Hypersensitivity pneumonitis (HP) or organic dust toxic syndrome (ODTS)?: the clinical dilemma in organic dust exposures.

Details

• Personal Author:
  Jones, William G. ; Kullman, Greg J. ; Olenchock S ; Parker J ; Petsonk, Edward L. ; Sorenson, William ; Weber S
• Description:
  Twelve hours after shovelling composed wood chips and leaves, a healthy 52-year-old male presented to the emergency room with fever (T 38.8 degree Celsius), myalgia, and marked dyspnea. lnspiratory crackles, hypoxemia (room air arterial P02 53mm Hg), and bilateral patchy pulmonary infiltrates were seen. Systemic steroids were given, and he improved over 3 days. No antibodies were found to 10 common HP antigens. Using respiratory protection, we repeated the exposure setting and made extensive environmental measurements. General area samples for respirable particulate were < 1 mg/m3. Peak exposures were > 80 mg/m3. Mass median aerodynamic diameter of the aerosol was approximately 3 micrometers. Microscopic analysis of the dust indicated a predominance of spores, with counts ranging from 106 to 109 spores/m3. Airborne endotoxin concentrations ranged from 244 to 16,300 endotoxin units/m3, levels previously associated with illness in similar settings. Cultures of air samples yielded high levels of mesophilic fungi and lower levels of thermophilic bacteria. Serum from the patient showed precipitation with extracts of bulk samples of the compost material. Inhalation of dust from contaminated organic materials may result in acute respiratory tract illness. Possible mechanisms include toxic and cellular reactions from microbial and other organic products or immunologic responses after prior sensitization to an antigen. Differentiation is based on clinical and epidemiologic clues. Our data suggest that, in a clinical setting even with extensive environmental measurements, separation of ODTS and HP may not be possible.
• Subjects:
  Accidents, Occupational Biochemistry Carcinogens Energy Metabolism Hazardous Substances Methylnitronitrosoguanidine Mutagens Occupational Health Safety
• Keywords:
  Aerosols Airborne Particles Airborne Particulates Air Samples Antibodies Antigens Bacteria Blood Serum Dust Exposure Dusts Endotoxins Environmental Exposure Epidemiology Exposure Levels Fungi Fungicides Microscopic Analysis Organic Dusts Particle Size Particulates Pneumonitis Pulmonary System Disorders Respiratory Protection Reticuloendothelial System Disorders Risk Factors Sampling Steroids Toxic Effects Toxins

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• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Genre:
  Abstract
• Place as Subject:
  OSHA Region 3 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DRDS - Division of Respiratory Disease Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  574
• NIOSHTIC Number:
  nn:20056036
• Citation:
  Papers and Proceedings of the Surgeon General's Conference on Agricultural Safety and Health (FarmSafe 2000). Myers ML, Herrick RF, Olenchock SA, Myers JR, Parker, John E., Hard DL, Wilson K, eds. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Institute for Occupational Safety and Health, DHHS (NIOSH) Publication No. 92-105, 1992 Sep; :574
• Editor(s):
  Myers ML ; Herrick RF ; Olenchock SA ; Myers JR ; Parker, John E. ; Hard DL ; Wilson K
• Federal Fiscal Year:
  1992
• Peer Reviewed:
  False
• Source Full Name:
  Papers and Proceedings of the Surgeon General's Conference on Agricultural Safety and Health (FarmSafe 2000), April 30-May 3, 1991, Des Moines, Iowa
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:834acc8f404c72f06bb3f40be6d4d9ef997be607108144f1fa8fd934983454137917cf80aa0e466ef2dcafed6fd4ce8da3a8194ddcc63983bd35222e2e1745cb
• Download URL:
  https://stacks.cdc.gov/view/cdc/181776/cdc_181776_DS1.pdf
• File Type:
  [PDF - 62.23 KB ]