BIRD FANCIERS LUNG: A CASE OF HYPERSENSITIVITY PNEUMONITIS IN AN OTHERWISE HEALTHY 51-YEAR-OLD WOMAN

SESSION TITLE: Occupational and Environmental Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILD) and is caused by an allergic reaction to an inciting agent in the airway of a susceptible individual1. The diagnosis is challenging as many of the classic symptoms, dyspnea and fatigue, are nonspecific. An accurate diagnosis involves careful history taking, physical exam, pulmonary function tests (PFTs), chest computed tomography (CT) imaging, and lung biopsy. CASE PRESENTATION: Patient is a 51 year old female with no PMH presents to clinic with worsening dyspnea and nonproductive cough. Symptoms began 6 months ago. She could not identify any triggers and was prescribed steroids and antibiotics with minimal relief. The patient has never smoked, denies drug use but had two pigeons. During the COVID pandemic she admitted to staying indoors more often and was not nearly as active outdoors as before. She denied fevers, chills, night sweats and weight loss. CXR showed no focal infiltrates, sharp costophrenic angels with no evidence of acute pathology. PFT's showed FVC pre 1.78, FVE1 pre 1.35, FVE1 % predicted pre 48%, FEV1/FVC pre 76%, TLC pre 3.23, VC pre 2.06 and a DLCO pre 10.98 with her LLN of 16.59. FVC post 1.91, FEV1 post 1.57, FVE1 % predicted post 58%, FEV1/FVC post 82% (Fig 1). She had positive pigeon serum antibodies. CT chest showed faint diffuse ground glass opacities bilaterally with mild mosaic attenuation reflecting HP (Figs 2, 3). The patient was diagnosed with HP, started on steroids and surrendered her pigeons with resolution of her symptoms. DISCUSSION: Diagnosis of HP is challenging as the classic symptoms of dyspnea and fatigue can be nonspecific. Physicians should be aware about increasing exposures to home antigens during the COVID pandemic in patients who have been indoors for prolonged periods of time. PFTs show a restrictive pattern and DLCO impairment. CT show the presence of centrilobular nodules, ground-glass opacities, mosaic attenuation/perfusion and air trapping and in longstanding disease there can be honeycombing and traction bronchiectasis2. Mainstay treatment is antigen avoidance and corticosteroids. Identification and complete avoidance of the antigen is the mainstay of treatment. Antigen avoidance is critically stressed as repeated exposures can result in HP progression and avoidance of the antigen is associated with improved lung function1. Corticosteroid initiation in progressive patients resulted in a reversal with an improvement of lung function3. Corticosteroids are often used in non-fibrotic HP however its efficacy remains unclear as long term prognosis has never been studied1. CONCLUSIONS: Physicians should recognize that prolonged time indoors, that have been exacerbated during the COVID19 pandemic, can increase the time patients are exposed to home antigens thus a prompt diagnosis and strict avoidance of the antigen is required to prevent irreversible damage. Reference #1: Maria Laura Alberti, "Hypersensitivity Pneumonitis: Diagnostic and Therapeutic Challenges". Frontiers in Medicine, Front. Med., 23 September 2021 ;https://doi.org/10.3389/fmed.2021.718299 Reference #2: Zompatori M, Calabrò E, Chetta A, Chiari G, Marangio E, Olivieri D. Chronic hypersensitivity pneumonitis or idiopathic pulmonary fibrosis? Diagnostic role of high resolution Computed Tomography (HRCT). Radiol Med. 2003 Sep;106(3):135-46. English, Italian. PMID: 14612834 Reference #3: De Sadeleer LJ, Hermans F, De Dycker E, Yserbyt J, Verschakelen JA, Verbeken EK, Verleden GM, Wuyts WA. Effects of Corticosteroid Treatment and Antigen Avoidance in a Large Hypersensitivity Pneumonitis Cohort: A Single-Centre Cohort Study. J Clin Med. 2018 Dec 21;8(1):14. doi: 10.3390/jcm8010014. PMID: 30577667;PMCID: PMC6352061. DISCLOSURES: No relevant relationships by Aryeh Bernstein No relevant relationships by Thai Donenfeld No relevant relationships by Lourdes Marie F aminiano

Risk Factors for COVID-19 in a Retired FDNY WTC-Exposed Cohort.

We evaluated the incidence and risk factors for COVID-19 in a prospectively followed cohort of Fire Department of the City of New York (FDNY) World Trade Center (WTC)-exposed workers, thus reducing the potential for selection bias, a limitation in published studies of hospitalized individuals. Participants were retired FDNY WTC-exposed rescue/recovery workers with ≥1 medical visit between 1 March 2020 and 1 August 2021. The cumulative incidence was calculated using self-reported COVID-19 diagnoses. Cox regression was performed to evaluate the association of WTC-exposure and COVID-19, adjusting for history of comorbidities, age, race, work assignment (emergency medical service providers vs. firefighter), and sex. The cumulative incidence of COVID-19 was 130 per 1000. The adjusted models showed the risk of infection was greater in those with highest WTC exposure versus less exposure (hazard ratio (HR) = 1.14 (95% CI 1.00-1.31)). Older age was associated with a lower risk of infection HR = 0.97 (95% CI 0.96-0.98). WTC-associated diseases (obstructive airways disease and interstitial lung disease) were not COVID-19 risk factors. This study is the first to show an association between WTC exposure and the risk of COVID-19. While participants are retired from FDNY work, the youngest individuals may still be in the workforce, explaining why younger age was a significant risk for COVID-19.

LIPOID PNEUMONIA DUE TO PHARYNGOESOPHAGEAL DYSPHAGIA CAUSING PARAFFIN BRONCHOASPIRATION

TYPE: Case Report TOPIC: Occupational and Environmental Lung Diseases INTRODUCTION: We present a case of exogenous lipoid pneumonia caused by paraffin broncoaspiration due to pharyngoesophageal motor dysphagia. CASE PRESENTATION: A 57 year old female consulted for diarrhea. She had a previous history of ischemic stroke related to hypercoagulability syndrome, causing oropharyngeal dysphagia due to pharyngo-esophageal motor incoordination. Owing to possible neurogenic dysfunction she also presented megadolichocolon with chronic diarrhea-constipation syndrome. Due to the epidemiological situation caused by SARS-COV2, a chest X-ray was performed showing increased density of the right middle lobe. The control X-ray exhibited a persistence of this alteration, therefore a thoracic tomographic study was performed (findings included in image), as well as a bronchoalveolar lavage. The bronchoalveolar lavage fluid was initially turbid white which, posterior to resting, revealed a superficial layer of fat, supporting the diagnosis of lipoid pneumonia. The patient was subsequently interrogated. She associated the consumption of oily materials from herbalists and paraffin in order to palliate her constipation symptoms, which in relation to her esophageal motor-pharyngeal incoordination produced bronchoaspiration of the referred oily material. DISCUSSION: Oily substance ingestion was suspended. Subsequently she underwent a corticosteroid treatment and is currently under clinical control. CONCLUSIONS: The ground glass pattern is a finding that causes a wide differential diagnosis in the radiological study, therefore it is of great importance to take an adequate clinical history and to take into account the motor dysfunctions related to swallowing, due to the high consumption of herbalist products that contain oily materials that can cause exogenous lipoid pneumonia. DISCLOSURE: Nothing to declare. KEYWORD: Exogenous_Lipoid_Pneumonia

Shift work is associated with positive COVID-19 status in hospitalised patients.

INTRODUCTION: Shift work is associated with lung disease and infections. We therefore investigated the impact of shift work on significant COVID-19 illness. METHODS: 501 000 UK Biobank participants were linked to secondary care SARS-CoV-2 PCR results from Public Health England. Healthcare worker occupational testing and those without an occupational history were excluded from analysis. RESULTS: Multivariate logistic regression (age, sex, ethnicity and deprivation index) revealed that irregular shift work (OR 2.42, 95% CI 1.92 to 3.05), permanent shift work (OR 2.5, 95% CI 1.95 to 3.19), day shift work (OR 2.01, 95% CI 1.55 to 2.6), irregular night shift work (OR 3.04, 95% CI 2.37 to 3.9) and permanent night shift work (OR 2.49, 95% CI 1.67 to 3.7) were all associated with positive COVID-19 tests compared with participants that did not perform shift work. This relationship persisted after adding sleep duration, chronotype, premorbid disease, body mass index, alcohol and smoking to the model. The effects of workplace were controlled for in three ways: (1) by adding in work factors (proximity to a colleague combined with estimated disease exposure) to the multivariate model or (2) comparing participants within each job sector (non-essential, essential and healthcare) and (3) comparing shift work and non-shift working colleagues. In all cases, shift work was significantly associated with COVID-19. In 2017, 120 307 UK Biobank participants had their occupational history reprofiled. Using this updated occupational data shift work remained associated with COVID-19 (OR 4.48 (95% CI 1.8 to 11.18). CONCLUSIONS: Shift work is associated with a higher likelihood of in-hospital COVID-19 positivity. This risk could potentially be mitigated via additional workplace precautions or vaccination.

Informatics Approaches for Recognition, Management, and Prevention of Occupational Respiratory Disease.

Computer and information systems can improve occupational respiratory disease prevention and surveillance by providing efficient resources for patients, workers, clinicians, and public health practitioners. Advances include interlinking electronic health records, autocoding surveillance data, clinical decision support systems, and social media applications for acquiring and disseminating information. Obstacles to advances include inflexible hierarchical coding schemes, inadequate occupational health electronic health record systems, and inadequate public focus on occupational respiratory disease. Potentially transformative approaches include machine learning, natural language processing, and improved ontologies.

Disinfection of Pseudomonas aeruginosa from N95 respirators with ozone: a pilot study.

INTRODUCTION: Personal protective equipment shortages require the reuse of N95 respirators. We sought the necessary conditions for ozone to disinfect N95 respirators for reuse and the effects of multiple cycles of exposure. METHODS: Portions of 3M 1870 N95 respirators were exposed to ozone at 400 ppm with 80% humidity for 2 hours to determine effectiveness of ozone on killing Pseudomonas aeruginosa. Entire 3M 1870 N95 respirators were exposed to five cycles of 400 ppm with 80% or higher humidity for 2 hours then evaluated for ozone's effects on airflow resistance, filtration efficiency, strap strength and quantitative fit. RESULTS: Ozone exposure disinfected 3M 1870 N95 respirators heavily inoculated with P. aeruginosa. Ozone exposure did not negatively affect the airflow resistance, filtration efficiency, strap strength or fit of the 3M 1870 N95 respirator. DISCUSSION: These results suggest that ozone is a feasible strategy to disinfect N95 respirators for reuse during this and future pandemics.