Suda T, Sato A, Ida M, Gemma H, Hayakawa H, Chida K
Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
Chest. 1995 Mar;107(3):711-7. doi: 10.1378/chest.107.3.711.
We describe five patients with hypersensitivity pneumonitis (HP) that was related to using home ultrasonic humidifiers. All patients had micronodular infiltrates on their chest radiograph, and their lung biopsy specimens revealed alveolitis with or without epithelioid cell granulomas. Challenge tests were performed on two patients with the humidifier water and three patients using the humidifier. All patients tested exhibited a positive response. Tests for precipitating antibodies against an extract of the humidifier water gave strongly positive reactions in all patients tested. Precipitins to Cephalosporium acremonium and Candida albicans were also present in all cases, whereas precipitins to thermophilic actinomycetes were not detected. Although cultures of the water grew a variety of fungal and bacterial organisms, thermophilic actinomycetes could not be detected. These findings suggest that thermophilic organisms may not be the causative antigens of HP associated with ultrasonic humidifiers. All five patients had an increase in the bronchoalveolar lavage (BAL) lymphocytes that were predominantly CD4+ lymphocytes. The T helper cell count (CD4) to suppressor T cell count (CD8) ratio was significantly higher than that observed in summer-type HP, and lower than that observed in bird fancier's lung, indicating that the phenotypes of the BAL lymphocytes may vary with the type of HP.
我们描述了五例与使用家用超声加湿器相关的过敏性肺炎（HP）患者。所有患者胸部X线片均有微结节浸润，肺活检标本显示有或无上皮样细胞肉芽肿的肺泡炎。对两名使用加湿器水的患者和三名使用加湿器的患者进行了激发试验。所有受试患者均呈阳性反应。对加湿器水提取物的沉淀抗体检测在所有受试患者中均呈强阳性反应。所有病例中也均存在对顶头孢霉和白色念珠菌的沉淀素，而未检测到对嗜热放线菌的沉淀素。尽管水培养物中生长出多种真菌和细菌，但未检测到嗜热放线菌。这些发现提示嗜热生物可能不是与超声加湿器相关的HP的致病抗原。所有五例患者支气管肺泡灌洗（BAL）淋巴细胞均增加，且以CD4+淋巴细胞为主。辅助性T细胞计数（CD4）与抑制性T细胞计数（CD8）之比显著高于夏季型HP患者，低于养鸟人肺患者，表明BAL淋巴细胞的表型可能因HP类型而异。
