Farmer's lung in infants and small children

A boy and a girl, 10 weeks and 3 years of age, respectively, were admitted to our department with low temperature, dry cough, fatigue and weight loss. In both patients pulmonary X-rays showed diffuse, bilateral, micronodular infiltrations, and sparse signs of fibrosis. Serum IgG and blood eosinophils were abnormally high. After a stay in hospital for 3 weeks, the patients recovered slowly. However, after a few days at home, they were readmitted with the same symptoms. Family histories revealed that the children lived on farms with huge grain magazines and dryers, where moist grain and straw were stored. Massive amounts of mould spores were cultured from the residential areas, and, in addition, the male patient had an elevated titer to Micropolyspora faeni and the female patient, elevated titers to Thermoactinomyces vulgaris, Micropolyspora faeni, Aspergillus fumigatus and Alternaria alternans. The patients and their families moved from the farms and, for approximately a year, have been without lung symptoms. Farmer's disease in infants and small children is extremely rare. However, the incidence may be increasing due to the tendency in latter years to decentralize grain dryers and store moist grain and straw in big magazines, often close to residential areas.