Dean A. Emanuel

Immunofluorescent studies in patients with farmer's lung

Abstract Pulmonary tissues from patients with farmers lung have been studied with the use of fluorescein-labeled globulins from patients with this disease and with fluorescein-labeled antisera specific for IgG, IgA, IgM and C3 complement. Immunoglobulins of all three classes were found in the plasma cells and lymphocytes. The walls of the bronchioles appeared rich in antigen, staining well with the fluorescein-labeled globulins isolated from patients with the disease. Fixed C3 complement was present in the histiocytes, suggesting the antecedent presence of antigen-antibody complexes. No histologic or immunologic evidence of vasculitis could be found. These findings suggest further investigation of the hypothesis that at least part of the pathogenesis of farmers lung may involve a cytotoxic type II reaction. In this event, antigen adsorbed to the cells reacts with antibody in the presence of complement, causing cellular destruction. The presence or absence of a delayed component is still uncertain.

Precipitating antibodies in a midwest dairy farming population toward the antigens associated with farmer's lung disease

A survey of the frequency of precipitins to the antigens of the thermophilic actinomycetes and Aspergillus species was conducted on serum samples from 1,045 farmers obtained at a 3-day exposition on modern farm equipment and farming practices in central Wisconsin. Each farmer filled out a questionnaire including socioeconomic information, lung disease history, exposure history, and smoking history. Precipitins were detected by the double-diffusion method. The antigen panel included eight thermophilic actinomycetes species and a mixture of Aspergillus species. Precipitins were found in the sera of 93 famers (8.9%). The distribution of positive precipitins was: Micropolyspora faeni 63 (67.7%), Thermoactinomyces vulgaris 7 (7.5%), Thermomonospora viridis 2 (2.2%), M. faeni + T. viridis 16 (17.2%), M. faeni + T. vulgaris 1 (1.1%), Aspergillus species 4 (4.3%). Of all the parameters tested for in the questionnaire, those with positive serology differed significantly from the whole population only in that a higher proportion of the positives reported exposure to silo gas and illness after uncapping silos. Comparison of the size of the farm and the number of dairy cows in the state of Wisconsin with the population samples indicated that the sample population was skewed toward those with larger farms and larger dairy herds. This study confirms that a significant proportion of the farm population in Wisconsin does have precipitins to the microorganisms associated with farmers lung disease. Follow-up studies to establish the relationship between the positive precipitin reactions to the presence of clinical disease are now under way.

Farmer's lung disease among farmers with precipitating antibodies to the thermophilic actinomycetes: A clinical and immunologic study☆

Farmers were evaluated for the presence of farmers lung disease by serologic methods and by clinical histories. From a large farming population screened serologically, 40 of 92 farmers with precipitating antibodies to the thermophilic actinomycetes consented to be evaluated for clinical evidence of farmers lung disease. Each subject completed a standardized questionnaire which was reviewd by a trained observer. On the basis of the questionnaire and an indepth clinical history, the subjects were grouped into those farmers who had a history of farmers lung disease (38%), those with no history (50%), or a doubtful group (12%). When these groups were compared for radiologic changes, pulmonary function abnormalities, and immune function, no differences were discernible. None of the parameters tested were useful in predicting which farmer would develop clinical farmers lung disease. The parameters tested did not provide reliable criteria for differentiating those patients who present without acute symptoms but relate a history of recurrent pulmonary illnesses associated with moldy forage.

Serum immunoglobulin levels in farmer's lung disease

Abstract The serum concentrations of the five major classes of immunoglobulins were measured in 27 farmers lung patients and compared with a group of normals and a group of patients with diffuse lung disease, but no precipitins to our antigen panel. The mean IgG and IgA levels in the sera of the farmers lung patients were found to be significantly higher than that of the normal group. In addition, the IgG level of the farmers lung group was also significantly higher than the group with negative precipitin tests. The remaining immunoglobulin classes, IgM, IgD, and IgE, were not remarkably different from normal in either diffuse lung disease group.

Association of pulmonary valvular stenosis and muscular ventricular septal defect. Report of a case in a patient aged 75 years.

Abstract This case demonstrates unusual longevity with congenital cyanotic heart disease. The association of a muscular ventricular septal defect with valvular pulmonic stenosis is unusual, for valvular pulmonic stenosis is usually associated with an intact ventricular septum. It is of interest that while there was calcific stenosis of the tricuspid valve, the bicuspid aortic valve had no calcification.