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Hyaluronic acid (hyaluronan) in BAL fluid distinguishes farmers with allergic alveolitis from farmers with asymptomatic alveolitis.

Pulmonary function measurements, bronchoalveolar lavage (BAL), and analyses of precipitating antibodies in blood were performed in 12 farmers wtih no symptoms from the airways and 12 farmers who were admitted to the hospital due to acute symptoms of alveolitis (all nonsmokers). In addition, a bronchial methacholine provocation test was performed in the asymptomatic farmers. In 11 of the 12 symptomatic farmers but in none of the asymptomatic farmers, precipitating antibodies against one or more of the microorganisms which usually occur in a farmer's environment were found. In the farmers with symptomatic alveolitis, a restrictive impairment of pulmonary function was found, while pulmonary function was normal in all asymptomatic farmers. Findings in the BAL fluid showed increased concentrations of total cells, lymphocytes, and neutrophils and elevated levels of albumin, fibronectin, and angiotensin-converting enzyme in asymptomatic farmers compared with our own reference group. The same analyses in BAL fluid from the symptomatic farmers revealed a further increase in all parameters compared with the asymptomatic farmers. The BAL fluid from asymptomatic farmers had normal levels of hyaluronic acid (hyaluronan) and procollagen 3 N-terminal peptide, while these levels were significantly increased in the symptomatic group. We conclude that inflammation in the alveolar space and signs of activation of alveolar macrophages are present in farmers regardless of respiratory symptoms, although these findings are more pronounced in the presence of symptoms of acute alveolitis; however, the findings of impaired pulmonary function and the occurrence of precipitins and elevated levels of hyaluronic acid and procollagen 3 N-terminal peptide in BAL fluid were exclusively found in the farmers with airways symptoms. We postulate the hyaluronic acid, due to its pronounced ability to immobilize water, may be of importance in the development of the pulmonary function impairment observed in farmer's lung disease.

Acute Disease

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 farmer's 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 farmer's 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 farmer's 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 farmer's 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.

Actinomycetales

The frequency of precipitins to trichloroacetic acid-extractable antigens from thermophilic actinomycetes in farmer's lung patients and asymptomatic farmers.

The hypothesis that the trichloroacetic acid (TCA)-extractable antigen fractions prepared from Micropolyspora faeni cells and other thermophilic actinomycetes are better diagnostic immunodiffusion reagents for the detection of farmer's lung disease than the crude extracellular antigen concentrates has been tested. The frequency of serum precipitins to the TCA-extractable antigens has been compared in symptomatic farmer's lung patients and in healthy farmers having positive precipitin tests to the crude antigen concentrates of the analogous thermophilic actinomycetes. Sixty-eight per cent of the symptomatic group were found to have precipitins to the M. faeni TCA-extractable antigens compared with only 22 per cent of the asymptomatic group. With regard to the other thermophilic actinomycetes tested, no significant differences in frequencies of precipitins to TCA-extractable antigens between the symptomatic and asymptomatic groups were found. However, the total number of patients available for testing with each of these antigens was small. Sufficient chemical characterization of the TCA-extractable antigens was carried out to show that they were chemically similar to the TCA-extractable antigens prepared by other workers.

Antigens, Bacterial

Cancer risk among Danish and Italian farmers.

Cancer risk for farmers in Denmark and Italy was studied by linking occupational census data with incidence of cancer in Denmark and with cancer mortality in Italy. Farmers in the two countries had a consistent risk reduction for cancer of the lung, bladder, small intestine, colon, rectum, and prostate. No excess of stomach cancer was found among farmers in the two countries, which is in agreement with the most recent data from other surveys. The risk of oesophageal cancer was reduced among the Danish and increased among the Italian male farmers. This can probably be explained by differences in alcohol consumption between the Danish and Italian farmers compared with the general population. The risk of brain cancer was significantly reduced among Italian farmers. There was a significant risk reduction for Hodgkin's disease and no excess for non-Hodgkin's lymphoma in Denmark, whereas in Italy a statistically significant excess risk was found for the first and a slight excess risk for the second of these diseases. The per capita consumption of phenoxy-herbicides between 1950 and 1970 was lower in Italy than in Denmark but treatments were performed mainly by professional applicators in Denmark and by the farmers themselves in Italy. Risk of leukaemia among Italian female farmers was increased. In Denmark, this increase was limited to women who were themselves owners of a farm. Specific occupations in agriculture showing a high risk for cancers of the lymphopoietic system in Denmark mostly entailed contact with animals.

Adolescent

[Epidemiological studies on the symptoms due to strawberry culture in the vinyl-house. 1. An analysis of subjective symptoms by working conditions and constitution of the farmers (author's transl)].

An epidemiological survey focused on farmers engaged in vinyl-house culture of strawberry was carried out among the inhabitants of a farming village. For avoiding residential and habitual factors, all residents (851 in number) over 12 years of age in the area were inquired about symptoms, personal and family histories. There were no marked difference in age and sex among three groups, i.e. farmers with and without vinyl-house culture and people with no relation to farming in this area. Incidence of one of the inquired symptoms were 54% and 45% in farmers with and without strawberry culture in vinyl-house respectively, and 34% in the non-farming people. This difference became more larger up to 83% in the strawberry farmers of allergic constitution. Symptoms found more in the farmers than the other were headache, dizziness, conjunctivitis, rhinorrea, sneeze, palpitation and neuralgia, and the last four symptoms were more marked among farmers in charge of strawberry culture. Incidence of the allergic symptom consisting of conjunctivitis, rhinorrea and sneeze was more marked among the persons of allergic constitution . In conclusion, health effects of strawberry culture in vinyl-house in farmers can be look upon from three aspects; overwork, a particular stance during the work and allergic responses to the dust in the vinyl-house.

Adolescent

Correlation of exposure to various respiratory pathogens with farmer's lung disease.

Complement-fixing antibodies (CFA) to a panel of microorganisms commonly associated with respiratory disease were measured in a number of agricultural populations. The panel included Mycoplasma pneumoniae, influenza viruses A and B, parainfluenza virus types 1, 2, and 3, adenovirus, and respiratory syncytial virus. The agricultural populations were grouped according to a clinical history of farmer's lung disease (FLD) and the presence of antibodies to the thermophilic actinomycetes (TA). Farmers with precipitating antibody activity to one or more of the TA (groups I and II) demonstrated a greater frequency of CFA to M. pneumoniae and parainfluenza virus types 1, 2, and 3 than those groups without antibody to the TA, but the level of CFA was not higher in the positive subjects. Immunoglobulin levels were also elevated in groups I and II when compared to the control groups. Unlike IgG and IgM, IgA was elevated only in the farmers who had a clinical history of FLD (group I) but not in farmers without a clinical history. The results suggest that farmers who develop FLD are exposed to a wider variety of pathogens than are other farmers, but do not respond in an accelerated manner.

Actinomycetales

Contact with pigs and cats associated with high prevalence of Toxoplasma antibodies among farmers.

Antibodies to Toxoplasma were measured by enzyme linked immunosorbent assay (ELISA) in sera from 159 abattoir workers, 142 pig farmers, and 106 grain or berry farmers. Farmers occupationally exposed to pigs had antibodies in 53 (37%) cases, abattoir workers in 40 (25%) cases, and farmers not exposed to pigs in 24 (23%) cases. In each group antibodies were more prevalent among those who had a cat or cats in the household. Controlling for age and cat contacts changed the prevalences less than one percent. The results indicate that pig farmers might have an occupational risk of toxoplasmosis. As the prevalence of antibodies among abattoir workers was about the same as among the referent farmers, it seems unlikely that infection from Toxoplasma could be acquired by mere handling of raw meat.

Agricultural Workers' Diseases

Farmer's lung disease in Vermont.

Several Vermont population groups were surveyed for the occurrence of antibodies to thermophilic actinomycetes. Antibodies to M. faeni and T. vulgaris were measured by the precipitin method in all subjects and, in 124 subjects, M. faeni antibodies were also measured by the indirect fluorescent antibody (IFA) technique. There was relatively good correlation between the two techniques (r 0.48, p less than 0.01). Hospital employees, blood donors and patients with chronic bronchitis were generally negative for precipitins to thermophilic actinomycetes. Of the 258 Vermont dairy farmers surveyed, 14 (5.4%) had precipitins to M. faeni, 3 (1.2%) had precipitins to T. vulgaris but only 1 farmer with antibodies to M. faeni had symptoms of possible farmer's lung disease (FLD). On the other hand, 10 (4.1%) precipitin-negative farmers had symptoms possibly consistent with FLD. The IFA test did not correlate any better with symptoms. 7 (5.6%) patients with pulmonary fibrosis had precipitins to M. faeni 5 of these were diagnosed as having FLD. 18 (14.4%) had precipitins to T. vulgaris and only 3 of these patients were felt to have hypersensitivity pneumonitis. Patients with pulmonary fibrosis and FLD hat IFA titers of greater than or equal to 1/128, but so did asymptomatic farmers.

Adolescent

[Case report of Farmer's lung disease in siblings in Kagoshima Prefecture].

Two cases of farmer's lung disease in siblings are reported. A 54-year-old male farmer, who had been engaged in stock work for 20 years, presented to our clinic for the second episode of fever, productive cough and shortness of breath. Chest roentgenogram revealed diffuse micronodular pattern, and mild hypoxemia was recognized on arterial blood gas analysis. Cytology obtained from BALF showed lymphocytosis, with especially increased OKT3, OKT4 positive cells and OKT4/8 ratio. The diagnosis was confirmed by highly positive reaction of precipitins to Thermoactinomyces vulgaris and granulomatous interstitial pneumonitis on histopathological examination. The second case was a 51-year-old female patient, the sister of the first case, who also worked as a stock farmer of another farm for 20 years. She presented with an episode of similar symptoms to the first case, one and a half years after the onset of her brother's symptoms. The findings of roentgenogram, BALF analysis, precipitins to T. Vulgaris and pathology were similar to those of the first case. The finding of high OKT4/8 ratio on BALF analysis in both cases is characteristic of formers lung disease, in contrast to the summer-type hypersensitivity pneumonitis which usually shows low OKT4/8 ratio in BALF. To our knowledge, this is the first report of farmer's lung disease in an area other than the northern part of Japan. Thus we conclude that farmer's lung disease may occur in Japan under any environmental conditions, and that some genetic factor may take part in the onset of this disease.

Bronchoalveolar Lavage Fluid

A comparison of the seroepidemiology of chlamydial infection in pigeon fanciers and farmers in the U.K.

A detailed comparative seroepidemiological study of antibody responses was performed in 271 pigeon fanciers and 100 farmers. Overall 73% of pigeon fanciers had IgG antibodies at a titre greater than or equal to 16 to Chlamydia pneumoniae, 39% to Chlamydia psittaci, and 6.6% to Chlamydia trachomatis. The prevalence of chlamydial antibodies was significantly lower in the farmers at 47% for C. pneumoniae, 6% for C. psittaci, and 2% for C. trachomatis. Both populations were exposed to complex microbiological and antigenic environments: 50.5% of the pigeon fanciers had antibodies to pigeon antigens, 34% to egg membrane, and 0.73% to yolk sac antigen, and 59% of the farmers had antibodies to Micropolyspora faeni, but the high prevalence of chlamydial antibodies could not be attributed to interaction with these antigens. There was considerable overlap of chlamydial antibody responses in the pigeon fanciers but not in the farmers: 36% of the pigeon fanciers had antibodies to C. pneumoniae alone, 5% to C. psittaci alone, and 31% to both agents, whereas only 3% of farmers had antibodies to both C. pneumoniae and C. psittaci. The high prevalence of antibodies to C. psittaci in the pigeon fanciers is compatible with the known avian reservoir for this infection. The particularly high prevalence of antibodies to C. pneumoniae suggests that complex interactions may be occurring in a population exposed to two chlamydial organisms, whereby infection with one species may provoke an anamnestic response against other chlamydial organisms with which the subject has previously been infected.

Adolescent

Ancestry, admixture, and pathogens in contemporaneous Neolithic farmers and foragers on the Island of Gotland.

Two archaeological cultural complexes; the Neolithic Funnelbeaker culture (FBC) and the Pitted ware culture (PWC), coexisted on Gotland for over 500 years, between ~3300 and 2800 calBCE. The ancestry of the FBC farmers and PWC marine foragers largely aligns with European Neolithic Farmers and European Mesolithic foragers, respectively, but the direct interactions between the groups on Gotland is not understood. We present a Middle Neolithic (MN) high-coverage genome and a Late Neolithic (LN) low-coverage genome from the Ansarve FBC dolmen. We investigate ancestry, admixture, and pathogens among these MN farmers (n = 6), foragers (n = 19), and the LN individual. We find that recent gene-flow between farmers and foragers could have taken place, although most gene-flow happened prior to their coexistence on the island. We also find evidence of different Yersinia pestis strains in the three cultural groups, showing that the pestis was widespread among groups with different subsistence strategies.

Humans

The prevalence of farmer's lung in an agricultural population.

Four hundred seventy-one persons associated with farming or dairy production were surveyed by means of a questionnaire for evidence of hypersensitivity lung disease due to inhalation of moldy hay or grain (farmer's lung). Of these, 172 were evaluated with spirometry, serologic studies, and chest roentgenographs. A history typical of the farmer's lung syndrome was given by 14 of the 471 subjects (3.9 per cent). Precipitating antibodies to Micropolyspora faeni were identified in sera from 2 of these 14 subjects (14 per cent), and spirograms were abnormal in 4 (28 per cent). The prevalence of farmer's lung in this community (i.e., 3 per cent) is comparable to that found in epidemiologic studies in Britain and Scotland. Farmer's lung disease may be an important occupational illness of dairy and cattlemen in this country, but the diagnosis may be overlooked frequently because of the lack of patient and/or physician awareness.

Farmer's Lung

Antibodies of different immunoglobulin classes against antigens causing farmer's lung.

A solid phase radioimmunoassay technique was used to demonstrate antibodies of various immunoglobulin classes in sera against farmer's lung antigens. IgG, IgA, and IgM antibody activity in normal patients and in patients with farmer's lung were detected against Micropolyspora faeni. Only the IgG and IgA antibody activity was different in farmers and in control subjects. An asymptomatic subject could not be differentiated from symptomatic farmers by IgG antibody activity. No IgE antibody activity was detected. The radioimmunoassay technique can be used to show antibody activity against carbohydrate antigens and as a method of evaluation of antigens by inhibition analysis. Certain types of hypersensitivity lung disease can be discriminated by in vitro analysis of serum antibody of various immunoglobulin classes. This is apparent for IgE and possibly true for IgM.

Adult

The quantitation of antibody in farmer's lung syndrome using a radioimmunoassay. Results of a clinical survey and comparison of three serological methods.

Three serological tests for antibody to Micropolyspora faeni, the precipitin test (Ouchterlony double diffusion test in two dimensions) the fluorescent antibody test (double-layer technique using patient's serum in middle layer) and a quantitative radioimmunoassay for IgG antibody were applied to cases of farmer's lung syndrome and compared as to their value in diagnosis and management of these cases. Of twenty-one cases with clinical symptoms only ten (48%) had positive precipitin tests, while all (100%) showed a positive fluorescent antibody test. Sixteen (76-4%) were found by the radioimmunoassay to have antibody in excess of the normal controls. The remaining five cases with symptoms had a range of antibody levels which overlapped with those of symptom-free individuals (with sera negative to fluorescent antibody tests). The precipitin test was positive above a level of 75 mug/ml of IgG antibody as determined by the radioimmunoassay, whilst the cases judged by the fluorescent antibody test to be positive were all above a level of 35 mug/ml of IgG antibody. Application of the radioimmunoassay to a group of farmers in the West of Scotland successfully detected high antibody levels in all with clinical evidence of farmer's lung syndrome; farmers who were symptom-free also had measurable antibody. The advantages of a quantitative test for antibody levels in the management of cases of this disease are discussed.

Antibodies, Bacterial

Leukemia among Nebraska farmers: a death certificate study.

The risk of leukemia among farmers was studied using records of death certificates from Nebraska, 1957--1974. Comparison of occupation, as recorded on the death certificate, for 1084 leukemia deaths and 2168 deaths from other causes, matched for age at death, year of death, county of residence, race, and sex, revealed an elevated risk of leukemia among farmers (odds ratio = 1.25). The risk was greatest among farmers born after 1900 and dying before age 66 (odds ratio = 1.83). Stratification by county of residence showed a significantly elevated risk for farmers from heavy corn producing counties.

Adult

Primary, secondary, and tertiary prevention in reducing pesticide-related illness in farmers.

American farmers are a specific population with specific health concerns, and there is little in the literature that addresses nursing care of farmers. The farmer needs to be educated and assessed for the potential of poisoning injury related to pesticide exposure. Studies done by the National Cancer Institute (NCI) and others have shown a somewhat greater risk of specific cancers in farmers using pesticides. Acute exposures and chronic conditions resulting from years of exposure to pesticides are oftentimes not attributed to pesticides. By use of the nursing process, nurses can develop programs at all levels of prevention to deal with this problem. This article describes such programs, as well as providing resources useful in their development.

Agricultural Workers' Diseases

Clues to cancer etiology from studies of farmers.

This article summarizes cancer risks among farmers to clarify the magnitude of the problem and to suggest directions for future research. Significant excesses occurred for Hodgkin's disease, multiple myeloma, leukemia, skin melanomas, and cancers of the lip, stomach, and prostate. Nonsignificant increases in risk were also noted for non-Hodgkin's lymphoma and cancers of connective tissue and brain. These excesses occurred against a background of substantial deficits among farmers for total mortality and mortality from many specific diseases. The tumors vary in frequency, histology, and prognosis and do not fall into any obvious grouping. Two commonalities may be important. Several of the tumors excessive among farmers appear to be rising in the general population and are excessive among patients with naturally occurring or medically induced immunodeficiencies. Therefore epidemiologic studies on specific exposures among farmers may help explain the rising trend of certain cancers in developed countries and provide clues to mechanisms of action for environmental carcinogens.

Agricultural Workers' Diseases

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 farmer's lung disease. Follow-up studies to establish the relationship between the positive precipitin reactions to the presence of clinical disease are now under way.

Antigens, Bacterial