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Update on ARDS

Bird Fancier's lung: An underdiagnosed etiology of dyspnea Many cases of alveolitis not diagnosed as we dnt ask patients if he has bird in home or work !!! 1.  one of the most common causes of hypersensitivity pneumonitis. 2.  Underdiagnosed etiology of dyspnea, 3.  Triggered by exposure to highly antigenic avian proteins excreted in bird droppings and waxy proteins covering feathers of a variety of birds 4.  Typically presents with cough, dyspnea, fever, generalized fatigue. and Rhinitis and conjunctivitis]. Tachypnea, tachycardia, and bibasilar crackles are often present on physical exam, and hypoxemic respiratory failure may occur in severe cases 5.  Diagnosis is often difficult due to non-specific lab markers, such as elevation in erythrocyte sedimentation rate [ESR] and lactate dehydrogenase (LDH . 6.  Chest radiograph and CT scan findings can vary based on stage of disease, with mostly nonspecific findings. 7.  Respiratory functions is restrictive but may be obstructive 8.  Medical therapy in the form of systemic corticosteroids may be useful

"apathetic occult thyrotoxicosis," In older patients, cardiopulmonary symptoms such as tachycardia (or atrial fibrillation), dyspnea on exertion, and edema weight loss and less of an increase in appetite, weakness and asthenia may predominate .Diarrhea and malabsosrption may be the initial presentation. Apathetic thyrotoxicosis may present with diabetes mellitus or hypercalcemia. Occult thyrotoxicosis is a common cause of idiopathic AF in elderly. A diagnosis of thyrotoxic crisis can be missed with consequent fatal outcome.

Interferon-gamma release assays IGRAs cannot distinguish between LTBI and active tuberculosis (TB) disease and should not be used for diagnosis of active TB disease in adults. Individuals with a positive IGRA should have prompt evaluation to exclude active TB.by sputum for acid-fast bacilli smear and culture and nucleic acid amplification tests in addition to chest radiographs

diagnostic criteria for allergic bronchopulmonary aspergillosis Asthma Obligatory criteria (both must be present): A- Elevated total IgE concentration (typically >1000 IU/mL, B- Other criteria (at least two must be present): 1.  Precipitating serum antibodies to A. fumigatus or elevated serum Aspergillus IgG by immunoassay (>27 mg/L) 2.  Radiographic pulmonary opacities consistent with ABPA 3.  Total eosinophil count >500 cells/microL

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