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Hypersensitivity pneumonitis: the dug-well lung.
[allergic bronchopulmonary aspergillosis]
Hypersensitivity
pneumonitis
(
HP
)
,
also
known
as
extrinsic
allergic
alveolitis
,
is
caused
by
a
variety
of
environmental
agents
and
may
present
as
occult
respiratory
illness
.
HP
represents
a
potentially
curable
subgroup
of
interstitial
lung
disease
.
This
study
was
designed
to
examine
a
group
of
patients
with
HP
due
to
a
unique
mechanism
of
environmental
exposure
.
Five
patients
with
HP
were
retrospectively
identified
,
from
our
hospital
records
,
admitted
during
the
period
of
March
2007
to
February
2011
with
history
of
exposure
to
dug
wells
.
The
mode
of
exposure
was
specified
as
multiple
entries
into
a
dug
well
for
different
reasons
.
Other
modes
of
exposure
were
considered
as
criteria
of
exclusion
.
All
of
the
five
patients
had
subacute
HP
based
on
available
clinical
,
radiographic
,
immunologic
,
and
supportive
evidence
and
exposure
.
There
were
additional
allergic
bronchopulmonary
aspergillosis
-like
features
in
one
patient
who
did
not
have
antecedent
asthma
.
The
evaluation
of
patient
records
indicated
a
fungal
etiology
.
The
air
and
soil
from
selected
wells
were
tested
for
fungal
organisms
.
Both
settings
grew
Aspergillus
as
the
predominant
species
.
This
novel
mechanism
of
HP
is
labeled
"
dug-well
lung
"
because
the
disease
was
attributed
to
exposure
to
dug
wells
.
Lung
disease
may
result
from
exposure
to
a
dug
well
.
Farmers
or
mechanics
,
climbing
down
these
damp
wells
for
a
multitude
of
reasons
,
are
prone
to
develop
HP
.
The
public
health
care
personnel
and
farming
community
should
be
made
aware
of
this
potential
occupation-related
health
hazard
.