ABSTRACT
Background: Fibrotic hypersensitivity pneumonitis (fHP) is an immune-mediated interstitial lung disease caused by sensitisation to chronic allergen inhalation. This study aimed to determine prognostic indicators of progression and mortality in fHP. Methods: This was a retrospective, multicentre, observational, cross-sectional cohort study of consecutive patients diagnosed with fHP from 1 January 2012 to 31 December 2021. Multivariate Cox regression analyses were used to calculate hazard ratios (HRs) with 95% confidence intervals for predictors of progression and survival. Results: A total of 403 patients were diagnosed with fHP: median (interquartile range) age 66.5 (14.0)â years, 51.9% females and 55.1% never-smokers. The cause of fHP was mainly fungal (39.7%) or avian (41.4%). Lung biopsy was performed in 269 cases (66.7%). In the whole cohort the variables that were related to mortality or lung transplant were older age (HR 1.08; p<0.001), percentage predicted forced vital capacity (HR 0.96; p=0.001), lymphocytosis in bronchoalveolar lavage (BAL) (HR 0.93; p=0.001), presence of acute exacerbation during follow-up (HR 3.04; p=0.001) and GAP (gender, age and lung physiology) index (HR 1.96; p<0.01). In the group of biopsied patients, the presence of fibroblastic foci at biopsy (HR 8.39; p<0.001) stands out in multivariate Cox regression analyses as a highly significant predictor for increased mortality or lung transplant. GAP index (HR 1.26; p=0.009), lymphocytosis in BAL (HR 0.97; p=0.018) and age (HR 1.03; p=0.018) are also predictors of progression. Conclusions: The study identified several prognostic factors for progression and/or survival in fHP. The presence of fibroblastic foci at biopsy was a consistent predictor for increased mortality and the presence of lymphocytosis in BAL was inversely related to mortality.
ABSTRACT
AIM: To describe the prevalence, clinical characteristics and risk factors of opportunistic infection (OI) in a cohort of patients with inflammatory myopathies, and compare mortality rates between those with and without OIs. METHODS: In total, 204 patients from our myositis cohort were reviewed to identify patients who had experienced an OI during the period 1986-2014. The patients' clinical characteristics, treatments received, and outcomes were systematically recorded. Disease activity at the OI diagnosis and the cumulative doses of immunosuppressive drugs were analyzed, as well as the specific pathogens involved and affected organs. RESULTS: The prevalence of OI in the total cohort was 6.4%: viruses, 44.4% (varicella-zoster virus, cytomegalovirus); bacteria, 22.2% (Salmonella sp., Mycobacterium tuberculosis, M. chelonae); fungi, 16.7% (Candida albicans, Pneumocystis jirovecii); and parasites, 16.7% (Toxoplasmosis gondii, Leishmania spp.). Lung and skin/soft tissues were the organs most commonly affected (27.8%). Overall, 55.6% of OIs developed during the first year after the myositis diagnosis and OI was significantly associated with administration of high-dose glucocorticoids (P = 0.0148). Fever at onset of myositis (P = 0.0317), biological therapy (P < 0.001) and sequential administration of four or more immunosuppressive agents during myositis evolution (P = 0.0032) were significantly associated with OI. All-cause mortality in the OI group was 3.69 deaths per 100 patients/year versus 3.40 in the remainder of the cohort (P = 0.996). CONCLUSIONS: The prevalence of OI was 6.4% in our myositis cohort, higher than the rest of the inpatients of our hospital (1.7%; P < 0.01). High-dose glucocorticoids at disease onset and severe immunosuppression are the main factors implicated.
Subject(s)
Bacterial Infections/chemically induced , Biological Products/adverse effects , Glucocorticoids/adverse effects , Immunosuppressive Agents/adverse effects , Myositis/drug therapy , Opportunistic Infections/chemically induced , Virus Diseases/chemically induced , Adult , Bacterial Infections/diagnosis , Bacterial Infections/immunology , Bacterial Infections/mortality , Biological Products/administration & dosage , Female , Glucocorticoids/administration & dosage , Humans , Immunocompromised Host , Immunosuppressive Agents/administration & dosage , Incidence , Male , Middle Aged , Myositis/diagnosis , Myositis/mortality , Opportunistic Infections/diagnosis , Opportunistic Infections/immunology , Opportunistic Infections/mortality , Prevalence , Retrospective Studies , Risk Factors , Spain/epidemiology , Time Factors , Virus Diseases/diagnosis , Virus Diseases/immunology , Virus Diseases/mortalityABSTRACT
OBJECTIVE: Occupational asthma (OA) is highly prevalent in industrialized countries and nearly 400 causal agents of this condition have been described to date. This study aims to describe the case of a patient who developed OA secondary to exposure to a surfactant agent comprised of alkylamine ethoxylate and a mixture of alkyleneoxy and ethylenediamine. METHODS: We present the case of a male worker in the meat industry suffering from OA resulting from exposure to a surfactant agent used to clean the animal carcass before it is quartered. We performed various tests on the individual, including: a chest computed tomography; total serum immunoglobulin E (IgE) and specific IgE tests against common pneumoallergens; pulmonary function studies; a methacholine test; and a specific inhalation challenge to the surfactant agent. RESULTS: The tests confirmed the diagnosis of OA. CONCLUSIONS: We discuss whether the amines present in the surfactant or the agent itself might be the cause of the condition. Because of the extensive use of surfactants in several types of industries, it is reasonable to think that their possible relationship with OA may have relevant health implications.
