Working with argan cake: a new etiology for hypersensitivity pneumonitis

International audienceAbstractBackgroundArgan is now used worldwide in numerous cosmetic products. Nine workers from a cosmetic factory were examined in our occupational medicine department, following the diagnosis of a case of hypersensitivity pneumonitis (HP) related to handling of argan cakes.MethodsOperators were exposed to three forms of argan (crude granulates, powder or liquid) depending on the step of the process. All workers systematically completed standardized questionnaires on occupational and medical history, followed by medical investigations, comprising, in particular, physical examination and chest X-rays, total IgE and a systematic screening for specific serum antibodies directed against the usual microbial agents of domestic and farmer’s HP and antigens derived from microbiological culture and extracts of various argan products. Subjects with episodes of flu-like syndrome several hours after handling argan cakes, were submitted to a one-hour challenge to argan cakes followed by physical examination, determination of Carbon Monoxide Diffusing Capacity (DLCO) and chest CT-scan on day 2, and, when necessary, bronchoalveolar lavage on day 4.ResultsSix of the nine workers experienced flu-like symptoms within 8 hours after argan handling. After challenge, two subjects presented a significant decrease of DLCO and alveolitis with mild lymphocytosis, and one presented ground glass opacities. These two patients and another patient presented significant arcs to both granulates and non-sterile powder. No reactivity was observed to sterile argan finished product, antigens derived from argan cultures (various species of Bacillus) and Streptomyces marokkonensis (reported in the literature to contaminate argan roots).ConclusionsWe report the first evidence of hypersensitivity pneumonitis related to argan powder in two patients. This implies preventive measures to reduce their exposure and clinical survey to diagnose early symptoms. As exposure routes are different and antibodies were observed against argan powder and not the sterile form, consumers using argan-based cosmetics should not be concerned

Interstitial Lung Abnormalities Detected by CT in Asbestos-Exposed Subjects Are More Likely Associated to Age

OBJECTIVE: the aim of this study was to evaluate the association between interstitial lung abnormalities, asbestos exposure and age in a population of retired workers previously occupationally exposed to asbestos. METHODS: previously occupationally exposed former workers to asbestos eligible for a survey conducted between 2003 and 2005 in four regions of France, underwent chest CT examinations and pulmonary function testing. Industrial hygienists evaluated asbestos exposure and calculated for each subject a cumulative exposure index (CEI) to asbestos. Smoking status information was also collected in this second round of screening. Expert radiologists performed blinded independent double reading of chest CT-scans and classified interstitial lung abnormalities into: no abnormality, minor interstitial findings, interstitial findings inconsistent with UIP, possible or definite UIP. In addition, emphysema was assessed visually (none, minor: emphysema 50% of the lung). Logistic regression models adjusted for age and smoking were used to assess the relationship between interstitial lung abnormalities and occupational asbestos exposure. RESULTS: the study population consisted of 2157 male subjects. Interstitial lung abnormalities were present in 365 (16.7%) and emphysema in 444 (20.4%). Significant positive association was found between definite or possible UIP pattern and age (OR adjusted =1.08 (95% CI: 1.02-1.13)). No association was found between interstitial abnormalities and CEI or the level of asbestos exposure. CONCLUSION: presence of interstitial abnormalities at HRCT was associated to aging but not to cumulative exposure index in this cohort of former workers previously occupationally exposed to asbestos

Deep Learning for the Automatic Quantification of Pleural Plaques in Asbestos-Exposed Subjects

OBJECTIVE: This study aimed to develop and validate an automated artificial intelligence (AI)-driven quantification of pleural plaques in a population of retired workers previously occupationally exposed to asbestos. METHODS: CT scans of former workers previously occupationally exposed to asbestos who participated in the multicenter APEXS (Asbestos PostExposure Survey) study were collected retrospectively between 2010 and 2017 during the second and the third rounds of the survey. A hundred and forty-one participants with pleural plaques identified by expert radiologists at the 2nd and the 3rd CT screenings were included. Maximum Intensity Projection (MIP) with 5 mm thickness was used to reduce the number of CT slices for manual delineation. A Deep Learning AI algorithm using 2D-convolutional neural networks was trained with 8280 images from 138 CT scans of 69 participants for the semantic labeling of Pleural Plaques (PP). In all, 2160 CT images from 36 CT scans of 18 participants were used for AI testing versus ground-truth labels (GT). The clinical validity of the method was evaluated longitudinally in 54 participants with pleural plaques. RESULTS: The concordance correlation coefficient (CCC) between AI-driven and GT was almost perfect (>0.98) for the volume extent of both PP and calcified PP. The 2D pixel similarity overlap of AI versus GT was good (DICE = 0.63) for PP, whether they were calcified or not, and very good (DICE = 0.82) for calcified PP. A longitudinal comparison of the volumetric extent of PP showed a significant increase in PP volumes (p < 0.001) between the 2nd and the 3rd CT screenings with an average delay of 5 years. CONCLUSIONS: AI allows a fully automated volumetric quantification of pleural plaques showing volumetric progression of PP over a five-year period. The reproducible PP volume evaluation may enable further investigations for the comprehension of the unclear relationships between pleural plaques and both respiratory function and occurrence of thoracic malignancy

Agressions respiratoires des expositions aux contaminants professionnels et leurs conséquences sur la santé mentale

De multiples activités professionnelles, en milieu agricole, industriel ou dans le secteur du bâtiment peuvent, ou ont pu, exposer les travailleurs à l’inhalation de gaz, poussières, fumées et/ou aérosols. Ces derniers peuvent de nature variable : particules minérales par exemple amiante ou silice, mélanges complexes de gaz et particules métalliques dans les fumées de soudage, particules végétales chez les agriculteurs ou les boulangers, bioaérosols constitués de micro-organismes bactériens ou fongiques chez les agriculteurs mais également chez les usineurs en cas de contaminations de fluides de coupe. Ces expositions, facteurs d’agressions de l’appareil respiratoire peuvent favoriser l’apparition de pathologies diverses, variables selon la nature de l’exposition : troubles ventilatoires obstructifs (asthme, BPCO), pneumopathies interstitielles (pneumoconioses, pneumopathies d’hypersensibilité voire fibroses pulmonaires idiopathiques) mais aussi, pour certaines expositions, de cancers. Ces derniers surviennent souvent plusieurs dizaines d’années après l’exposition pouvant engendrer un phénomène d’épée de Damoclès. Ainsi chez certains sujets ayant été exposés à l’amiante inclus dans des programmes de surveillance un impact sur la santé mentale (anxiété et dépression) et sur la santé perçue a être pu être observé. L’exploration des déterminants de cet impact sur la santé mentale et sur la santé perçue des expositions à l’amiante voire à d’autres cancérogènes professionnels mérite d’être approfondie

Agressions respiratoires des expositions aux contaminants professionnels et leurs conséquences sur la santé mentale

De multiples activités professionnelles, en milieu agricole, industriel ou dans le secteur du bâtiment peuvent, ou ont pu, exposer les travailleurs à l’inhalation de gaz, poussières, fumées et/ou aérosols. Ces derniers peuvent de nature variable : particules minérales par exemple amiante ou silice, mélanges complexes de gaz et particules métalliques dans les fumées de soudage, particules végétales chez les agriculteurs ou les boulangers, bioaérosols constitués de micro-organismes bactériens ou fongiques chez les agriculteurs mais également chez les usineurs en cas de contaminations de fluides de coupe. Ces expositions, facteurs d’agressions de l’appareil respiratoire peuvent favoriser l’apparition de pathologies diverses, variables selon la nature de l’exposition : troubles ventilatoires obstructifs (asthme, BPCO), pneumopathies interstitielles (pneumoconioses, pneumopathies d’hypersensibilité voire fibroses pulmonaires idiopathiques) mais aussi, pour certaines expositions, de cancers. Ces derniers surviennent souvent plusieurs dizaines d’années après l’exposition pouvant engendrer un phénomène d’épée de Damoclès. Ainsi chez certains sujets ayant été exposés à l’amiante inclus dans des programmes de surveillance un impact sur la santé mentale (anxiété et dépression) et sur la santé perçue a être pu être observé. L’exploration des déterminants de cet impact sur la santé mentale et sur la santé perçue des expositions à l’amiante voire à d’autres cancérogènes professionnels mérite d’être approfondie

Facteurs de risque de la BPCO chez les producteurs laitiers (Etude à partir de trois cohortes)

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

Les troubles musculo-squelettiques en Franche-Comté (évaluation du processus de réparation des troubles musculo-squelettiques en Franche-Comté à travers les données d'un programme de surveillance épidémiologique des maladies à caractère professionnel)

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF