INTRODUCTION AND OBJECTIVE:Mushroom compost worker's lung (MCWL) is a hypersensitivity pneumonitis (HP) entity occurring in workers employed at preparing compost for the cultivation of white button mushrooms. The aim of the study is to identify the strains of thermophilic actinobacteria as the potential causative agents of MCWL symptoms in workers. MATERIAL AND METHODS:Clinical examinations included chest X-ray, high-resolution computed tomography (HRCT), bronchoscopy with bronchoalveolar lavage (BAL), pulmonary function tests comprising spirometric measurements, DLCO measurements, body pletysmography, and arterial - blood gas tests. Identification of thermophilic actinobacteria was performed by microscopy, culture and genetic methods. Allergological tests included the agar gel precipitation test and inhalation challenge with actinomycetal antigens. RESULTS:Among a group of 20 patients, 15 showed in HRCT ground-glass attenuations solely and were diagnosed with acute HP, 3 showed ground-glass attenuations with pulmonary fibrosis and were diagnosed with subacute HP, while 2 patients were diagnosed with Organic Dust Toxic Syndrome (ODTS). Thermobifida fusca and Laceyella sacchari strains were isolated from the symptom-causing mushroom compost. In 3 workers, strong precipitin reactions to Th. fusca were found, whereas there were no reactions to L. sacchari. Four workers showed a positive inhalation response to small doses of Th. fusca antigen. CONCLUSIONS:The results of this study indicate that Th. fusca is most probably a major causative agent of MCWL and should be considered in the diagnosis of HP in workers of the mushroom compost facility.

The COVID-19 pandemic has profoundly affected mental health, with many survivors experiencing psychological challenges, including Post-Traumatic Stress Disorder (PTSD). This study assessed PTSD symptoms and Post-Traumatic Growth (PTG) among 62 individuals recovering from COVID-19 infection, all of whom were under the care of the Department of Pneumonology, Oncology, and Allergology at the Medical University of Lublin. Results revealed that 40.32% of participants exhibited PTSD symptoms. Key predictors of PTSD severity included cognitive symptoms and post-COVID self-rated health, with cognitive symptoms positively associated and self-rated health negatively associated with PTSD severity. A positive correlation was also found between PTSD severity and PTG, suggesting that while individuals endure significant psychological distress, they may also experience personal growth, such as enhanced resilience and a redefined life perspective. These findings highlight the dual psychological impact of COVID-19 infection, particularly for individuals with preexisting pulmonary conditions. They underscore the importance of holistic, integrated care that addresses both the reduction of PTSD symptoms and the promotion of meaningful psychological growth in COVID-19 survivors.

A Gram-positive, aerobic, rod-shaped mesophilic bacterium was isolated from birch wood, referred to as the AB strain. Allergological tests suggest that this strain may cause allergic alveolitis in sawmill workers. Employing a polyphasic taxonomic approach, the AB strain's 16S rRNA gene sequence showed high similarity to Microbacterium barkeri and M. oryzae, with 97.25% and 96.91%, respectively, a finding supported by rpoB and gyrB sequence analysis. Further genome sequence comparison with the closely related M. barkeri type strain indicated a digital DNA-DNA hybridization value of 25.5% and an average nucleotide identity of 82.52%. The AB strain's cell wall peptidoglycan contains ornithine, and its polar lipids comprise diphosphatidylglycerol, phosphatidylglycerol, and unidentified glycolipids. Its major fatty acids include anteiso C15:0, anteiso C17:0, and iso C16:0, while MK-10 is its predominant respiratory quinone. Comprehensive analysis through 16S rRNA, whole-genome sequencing, phenotyping, chemotaxonomy, and MALDI-TOF MS profiling indicates that the AB strain represents a new species within the Microbacterium genus. It has been proposed to name this species Microbacterium betulae sp. nov., with ABT (PCM 3040T = CEST 30706T) designated as the type strain.

The COVID-19 pandemic has had a profound impact on mental health, with many survivors experiencing psychological challenges, including Post-Traumatic Stress Disorder (PTSD). This study assessed PTSD symptoms and Post-Traumatic Growth (PTG) among 62 individuals who recovered from COVID-19 and were under the care of the Department of Pneumonology, Oncology, and Allergology at the Medical University of Lublin. The results revealed that 40.32% of participants exhibited PTSD symptoms. Cognitive symptoms and post-COVID self-rated health were significant predictors of PTSD severity, with cognitive symptoms positively associated and self-rated health negatively associated with PTSD severity. Additionally, a positive correlation was found between PTSD severity and PTG, suggesting that while many individuals endure significant distress, they may also experience positive psychological changes, such as improved self-perception and resilience. These findings highlight the dual impact of COVID-19 on mental health and underscore the importance of integrated mental health care that addresses both mitigating PTSD symptoms and promoting resilience and growth in COVID-19 survivors.

Nintedanib is a disease-modifying agent licensed for the treatment of IPF. Data on Polish experience with nintedanib in IPF are lacking. The present study aimed to describe the safety and efficacy profiles of nintedanib in a large real-world cohort of Polish patients with IPF. This was a multicenter, retrospective, observational study of IPF patients treated with nintedanib between March 2018 and October 2021. Data collection included baseline clinical characteristics, results of pulmonary function tests (PFTs), and a six-minute walk test (6MWT). Longitudinal data on PFTs, 6MWT, adverse drug reactions (ADRs), and treatment persistence were also retrieved. A total of 501 patients (70% male) with a median age of 70.9 years (IQR 65–75.7) were included in this study. Patients were followed on treatment for a median of 15 months (7–25.5). The majority of patients (66.7%) were treated with the full recommended dose of nintedanib and 33.3% of patients were treated with a reduced dose of a drug. Intermittent dose reductions or drug interruptions were needed in 20% of patients. Over up to 3 years of follow-up, pulmonary function remained largely stable with the minority experiencing disease progression. The most frequent ADRs included diarrhea (45.3%), decreased appetite (29.9%), abdominal discomfort (29.5%), weight loss (32.1%), nausea (20.8%), fatigue (19.2%), increased liver aminotransferases (15.4%), and vomiting (8.2%). A total of 203 patients (40.5%) discontinued nintedanib treatment due to diverse reasons including ADRs (10.2%), death (11.6%), disease progression (4.6%), patient’s request (6.6%), and neoplastic disease (2.2%). This real-world study of a large cohort of Polish patients with IPF demonstrates that nintedanib therapy is safe, and is associated with acceptable tolerance and disease stabilization. These data support the findings of previously conducted clinical trials and observational studies on the safety and efficacy profiles of nintedanib in IPF.

"Hypersensitivity Pneumonitis: Correct Identification of Causative Microbial Agents Is Essential for Efficient Diagnosis and Prevention ." American Journal of Respiratory and Critical Care Medicine, 0(ja), pp. –

In December 2019, an atypical form of severe pneumonia emerged in Wuhan in China's Hubei province, which in February 2020 was named COVID-19. The disease may have features of interstitial pneumonia and severe respiratory failure requiring intensive oxygen therapy. Spontaneous pneumomediastinum is a rare pathological condition with air in the mediastinum outside the trachea, oesophagus and bronchi. It is potentially life-threatening complication of both invasive and non-invasive mechanical ventilation. There have been reports that it may complicate the course of interstitial lung disease in the course of COVID-19. The report describes two cases of young patients who spontaneously developed this complication. Immediate diagnose is important in order to applicate adequate procedures.

OCCURRENCE:Gram-negative bacteria occur commonly in the inner tissues of stored coniferous and deciduous timber, showing a marked variation in numbers. The greatest maximal numbers are found in the sapwood of coniferous timber. The common constituents of the Gram-negative biota are potentially pathogenic species of Enterobacteriaceae family of the genera Rahnella, Pantoea, Enterobacter, and Klebsiella. The air of wood-processing facilities is polluted with the wood-borne Gram-negative bacteria and produced by them endotoxin, as demonstrated worldwide by numerous studies.EFFECTS:There are three potential pathways of the pathogenic impact of wood-borne Gram-negative bacteria on exposed woodworkers: allergic, immunotoxic, and infectious. Allergic impact has been underestimated for a long time with relation to Gram-negative bacteria. Hopefully, the recent demonstration of the first documented case of hypersensitivity pneumonitis (HP) in woodworkers caused by Pantoea agglomerans which developed in extremely large quantities in birch sapwood, would speed up finding of new wood-related cases of HP caused by Gram-negative bacteria. The second pathway is associated with endotoxin, exerting strong immunotoxic (excessively immunostimulative) action. It has been demonstrated that endotoxin is released into wood dust in the form of nano-sized microvesicles, by peeling off the outer membrane of bacteria. Endotoxin microvesicles are easily inhaled by humans together with dust because of small dimensions and aerodynamic shape. Afterwards, they cause a nonspecific activation of lung macrophages, which release numerous inflammatory mediators causing an inflammatory lung reaction, chest tightness, fever, gas exchange disorders, and bronchospasm, without radiographic changes. The resulting disease is known as "Organic Dust Toxic Syndrome" or "toxic pneumonitis." The potential third pathway of pathogenic impact is infection. The suspected species is Klebsiella pneumoniae that may occur commonly in wood dust; however, until now this pathway has not been confirmed.CONCLUSION:Summarizing, Gram-negative bacteria-inhabiting timber should be considered, besides filamentous fungi and actinobacteria, as important risk factors of occupational disease in woodworkers that could be either HP with allergenic background or toxic pneumonitis elicited by endotoxin.

The recommendations were developed as answers to previously formulated questions concerning everyday diagnostic and therapeutic challenges. They were developed based on a review of the current literature using the GRADE methodology. The experts suggest that PF-ILD be diagnosed based on a combination of different criteria, such as the aggravation of symptoms, progression of radiological lesions, and worsening of lung function test parameters. The experts recommend a precise diagnosis of an underlying disease, with serological testing for an autoimmune disease always being included. The final diagnosis should be worked out by a multidisciplinary team (MDT). Patients with an interstitial lung disease other than IPF who do not meet the criteria for the progressive fibrosis phenotype should be monitored for progression, and those with systemic autoimmune diseases should be regularly monitored for signs of interstitial lung disease. In managing patients with interstitial lung disease associated with autoimmune diseases, an opinion of an MDT should be considered. Nintedanib rather than pirfenidon should be introduced in the event of the ineffectiveness of the therapy recommended for the treatment of the underlying disease, but in some instances, it is possible to start antifibrotic treatment without earlier immunomodulatory therapy. It is also admissible to use immunomodulatory and antifibrotic drugs simultaneously. No recommendations were made for or against termination of anti-fibrotic therapy in the case of noted progression during treatment of a PF-ILD other than IPF. The experts recommend that the same principles of non-pharmacological and palliative treatment and eligibility for lung transplantation should be applied to patients with an interstitial lung disease other than IPF with progressive fibrosis as in patients with IPF.

INTRODUCTION AND OBJECTIVE Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by iterative inhalation of various environmental agents. The clinical presentation is variable, acute HP commonly presents an inflammatory response, whereas the development and clinical consequences in chronic HP may be similar to IPF (idiopathic pulmonary fibrosis). The aim of the study is to present the latest discoveries regarding the genetic predisposition of HP. MATERIAL AND METHODS The appropriate scientific literature was reviewed and analyzed. RESULTS Studies have discovered relevant gene polymorphisms in HP, including polymorphisms in the major histocompatibility complex in the metalloproteinases genes. The length of the peripheral blood leukocyte telomere has been investigated and discovered to be important. Recently, the need to study miRNAs in ILD (interstitial lung disease) has been highlighted. CONCLUSIONS Exposed HP developed only in some people and a genetic susceptibility significantly increases the risk. Further more current studies on large groups of patients are needed to learn more about the genetic predisposition and risk factors of HP.

Introduction and objective The course of COVID-19 caused by the SARS-CoV-2 may be aggravated by bioaerosols containing other viruses, bacteria, and fungi, occurring mainly in the occupational environment. Hence, the diagnostics and treatment of COVID-19 should address such a possibility in the anamnesis, treatment and final recommendations for avoiding of adverse exposure. Abbreviated description of the state of knowledge As SARS-CoV-2 attacks primarily the respiratory system and the severe manifestation of COVID-19 is interstitial pneumonia, diagnostics should include the following clinical and laboratory examinations: chest X-ray; high resolution computed tomography (HRCT); pulmonary function tests; arterial-blood gas test; genetic tests for the presence of SARS-CoV-2, in the future with the use of highly specific and sensitive nano-based biosensors; tests for the presence of specific immunity against the antigens of microorganisms causing other infectious or allergic pulmonary diseases (in the case of anamnestic indications). Because an universally accepted treatment for COVID-19 does not exist, the hitherto prescribed antiviral and immune-modulating drugs should be used be with caution. In many cases, a better alternative could be a safe supportive therapy, such as supplementation of the diet with probiotics, prebiotics, vitamins and microelements. Summary The most important preventive measures against COVID-19 should include: vaccination; the use of filter or surgical masks; disinfection and sterilization; maintaining of well-functioning ventilation and air conditioning systems; reduction of the community air pollution which has been identified as an important factor increasing the COVID-19 severity. In the choice of preventive measures, the above should be considered for their potential efficacy against other bioaerosols as potential disease-aggravating agents.

The occupational bioaerosols containing viruses, bacteria, fungi, microbial toxins and plant or animal particles, may evoke infectious, allergic or immunotoxic diseases which may co-exist as comorbidities with COVID-19 and exacerbate the course of disease. They include hypersensitivity pneumonitis (HP) caused mostly by bacteria, fungi, and particles containing animal proteins, and immunotoxic diseases such as organic dust toxic syndrome (ODTS) and byssinosis, caused mostly by bacterial and fungal toxins. The two most probable scenarios of possible interrelations between these three comorbidities (CM) and COVID-19 are: 1) 'Triggering' - when infection with SARS-CoV-2 triggers severe CM after bioaerosol exposure; 2) 'Reverse triggering' when exposure to bioaerosol exacerbates a symptomless or mild course of COVID-19, and evokes a severe disease. The occupations mostly endangered by COVID-19 as the result of exposure to SARS-CoV-2 bioaerosol, or to other bioaerosols which may exacerbate this disease, include: health care workers, social workers, breeders of fur animals, slaughterhouse workers, workers engaged in the processing and selling of seafood, and probably also agricultural workers, mainly in the developing countries. The authors present a hypothesis for the origin of the present pandemic. It assumes that a mild form of the present SARS-CoV-2 that is supposedly circulating among the Chinese population in the eastern part of the country, mutated under the influence of as yet unknown factor(s) present in the Chinese seafood markets, probably component(s) of bioaerosols, into the virulent and highly contagious form, known as the present SARS-CoV-2, under a scenario similar to that the authors have named 'Reverse triggering'.

Pantoea agglomerans is gram-negative bacteria widely distributed in nature. It predominates in inhalable dust from grain, herbs, and flax, and was identified as the most important cause of hypersensitivity pneumonitis (HP) in eastern Poland. To better understand the molecular mechanism of HP development studies focused on the interactions between P. agglomerans and alveolar epithelial cells as well as lung tissue with particular emphasis on the epithelial-mesenchymal transition (EMT). The studies were conducted on human normal lung epithelial NL20 cells and mice strain C57BL/6J. Cells and mice underwent chronic exposure to saline extract of P. agglomerans (SE-PA). Morphological changes were evaluated under light microscopy, the concentration of fibrosis markers was examined by the ELISA method, while the expression of genes involved in EMT was evaluated by RealTime PCR. During incubation with SE-PA epithelial cells underwent conversion and assumed fibroblast phenotype characterized by a decrease in epithelial cells markers (CDH1, CLDN1, JUP) and increase in mesenchymal cells markers (FN1, VIM, CDH2). Mice lungs collected after 14 days of SE-PA treatment revealed inflammation with marked lymphocytes infiltration. The intensified inflammatory process accompanied by increased proliferation of fibrous connective tissue was noted in mice lungs after 28 days of SE-PA exposure. Histological changes correlated with an increase of fibrosis markers (hydroxyproline, collagens), downregulation of epithelial markers (Cdh1, Cldn1, Jup, Ocln) and upregulation of myofibroblasts markers (Acta2, Cdh2, Fn1, Vim). Obtained results revealed SE-PA ability to induce EMT in human lung epithelial cells and mice lung tissue, with the scale of changes proportional to the time of treatment.

INTRODUCTIONThiram, a fungicides, is widely used on seeds and as foliar agent on turf, vegetables and fruit. It is also used in the rubber industry as a vulcanization accelerator. When absorbed through the respiratory system, it is rapidly metabolised to dimethylthiocarbamate and carbon disulphide, causing noxious effects. A brief review is presented of the literature, centering on the interesting case of a 45-year-old woman admitted to the hospital suffering from acute respiratory failure.RESULTSComputer tomography in angiographic option (angio-CT) showed an extensive, irregular area of ground glass in both upper lobes and apical segments of the lower lobes of the lungs. A significant enlargement of both atria was also described. There was no improvement after cardiac treatment and patient was transferred to the pulmonary department where she was succesfully treated with systemic glucocortycosteroids. The patient remains under the supervision of the pulmonary out-patient department.

IntroductionPeak expiratory flow (PEF), a measure of lung function, was first described by Hadorn in 1942. The definition of PEF, written by the European Respiratory Society, states that it is the maximum flow achieved during the expiration phase, delivered with maximal force, starting from the maximum level of lung inflation. The aim of this study was to evaluate the variations of PEF associated with height, age, body surface area, place of residence and environmental factors among healthy adults in an urban setting in Poland.Material and methodsThe study comprised 88 healthy, non-smoking subjects: 30 females and 58 males, aged 20–80 years. Epidemiological and demographic data were collected from each participant, as well as information on symptoms and the occurrence of lung diseases. Only healthy subjects were selected for analysis. Participants completed spirometry testing; physical parameters were measured, and appropriate additional data obtained.ResultsAmong the study group of 88 participants (30 females and 58 males), peak expiratory flow rate was negatively correlated with age (p = 0.000001), and positively correlated with height and body surface area (both p < 0.000001). There was a significant negative correlation between PEF and longitudinal environmental factors such as different particulate matter levels (p = 0.0007) present at the place of residence.ConclusionsPeak expiratory flow changes are present in a healthy adult population. Place of residence and environmental factors influence the results of spirometry tests.

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.

Hypersensitivity pneumonitis (HP), called extrinsic allergic alveolitis, is a syndrome characterized by diffuse inflammation of lung parenchyma and airways in response to the inhalation of antigens to witch the patient has been previously sensitized. The clinical presentation of HP have been categorized as acute, subacute and chronic. The patient with chronic HP may lack a history of acute episodes and usually reports the insidious onset of cough, dyspnoea, fatigue, and weight los. Idiopathic pulmonary fibrosis (IPF) is a type of lung disease that results in scarring (fibrosis) of the lungs for an unknown reason. Symptoms of IPF are the same as in chronic hypersensitivity pneumonitis and differentiation may be difficult. We present a case of patient with chronic HP, in whom the course of the end stage of the disease mimic acute exacerbations idiopathic pulmonary fibrosis.

Introduction: Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently introduced method of biopsy of the mediastinal lymph nodes. This is a safe and minimally invasive and save procedure. The material can be obtained as a smear or cell block (CB). Aims: This study focused on the role of cell block (CB) analysis in determining the diagnostic yield of EBUS-TBNA. Objective of the study was to assess the effectiveness of the new method of collecting CB. Methods: We included 25 patients (different causes). We performed 32 biopsies nodes (twice each). For the biopsy a cytological 22 G needle was used. First biopsy: CB was taken by conventional method - needle was purged by air. Second biopsy: CB was taken by new method – needle was rinsed by cytospin (RCB). Diagnostic yield on cell block versus rinsed cell block was recorded. Cell blocks were reviewed by an experienced pathologist to determine diagnostic accuracy. Results: Diagnostic material was found in CB n=11 (34%) vs.RCB n= 16 (50%). No statistical significance was found (p=0,2). Do not observed any side effects. Conclusions: The data demonstrate no remarkable difference in diagnostic yield. We observed a nonsignificant 16% advantage in favor of the rinsed CB. It requires further research on a larger group of patients. Do not observed any side effects.

The lungs are highly sensitive to tissue fibrosis, with a clear age-related component. Among the possible triggers of pulmonary fibrosis are repeated inhalations of fine organic particles. How age affects this response, is still far from being fully understood. We examined the impact of middle-age on gene expression in pulmonary fibrosis, using the novel “inhalation challenge set” mouse model. Our results demonstrate that the response of female mice to exposure of Pantoea agglomerans extract primarily involves various immune-related pathways and cell–cell/cell–extracellular matrix interactions. We found that middle-age had a strong effect on the response to the P. agglomerans-induced lung fibrosis, featured by a more rapid response and increased magnitude of expression changes. Genes belonging to innate immunity pathways (such as the TLR signaling and the NK-cell mediated cytotoxicity) were particularly up-regulated in middle-aged animals, suggesting that they may be potential targets for the treatment of pulmonary fibrosis caused by inhalations of organic particles. Our analysis also highlights the relevance of the “inhalation challenge set” mouse model to lung aging and related pathology.

Introduction and objective. COPD is a medical state characterized by chronically poor airflow, and typically worsens over time. Farmers have an increased risk of COPD because of being exposed to ammonia, hydrogen sulfide, inorganic dust, and organic dust. The quality of life of the ill depends on biomedical as well as psychosocial factors, the impact of which has not been a frequent subject of studies among COPD patients. The aim of the study was to indicate the factors that have negative and positive influence on the quality of life of farmers suffering from COPD. Materials and method. The study was conducted among 84 farmers treated for COPD in the Department of Pneumology, Oncology and Allergology of the Medical University in Lublin, Poland. The differences between the farmers concerned: severity of the disease, level of education and income, frequency of smoking tobacco and drinking alcohol, kinds of support they receive from their families, and the level of depression and anxiety experienced by the patients. Results. The study revealed that most patients suffered from depressive and anxiety disorders, and the level of depression higher among the patients who smoked more. Lack of family support had significant influence on exacerbation of the patient's depressive and anxiety symptoms. Patients who had recently experienced a critical situation presented with more severe COPD symptoms, lower quality of life and a higher level of depression. Higher income of the patients had positive influence on their quality of life. Farmers addicted to alcohol suffered from a higher level of anxiety.