Chest
Volume 103, Issue 4, April 1993, Pages 1202-1209
Journal home page for Chest

Clinical Investigations
Exposure to Microorganisms Associated With Allergic Alveolitis and Febrile Reactions to Mold Dust in Farmers

https://doi.org/10.1378/chest.103.4.1202Get rights and content

Study objective:

To compare exposure to microorganisms associated with allergic alveolitis (AA) and with febrile reactions to inhaled mold dust (organic dust toxic syndrome [ODTS]) in farmers and in normal subjects.

Design

A prospective study in which exposure was evaluated within two weeks of medical consultation for AA or ODTS. Samples were collected during normal farming (background) and during the handling of materials associated with disease or causing maximal exposure in reference farms (worst case).

Setting:

Swedish farms

Participants:

Eleven farmers with a confirmed diagnosis of AA from ten farms, 16 subjects with symptoms of ODTS from 12 farms, and 17 reference farmers.

Measurements and results:

Worst-case samples representative of the exposure preceding disease were obtained on four farms where five farmers had had AA; the samples contained on average 2.6 ± 1.8 × 109 (SD) spores/m3 of air. On six farms where nine farmers had had ODTS, representative samples averaged 13 ± 13 × 109 spores/m3, and on reference farms this figure was 0.12 ± 0.20 × 109 spores/m3. The daily spore dose associated with allergic alveolitis was 2 × 109 spores/d, which was ten times higher than on reference farms. The average dose associated with ODTS was 2 × 1010 spores. Worst-case samples, collected during 10 to 30 min, contributed to more than 90 percent of the day exposure on farms where AA or ODTS had occurred.

Conclusion:

Allergic alveolitis was associated with high exposure levels on most weekdays for weeks, and ODTS was associated with extreme exposure occurring on a single day. There was no correlation with individual spore types and disease and the present results are compatible with a hypothesis that common cell wall components of microorganisms may cause “toxic” symptoms and stimulate immune reactions.

Section snippets

Allergic Alveolitis and Febrile Reactions

The investigation was designed as a prospective study which lasted for 28 months. Physicians in all departments of internal medicine, lung medicine, occupational medicine, and infectious diseases; district medical centers; and health care centers in Sweden were requested to participate in this study. The physicians were asked to report to the project all new cases of probable AA and cases involving farmers with febrile reactions to mold dust who did not meet the criteria of AA (febrile reaction

Allergic Alveolitis

Eighteen patients were reported with a preliminary diagnosis of AA caused by mold dust. In two farms, the workplaces had been completely cleaned before notification to the project, and these farmers were not further evaluated. Based on evaluation of the clinical data, the diagnosis was confirmed in 11 of the remaining 16 farmers (Table 1). Two farmers with AA who became ill at approximately the same time were from the same farm. In five cases, the diagnosis of AA was not confirmed. In two of

DISCUSSION

The concentrations of mold spores or actinomycetes, or both, were very high in representative samples from farms of the two disease groups compared with levels observed in normal farming. The most conspicuous difference between the disease groups was that exposure associated with AA had occurred on most days for weeks, while the febrile reactions (ODTS) were observed following a single occurrence of exceptional exposure. One out of 11 farmers with a confirmed diagnosis of AA had, however, an

ACKNOWLEDGMENTS:

The authors thank Dr. Urban Palmgren; Göran Blomquist, Ph.D; and laboratory technicians Maria Eriksson and Sven Olof Westermark for collecting and enumerating spore samples. We also thank Katrin Karlsson who evaluated spore samples with electron microscopy and Lars Belin, M.D., who performed the analysis of precipitating antibodies. Finally, we thank all physicians who reported cases to the project, notably the physicians of the Farmers Safety and Health Association.

REFERENCES (41)

  • WT Brinton et al.

    An outbreak of organic dust toxic syndrome in a college fraternity

    JAMA

    (1987)
  • JJ May et al.

    Organic dust toxicity (pulmonary mycotoxicosis) associated with silo unloading

    Thorax

    (1986)
  • S Von Essen et al.

    Organic dust toxic syndrome: an acute febrile reaction to organic dust exposure distinct from hypersensitivity pneumonitis

    Clin Toxicol

    (1990)
  • GA doPico

    Health effects of organic dusts in the farm environment: report on diseases

    Am J Industr Med

    (1986)
  • A Rask-Andersen et al.

    Inhalation fever: a proposed unifying term for febrile reactions to inhalation of noxious substances [abstract]

    Br J Industr Med

    (1992)
  • R Rylander et al.

    Non-infectious fever: inhalation fever or toxic alveolitis?

    [abstract] Br J Industr Med

    (1992)
  • U Palmgren et al.

    Collection of airborne micro-organisms on Nuclepore filters, estimation and analysis-CAMNEA method

    J Appl Bacteriol

    (1986)
  • L Bjermer et al.

    Bronchoalveolar mastocytosis in farmer's lung is related to the disease activity

    Arch Intern Med

    (1988)
  • L Bjermer et al.

    Hyaluronate and type III procollagen peptide concentrations in bronchoalveolar lavage fluid as markers of disease activity in farmers lung

    BMJ

    (1987)
  • K Larsson et al.

    Exposure to microorganisms, airway inflammatory changes and immune reactions in asymptomatic dairy farmers: bronchoalveolar lavage evidence of macrophage activation and permeability changes in the airways

    Int Arch Allergy Appl Immunol

    (1988)
  • Cited by (93)

    • Pulmonary illness as a consequence of occupational exposure to shrimp shell powder

      2016, Environmental Research
      Citation Excerpt :

      For HP, patients may upon continued exposure, develop a chronic form of the disease with lung fibrosis. ODTS is described as a self-limiting syndrome, but where some cases may progress to severe acute lung injury (Seifert et al., 2003), and extremely high exposure during ODTS episodes have been attributed to development of asthma (Malmberg et al., 1993; May et al., 1990). Microbial contaminants, such as endotoxins or bacterial contaminants, or high exposure to respirable particles were considered plausible causes of the condition.

    • Farmer's Lung Disease. A Review

      2016, Archivos de Bronconeumologia
      Citation Excerpt :

      A negative result for plasma precipitins does not rule out the diagnosis, particularly in the chronic forms of the disease, since antibody titers and levels of exposure are correlated, and may become negative if there has been no contact with the causative antigen for some time. The determination of precipitins may also be limited, firstly by the lack of standardized analytical methods, and secondly because the panel of precipitins will vary among the different regions, so it will be necessary to determine which are the most common antigens in each site.23,24 In this respect, it is also very useful to perform a culture for fungi and actinomycetes from the hay or other material to which the patient has been exposed.

    • Evaluation of exposure-response relationships for health effects of microbial bioaerosols - A systematic review

      2015, International Journal of Hygiene and Environmental Health
      Citation Excerpt :

      Six studies from farming workplaces were analyzed by the bioaerosol expert network. None of the six evaluated studies are appropriate for derivation of exposure limits because of insufficient exposure data (V1) (Cormier et al., 2000; Eduard et al., 2009; Heederik et al., 1991; Malmberg et al., 1993; Rimac et al., 2010), missing evaluation of dust measurements (V2) (Heederik et al., 1991; Malmberg et al., 1993; Sabino et al., 2012), inappropriate or insufficient health endpoints (V5) (Rimac et al., 2010; Sabino et al., 2012) and missing indicator parameters (V6) (Cormier et al., 2000; Heederik et al., 1991; Malmberg et al., 1993). However, three studies demonstrated exposure data on possible indicator parameters for the workplace farming (Eduard et al., 2009; Rimac et al., 2010; Sabino et al., 2012).

    • Attempts to reduce exposure to fungi, β-glucan, bacteria, endotoxin and dust in vegetable greenhouses and a packaging unit

      2014, Science of the Total Environment
      Citation Excerpt :

      For handling of straw, we have previously seen that increasing water content caused a decrease in dustiness in terms of endotoxin (Madsen and Nielsen, 2010). Avoiding exposure to the extremely high concentrations of endotoxin (3700 EU m− 3) and dust (15 mg m− 3) is important because exposure to very high concentrations of bioaerosols can cause diseases like ODTS and allergic alveolitis (Malmberg et al., 1993; Weber et al., 1993; Madsen et al., 2012). Clearing of cucumber plants is a task performed few times a year, and it is more important during clearing to protect the workers from acute health effects caused by very high short-term exposure than from health effects caused by repeated long-term exposure.

    View all citing articles on Scopus

    Supported by grants 83–0153, 84–0952, 85–1236, 85–0508 and 86–1229 from the Swedish Work Environment Fund.

    Manuscript received May 22; revision accepted August 25.

    View full text