Hypersensitivity pneumonitis: the dug-well lung

Area of Science:

• Pulmonary Medicine
• Environmental Health
• Occupational Medicine

Background:

• Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a lung disease triggered by environmental agents.
• HP is a potentially curable form of interstitial lung disease.
• A unique exposure mechanism leading to HP was investigated.

Purpose of the Study:

• To examine patients with HP resulting from exposure to dug wells.
• To identify the causative agents and clinical presentation of this novel HP subtype.
• To raise awareness about this occupation-related health hazard.

Main Methods:

• Retrospective review of five patients with HP and dug well exposure (March 2007-February 2011).
• Exclusion of other known HP exposure modes.
• Analysis of clinical, radiographic, immunologic data, and environmental fungal cultures (air and soil).

Main Results:

• All five patients presented with subacute HP linked to dug well exposure.
• Aspergillus was the predominant fungal species identified in well air and soil samples.
• One patient exhibited features similar to allergic bronchopulmonary aspergillosis without prior asthma.

Conclusions:

• A novel mechanism of HP, termed "dug-well lung," is attributed to exposure in dug wells.
• Fungal exposure, particularly Aspergillus, in damp dug wells can cause HP.
• Farmers and mechanics working in dug wells are at risk; public health awareness is crucial.