Farmer's Lung in Maryland

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Abstract
Farmer''s lung, an occupational disease of agricultural workers exposed to moldy forage, was identified in 2 Maryland farmers with symptoms of dyspnea, cough, and fever. In 1, decreased pulmonary diffusing capacity was found, and a lung biopsy revealed the characteristic interstitial granulomatous pneumonitis. An organic foreign body, probably a vegetable fiber, was found in chest drainage material, and budding yeast forms were identified. Moldy hay from the barn of this patient grew thermophilic actinomycetes on culture. Both patients were found to have serum precipitins to extracts of moldy hay and to extracts of actinomycetes from Wisconsin and Great Britain. The Maryland moldy hay was shown to possess antigens cross-reacting with antigens derived from the Wisconsin and British organisms. Aspergillus precipitins were also present in the sera from both patients. In Maryland climate and farming practices apparently combine to make the condition less common than in the midwestern US and in western Great Britain. The evidence indicates that the disease is a hypersensitivity reaction to inhalation of the antigen rather than an infection.

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