhalation exposure to organic dust in hops farmers

Medical examinations were performed in a group of 23 hops farmers exposed to organic dust from hop (Humulus lupulus). The examinations took place in individual farms during harvesting, sorting and transporting of hop cones. As a reference group, 50 urban dwellers not exposed to organic dust were examined. There were conducted physical examinations, interviews concerning the occurrence of respiratory disorders and work-related symptoms, lung function tests, determination of cytokines concentrations, and allergological tests comprising skin prick test with 4 microbial antigens associated with organic dust, precipitin test with 12 microbial antigens, and a test for inhibition of leukocyte migration. Five farmers (21.7%) reported occurrence of work-related symptoms, including dry cough and dyspnoea. Eight farmers (34.8%) reported symptoms of chronic bronchitis. Mean spirometric values were within normal ranges. The farmers showed positive responses in precipitin test and test for inhibition of leukocyte migration to antigens of environmental microbes, mainly to the antigen of Gram-negative bacterium Pantoea agglomerans. The results showed a potential risk of occupational respiratory diseases in the population of hops farmers.

Prevalence of antibodies to Coxiella burnetii among farming population in eastern Poland

The presence of blood serum antibodies to Coxiella burnetii phase I antigen, indicative of chronic Q fever or convalescence, was found by indirect immuno-fluorescent test in 16 out of 90 examined farmers (17.8 %) living in the Lublin region (eastern Poland) and in none of 30 examined urban blood donors living in the city of Lublin (p < 0.05). In both groups no antibodies to C. burnetii phase II antigen, indicative of acute Q fever, were detected. The frequency of antibodies among farmers was greater in females than in males (26.1 % versus 9.1 %, p < 0.05) and was significantly dependent on age ( xi(2) = 146.42, p < 0.000001) being greatest in the subgroup of farmers aged 41-55 (38.5 %) while no positive reactions were found in young and elderly farmers (respectively, equal to or below 25 and above 56 years). The results suggest that the examined agricultural region could be in the past an epidemic area of Q fever, probably before 15-30 years.

The effects of exposure to organic dust on the respiratory system of potato processing workers

A cross-sectional study was carried out to evaluate lung function and the prevalence of work-related symptoms in workers of a potato processing plant located in Lublin region (eastern Poland). The study group comprised 61 workers employed in 2 departments. The examination included: physician-administrated questionnaire on occurrence of work-related symptoms, occupational history and smoking habits. Spirometry was performed before (7:00-8:00) and after (16:00-17:00) the morning shift. Altogether 41/61 (67.2%) subjects reported at least one symptom associated with their job. Pulmonary symptoms were recorded in 28/61 (45.9%) subjects. The most commonly recorded complaints were: cough (44.3%), hoarseness (19.7%), shortness of breath (18%), followed by headache and skin lesion (13.1% each), and eye and nose irritation (11.5%). The prevalence of work-related symptoms (except for eye and nose irritation) was higher in the group of subjects working longer than 4 years (the difference was statistically significant only for skin lesion). Among non-smoking workers a significantly higher prevalence of headache was seen compared to smokers (Fisher's test, p < 0.05). Smokers complained more frequently of respiratory symptoms such as cough, shortness of breath, hoarseness and chest pain. The difference was significant only for cough (p < 0.05). A statistically significant over-shift decline in all measured spirometric values: FVC, FEV(1) (p < 0.001), FEV(1)/VC (p < 0.05), PEF (p < 0.01) was observed.

Work-related symptoms among furniture factory workers in Lublin region (eastern Poland)

48 woodworkers employed in the furniture factory were examined. The control group consisted of 41 office workers with no exposure to organic dust. The examination included: interview on work-related symptoms, physical examination, and lung function test performed before and after the working-day. 38 out of 48 (79.2%) woodworkers reported work-related symptoms. The most common complaint was dry cough reported by 25 workers (52.1%), followed by general malaise -- reported by 17 (35.45%), conjunctivitis -- by 16 (33.3%), rhinitis - by 16 (33.3%), and skin symptoms by 16 (33.3%). Other symptoms such as headache, shortness of breath and chest pain occurred less frequently. Subjects working in initial processing and board processing departments had a higher prevalence of cough compared to workers employed in the varnishing department (p < 0.01). The prevalence of skin symptoms was significantly higher in board processing and varnishing departments compared to initial processing department (p < 0.05). Occupational asthma and allergic alveolitis were recorded in 3 out of 48 (6.2%) and 2 out of 48 (4.2%) workers, respectively. Baseline FVC and FEV(1) values were lower in woodworkers compared to controls (p < 0.01). The increased lung function parameters (FVC, FEV(1)) were observed in woodworkers who smoked compared to non-smokers. The difference was not statistically significant. There was a significant over-shift decrease of all measured spirometric values: FVC, FEV(1)), FEV(1)) /VC, PEF among woodworkers (p < 0.001). There was a significant pre-shift, post-shift decline in FVC, FEV(1)), FVC/FEV(1)), and PEF among workers under 30 years of age (p < 0.001). The same tendency was seen for FVC and FEV(1)) in subjects over 30. The percentage changes in FVC and FEV(1)) were greater in the group of younger workers (15.1% and 17.6%) respectively, than in the group of older subject (6.2%, 7.1%). The difference was not statistically significant.

Response of herb processing workers to work-related airborne allergens

A group of 51 herb processing workers employed in a big herb processing facility located in eastern Poland were examined by the skin and precipitin tests with, respectively, 4 and 17 extracts of microorganisms associated with organic dusts. Out of this number, 32 workers were examined by the skin test with 7 extracts of selected herbs processed in the facility. All the subjects were asked about the occurrence of work-related symptoms. 32 healthy office workers were examined with microbial extracts as a reference group. The herb processing workers showed a high proportion of early skin reactions (after 20 min) to the extract of Gram-negative bacterium Alcaligenes faecalis (41.2%), significantly higher compared to the reference group (p<0.01). At all time intervals (20 min, 8 hrs, 24 hrs), the workers responded with a high frequency to the extract of Bacillus subtilis (respectively 72.5%, 64.7%, and 15.7%), significantly greater compared to the reference group (respectively p<0.001, p<0.001, and p<0.05). No significant differences were found between the groups of herb processing workers and referents in skin response to the extracts of Streptomyces albus and Alternaria alternata and, except for the extract of Pantoea agglomerans, in the frequency of positive precipitin reactions to microbial antigens. In the skin test with herb extracts, the highest response among workers were caused by the extracts of chamomile flowers and nettle leaves which evoked 40-65% of positive skin reactions at all time intervals. 39 out of 51 interviewed herb processing workers (76.5%) reported the occurrence of work-related general, respiratory and skin symptoms. The positive skin reactions occurred more frequently among symptomatic workers which suggests that the specific immunologic response might be implicated in etiopathogenesis of work-related symptoms in examined workers. However, in most cases the differences did not attain a significance level which indicates that there is no direct relationship between a positive immunologic response and the appearance of symptoms caused by occupational exposure to herb dust, and that most probably a considerable part of these symptoms might be also due to non-specific immunologic and/or toxic mechanisms.

Effects of exposure to flax dust in Polish farmers: work-related symptoms and immunologic response to microbial antigens associated with dust

Medical examinations were performed in a group of 51 Polish farmers heavily exposed to flax dust during harvesting and scutching (threshing) and in a group of 50 healthy urban dwellers not exposed to organic dusts (controls). The examinations included: interview concerning the occurrence of respiratory disorders and work-related symptoms, physical examination, X-ray examination of chest, lung function tests, oxymetric examinations, determination of the concentration of cytokines (IL-1alpha IL-6, TNFalpha) in blood serum and allergological tests with microbial antigens associated with organic dust, comprising: skin prick test with 4 antigens, agar-gel precipitation test with 12 antigens and test for specific inhibition of leukocyte migration with 4 antigens. As many as 32 farmers (62.7%) reported the occurrence of work-related symptoms during harvesting, transporting and scutching of flax. The most common complaint was general weakness reported by 15 farmers (29.4%), followed by headache reported by 14 (27.5%), blocking of the nose - by 11 (21.6%), dry cough, shivering, and eyes itching - each by 10 (19.8%), chest tightness and hoarseness - each by 9 (17.6%). No control subjects reported these work-related symptoms. The mean spirometric values in the examined group of farmers were within a normal range and did not show a significant post-shift decline. In contrast, a significant post-shift decline of oxymetric values was found among flax farmers. The farmers showed a frequency of the positive early skin reactions to environmental allergens in the range of 0-19.6%, a frequency of positive precipitin reactions in a range of 0-56.9%, and frequency of positive reactions of leukocyte migration inhibition in a range of 7.8-21.6%. The members of the control group responded to the majority of allergens with a significantly lower frequency of positive results compared to the farmers. Elevated concentrations of IL-1alpha and IL-6, but not TNFalpha, were found in blood sera of flax farmers. In conclusion, farmers engaged in harvesting and scutching of flax represent a group of elevated professional risk because of high incidence of work-related symptoms and high frequency of allergic reactions to bacteria and fungi associated with organic dust.

Allergic alveolitis due to herb dust exposure

We report an episode of allergic alveolitis in a female farmer due to massive exposure to organic dust contaminated with microorganisms during threshing of herbs (thyme). The patient's medical history, the results of exposure test, inhalation challenge, and bronchoalveolar lavage suggested the diagnosis of allergic alveolitis

Study on exposure of pig farm workers to bioaerosols, immunologic reactivity and health effects

Occupational inhalation of organic dust may be a cause of numerous symptoms and diseases. Organic dust consists of various biological compounds which induce inflammatory reactions in the lungs on an immunotoxic or allergic basis. Bacteria and their metabolites, moulds and their spores, mycotoxins, glucans, and other still unidentified substances, can be potential aetiologic factors of diseases caused by organic dust. The aim of this study was to determine the concentration and composition of airborne microflora in typical Polish swine buildings and to assess the health conditions of the workers employed within them. Total concentration of microorganisms in the air of five examined swine breeding farms ranged from 613.7-1246.7 x 10(3) cfu/m3 (mean value 930.6 x 10(3) cfu/ m3). The examination of 53 employees working in the swine buildings included their medical history, physical examination, spirometry, and allergological tests. Work-related symptoms were reported by 31 (58.5%) of the subjects. No abnormal findings were present upon physical and spirometric examinations. The results suggest the common occurrence of work-related respiratory disease in swine workers, mostly corresponding to the Organic Dust Toxic Syndrome (ODTS).

Effects of exposure to grain dust in Polish farmers: work-related symptoms and immunologic response to microbial antigens associated with dust

Medical examinations were performed in a group of 76 Polish farmers heavily exposed to grain dust during harvesting and threshing, and in a group of 63 healthy urban dwellers not exposed to organic dusts (controls). The examinations included: interview concerning the occurrence of respiratory disorders and work-related symptoms, physical examination, lung function tests, and allergological tests comprising skin prick test with 4 microbial antigens associated with grain dust and agar-gel precipitation test with 12 microbial antigens. As many as 34 farmers (44.7%) reported the occurrence of work-related symptoms during harvesting and threshing. The most common was dry cough reported by 20 individuals (26.3%). Dyspnoea was reported by 15 farmers (19.7%), tiredness by 12 (15.7%), chest tightness by 8 (10.5%), plugging of nose and hoarseness by 5 each (6. 5%). No control subjects reported these work-related symptoms. The mean spirometric values in the examined group of farmers were within the normal range, but a significant post-shift decrease of these values was observed after work with grain. The farmers showed a frequency of the positive early skin reactions to environmental allergens in the range of 10.8 - 45.5%, and a frequency of positive precipitin reactions in range of 3.9 - 40.8%. The control group responded to the majority of allergens with a significantly lower frequency of positive results compared to the farmers. The obtained results showed a high response of grain farmers to inhalant microbial allergens and indicate a potential risk of occupational respiratory diseases (such as allergic alveolitis, asthma, Organic Dust Toxic Syndrome) among this population

[Exposure to organic dust and microorganisms as a factor affecting respiratory function of workers of purebred horse farms]

In two farms of purebred horses, microbiological studies of the air and medical examination of the workers were performed. The concentration of microorganisms in the air were within the range 29.2-336.0 cfu x 10(3)/m3. The respirable fraction in most cases was between 30-60% of the total count. The levels of dust and endotoxin were low except for one sampling point where the concentration of endotoxin was as high as 3.44 g/m3. As many as 16 workers out of the total of 31 examined reported occurrence of work-related symptoms. However, the results of physical examination and of lung function tests were within normal range. A high proportion of workers showed a positive skin response to Saccharopolyspora rectivirgula (51.6%) and the presence of precipitins to Acinetobacter calcoaceticus (32.3%). No significant relationship could be found between the presence of symptoms and positive allergological reactions. Total medical results indicate the probability of the occurrence of Organic Dust Toxic Syndrome in high proportion of the workers.