Idiopathic Pulmonary Hemorrhage Research Articles

Diffuse alveolar hemorrhage in children with interstitial lung disease: Determine etiologies!

Diffuse alveolar hemorrhage (DAH) in children is a rare condition resulting from different underlying diseases. This study aimed at describing characteristics and diagnostic measures in children with ILD (children's interstitial lung disease, chILD) and DAH to improve the diagnostic approach by increasing clinician's awareness of diagnostic shortcomings. A retrospective data analysis of patients with ILD and DAH treated in our own or collaborating centers between 01/07/1997 and 31/12/2020 was performed. Data on clinical courses and diagnostic measures were systematically retrieved as case-vignettes and investigated. To assess suitability of diagnostic software-algorithms, the Human Phenotype Ontology (HPO) was revised and expanded to optimize conditions of its associated tool the "Phenomizer." For 97 (74%) of 131 patients, etiology of pulmonary hemorrhage was clarified. For 34 patients (26%), no underlying condition was found (termed as idiopathic pulmonary hemorrhage, IPH). Based on laboratory findings or clinical phenotype/comorbidities, 20 of these patients were assigned to descriptive clusters: IPH associated with autoimmune features (9), eosinophilia (5), renal disease (3) or multiorgan involvement (3). For 14 patients, no further differentiation was possible. Complete and sometimes repeated diagnostics are essential for establishing the correct diagnosis in children with DAH. We suggest assignment of patients with IPH to descriptive clusters, which may also guide further research. Digital tools such as the Phenomizer/HPO are promising, but need to be extended to increase diagnostic accuracy.

ЛЕГОЧНО-ПОЧЕЧНЫЙ СИНДРОМ, ОБУСЛОВЛЕННЫЙ АНТИ-ГБМ БОЛЕЗНЬЮ В СОЧЕТАНИИ С АНЦА-ВАСКУЛИТОМ ПОСЛЕ SARS-COV-2 ИНФЕКЦИИ

Introduction. Pulmonary-renal syndrome (PRS) manifested by a combination of idiopathic pulmonary alveolar hemorrhage and rapidly progressing glomerulonephritis, is most commonly associated with either anti-neutrophil cytoplasmic antibodies (ANCA) or anti-glomerular basement membrane (anti-GBM) antibodies. Despite the rather rarity of this disease, there is a sufficient number of observations with the simultaneous presence of both types of antibodies, the so-called double antibody-positive phenotype. During the pandemic of SARS-CoV-2 infection an increase in cases of PRS was noted, however, the phenomenon of double antibody positi¬vity – ANCA plus anti-GBM – is still a clinical casuistry. Observation. A 64-year-old woman was hospitalized 2 months after SARS-CoV-2 infection with PRS of a severe course with rapidly progressing renal failure, as well as lung affection with hemoptysis and typical changes on multidetector computed tomography. The patient was found to be double positive for ANCA and anti-GBM. Therapy including plasma exchanges, high doses of steroids and cyclophosphamide was carried out which gave a short-term improvement, but did not prevent dependence on hemodialysis. 7 months after the onset of PRS the patient died from a secondary infection. According to the pathoanatomical study, the diagnosis of anti-GBM disease in combination with ANCA-associated vasculitis was confirmed. Conclusion. As far as we know, this is the second reported case of 'double antibody' PRS after SARS-CoV-2 infection. We believe that in all such clinical situations it is necessary to test for both types of antibodies as this will determine the clinical tactics.

Prospective evaluation of hydroxychloroquine in pediatric interstitial lung diseases: Study protocol for an investigator-initiated, randomized controlled, parallel-group clinical trial

BackgroundInterstitial lung diseases in children (chILD) are rare and consist of many different entities that affect the parenchyma of the lungs, leading to a chronic lung disease. The natural course of many of these diseases is connected with a high morbidity and significant mortality. Symptomatic treatment consists of oxygen supplementation, adequate nutrition adapted to the high energy demand generated by the disease due to the increased breathing effort required, as well as immunization against respiratory pathogens to prevent exacerbations through respiratory infections. No proven pharmacological treatments are available to date. This placebo-controlled study aims to evaluate the efficacy and safety of the mid-term use of hydroxychloroquine in chILD.Methods and designThe study is an explorative, prospective, randomized, double-blind, placebo-controlled investigation of hydroxychloroquine (HCQ) in chILD. Patients can be included into the trial when diagnosed with a chronic (≥ 3 weeks’ duration) diffuse parenchymal lung disease (chILD) (1) genetically defined, (2) histologically defined or (3) diagnosed with idiopathic pulmonary hemorrhage (hemosiderosis). The study contains of two different study blocks, a START and a STOP block, which can be initiated in any sequence. Each patient can participate in each block only once. In the START block subjects are randomized to parallel groups for 4 weeks treatment, then the placebo group is switched to the active drug. In the STOP block, subjects taking HCQ are randomized into parallel groups treated with placebo or HCQ.DiscussionThis study is the first international, investigator-initiated, prospective and controlled investigation of a pharmacological treatment in chILD. The block design was selected as it has the advantage of accommodating patients who are initiating or withdrawing from HCQ therapy, thus allowing the participation of those who were previously started on off-label HCQ. The cross-over design and selected outcome parameters enables us to include appropriate numbers of patients of all age groups from neonates to adults suffering from these rare diseases.Trial registrationThis is an exploratory, Phase 2a, randomized, double-blind, placebo-controlled, parallel-group, multinational study investigating the initiation or withdrawal of hydroxychloroquine in subjects with chILD. Study title: Hydroxychloroquine in pediatric ILD: START randomized controlled in parallel groups, then switch placebo to the active drug, and STOP randomized controlled in parallel groups to evaluate the efficacy and safety of hydroxychloroquine (HCQ). Short title: HCQ in pediatric ILD, particularly 4surfdefect. EudraCT, ID: 2013–003714-40. Registered on 2 July 2013. ClinicalTrials.gov, ID: NCT02615938. Registered on 8 November 2015. IZKS trial code: 2013–006; Sponsor: University Hospital, Ludwig-Maximilians University of Munich. Responsible Party: Prof. Dr. med. Matthias Griese, University Hospital, Ludwig-Maximilians University of Munich, Germany.

Lane-Hamilton Syndrome With Respiratory Failure: A Case Report

Lane-Hamilton syndrome is a rare coexistence of idiopathic pulmonary hemosiderosis with celiac disease. Idiopathic pulmonary hemorrhage presents clinically as a classic triad of hemoptysis, iron deficiency anemia and infiltrates on chest radiograph with a variable clinical course. Celiac disease is an autoimmune enteropathy in genetically susceptible individuals triggered by gluten-containing food. We describe a 12-year-old girl with Lane-Hamilton syndrome presenting with severe anemia, pulmonary hemorrhage and respiratory failure. The child had remained previously asymptomatic. A high index of suspicion is required for diagnosis of Lane-Hamilton syndrome in a critically ill child. Int J Clin Pediatr. 2020;9(3):87-91 doi: https://doi.org/10.14740/ijcp379

Pulmonary hemorrhage in infancy: A 10‐year single‐center experience

Pulmonary hemorrhage in infancy is rare, with challenges in determining its incidence, causes, and outcomes across diverse groups. Our aim was to better understand the incidence and identified causes. We further analyzed the subgroup of patients meeting criteria for acute idiopathic pulmonary hemorrhage of infancy (AIPHI) to determine recurrence, mortality, and treatment. We performed a 10-year retrospective cohort study of infants with pulmonary hemorrhage in a large tertiary care center. One-hundred fifty-seven patients overall were identified. The most common diagnoses in infants with pulmonary hemorrhage were congenital heart disease (36.6%), prematurity/premature lung disease (34.6%), congenital or acquired lung disorders (15.0%), and congenital or acquired coagulopathies (13.7%). Nonaccidental trauma (NAT; n = 3) was also an important cause of pulmonary hemorrhage. All patients diagnosed with NAT had normal retinal examinations and skeletal surveys. Only four patients were identified with AIPHI. There was no mortality in this group of infants. One of four patients with AIPHI had a recurrence. Steroids were the consistent treatment for AIPHI, with a large range of treatment duration. Diagnostic studies should focus on identifying non-pulmonary sources of bleeding, infection, underlying lung disease, congenital heart defects, coagulopathies, infection, and NAT, as these were the most frequently identified causes of bleeding. NAT is not adequately identified with ophthalmology exam and skeletal survey. Overall, we found AIPHI to be a rare diagnosis. All of the patients with idiopathic hemorrhage received systemic steroids with varying doses and lengths of treatment.

Abridged version of the AWMF guideline for the medical clinical diagnostics of indoor mould exposure

This article is an abridged version of the AWMF mould guideline “Medical clinical diagnostics of indoor mould exposure” presented in April 2016 by the German Society of Hygiene, Environmental Medicine and Preventive Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin, GHUP), in collaboration with the above-mentioned scientific medical societies, German and Austrian societies, medical associations and experts. Indoor mould growth is a potential health risk, even if a quantitative and/or causal relationship between the occurrence of individual mould species and health problems has yet to be established. Apart from allergic bronchopulmonary aspergillosis (ABPA) and mould-caused mycoses, only sufficient evidence for an association between moisture/mould damage and the following health effects has been established: allergic respiratory disease, asthma (manifestation, progression and exacerbation), allergic rhinitis, hypersensitivity pneumonitis (extrinsic allergic alveolitis), and increased likelihood of respiratory infections/bronchitis. In this context the sensitizing potential of moulds is obviously low compared to other environmental allergens. Recent studies show a comparatively low sensitizing prevalence of 3–10% in the general population across Europe. Limited or suspected evidence for an association exist with respect to mucous membrane irritation and atopic eczema (manifestation, progression and exacerbation). Inadequate or insufficient evidence for an association exist for chronic obstructive pulmonary disease, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis and cancer. The risk of infection posed by moulds regularly occurring indoors is low for healthy persons; most species are in risk group 1 and a few in risk group 2 (Aspergillus fumigatus, A. flavus) of the German Biological Agents Act (Biostoffverordnung). Only moulds that are potentially able to form toxins can be triggers of toxic reactions. Whether or not toxin formation occurs in individual cases is determined by environmental and growth conditions, above all the substrate. In the case of indoor moisture/mould damage, everyone can be affected by odour effects and/or mood disorders. However, this is not a health hazard. Predisposing factors for odour effects can include genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for mood disorders may include environmental concerns, anxiety, condition, and attribution, as well as various diseases. Risk groups to be protected particularly with regard to an infection risk are persons on immunosuppression according to the classification of the German Commission for Hospital Hygiene and Infection Prevention (Kommission für Krankenhaushygiene und Infektionsprävention, KRINKO) at the Robert Koch- Institute (RKI) and persons with cystic fibrosis (mucoviscidosis); with regard to an allergic risk, persons with cystic fibrosis (mucoviscidosis) and patients with bronchial asthma should be protected.The rational diagnostics include the medical history, physical examination, and conventional allergy diagnostics including provocation tests if necessary; sometimes cellular test systems are indicated. In the case of mould infections the reader is referred to the AWMF guideline “Diagnosis and Therapy of Invasive Aspergillus Infections”. With regard to mycotoxins, there are currently no useful and validated test procedures for clinical diagnostics. From a preventive medicine standpoint it is important that indoor mould infestation in relevant dimension cannot be tolerated for precautionary reasons. With regard to evaluating the extent of damage and selecting a remedial procedure, the reader is referred to the revised version of the mould guideline issued by the German Federal Environment Agency (Umweltbundesamt, UBA).

Medical diagnostics for indoor mold exposure.

In April 2016, the German Society of Hygiene, Environmental Medicine and Preventative Medicine (Gesellschaft für Hygiene, Umweltmedizin und Präventivmedizin (GHUP)) together with other scientific medical societies, German and Austrian medical societies, physician unions and experts has provided an AWMF (Association of the Scientific Medical Societies) guideline 'Medical diagnostics for indoor mold exposure'. This guideline shall help physicians to advise and treat patients exposed indoors to mold. Indoor mold growth is a potential health risk, even without a quantitative and/or causal association between the occurrence of individual mold species and health effects. Apart from the allergic bronchopulmonary aspergillosis (ABPA) and the mycoses caused by mold, there is only sufficient evidence for the following associations between moisture/mold damages and different health effects: Allergic respiratory diseases, asthma (manifestation, progression, exacerbation), allergic rhinitis, exogenous allergic alveolitis and respiratory tract infections/bronchitis. In comparison to other environmental allergens, the sensitizing potential of molds is estimated to be low. Recent studies show a prevalence of sensitization of 3-10% in the total population of Europe. The evidence for associations to mucous membrane irritation and atopic eczema (manifestation, progression, exacerbation) is classified as limited or suspected. Inadequate or insufficient evidence for an association is given for COPD, acute idiopathic pulmonary hemorrhage in children, rheumatism/arthritis, sarcoidosis, and cancer. The risk of infections from indoor molds is low for healthy individuals. Only molds that are capable to form toxins can cause intoxications. The environmental and growth conditions and especially the substrate determine whether toxin formation occurs, but indoor air concentrations are always very low. In the case of indoor moisture/mold damages, everyone can be affected by odor effects and/or impairment of well-being. Predisposing factors for odor effects can be given by genetic and hormonal influences, imprinting, context and adaptation effects. Predisposing factors for impairment of well-being are environmental concerns, anxieties, conditioning and attributions as well as a variety of diseases. Risk groups that must be protected are patients with immunosuppression and with mucoviscidosis (cystic fibrosis) with regard to infections and individuals with mucoviscidosis and asthma with regard to allergies. If an association between mold exposure and health effects is suspected, the medical diagnosis includes medical history, physical examination, conventional allergy diagnosis, and if indicated, provocation tests. For the treatment of mold infections, it is referred to the AWMF guidelines for diagnosis and treatment of invasive Aspergillus infections. Regarding mycotoxins, there are currently no validated test methods that could be used in clinical diagnostics. From the perspective of preventive medicine, it is important that mold damages cannot be tolerated in indoor environments.

Idiopathic pulmonary hemorrhage: morphology and differential diagnosis. Case report

Idiopathic pulmonary hemorrhage (IPH) is a rare cause of alveolar hemorrhage (AH) with unknown etiology that primarily affects children. The process has a variable clinical progression, and its diagnosis is established after excluding all causes of AH. Herein, the authors report a case of IPH in an adult male patient referring cough and hemoptysis. The conventional radiography computed tomography imaging identified zones of consolidation and areas of ground-glass attenuation in the lower lobes and lingula. Forced spirometry, bronchoscopy, and laboratorial tests yielded normal results. Several alveolar hemosiderin-laden macrophages were identified on bronchoalveolar lavage and lung biopsy. Thus, the histopathological findings associated with clinical data were compatible with IPH.

Inhalation of Stachybotrys chartarum causes pulmonary arterial hypertension in mice

Inhalation of Stachybotrys chartarum, a ubiquitous fungus in our living environment, has been suspected as a cause of acute idiopathic pulmonary haemorrhage in infants, but its relation to human diseases is not yet known. The aim of present study was to investigate the effect of repeated intratracheal injection of the fungus into mice, paying special attention to the pulmonary vascular system. Spores of S. chartarum were injected into the trachea of mice from 6 to 18 times over 4-12 weeks, and the lungs were examined by histopathology, morphometrics and haemodynamics. When 1 x 10(4) spores/mouse were injected, histopathological examination showed the development of pulmonary arterial hypertension (PAH). Symmetrical thickening of the intima and media of the pulmonary arterial walls was seen after six injections over 4 weeks. Right ventricular hypertrophy was also evident after 12 injections. PAH was confirmed by the elevation of right ventricular systolic pressure (20.1 +/- 5.7 mmHg in the injected group vs. 12.0 +/- 2.4 mmHg in the control group, P < 0.01). This study showed that the inhalation of S. chartarum caused PAH in mice, suggesting a potential of S. chartarum as a cause of human health problem such as PAH.

Surfactant treatment of an infant with acute idiopathic pulmonary hemorrhage

To describe the successful use of surfactant for treatment of respiratory distress refractory to conventional mechanical ventilation in a 4-wk-old with pulmonary hemorrhage. Case report. Tertiary care center pediatric intensive care unit. Four-week-old infant. Clinical improvement of respiratory distress as evidenced by 50% reduction in oxygenation index and subsequent extubation. Pulmonary hemorrhage is a rare but potentially fatal condition in children. Previously described therapeutic approaches include high-frequency oscillation ventilation and extracorporeal membrane oxygenation. Infants with pulmonary hemorrhage and respiratory distress may benefit from a trial of surfactant before escalating care.

Testing antimicrobial cleaner efficacy on gypsum wallboard contaminated with Stachybotrys chartarum

Reducing occupant exposure to indoor mold is the goal of this research, through the efficacy testing of antimicrobial cleaners. Often mold contaminated building materials are not properly removed, but instead surface cleaners are applied in an attempt to alleviate the problem. The efficacy of antimicrobial cleaners to remove, eliminate or control mold growth on surfaces can easily be tested on non-porous surfaces. However, the testing of antimicrobial cleaner efficacy on porous surfaces, such as those found in the indoor environment such as gypsum board can be more complicated and prone to incorrect conclusions regarding residual organisms. The mold Stachybotrys chartarum has been found to be associated with idiopathic pulmonary hemorrhage in infants and has been studied for toxin production and its occurrence in water damaged buildings. Growth of S. chartarum on building materials such as gypsum wallboard has been frequently documented. Research to control S. chartarum growth using 13 separate antimicrobial cleaners on contaminated gypsum wallboard has been performed in laboratory testing. Popular brands of cleaning products were tested by following directions printed on the product packaging. A variety of gypsum wallboard surfaces were used to test these cleaning products at high relative humidity. The results indicate differences in antimicrobial efficacy for the six month period of testing. Results for the six types of GWB surfaces varied extensively. However, three cleaning products exhibited significantly better results than others. Lysol All-Purpose Cleaner-Orange Breeze (full strength) demonstrated results which ranked among the best in five of the six surfaces tested. Both Borax and Orange Glo Multipurpose Degreaser demonstrated results which ranked among the best in four of the six surfaces tested. The best antimicrobial cleaner to choose is often dependent on the type of surface to be cleaned of S. chartarum contamination. For Plain GWB, no paint, the best cleaners were Borax, Lysol All-Purpose Cleaner-Orange Breeze (full strength), Orange Glo Multipurpose Degreaser, and Fantastik Orange Action. These results are not meant to endorse the incomplete removal of mold contaminated building materials. However, it is recognized that complete removal may not always be possible and solutions to control mold regrowth may contribute to reduced occupant exposure. Current recommendations of removal and replacement of porous building materials should be followed. It is not the intension of this discussion to endorse any product. Reporting on the performance of these products under the stated conditions was and remains the only purpose.

Diffuse alveolar hemorrhage syndromes in children

In this review we discuss the changing concepts of diffuse alveolar hemorrhage in children in terms of an expanded differential diagnosis and new approaches to diagnosis and treatment. More commonly found in adults, pulmonary capillaritis, an immune-mediated form of diffuse alveolar hemorrhage often associated with systemic disease, has been recently reported in children. In a series of eight children with pulmonary capillaritis, serology for immune-mediated disorders was positive in only half. Acute idiopathic pulmonary hemorrhage is a unique condition of infants who present with acute pulmonary hemorrhage and respiratory failure. The hypothesis that acute idiopathic pulmonary hemorrhage is caused by toxigenic mold has not been proven, and its cause remains uncertain. Classification of diffuse alveolar hemorrhage in children has been revised to include those conditions with and without pulmonary capillaritis. As idiopathic pulmonary hemosiderosis, the classic form of diffuse alveolar hemorrhage in children, is a diagnosis of exclusion and children with pulmonary capillaritis may have negative serology, lung biopsy should be strongly considered in any child with diffuse alveolar hemorrhage without a cardiovascular cause. Generally, patients with immune-mediated lung disease require more aggressive pharmacologic intervention.

Micropolyangéite révélée par une anémie d'évolution chronique secondaire à une hémorragie intra-alvéolaire paucisymptomatique: à propos d'un cas

An alveolar haemorrhage occurs in 12 to 29% during microscopic polyangeitis and can reveal this disease. We report the case of a fifteen years old female patient with a microscopic polyangeitis which was diagnosed during the investigation of a chronic anemia with chronic asymptomatic alveolar haemorrhage and extracapillary glomerulonephritis with antineutrophil cytoplasmic antibodies positive (anti-myeloperoxydase antibodies). The good tolerance of alveolar haemorrhage is usual for children, particularly in idiopathic pulmonary haemorrhage but is exeptionnal for adults. According to some studies, thirty percent of idiopathic pulmonary haemorrhage goes to auto-immune disease. This observation shows that complementary pulmonary investigations are necessary in chronic anemia when gynaecologic and digestive investigations are negative and that auto-immune investigations are judicious in the survey of idiopathic pulmonary haemorrhage.

Spectrum of Noninfectious Health Effects From Molds

Molds are multicellular fungi that are ubiquitous in outdoor and indoor environments. For humans, they are both beneficial (for the production of antimicrobial agents, chemotherapeutic agents, and vitamins) and detrimental. Exposure to mold can occur through inhalation, ingestion, and touching moldy surfaces. Adverse health effects may occur through allergic, infectious, irritant, or toxic processes. The cause-and-effect relationship between mold exposure and allergic and infectious illnesses is well known. Exposures to toxins via the gastrointestinal tract also are well described. However, the cause-and-effect relationship between inhalational exposure to mold toxins and other untoward health effects (eg, acute idiopathic pulmonary hemorrhage in infants and other illnesses and health complaints) is controversial and requires additional investigation. In this report we examine evidence of fungal-related illnesses and the unique aspects of mold exposure to children. Mold-remediation procedures are also discussed.

Spectrum of Noninfectious Health Effects From Molds

Molds are eukaryotic (possessing a true nucleus) nonphotosynthetic organisms that flourish both indoors and outdoors. For humans, the link between mold exposure and asthma exacerbations, allergic rhinitis, infections, and toxicities from ingestion of mycotoxin-contaminated foods are well known. However, the cause-and-effect relationship between inhalational exposure to mold and other untoward health effects (eg, acute idiopathic pulmonary hemorrhage in infants and other illnesses and health complaints) requires additional investigation. Pediatricians play an important role in the education of families about mold, its adverse health effects, exposure prevention, and remediation procedures.

Acute idiopathic pulmonary haemorrhage in infancy: Case report and review of the literature

This report presents the case of a 4-month-old male infant with recurrent bouts of haemoptysis for which no cause could be detected after extensive investigation. Literature reports of this condition from other geographic locations around the world are reviewed, together with epidemiologic studies attempting to provide a link with certain environmental exposures, toxic and infectious. A diagnostic entity of acute idiopathic pulmonary haemorrhage in infancy has recently been proposed. To my knowledge, this is the first case reported from New Zealand. Although the incidence of such reported cases appears to be rare, they constitute an interesting public health problem, particularly because some of the risk factors appear to overlap with risk factors for sudden infant death. They can therefore trigger an investigation into the home and outdoor environments, and may provide valuable insights into a possible underlying genetic factor and potentially harmful exposures in the modern urban or rural settings.

Toxic Moulds and Indoor Air Quality

Indoor air quality issues associated with exposure to moulds and their metabolites, mycotoxins, are becoming of increasing importance. There are believed to be about 1.5 million species of fungi of which more than 1000 species have evolved to exploit the built environment. Sexually mature fungi produce large numbers of spores that when airborne can be inhaled and deposited on the mucosal surface of the upper airways and in the eyes. Occupants of buildings may be affected in any of a number of ways. Fungi and moulds can contribute to the sick building syndrome or other building related illnesses and some people can have an allergic response. Such exposure to moulds and the other fungi and their spores indoors is unavoidable except when the most stringent air filtration or other environmental measures are observed. The repeated exposure to large amount of particular fungal propagules is an important risk factor for the development of specific allergic reactions. There are also a large number of toxic mould metabolites which can have a range of biological activities. Black Mould ( Stachybotrys chartarum), in particular has been implicated in illnesses associated with living in damp houses. Reactions may be severe as in recent reports of idiopathic pulmonary haemorrhage in very young children in Cleveland, Ohio. Although some governmental agencies have published guidelines on mould assessment and remediation most are very general in nature and most focus on Black Mould as the major concern.

The Pathogenicity of Stachybotrys chartarum

Stachybotrys chartarum is a dematiaceous fungus that is ubiquitous in our living environment. This fungus has long been regarded as non-pathogenic and its inhalation effect on humans has been scarcely studied. Recently, however, epidemiologic studies on acute idiopathic pulmonary hemorrhage in infants suggested that the fungus might be potentially pathogenic to humans. To determine the pathogenicity of this fungus, its interaction with the host defense system was studied using polymorphonuclear leukocytes (PMNs) and macrophages. Histopathological analysis of mice intratracheally injected with this fungus was also performed. The results disclosed that the conidia of S. chartarum were resistant to the antifungal activities of alveolar macrophages in terms of phagocytosis, killing and inhibition of germination. However, the conidia could not survive in the lungs of mice when injected intratracheally. Lavage fluid of mycelia that contained the dark slimy material coating the surface of conidia showed cytotoxic activity against macrophages and PMNs. Intratracheal injection of conidia in mice resulted in intraalveolar infiltration of PMNs. When using multiple injections during a 3-week period, strong eosinophilic infiltration into the proximal alveoli and perivascular tissues was observed. Our results suggest that inhalation of conidia may cause serious damage to the human lung, particularly when repeated.

Growth Response of Stachybotrys Chartarum to Moisture Variation on Common Building Materials

The mould Stachybotrys chartarum has been found to be associated with idiopathic pulmonary haemorrhage in infants and indoor exposure has also been linked to other pulmonary diseases, including allergies and asthma. S. chartarum has been studied both for toxin production and its occurrence in water-damaged buildings. Growth of S. chartarum on building materials such as gypsum wallboard has been frequently documented. Given that there may be a high frequency of occurrence and so the risk of exposure, environmental factors leading to the growth of S. chartarum have been studied. Samples of commonly used building materials were sterilised, inoculated with S. chartarum and exposed to controlled levels of relative humidity and wetting. A quantitative analysis of viable S. chartarum was performed on the building materials during a 7-month period. The results indicate that for environments with a relative humidity below total saturation, wetting was necessary for visible growth to occur. Conversely, high levels of relative humidity without wetting did not initiate growth. Porous materials, after becoming sufficiently wet and measuring saturation on a moisture meter, exhibited mould growth in every experiment conducted.

Management with High Frequency Ventilation of Acute Idiopathic Pulmonary Hemorrhage in Infants

Acute idiopathic pulmonary hemorrhage in infants (AIPHI) is characterized by a sudden onset of pulmonary hemorrhage in previous healthy infants. Evidence of pulmonary hemorrhage may present as hemoptysis or a finding of blood in the nose or airway with no evidence of upper respiratory or gastrointestinal bleeding. Patients presenting with acute, severe respiratory distress or failure, and those requiring mechanical ventilation and often demonstrate bilateral infiltrates by chest radiography. We report a case of AIPHI which developed during the induction of anesthesia. A 3-month-old male infant received right herniorraphy under general endotracheal anesthesia. After intubation, blood tinged fluid was aspirated using an endotracheal tube during operation. Chest radiography showed bilateral ground glass opacity. We transferred the patient to the ICU and applied conventional mechanical ventilation. However hypoxemia and respiratory acidosis were persisted. We then switched to a high frequency ventilator (HFV), the hypoxemia and respiratory acidosis were corrected. The patient was transferred to the general ward on the 7th postoperative day.