Pimentel, J. Cortez, and Avila, Ramiro (1973).Thorax, 28, 409-423. Respiratory disease in cork workers (`suberosis'). A clinical, immunological, and histological study of 63 workers in the cork industry with bronchopulmonary manifestations is described. From this study, it was possible to recognize three types of reaction to the inhalation of cork dust: asthma-like syndromes, extrinsic allergic alveolitis, and chronic bronchitis with bronchiectasis. The place of histological (lung biopsy and scalene node biopsy) and immunological methods in the diagnosis of these different forms of the disease is evaluated. The high incidence of precipitins to Penicillium frequentans is stressed because the antigens produced by this fungus seem to be more pathogenic than those produced by the mouldy cork itself. The histological studies have demonstrated extrapulmonary foci of disease and have also revealed for the first time, abnormalities in the lungs of symptomless subjects. Pathological changes present in the lungs of patients with the chronic form of extrinsic allergic alveolitis, long after removal from exposure to cork dust, are also described. The experimental material of Horta and Cancella (1956) is reviewed in the light of present knowledge, and the similarity between the lesions produced in animals and those found in cork workers is noted. Finally, especial importance is attached to the finding of cork dust within the lesions, the technique for its identification and staining being described.
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