Chronic cough and progressive dyspnea for the last 6yrs

Question Number 1157
A 60yr old farmer presents with a chronic cough and progressive dyspnea for the last 6yrs. The chest x-ray revealed a reticulonodular infiltrate associated with honey-combing of the lung.
Pulmonary function studies show a restrictive pattern with loss of lung volumes, impaired diffusion capacity, decreased compliance, and an exercise-induced hypoxemia. Serum studies demonstrate precipitating antibodies against extracts of moldy hay.
The causative organism in this case is likely to be:
a) Aspergillus
b) Thermophillic actinomycetes
c) Pencillium casei
d) Bacillus subtillis
e) Bacillus anthracis

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