Article

Lung

, Volume 192, Issue 6, pp 841-847

Calcified Granulomatous Disease: Occupational Associations and Lack of Familial Aggregation

  • Robert M. ReedAffiliated withDivision of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine Email author 
  • , Anthony AmorosoAffiliated withDivision of Infectious Disease, University of Maryland School of Medicine
  • , Salman HashmiAffiliated withDivision of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine
  • , Seth KligermanAffiliated withDepartment of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine
  • , Alan R. ShuldinerAffiliated withDivision of Endocrinology, Diabetes, and Nutrition, University of Maryland School of MedicineDepartment of Veterans Affairs and Veterans Affairs Medical Center Baltimore Geriatric Research Education and Clinical Center (GRECC)Department of Epidemiology and Public Health, University of Maryland School of Medicine
  • , Braxton D. MitchellAffiliated withDivision of Endocrinology, Diabetes, and Nutrition, University of Maryland School of MedicineDepartment of Veterans Affairs and Veterans Affairs Medical Center Baltimore Geriatric Research Education and Clinical Center (GRECC)Department of Epidemiology and Public Health, University of Maryland School of Medicine
  • , Giora NetzerAffiliated withDivision of Pulmonary and Critical Care Medicine, University of Maryland School of MedicineDepartment of Epidemiology and Public Health, University of Maryland School of Medicine

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Abstract

Purpose

The acute host response to histoplasma capsulatum infection varies according to exposure and susceptibility. Late sequelae include calcifications in the lung, thoracic lymphatics, and spleen. Determinants of calcified granuloma formation are poorly studied and may differ from those affecting acute response. We examined the occupational associations and familial aggregation of radiographic calcified granulomatous disease to characterize the determinants of calcified granuloma formation.

Methods

We analyzed prospectively collected cross-sectional data including computed tomograms from 872 adult members of the Old Order Amish of Lancaster County.

Results

Granulomas were present in 71 % of participants. Granulomas were present in the lung of 57 % of participants, in the hilar or mediastinal lymph nodes of 55 % of participants, and in the spleen of 29 % of participants. No significant differences were observed in the presence of granulomas between men and women. Each year of age was associated with 4 % higher odds of splenic calcifications, and a primary occupation of farming was associated with an 84 % higher odds of splenic calcifications. A compelling pattern of familial aggregation was not observed.

Conclusions

Calcified granulomatous disease does not appear to aggregate in families. Determinants influencing patterns of granulomatous disease include occupation, age, and geographic location.

Keywords

Calcified granuloma Occupational lung disease Farming lung disease Old Order Amish Amish Familial aggregation Histoplasma Granulomatous lung disease