Pigeon breeder's lung (PBL) is an extrinsic allergic alveolitis secondary to inhalation of pigeon antigen [1]. Specifically, this ailment stems from persistent exposure to droppings as well as feather and serum proteins of pigeons and other birds. Hypersensitivity pneumonia is frequently caused by avian antigens [2], which emerge from both domestic exposure [3] and the global poultry handling industry.

The clinical presentation of symptomatic hypersensitivity pneumonitis is characterized as acute, subacute, or chronic, which is associated with symptoms of differing intensity and timing [4] [5]. Acute cases develop hours post exposure and resolve hours to days after withdrawal of exposure. Patients will experience fever, cough, headache, dyspnea, malaise, and chills. The subacute disease is characterized by an insidious onset that may take weeks to months, in which there is a progressive cough, shortness of breath and possibly anorexia. Chronic manifestations of this condition include fatigue, persistent cough, worsening dyspnea, anorexia, and weight loss [6]. Patients with pigeon breeder's lung do not respond to anti-asthma therapy.

Complications

One potential long-term sequela of this disease is the progression to irreversible fibrosis or other structural abnormalities [3] [7].

Physical exam

Vital signs in acute episodes are notable for fever, tachycardia, tachypnea, and oxygen desaturation [6]. The lung exam may be remarkable for use of accessory muscles. Findings on auscultation may include bibasilar crackles.

Patients with chronic disease appear cachectic [6] and exhibit clubbing, weight loss, inspiratory crackles, and signs of respiratory distress.

• Inflammation

  The exponential analysis of the lung pressure-volume (PV) curve (V = A - Be-kp) has been suggested as a method to separate the lung restriction caused by inflammation from that caused by pulmonary fibrosis; a significantly decreased value for the exponential [ncbi.nlm.nih.gov]

  This disease is an inflammation of the alveoli in the lungs caused by an immune response to inhaled allergens from birds. [en.wikipedia.org]

  The inflammation and scarring make it hard to get enough oxygen. The scarring is called pulmonary fibrosis. Breathing in dust or other particles in the air is responsible for some types of interstitial lung diseases. [icdlist.com]

  […] brassy cough, persistant dyspnea and tactnea -treatment may include bed rest, fluids, alleviation of airway obstruction, vaporizers, steam, humidifiers, and sometimes an endotrachial tube has to be put in place to ensure breathing -3-7 days of infection -inflammation [quizlet.com]

• Fatigue

  The subacute form is characterized by the insidious onset of productive cough, dyspnea, and fatigue over weeks to months. Chronic hypersensitivity pneumonitis is characterized by long-term progressive dyspnea, weight loss, cough, and fatigue. [amboss.com]

  Chronic manifestations of this condition include fatigue, persistent cough, worsening dyspnea, anorexia, and weight loss. Patients with pigeon breeder's lung do not respond to anti-asthma therapy. [symptoma.com]

  Additional symptoms may include chills, sweating, aching, and fatigue. Most cases involve typical episodes that are mild and short and may be misdiagnosed. [healthcentral.com]

  In the chronic form there is usually anorexia, weight loss, extreme fatigue and progressive pulmonary fibrosis, which is generally the most serious consequence of the disease because it irreversibly and increasingly diminishes the lungs' efficiency over [en.wikipedia.org]

  The chronic form of hypersensitivity pneumonia results from long term low-grade exposure, and is characterized by dyspnea, chronic cough, fatigue, anorexia and weight loss. PFT typically reveals a restrictive pattern and a decrease in DLCO. [indianpediatrics.net]

• Hypoxemia

  Laboratory studies reveal an increase in the white blood cell count with a shift to the left, hypoxemia, and the presence of precipitating antibodies to the offending agent in serum. [healthcentral.com]

  Chronic : ground-glass attenuation with honeycombing ( fibrotic changes) +/- emphysema Pulmonary function test : : restrictive or mixed restrictive / obstructive pattern Particularly ↓ forced vital capacity Resting hypoxemia, which worsens on exertion [amboss.com]

• Exposure to Pigeon Droppings

  Researchers suggest that just as long-term exposure to cockroaches and mice can lead to allergic conditions in senstive individuals, so also can long term exposure to pigeon droppings. [wildlifecontrolconsultant.com]

• Weakness

  Chest pains, weakness, and loss of weight are later symptoms, as is dyspnea. Diagnosis depends on a careful physical examination, including a chest x-ray. [medical-dictionary.thefreedictionary.com]

• Cough

  Patients will experience fever, cough, headache, dyspnea, malaise, and chills. [symptoma.com]

  Pigeon-breeder's lung should be included in the differential diagnosis when patients present with interstitial lung disease or intermittent cough and dyspnea. No single test confirms the diagnosis. [ncbi.nlm.nih.gov]

  Acute illness is characterized by sudden onset of malaise, chills, fever, cough, shortness of breath, and nausea 4 to 8 hours after exposure to the offending agent. [healthcentral.com]

  […] exposure) Insidious onset of fatigue, productive cough, progressive dyspnea, cyanosis Bilateral rales Weight loss A recurrent 'common cold' with an irritating cough and fever may indicate hypersensitivity pneumonitis ! [amboss.com]

  […] primary form is less severe and shows rapid recovery with node calcification -progressive form, aka darling's disease, is where tissues within lungs become totally calcified and breathing stops (sometimes within a few days) -causes fever, malaise, cough [quizlet.com]

• Dry Cough

  Symptoms Symptoms generally include dyspnea, wheezing, and dry coughs that seem to shake the entire body. Additional symptoms may include chills, sweating, aching, and fatigue. [healthcentral.com]

  The earliest and most common symptom is a cough. Dry at first, this cough later produces sputum, which eventually becomes blood-streaked. [medical-dictionary.thefreedictionary.com]

  Case Report A 12-year-old girl was referred to us with persistent dry cough for 3 years, progressive dyspnea for last 2 years and significant weight loss for last 1 year. She had received anti-tubercular and anti-asthma treatment without any relief. [indianpediatrics.net]

• Rales

  The chronic disease that develops with prolonged exposure to the irritant may be characterized by fever, rales, cyanosis, and, possibly, expectoration of blood. Bibasilar crackles, tachypnea, tachycardia and occasionally cyanosis are present. [healthcentral.com]

  Insidious onset of fatigue; Possible progression to persistent productive cough and dyspnea May begin noticing weight loss Chronic (months after continuous exposure) Insidious onset of fatigue, productive cough, progressive dyspnea, cyanosis Bilateral rales [amboss.com]

• Nausea

  Acute illness is characterized by sudden onset of malaise, chills, fever, cough, shortness of breath, and nausea 4 to 8 hours after exposure to the offending agent. [healthcentral.com]

• Irritability

  […] lymphadenopathy, and dyspnea -fungus is common in animal droppings and the soil of the ohio and mississippi river areas -antibiotics used for treatment -viral infection that attacks respiratory system where larynx swells -characterized by hoarseness, irritability [quizlet.com]

  […] persistent productive cough and dyspnea May begin noticing weight loss Chronic (months after continuous exposure) Insidious onset of fatigue, productive cough, progressive dyspnea, cyanosis Bilateral rales Weight loss A recurrent 'common cold' with an irritating [amboss.com]

  The air brought to the lungs is filtered, moistened, and warmed on its way along the respiratory tract but it can nevertheless bring irritants and infectious organisms, and when the body resistance is low for any reason the lungs may suffer diseases of [medical-dictionary.thefreedictionary.com]

In addition to evaluation of the clinical picture, diagnosis of pigeon breeder's lung is achieved by assessing the patient's environmental exposures [3], detailed history, physical exam, and the appropriate studies. It is also important to rule out differential diagnoses such as tuberculosis, sarcoidosis, connective tissue diseases, mycoplasma, allergic bronchopulmonary aspergillosis, Langerhans cell histiocytosis, malignancies and others [6] [8] [9].

Some authors argue that a diagnosis is achieved by demonstration of specific antibodies, a positive skin prick test, and cessation of symptoms following the withdrawal of exposure [10] [11].

Laboratory

Common findings include neutrophilia (acute cases). Moreover, tests will show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).

Imaging

Chest radiography in acute hypersensitivity pneumonitis reveals poorly defined micronodular or interstitial patterns while chronic cases typically feature progressive fibrosis and linear opacities.

High-resolution CT (HRCT) scanning in acutely ill patients displays ground-glass opacities that are particularly observed in the lower lobes [12]. In the chronic phase, HRCT displays fibrotic changes, centrilobular nodular lesions, honeycombing, traction bronchiectasis, ground glass attenuation, and irregular linear opacities [2] [3] [7].

Other

Pulmonary function tests are important components of the workup. Acute cases will demonstrate a restrictive pattern in which the total lung capacity and forced vital capacity are diminished. Chronic disease is associated with either a restrictive or a mixed picture with both obstructive and restrictive pattern.

Additionally, the diffusing capacity of lungs for carbon monoxide (DLCO) is decreased [6]. The inhalation challenge is another test in which the patient is exposed to the offending agent for confirmation.

Cytology on specimens from bronchoalveolar lavage (BAL) may be inconclusive [6] but will typically display lymphocytosis [13]. A lung biopsy is not necessary, but findings such as foamy histiocytes from interstitial and alveolar samples are consistent with hypersensitivity pneumonia [2] [14].

• Leukocytosis

  The acute form is characterized by fever, flu-like symptoms, and leukocytosis. The subacute form is characterized by the insidious onset of productive cough, dyspnea, and fatigue over weeks to months. [amboss.com]

Phytohaemagglutinin responsiveness was not affected by the hydrocortisone treatment. This may indicate difference between the cell populations that respond, after steroid treatment, to antigen and to mitogenic stimulation. [ncbi.nlm.nih.gov]

Treatment Identification and, if possible, avoidance of the irritant are the initial concerns of treatment. In an occupational setting, improved ventilation and air filtering masks are recommended for mild symptoms. [healthcentral.com]

Treatment is mainly via antigen avoidance and respiratory protection e.g. masks. Corticosteroid treatment has been shown to improve respiratory function in the short term of the allied condition acute farmer's lung. [gpnotebook.co.uk]

Furniture Wheelchair Wound & Scar Care Dental Education and Marketing Exam and Hygiene Gifts Home Care and Preventive Office Restorative and Specialties Safety Sterilization Treatment Laboratory Apparel Blood Bank Chemicals Chromatography Clinical Chemistry [berktree.com]

Prognosis Favorable in the acute stage, but the disease recurs and worsens upon re-exposure Worsens with severity of fibrosis References: [4] [amboss.com]

Exposures to avian antigens must be considered in patients with obstructive lung disease of unknown etiology. [ncbi.nlm.nih.gov]

Etiology Combined type III and type IV hypersensitivity reaction with genetic predisposition Inhalation of organic particles ; ( < 5 microns ), primarily through occupational exposure (notifiable occupational disease) Smokers are less likely to be symptomatic [amboss.com]

Although the pathogenic mechanism is unclear, the epidemiology of BFL shows that it occurs worldwide, and has been described in adults keeping birds and also in their children. [ncbi.nlm.nih.gov]

They review the epidemiology, electrocardiographic, laboratory, immunological, radiographic, functional and anatomoathological findings for the series. Skin sensitivity and bronchial challenge tests are considered useful diagnostic tests. [archbronconeumol.org]

Evaluation Exercise Equipment Mobility Modalities Orthopedics Pediatrics Rehab Supplies Sensory Motor Splinting Tourniquet and Cuff Treatment Furniture Wheelchair Wound & Scar Care Dental Education and Marketing Exam and Hygiene Gifts Home Care and Preventive [berktree.com]

[…] by plant pathogens, particularly by species of Fusarium, Aspergillus and Penicillium, their occurrence in infected plants, as well as their role in the plant-pathogen interaction, for example as virulence/pathogenicity factors, is a pre-requisite for preventing [books.google.it]

State and local units of the American Lung Association are excellent sources of information about lung disease and its prevention. Lung cancer clinical guidelines have been published in both the United States and Canada. [medical-dictionary.thefreedictionary.com]

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