标题：Acute hypersensitivity pneumonitis in woodworkers caused by inhalation of birch dust contaminated with Pantoea agglomerans and Microbacterium barkeri
期刊名称：Annals of Agricultural and Environmental Medicine
印刷版ISSN：1232-1966
电子版ISSN：1898-2263
出版年度：2019
卷号：26
期号：4
页码：1-12
DOI：10.26444/aaem/114931
出版社：Institute of Agricultural Medicine in Lublin
摘要：Case description. Five workers (2 males and 3 females) employed in a furniture factory located in eastern Poland developed
hypersensitivity pneumonitis (HP) after the pine wood used for furniture production was replaced by birch wood. All of
them reported onset of respiratory and general symptoms (cough, shortness of breath, general malaise) after inhalation
exposure to birch dust, showed crackles at auscultation, ground-glass attenuations in HRCT examination, and lymphocytosis
in the BAL examination. The diagnosis of acute HP was set in 4 persons and the diagnosis of subacute HP in one.
Identification of specific allergen. Samples of birch wood associated with evoking disease symptoms were subjected to
microbiological analysis with the conventional and molecular methods. Two bacterial isolates were found to occur in large
quantities (of the order 108
CFU/g) in examined samples: Gram-negative bacterium of the species Pantoea agglomerans
and a non-filamentous Gram-positive actinobacterium of the species Microbacterium barkeri. In the test for inhibition of
leukocyte migration, 4 out of 5 examined patients showed a positive reaction in the presence of P. agglomerans and 2 in the
presence of M. barkeri. Only one person showed the presence of precipitins to P. agglomerans and none to M. barkeri. In the
inhalation challenge, which is the most relevant allergological test in the HP diagnostics, all patients reacted positively to
P. agglomerans and only one to M. barkeri. The results indicate that P. agglomerans developing in birch wood was the main
agent causing HP in the workers exposed to the inhalation of dust from this wood, while the etiologic role of M. barkeri is
probably secondary.
Conclusion. The results demonstrate that apart from fungi and filamentous actinobacteria, regarded until recently as
causative agents of HP in woodworkers, Gram-negative bacteria and non-filamentous actinobacteria may also elicit disease
symptoms in the workers processing wood infected with large amounts of these microorganisms. The results obtained also
seem to indicate that cellular-mediated reactions are more significant for causing disease symptoms compared to those
that are precipitin-mediated.
