Determinants of microbial exposure in grain farming

An algorithm for quantitatively estimating occupational endotoxin exposure in the Biomarkers of Exposure and Effect in Agriculture (BEEA) study: I. Development of task-specific exposure levels from published data

BACKGROUND/OBJECTIVE

Farmers conduct numerous tasks with potential for endotoxin exposure. As a first step to characterize endotoxin exposure for farmers in the Biomarkers of Exposure and Effect in Agriculture (BEEA) Study, we used published data to estimate task-specific endotoxin concentrations.

METHODS

We extracted published data on task-specific, personal, inhalable endotoxin concentrations for agricultural tasks queried in the study questionnaire. The data, usually abstracted as summary measures, were evaluated using meta-regression models that weighted each geometric mean (GM, natural-log transformed) by the inverse of its within-study variance to obtain task-specific predicted GMs.

RESULTS

We extracted 90 endotoxin summary statistics from 26 studies for 9 animal-related tasks, 30 summary statistics from 6 studies for 3 crop-related tasks, and 10 summary statistics from 5 studies for 4 stored grain-related tasks. Work in poultry and swine confinement facilities, grinding feed, veterinarian services, and cleaning grain bins had predicted GMs > 1000 EU/m3 . In contrast, harvesting or hauling grain and other crop-related tasks had predicted GMs below 100 EU/m3 .

SIGNIFICANCE

These task-specific endotoxin GMs demonstrated exposure variability across common agricultural tasks. These estimates will be used in conjunction with questionnaire responses on task duration to quantitatively estimate endotoxin exposure for study participants, described in a companion paper.

Occupational cancer burden: the contribution of exposure to process-generated substances at the workplace

Respirable crystalline silica in mineral dust, wood dust, diesel engine exhaust emissions and welding fumes are among the most common process-generated substances to which millions of workers are exposed daily. The composition of process-generated substances can vary substantially, depending on the parameters of the underlying processes; for example, the composition and intensity of diesel motor emissions differs among the various generations of diesel engines and working environments (e.g. surface or underground mining). We illustrate how common these occupational exposures are and discuss challenges in estimating their global prevalence and their contribution to the burden of occupational cancer. Estimates of the number and proportion of workers exposed in most countries and on a global scale are generally scarce. A remarkable exception is based on the proactive bottom-up estimates generated within the European Network for Silica. Actions to reduce exposures and research to fill gaps in knowledge adapted to local settings are warranted to mitigate the occupational cancer burden, especially in under-researched settings including low- and middle-income countries.

Occupational exposure to Aspergillus section Fumigati: Tackling the knowledge gap in Portugal

Aspergillus section Fumigati is one of the sections of the Aspergillus genus most often associated with respiratory symptoms. The azole-resistant clinical isolates in this section have been widely described worldwide. More recently, the environmental origin of azole resistance has been correlated with the development of fungal diseases and therapeutic failure. This paper presents a review of several studies performed in Portuguese occupational environments focusing on occupational exposure to this section and give guidance to exposure assessors and industrial hygienists to ensure an accurate exposure assessment. Future studies should tackle the limitations concerning the assessment of occupational exposure to the Fumigati section, in order to allow the implementation of adequate risk management measures. In the light of the results of previous studies, the following approach is proposed to ensure an accurate exposure assessment: a) a combination of active and passive sampling methods appropriate to each occupational environment; b) the use, in parallel, of culture-based methods and molecular tools to overcome the limitations of each method; c) evaluation of the mycobiota azole resistance profile; and d) consider the possible simultaneous presence of mycotoxins produced by this section when assessing workers occupational exposure. In sum, preventing the development of fungal strains resistant to azoles will only be achieved with a holistic approach. An adequate "One Health approach" can contribute positively to concerted actions in different sectors, by reducing the use of fungicides through the introduction of crops and agricultural practices that prevent fungal colonization, and by promoting the rational use of antifungal drugs in human and animal health.

Factors Contributing to Sex Differences in Mice Inhaling Aspergillus fumigatus

Aspergillus fumigatus is a respiratory fungal pathogen and an allergen, commonly detected in flooded indoor environments and agricultural settings. Previous studies in Balb/c mice showed that repeated inhalation of live and dry A. fumigatus spores, without any adjuvant, elevated allergic immune response and airway remodeling. Sex-specific differences can influence host-pathogen interactions and allergic-asthma related outcomes. However, the effect of host sex on immune response, in the context of A. fumigatus exposure, remains unknown. In this study, we quantified the multivariate and univariate immune response of C57BL/6J mice to live, dry airborne A. fumigatus spores. Our results corroborate previous results in Balb/c mice that repeated inhalation of live A. fumigatus spores is sufficient to induce mucus production and inflammation by day 3 post last challenge, and antibody titers and collagen production by day 28 post-challenge. Principal Component Analysis (PCA) showed that females exhibited significantly higher levels of immune components than males did. Taken together, our data indicate that host-sex is an important factor in shaping the immune response against A. fumigatus, and must be considered when modeling disease in animals, in designing diagnostics and therapeutics for A. fumigatus-associated diseases or while drafting evidence-based guidelines for safe mold levels.

Respiratory diseases and allergy in farmers working with livestock: a EAACI position paper

Farmers constitute a large professional group worldwide. In developed countries farms tend to become larger, with a concentration of farm operations. Animal farming has been associated with negative respiratory effects such as work-related asthma and rhinitis. However, being born and raised or working on a farm reduces the risk of atopic asthma and rhinitis later in life. A risk of chronic bronchitis and bronchial obstruction/COPD has been reported in confinement buildings and livestock farmers. This position paper reviews the literature linking exposure information to intensive animal farming and the risk of work-related respiratory diseases and focuses on prevention. Animal farming is associated with exposure to organic dust containing allergens and microbial matter including alive microorganisms and viruses, endotoxins and other factors like irritant gases such as ammonia and disinfectants. These exposures have been identified as specific agents/risk factors of asthma, rhinitis, chronic bronchitis, COPD and reduced FEV₁. Published studies on dust and endotoxin exposure in livestock farmers do not show a downward trend in exposure over the last 30 years, suggesting that the workforce in these industries is still overexposed and at risk of developing respiratory disease. In cases of occupational asthma and rhinitis, avoidance of further exposure to causal agents is recommended, but it may not be obtainable in agriculture, mainly due to socio-economic considerations. Hence, there is an urgent need for focus on farming exposure in order to protect farmers and others at work in these and related industries from developing respiratory diseases and allergy.

Characterization and pro-inflammatory potential of indoor mold particles

A number of epidemiological studies find an association between indoor air dampness and respiratory health effects. This is often suggested to be linked to enhanced mold growth. However, the role of mold is obviously difficult to disentangle from other dampness-related exposure including microbes as well as non-biological particles and chemical pollutants. The association may partly be due to visible mycelial growth and a characteristic musty smell of mold. Thus, the potential role of mold exposure should be further explored by evaluating information from experimental studies elucidating possible mechanistic links. Such studies show that exposure to spores and hyphal fragments may act as allergens and pro-inflammatory mediators and that they may damage airways by the production of toxins, enzymes, and volatile organic compounds. In the present review, we hypothesize that continuous exposure to mold particles may result in chronic low-grade pro-inflammatory responses contributing to respiratory diseases. We summarize some of the main methods for detection and characterization of fungal aerosols and highlight in vitro research elucidating how molds may induce toxicity and pro-inflammatory reactions in human cell models relevant for airway exposure. Data suggest that the fraction of fungal hyphal fragments in indoor air is much higher than that of airborne spores, and the hyphal fragments often have a higher pro-inflammatory potential. Thus, hyphal fragments of prevalent mold species with strong pro-inflammatory potential may be particularly relevant candidates for respiratory diseases associated with damp/mold-contaminated indoor air. Future studies linking of indoor air dampness with health effects should assess the toxicity and pro-inflammatory potential of indoor air particulate matter and combined this information with a better characterization of biological components including hyphal fragments from both pathogenic and non-pathogenic mold species. Such studies may increase our understanding of the potential role of mold exposure.

Respiratory Health Outcomes, Rhinitis, and Eczema in Workers from Grain Storage Facilities in Costa Rica

Objectives

To examine the associations of inhalable grain dust exposure with respiratory health outcomes, rhinitis, and eczema reported by workers from rice, wheat, and maize storage facilities.

Methods

A cross-sectional study of 136 workers (73 operators and 63 administrative staff and other workers) from eight Costa Rican grain storage facilities was conducted in 2014-2015. Full-shift personal inhalable dust samples from all workers were collected. Study participants were administered a short version of the European Community Respiratory Health Survey questionnaire to identify symptoms of asthma, chronic bronchitis, rhinitis, and eczema. Associations between grain dust exposure and health outcomes were assessed using multivariable logistic and negative binomial regression models adjusted for age, smoking history, grain type, and presence of pets or farm animals in the home.

Results

The median inhalable grain dust concentration was 2.0 (25th to 75th percentile: 0.3-7.0) mg m-3. Higher concentrations of inhalable dust were associated with increased odds of (i) asthma symptoms or medication use [adjusted Odds ratio (ORa) per 10-fold increase in dust concentration 2.7; 95% confidence interval (CI): 1.3-6.7]; (ii) a score of at least two out of five symptoms suggestive of asthma (ORa 1.2; 95% CI: 1.0-1.3); and (iii) eczema (ORa 3.6; 95% CI: 1.7-9.6). No associations of inhalable grain dust exposure with chronic bronchitis and rhinitis were observed.

Conclusions

High exposure to inhalable dust in Costa Rican grain storage facilities was associated to asthma symptoms and eczema in workers.

Determinants of Airborne Solvent Exposure in the Collision Repair Industry

Objectives

To assess the determinants of airborne solvent exposures in contemporary vehicle collision repair workplaces.

Methods

Personal, full-shift airborne solvent exposures (n = 97) were assessed in 85 vehicle collision repair workers from 18 workshops. Peak exposures were assessed using a small number of video exposure monitoring measurements.

Results

Solvent exposures were highest in spray painters (geometric mean = 2.7 ppm) followed by panel beaters (0.5 ppm), but were well below workplace exposure standards. The lowest exposure levels were observed for mixing room extraction located away from the mixing bench [exposure ratio (ER) = 0.51, 95% confidence interval (CI) = 0.30-0.87]. Time spent mixing paint was associated with higher exposures (ER for every 10-min increase = 1.14, 95% CI = 1.05-1.24), as was time spent cleaning equipment with solvents (ER = 1.11, 95% CI = 0.88-1.39), spraying primer (ER = 1.10, 95% CI = 0.96-1.27), and spraying clear coat paint (ER = 1.07, 95% CI = 1.00-1.15). Overall, the combined non-spray painting tasks (mixing paint, degreasing, and cleaning equipment) were more strongly associated with exposure (ER = 1.10, 95% CI = 1.03-1.18) than the combined spray painting tasks (ER = 1.03, 95% CI = 1.00-1.05). Peak exposures ranged from 10 to 1100 ppm with the strongest and most frequent peaks occurring during paint mixing, decanting of solvents, cleaning of equipment, and painting in a cross-draft spray booth.

Conclusions

Airborne solvent exposures in the collision repair industry were associated with job title, the design and location of exhaust ventilation and emission sources, and time spent on specific tasks, with the highest average and peak exposures shown for non-spray painting tasks. These findings provide a contemporary basis for intervention programmes to reduce airborne solvent exposures in this industry.

Fungal aerosol composition in moldy basements

Experimental aerosolization studies revealed that fungal fragments including small fragments in the submicrometer size are released from fungal cultures and have been suggested to represent an important fraction of overall fungal aerosols in indoor environments. However, their prevalence indoors and outdoors remains poorly characterized. Moldy basements were investigated for airborne fungal particles including spores, submicron fragments, and larger fragments. Particles were collected onto poly-L-lysine-coated polycarbonate filters and qualitatively and quantitatively analyzed using immunogold labeling combined with field emission scanning electron microscopy. We found that the total fungal aerosol levels including spores, submicrometer, and larger fragments in the moldy basements (median: 80 × 10³  m^-3 ) were not different from that estimated in control basements (63 × 10³  m^-3 ) and outdoor (90 × 10³  m^-3 ). However, mixed effect modeling of the fungal aerosol composition revealed that the fraction of fragments increased significantly in moldy basements, versus the spore fraction that increased significantly in outdoor air. These findings provide new insight on the compositional variation of mixed fungal aerosols in indoor as compared to outdoor air. Our results also suggest that further studies, aiming to investigate the role of fungal aerosols in the fungal exposure-disease relationships, should consider the mixed composition of various types of fungal particles.

Fungal Fragments and Fungal Aerosol Composition in Sawmills

Assessment of exposure to fungi has commonly been limited to fungal spore measurements that have shown associations between fungi and development or exacerbation of different airway diseases. Because large numbers of submicronic fragments can be aerosolized from fungal cultures under laboratory conditions, it has been suggested that fungal exposure is more complex and higher than that commonly revealed by spore measurements. However, the assessment of fungal fragments in complex environmental matrix remain limited due to methodological challenges. With a recently developed immunolabeling method for field emission scanning electron microscope (FESEM), we could assess the complex composition of fungal aerosols present in personal thoracic samples collected from two Norwegian sawmills. We found that large fungal fragments (length >1 µm) dominated the fungal aerosols indicating that the traditional monitoring approach of spores severely underestimate fungal exposure. The composition of fungal aerosols comprised in average 9% submicronic fragments, 62% large fragments, and 29% spores. The average concentrations of large and submicronic fragments (0.2–1 µm) were 3 × 10⁵ and 0.6 × 10⁵ particles m⁻³, respectively, and correlated weakly with spores (1.4 × 10⁵ particles m⁻³). The levels of fragments were 2.6 times higher than the average spore concentration that was close to the proposed hazardous level of 10⁵ spores per m³. The season influenced significantly the fungal aerosol concentrations but not the composition. Furthermore, the ratio of spores in the heterogeneous fungal aerosol composition was significantly higher in saw departments as compared to sorting of green timber departments where the fungal fragments were most prevalent. Being the dominating particles of fungal aerosols in sawmills, fungal fragments should be included in exposure-response studies to elucidate their importance for health impairments. Likewise, the use of fungal aerosol composition in such studies should be considered.

Lung cancer risk and occupational exposures in crop farming: results from the AGRIculture and CANcer (AGRICAN) cohort

Objectives

Farmers are considered at lower risk of lung cancer. However, specific tasks can expose them to hazardous air contaminants such as pesticides, diesel exhaust and mineral dust. This study aimed to assess the associations between various crops and related tasks and the risk of lung cancer, overall and by histological subtypes.

Methods

AGRIculture and CANcer is a prospective French cohort of individuals affiliated to the agricultural health insurance scheme. Incident lung cancers (n=897) were identified by cancer registries from enrolment (2005–2007) to 2013. Data on crop and livestock exposure during lifetime were obtained from the enrolment questionnaire. We used a Cox model with attained age as timescale, adjusted for gender, smoking history and exposure to cattle and horses. Effects of duration and surface were assessed and analyses stratified on gender and smoking status were performed.

Results

Winegrowers were at higher risk of adenocarcinoma (HR=1.27 (95% CI 0.94 to 1.72)). We also found an association between pea growing and small cell lung cancer: significant effect of duration (ptrend=0.04) and the suggestion of a surface–effect relationship (ptrend=0.06); increased risk (HR=2.38 (95% CI 1.07 to 5.28)) for pesticide users; and significant effect of duration (ptrend=0.01) for harvesters. The risk of squamous cell carcinoma was increased for sunflower growing (HR=1.59 (95% CI 0.97 to 2.62), fruit-tree pruning (HR=1.44 (95% CI 0.92 to 2.27)) and pesticide use on beets (HR=1.47 (95% CI 0.92 to 2.34)). Corn and/or wheat/barley growers were at lower risk of lung cancer.

Conclusions

Our results suggest associations between lung cancer and several crop-related tasks, even if we cannot rule out some chance findings due to multiple comparisons.

Assessment of Workers' Exposure to Grain Dust and Bioaerosols During the Loading of Vessels' Hold: An Example at a Port in the Province of Québec

Longshoremen are exposed to large amounts of grain dust while loading of grain into the holds of vessels. Grain dust inhalation has been linked to respiratory diseases such as chronic bronchitis, hypersensitivity, pneumonitis, and toxic pneumonitis. Our objective was to characterize the exposure of longshoremen to inhalable and total dust, endotoxins, and cultivable bacteria and fungi during the loading of grain in a vessel's hold at the Port of Montreal in order to assess the potential health risks. Sampling campaigns were conducted during the loading of two different types of grain (wheat and corn). Environmental samples of microorganisms (bacteria, fungus, and actinomycetes) were taken near the top opening of the ship's holds while personal breathing zone measurements of dust and endotoxins were sampled during the worker's 5-hour shifts. Our study show that all measurements are above the recommendations with concentration going up to 390 mg m-3 of total dust, 89 mg m-3 of inhalable fraction, 550 000 EU m-3 of endotoxins, 20 000 CFU m-3 of bacteria, 61 000 CFU m-3 of fungus and 2500 CFU m-3 of actinomycetes. In conclusion, longshoremen are exposed to very high levels of dust and of microorganisms and their components during grain loading work. Protective equipment needs to be enforced for all workers during such tasks in order to reduce their exposure.

Exposure to Wood Dust, Microbial Components, and Terpenes in the Norwegian Sawmill Industry

Sawmill workers are exposed to wood dust (a well-known carcinogen), microorganisms, endotoxins, resin acids (diterpenes), and vapours containing terpenes, which may cause skin irritation, allergy, and respiratory symptoms including asthma. The health effects of most of these exposures are poorly understood as most studies measure only wood dust. The present study assessed these exposures in the Norwegian sawmill industry, which processes predominantly spruce and pine. Personal exposures of wood dust, resin acids, endotoxin, fungal spores and fragments, mono-, and sesquiterpenes were measured in 10 departments in 11 saw and planer mills. The geometric mean (GM) and geometric standard deviation (GSD) thoracic exposures were: 0.09 mg m-3 dust (GSD 2.6), 3.0 endotoxin units (EU) m-3 (GSD 4.9), 0.4 × 105 fungal spores m-3 (GSD 4.2), 2 × 105 fungal fragments m-3 (GSD 3.2), and 1560 ng m-3 of resin acids (GSD 5.5). The GM (GSD) inhalable exposures were: 0.72 mg m-3 dust (2.6), 17 EU m-3 (4.3), 0.4 × 105 fungal spores m-3 (3.8), and 7508 ng m-3 (4.4) of resin acids. The overall correlation between the thoracic and inhalable exposure was strong for resin acid (rp = 0.84), but moderate for all other components (rp = 0.34-0.64). The GM (GSD) exposure to monoterpenes and sesquiterpenes were 1105 µg m-3 (7.8) and 40 µg m-3 (3.9), respectively. Although mean exposures were relatively low, the variance was large, with exposures regularly exceeding the recommended occupational exposure limits. The exposures to spores and endotoxins were relatively high in the dry timber departments, but exposures to microbial components and mono-and sesquiterpenes were generally highest in areas where green (undried) timber was handled. Dust and resin acid exposure were highest in the dry areas of the sawmills. Low to moderate correlation between components (rp ranging from 0.02 to 0.65) suggests that investigations of exposure-response associations for these components (both individually and combined) are feasible in future epidemiological studies.

Dust exposure in workers from grain storage facilities in Costa Rica

BACKGROUND

About 12 million workers are involved in the production of basic grains in Central America. However, few studies in the region have examined the occupational factors associated with inhalable dust exposure.

OBJECTIVES

(i) To assess the exposure to inhalable dust in workers from rice, maize, and wheat storage facilities in Costa Rica; (ii) to examine the occupational factors associated with this exposure; and (iii) to measure concentrations of respirable and thoracic particles in different areas of the storage facilities.

METHODS

We measured inhalable (<100μm) dust concentrations in 176 personal samples collected from 136 workers of eight grain storage facilities in Costa Rica. We also measured respirable (<4μm) and thoracic (<10μm) dust particles in several areas of the storage facilities.

RESULTS

Geometric mean (GM) and geometric standard deviation (GSD) inhalable dust concentrations were 2.0mg/m³ and 7.8 (range=<0.2-275.4mg/m³). Personal inhalable dust concentrations were associated with job category [GM for category/GM for administrative staff and other workers (95% CI)=4.4 (2.6, 7.2) for packing; 20.4 (12.3, 34.7) for dehulling; 109.6 (50.1, 234.4) for unloading in flat bed sheds; 24.0 (14.5, 39.8) for unloading in pits; and 31.6 (18.6, 52.5) for drying], and cleaning task [15.8 (95% CI: 10.0, 26.3) in workers who cleaned in addition to their regular tasks]. Higher area concentrations of thoracic dust particles were found in wheat (GM and GSD=4.3mg/m³ and 4.5) and maize (3.0mg/m³ and 3.9) storage facilities, and in grain drying (2.3mg/m³ and 3.1) and unloading (1.5mg/m³ and 4.8) areas.

CONCLUSIONS

Operators of grain storage facilities showed elevated inhalable dust concentrations, mostly above international exposure limits. Better engineering and administrative controls are needed.

Occupational exposure to mould and microbial metabolites during onion sorting--insights into an overlooked workplace

Manual sorting of onions is known to be associated with a bioaerosol exposure. The study aimed to gain an initial indication as to what extent manual sorting of onions is also associated with mycotoxin exposure. Twelve representative samples of outer onion skins from different onion origins were sampled and analyzed with a multimycotoxin method comprising 40 mycotoxins using a single extraction step followed by liquid chromatography with electrospray ionization and triple quadrupole mass spectrometry. Six of the 12 samples were positive for mycotoxins. In those samples, deoxynivalenol, fumonisin B1, and B2 were observed in quantitatively detectable amounts of 3940 ng/g for fumonisin B1 and in the range of 126-587 ng/g for deoxynivalenol and 55-554 ng/g for fumonisin B2. Although the results point to a lower risk due to mycotoxins, the risk should not be completely neglected and has to be considered in the risk assessment.

Occupational exposure levels of bioaerosol components are associated with serum levels of the acute phase protein Serum Amyloid A in greenhouse workers

BACKGROUND

Occupational exposure to particles may be associated with increased inflammation of the airways. Animal experiments suggest that inhaled particles also induce a pulmonary acute phase response, leading to systemic circulation of acute phase proteins. Greenhouse workers are exposed to elevated levels of bioaerosols. The objective of this study is to assess whether greenhouse workers personal exposure to bioaerosol components was associated with serum levels of the acute phase proteins Serum Amyloid A (SAA) and C-reactive protein (CRP).

METHODS

SAA and CRP levels were determined in serum sampled repeatedly from 33 greenhouse workers. Blood was drawn repeatedly on Mondays and Thursdays during work weeks. Acute phase protein levels were compared to levels in a comparison group of 42 people and related to individual exposure levels to endotoxin, dust, bacteria, fungi and β-glucan.

RESULTS

Serum levels of SAA and CRP were not significantly different in greenhouse workers and a reference group, or on the two work days. In a mixed model, SAA levels were positively associated with endotoxin exposure levels (p = 0.0007). Results for fungi were not clear. CRP levels were positively associated with endotoxin exposures (p = 0.022). Furthermore, when workers were categorized into three groups based on SAA and CRP serum levels endotoxin exposure was highest in the group with the highest SAA levels and in the group with middle and highest CRP levels. SAA and CRP levels were elevated in workers with asthma.

CONCLUSION

Greenhouse workers did not have elevated serum levels of SAA and CRP compared to a reference group. However, occupational exposure to endotoxin was positively associated with serum levels of the acute phase proteins SAA and CRP. Preventive measures to reduce endotoxin exposure may be beneficial.

Occupational Exposure to Aflatoxin B1 in a Portuguese Poultry Slaughterhouse

Aflatoxin B1 (AFB1) is a secondary metabolite produced by the fungi Aspergillus flavus and is the most potent hepatocarcinogen known in mammals and has been classified by the International Agency of Research on Cancer as Group 1 carcinogen. Although dietary exposure to AFB1 has been extensively documented, there are still few studies dedicated to the problem of occupational exposure. Considering recent findings regarding AFB1 occupational exposure in poultry production, it was considered relevant to clarify if there is also exposure in poultry slaughterhouses. Occupational exposure assessment to AFB1 was done with a biomarker of internal dose that measures AFB1 in the serum by enzyme-linked immunosorbent assay. Thirty workers from a slaughterhouse were enrolled in this study. A control group (n = 30) was also considered in order to know AFB1 background levels for Portuguese population. Fourteen workers (47.0%) showed detectable levels of AFB1 with values from 1.06 to 4.03ng ml(-1), with a mean value of 1.73ng ml(-1). No AFB1 was detected in serum of individuals used as controls. Despite uncertainties regarding the exposure route that is contributing more to exposure (inhalation or dermal) is possible to state that exposure to AFB1 is occurring in the slaughterhouse studied. It seems that reducing AFB1 contamination in poultry production can have a positive result in this occupational setting.

Field evaluation of personal sampling methods for multiple bioaerosols

Ambient bioaerosols are ubiquitous in the daily environment and can affect health in various ways. However, few studies have been conducted to comprehensively evaluate personal bioaerosol exposure in occupational and indoor environments because of the complex composition of bioaerosols and the lack of standardized sampling/analysis methods. We conducted a study to determine the most efficient collection/analysis method for the personal exposure assessment of multiple bioaerosols. The sampling efficiencies of three filters and four samplers were compared. According to our results, polycarbonate (PC) filters had the highest relative efficiency, particularly for bacteria. Side-by-side sampling was conducted to evaluate the three filter samplers (with PC filters) and the NIOSH Personal Bioaerosol Cyclone Sampler. According to the results, the Button Aerosol Sampler and the IOM Inhalable Dust Sampler had the highest relative efficiencies for fungi and bacteria, followed by the NIOSH sampler. Personal sampling was performed in a pig farm to assess occupational bioaerosol exposure and to evaluate the sampling/analysis methods. The Button and IOM samplers yielded a similar performance for personal bioaerosol sampling at the pig farm. However, the Button sampler is more likely to be clogged at high airborne dust concentrations because of its higher flow rate (4 L/min). Therefore, the IOM sampler is a more appropriate choice for performing personal sampling in environments with high dust levels. In summary, the Button and IOM samplers with PC filters are efficient sampling/analysis methods for the personal exposure assessment of multiple bioaerosols.

Farm characteristics, allergy symptoms, and risk of non-hodgkin lymphoid neoplasms in the agricultural health study

BACKGROUND

Because of unique exposures, studies among farmers may yield insights into the relationship between allergies and non-Hodgkin lymphoid (NHL) neoplasms. We evaluated farm characteristics, allergic symptoms and conditions, and risk of NHL including specific subtypes in the Agricultural Health Study, a prospective cohort of farmers and spouses from North Carolina and Iowa.

METHODS

We identified 710 incident cases of NHL (including chronic lymphocytic leukemia and multiple myeloma) among 82,370 participants with baseline data on crop and animal exposures, including 454 cases among 52,850 participants with baseline data on recent allergy symptoms (rhinitis) and living on a farm during childhood. HR and 95% confidence intervals (CI) were calculated using multivariable-adjusted proportional hazards models.

RESULTS

We observed reduced risks of NHL among farmers and spouses with rhinitis at baseline (HR, 0.63; 95% CI, 0.51-0.79), related to growing soybeans (HR, 0.80; 95% CI, 0.67-0.96), and among farmers who handled stored grains or hay (HR, 0.66; 95% CI, 0.52-0.82). Growing up on a farm was associated with increased NHL risk (HR, 1.51; 95% CI, 1.15-1.98). Results did not differ significantly by NHL subtype.

CONCLUSIONS

Both the reduced risk of NHL among those with allergy symptoms and specific farm exposures in adulthood, and the increased risk among those who grew up on a farm suggest that the host immune response to agricultural allergens may influence NHL development.

IMPACT

This prospective study is, to our knowledge, the first to investigate the relationship between allergy symptoms and NHL risk in farmers; confirmation of these findings in other farming populations is warranted. Cancer Epidemiol Biomarkers Prev; 24(3); 587-94. ©2015 AACR.

Detection of airborne bacteria in a duck production facility with two different personal air sampling devices for an exposure assessment

Prevalent airborne microorganisms are not well characterized in industrial animal production buildings with respect to their quantity or quality. To investigate the work-related microbial exposure, personal bioaerosol sampling during the whole working day is recommended. Therefore, bioaerosol sampling in a duck hatchery and a duck house with two personal air sampling devices, a filter-based PGP and a NIOSH particle size separator, was performed. Subsequent, quantitative and qualitative analyses were carried out with" culture independent methods. Total cell concentrations (TCC) determined via fluorescence microscopy showed no difference between the two devices. In average, 8 × 10(6) cells/m(3) were determined in the air of the duck hatchery and 5 × 10(7) cells/m(3) in the air of the duck house. A Generated Restriction Fragment Length Polymorphism (RFLP) pattern revealed deviant bacterial compositions comparing samples collected with both devices. Clone library analyses based on 16S rRNA gene sequence analysis from the hatchery's air showed 65% similarity between the two sampling devices. Detailed 16S rRNA gene sequence analyses showed the occurrence of bacterial species like Acinetobacter baumannii, Enterococcus faecalis, Escherichia sp., and Shigella sp.; and a group of Staphylococcus delphini, S. intermedius, and S. pseudintermedius that provided the evidence of potential exposure to risk group 2 bacteria at the hatchery workplace. Size fractionated sampling with the developed by the Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA) device revealed that pathogenic bacteria would deposit in the inhalable, the thorax, and possibly alveolar dust fraction according to EN481. TCC analysis showed the deposition of bacterial cells in the third stage (< 1μm) at the NIOSH device which implies that bacteria can reach deep into the lungs and contaminate the alveolus after inhalation. Nevertheless, both personal sampling devices could be recommended for exposure assessment at agricultural workplaces.

Profile and Morphology of Fungal Aerosols Characterized by Field Emission Scanning Electron Microscopy (FESEM)

Fungal aerosols consist of spores and fragments with diverse array of morphologies; however, the size, shape, and origin of the constituents require further characterization. In this study, we characterize the profile of aerosols generated from Aspergillus fumigatus, A. versicolor, and Penicillium chrysogenum grown for 8 weeks on gypsum boards. Fungal particles were aerosolized at 12 and 20 L min^-1 using the Fungal Spore Source Strength Tester (FSSST) and the Stami particle generator (SPG). Collected particles were analyzed with field emission scanning electron microscopy (FESEM). We observed spore particle fraction consisting of single spores and spore aggregates in four size categories, and a fragment fraction that contained submicronic fragments and three size categories of larger fragments. Single spores dominated the aerosols from A. fumigatus (median: 53%), while the submicronic fragment fraction was the highest in the aerosols collected from A. versicolor (median: 34%) and P. chrysogenum (median: 31%). Morphological characteristics showed near spherical particles that were only single spores, oblong particles that comprise some spore aggregates and fragments (<3.5 μm), and fiber-like particles that regroup chained spore aggregates and fragments (>3.5 μm). Further, the near spherical particles dominated the aerosols from A. fumigatus (median: 53%), while oblong particles were dominant in the aerosols from A. versicolor (68%) and P. chrysogenum (55%). Fiber-like particles represented 21% and 24% of the aerosols from A. versicolor and P. chrysogenum, respectively. This study shows that fungal particles of various size, shape, and origin are aerosolized, and supports the need to include a broader range of particle types in fungal exposure assessment.

Mycotoxins and other fungal metabolites in grain dust from Norwegian grain elevators and compound feed mills

Employees at grain elevators and compound feed mills are exposed to large amounts of grain dust during work, frequently leading to airway symptoms and asthma. Although the exposure to grain dust, microorganisms, β-1→3-glucans and endotoxins has been extensively studied, the focus on the mycotoxin content of grain dust has previously been limited to one or few mycotoxins. Our objective was therefore to screen settled grain dust from grain elevators and compound feed mills for fungal metabolites by LC/MS-MS and explore differences between work places, seasons and climatic zones. Seventy fungal metabolites and two bacterial metabolites were detected. Trichothecenes, depsipeptides, ergot alkaloids, and other metabolites from Fusarium, Claviceps, Alternaria, Penicillium, Aspergillus, and other fungi were represented. The prevalence of individual metabolites was highly variable, and the concentration of each metabolite varied considerably between samples. The prevalence and concentration of most metabolites were higher in grain elevators compared to compound feed mills. Differences between seasons and climatic zones were inconclusive. All samples contained multiple mycotoxins, indicating a highly complex pattern of possible inhalational exposure. A mean exposure of 20 ng/m3 of fungal metabolites was estimated, whereas a worst case scenario estimated as much as 10 ?g/m3. Although many of these compounds may be linked to toxicological and immunological effects through experimental or epidemiological studies, it still remains to be determined whether the detected concentrations implicate adverse health outcomes when inhaled.

Submicronic fungal bioaerosols: high-resolution microscopic characterization and quantification

Submicronic particles released from fungal cultures have been suggested to be additional sources of personal exposure in mold-contaminated buildings. In vitro generation of these particles has been studied with particle counters, eventually supplemented by autofluorescence, that recognize fragments by size and discriminate biotic from abiotic particles. However, the fungal origin of submicronic particles remains unclear. In this study, submicronic fungal particles derived from Aspergillus fumigatus, A. versicolor, and Penicillium chrysogenum cultures grown on agar and gypsum board were aerosolized and enumerated using field emission scanning electron microscopy (FESEM). A novel bioaerosol generator and a fungal spores source strength tester were compared at 12 and 20 liters min(-1) airflow. The overall median numbers of aerosolized submicronic particles were 2 × 10(5) cm(-2), 2.6 × 10(3) cm(-2), and 0.9 × 10(3) cm(-2) for A. fumigatus, A. versicolor, and P. chrysogenum, respectively. A. fumigatus released significantly (P < 0.001) more particles than A. versicolor and P. chrysogenum. The ratios of submicronic fragments to larger particles, regardless of media type, were 1:3, 5:1, and 1:2 for A. fumigatus, A. versicolor, and P. chrysogenum, respectively. Spore fragments identified by the presence of rodlets amounted to 13%, 2%, and 0% of the submicronic particles released from A. fumigatus, A. versicolor, and P. chrysogenum, respectively. Submicronic particles with and without rodlets were also aerosolized from cultures grown on cellophane-covered media, indirectly confirming their fungal origin. Both hyphae and conidia could fragment into submicronic particles and aerosolize in vitro. These findings further highlight the potential contribution of fungal fragments to personal fungal exposure.

Exposure-affecting factors of dairy farmers' exposure to inhalable dust and endotoxin

INTRODUCTION

Studies on determinants of dairy farmers' exposure to dust and endotoxin have been sparse and so far none has addressed the combined effect of tasks and farm characteristics.

OBJECTIVE

To study whether and how work tasks and specific stable characteristics influence the level of dairy farmers' personal exposure to inhalable dust and endotoxin.

METHODS

We applied an observational design involving full-shift repeated personal measurements of inhalable dust and endotoxin exposure among 77 subjects (owners and farm workers) from 26 dairy farms. Performed tasks were self-registered in activity diaries, and information on stable characteristics was collected through personal interviews and walk-through surveys. Associations between exposure, tasks, and stable characteristics were examined in linear mixed-effect models with individual and farm treated as random effects. Separate as well as combined models for tasks and stable characteristics were elaborated.

RESULTS

The 124 personal samples collected had a geometric mean level (geometric standard deviation) of 360 EU m(-3) (3.8) for endotoxin exposure and of 1.0mg m(-3) (2.7) for dust exposure. Identified factors that increased endotoxin exposure included a lower outdoor temperature and use of slope-based or back-flushed slurry systems along with milking, distribution of bedding, and handling of feed and seeds in barns. For dust, exposure was higher when fully automatic (robotic) milking was used and during re-penning of animals, handling of feed and seeds, handling of silos and when distributing bedding. Dust exposure increased also as a result of use of rail feed dispensers in a model without fully automatic milking.

CONCLUSIONS

The current exposure to dust and in particular endotoxin among Danish dairy farmers demand effective strategies to reduce their exposure. The present findings suggest that future interventions should focus on feeding and manure handling systems. Use of respirators during handling of feed and distribution of bedding should be advised until adequate risk management measures have been established. The expected increased use of fully automatic milking in the future might increase dust exposure of dairy farmers.

Shotgun pyrosequencing metagenomic analyses of dusts from swine confinement and grain facilities

Inhalation of agricultural dusts causes inflammatory reactions and symptoms such as headache, fever, and malaise, which can progress to chronic airway inflammation and associated diseases, e.g. asthma, chronic bronchitis, chronic obstructive pulmonary disease, and hypersensitivity pneumonitis. Although in many agricultural environments feed particles are the major constituent of these dusts, the inflammatory responses that they provoke are likely attributable to particle-associated bacteria, archaebacteria, fungi, and viruses. In this study, we performed shotgun pyrosequencing metagenomic analyses of DNA from dusts from swine confinement facilities or grain elevators, with comparisons to dusts from pet-free households. DNA sequence alignment showed that 19% or 62% of shotgun pyrosequencing metagenomic DNA sequence reads from swine facility or household dusts, respectively, were of swine or human origin, respectively. In contrast only 2% of such reads from grain elevator dust were of mammalian origin. These metagenomic shotgun reads of mammalian origin were excluded from our analyses of agricultural dust microbiota. The ten most prevalent bacterial taxa identified in swine facility compared to grain elevator or household dust were comprised of 75%, 16%, and 42% gram-positive organisms, respectively. Four of the top five swine facility dust genera were assignable (Clostridium, Lactobacillus, Ruminococcus, and Eubacterium, ranging from 4% to 19% relative abundance). The relative abundances of these four genera were lower in dust from grain elevators or pet-free households. These analyses also highlighted the predominance in swine facility dust of Firmicutes (70%) at the phylum level, Clostridia (44%) at the Class level, and Clostridiales at the Order level (41%). In summary, shotgun pyrosequencing metagenomic analyses of agricultural dusts show that they differ qualitatively and quantitatively at the level of microbial taxa present, and that the bioinformatic analyses used for such studies must be carefully designed to avoid the potential contribution of non-microbial DNA, e.g. from resident mammals.

Exposure to airborne endotoxins among sewer workers: an exploratory study

Exploratory bioaerosol sampling was performed in order to assess exposure to airborne endotoxins during sewer work. Personal samples were collected in underground sewer pipes using 37-mm closed-face cassettes containing fibreglass filters (CFC-FG method) or polycarbonate filters (CFC-PC method). Endotoxins were quantified using the limulus amoebocyte lysate assay. Concentrations of airborne endotoxins at sewer workplaces (16-420 EU m(-3)) were higher than those measured outside the sewer network (0.6-122 EU m(-3)). Sewer worker exposure to airborne endotoxins depended on the workplace and on the tasks. Exposure levels were the highest for tasks involving agitation of water and matter, especially for 'chamber cleanup' and 'pipes cleanup' with a high-pressure water jet. Airborne endotoxin levels at the workplace tended to be higher when CFC-FG was used as the sampling method rather than CFC-PC. The adjusted mean of the measured concentrations for CFC-PC represents 57% of the mean observed with CFC-FG. The number of samples collected in the descriptive study was too low for drawing definitive conclusions and further exposure investigations are needed. Therefore, our exploratory study provides new exposure data for the insufficiently documented sewer working environment and it would be useful for designing larger exposures studies.

Characterization of the monthly variation in (1 → 3)-β-D-glucan concentrations in university laboratories

We characterize the monthly variation in (1 → 3)-β-D-glucan concentration measured over the course of 1 year, and we evaluate the characteristics of size selection using a two-stage cyclone sampler. The (1 → 3)-β-D-glucan concentrations were measured in four bio-related laboratories. A total of 156 samples were collected using a new two-stage cyclone sampler. Analysis of (1 → 3)-β-D-glucan was performed using the kinetic Limulus amebocyte lysate assay. The study showed that airborne (1 → 3)-β-D-glucan concentrations were significantly higher in laboratory D (mean ± SD 1,105 ± 1,893 pg/m(3)) and in the spring (5,458 pg/m(3)). The highest concentration of (1 → 3)-β-D-glucan occurred in the spring, particularly in May.

The impact of Aspergillus fumigatus viability and sensitization to its allergens on the murine allergic asthma phenotype

Aspergillus fumigatus is a ubiquitously present respiratory pathogen. The outcome of a pulmonary disease may vary significantly with fungal viability and host immune status. Our objective in this study was (1) to assess the ability of inhaled irradiation-killed or live A. fumigatus spores to induce allergic pulmonary disease and (2) to assess the extent to which inhaled dead or live A. fumigatus spores influence pulmonary symptoms in a previously established allergic state. Our newly developed fungal delivery apparatus allowed us to recapitulate human exposure through repeated inhalation of dry fungal spores in an animal model. We found that live A. fumigatus spore inhalation led to a significantly increased humoral response, pulmonary inflammation, and airway remodeling in naïve mice and is more likely to induce allergic asthma symptoms than the dead spores. In contrast, in allergic mice, inhalation of dead and live conidia recruited neutrophils and induced goblet cell metaplasia. This data suggests that asthma symptoms might be exacerbated by the inhalation of live or dead spores in individuals with established allergy to fungal antigens, although the extent of symptoms was less with dead spores. These results are likely to be important while considering fungal exposure assessment methods and for making informed therapeutic decisions for mold-associated diseases.

Exposure to grain dust and microbial components in the Norwegian grain and compound feed industry

OBJECTIVES

The aim of this study was to extensively characterize grain workers' personal exposure during work in Norwegian grain elevators and compound feed mills, to identify differences in exposures between the workplaces and seasons, and to study the correlations between different microbial components.

METHODS

Samples of airborne dust (n = 166) were collected by full-shift personal sampling during work in 20 grain elevators and compound feed mills during one autumn season and two winter seasons. The personal exposure to grain dust, endotoxins, β-1→3-glucans, bacteria, and fungal spores was quantified. Correlations between dust and microbial components and differences between workplaces and seasons were investigated. Determinants of endotoxin and β-1→3-glucan exposure were evaluated by linear mixed-effect regression modeling.

RESULTS

The workers were exposed to an overall geometric mean of 1.0mg m(-3) inhalable grain dust [geometric standard deviation (GSD) = 3.7], 628 endotoxin units m(-3) (GSD = 5.9), 7.4 µg m(-3) of β-1→3-glucan (GSD = 5.6), 21 × 10(4) bacteria m(-3) (GSD = 7.9) and 3.6 × 10(4) fungal spores m(-3) (GSD = 3.4). The grain dust exposure levels were similar across workplaces and seasons, but the microbial content of the grain dust varied substantially between workplaces. Exposure levels of all microbial components were significantly higher in grain elevators compared with all other workplaces. The grain dust exposure was significantly correlated (Pearson's r) with endotoxin (rp = 0.65), β-1→3-glucan (rp = 0.72), bacteria (rp = 0.44) and fungal spore (rp = 0.48) exposure, whereas the explained variances were strongly dependent on the workplace. Bacteria, grain dust, and workplace were important determinants for endotoxin exposure, whereas fungal spores, grain dust, and workplace were important determinants for β-1→3-glucan exposure.

CONCLUSIONS

Although the workers were exposed to a relatively low mean dust level, the microbial exposure was high. Furthermore, the exposure levels of microbial components varied between workplaces although the dust levels were similar. We therefore recommend that exposure levels at different workplaces should be assessed separately and a task-based assessment should be done for detailed evaluation of efficient dust-reducing measures. The microbial content and knowledge of health effects of the microbial components should be considered in health risk evaluations of these workplaces.

Indoor exposure to airborne endotoxin: a review of the literature on sampling and analysis methods

Assessment of exposure to airborne endotoxins has been studied for several years, especially in occupational environments, but a large number of procedures are used for sampling and analysis. This lack of standardization makes it very difficult to compare results and set internationally accepted threshold limit values (TLVs) or occupational exposure limits (OELs) for endotoxin exposure. This paper reviews the methods reported, using advanced bibliographical search techniques: 82 papers published from 2004 to the present were selected to analyze methods for the assessment of human exposure to airborne endotoxins, with particular reference to occupational settings, and to examine their performance and critical points. Only few studies have focused on the standardization of sampling and analysis methods. The European Committee for Standardization Guidelines coincide with the procedures most frequently applied, but this does not guarantee the best results in terms of recovery and reproducibility. The factor that mainly affects endotoxin measurements is the extraction method, the main concern being the presence in the samples of a fraction insoluble in aqueous media. If substantial differences in the proportions of this fraction in different environments are confirmed in the future, the contribution of insoluble endotoxins cannot be neglected.

Personal exposure to dust and endotoxin in Robusta and Arabica coffee processing factories in Tanzania

INTRODUCTION

Endotoxin exposure associated with organic dust exposure has been studied in several industries. Coffee cherries that are dried directly after harvest may differ in dust and endotoxin emissions to those that are peeled and washed before drying. The aim of this study was to measure personal total dust and endotoxin levels and to evaluate their determinants of exposure in coffee processing factories.

METHODS

Using Sidekick Casella pumps at a flow rate of 2l/min, total dust levels were measured in the workers' breathing zone throughout the shift. Endotoxin was analyzed using the kinetic chromogenic Limulus amebocyte lysate assay. Separate linear mixed-effects models were used to evaluate exposure determinants for dust and endotoxin.

RESULTS

Total dust and endotoxin exposure were significantly higher in Robusta than in Arabica coffee factories (geometric mean 3.41 mg/m(3) and 10 800 EU/m(3) versus 2.10 mg/m(3) and 1400 EU/m(3), respectively). Dry pre-processed coffee and differences in work tasks explained 30% of the total variance for total dust and 71% of the variance for endotoxin exposure. High exposure in Robusta processing is associated with the dry pre-processing method used after harvest.

CONCLUSIONS

Dust and endotoxin exposure is high, in particular when processing dry pre-processed coffee. Minimization of dust emissions and use of efficient dust exhaust systems are important to prevent the development of respiratory system impairment in workers.

Measurement of endotoxins in bioaerosols at workplace: a critical review of literature and a standardization issue

Endotoxins are lipopolysaccharides found in the outer membrane of most Gram-negative bacteria and cyanobacteria. Worker exposure to endotoxins has been shown in a number of work situations and is associated with both respiratory and systemic pathologies. The lack of an occupational exposure limit is mainly due to the absence of a standard protocol at the international level for sampling and analyzing airborne endotoxins. The bibliographic review in this article takes an exhaustive look at the current knowledge on measuring airborne endotoxins. It shows that, despite several reference documents at the international level, the methods used to measure endotoxin exposure differ considerably from one laboratory to another. Standardization is necessary to reduce interlaboratory variability and, ultimately, to improve the use of interstudy data. The bibliographic review presents the current status of standardization for airborne endotoxin measurement methods in the workplace and summarizes areas for further research. This article is both a reference document for all operators wishing to use such methods and a working document to build international consensus around the measurement of airborne endotoxins.

Immunological and inflammatory responses to organic dust in agriculture

PURPOSE OF REVIEW

Agriculture represents a major industry worldwide, and despite protection against the development of IgE-mediated diseases, chronic exposure to agriculture-related organic dusts is associated with an increased risk of developing respiratory disease. This article will review the literature regarding new knowledge of important etiologic agents in the dusts and focus on the immunologic responses following acute and repetitive organic dust exposures.

RECENT FINDINGS

Although endotoxin remains important, there is an emerging role of nonendotoxin components such as peptidoglycans from Gram-positive bacteria. Pattern recognition receptors including Toll-like receptor 4 (TLR4), TLR2 and intracellular nucleotide oligomerization domain-like receptors are partially responsible for mediating the inflammatory consequences. Repeated organic dust exposures modulate innate and adaptive immune function with a resultant adaptation-like response. However, repetitive exposures cause lung parenchymal inflammation, chronic disease, and lung function decline over time.

SUMMARY

The immunological consequences of organic dust exposure in the farming industry are likely explained by the diversity of microbial motifs in dust that can elicit differing innate immune receptor signaling pathways. Whereas initial activation results in a robust inflammatory response, repetitive dust exposures modulate immunity. This can result in low-grade, chronic inflammation, and/or protection against allergic disease.

The influence of bedding materials on bio-aerosol exposure in dairy barns

Bio-aerosol is a well-known cause of respiratory diseases. Exposure to bio-aerosols has been reported previously in dairy barns, but little is known about the sources of bio-aerosol. Bedding materials might be a significant source or substrate for bio-aerosol exposure. The aim of this study was to explore bio-aerosol exposure levels and its determinants in dairy barns with various bedding materials. Dust samples were collected at dairy barns using various bedding materials. Samples were analyzed for endotoxin and β(1 → 3)-glucan contents. Culturable bacteria and fungi were sampled by the Anderson N6 impactor. Exposure models were constructed using linear mixed models. The personal exposure levels to dust, endotoxin, and β(1 → 3)-glucan differed significantly between the barns utilizing diverse main bedding types (P<0.05), with the highest levels (GM: dust, 1.38 mg/m(3); endotoxin, 895 EU/m(3); β(1 → 3)-glucan, 7.84 μg/m(3)) in barns with compost bedding vs the lowest in barns with sawdust bedding (GM: dust, 0.51 mg/m(3); endotoxin, 183 EU/m(3); β(1 → 3)-glucan, 1.11 μg/m(3)). The exposure levels were also highly variable, depending on various extra bedding materials applied. Plant materials, particularly straw, utilized for bedding appeared to be a significant source for β(1 → 3)-glucan. Compost was significantly associated with elevated exposure levels. Between-worker variances of exposure were highly explained by determinants of exposure like type of bedding materials and milking by robot, whereas determinants could explain to lesser extent the within-worker variances. Exposure levels to endotoxin, β(1 → 3)-glucan, bacteria, and fungi in dairy barns were substantial and differed depending on bedding materials, suggesting bedding material types as a significant predictor of bio-aerosol exposure.

Organic dust toxic syndrome at a grass seed plant caused by exposure to high concentrations of bioaerosols

We describe an outbreak of sudden health problems in workers at a Danish grass seed plant after exposure to a particularly dusty lot of grass seeds. The seeds are called problematic seeds. The association between development of organic dust toxic syndrome (ODTS) and the handling of grass seeds causing exposure was assessed in a four-step model: (i) identification of exposure source, (ii) characterization of the emission of bioaerosols from the problematic and reference seeds, (iii) personal and stationary exposure measurement at the plant and (iv) repeated health examinations. The grass seeds were identified as the exposure source; the emissions of some bioaerosol components were up to 10(7) times higher from the problematic seeds than from reference seeds. Cleaning of the seeds was not enough to sufficiently reduce the high emission from the problematic seeds. Emission in terms of dust was 3.4 times as high from the problematic cleaned seeds as from cleaned reference seeds. The personal exposure reached 3 × 10(5) endotoxin units m(-3), 1 × 10(6) colony-forming units (cfu) of thermophilic actinomycetes m(-3), 8 × 10(5) cfu of Aspergillus fumigatus m(-3) and 9 × 10(6) hyphal fragments m(-3). Several workers working with the problematic seeds had symptoms consistent with ODTS. The most severe symptoms were found for the workers performing the tasks causing highest exposure. Respiratory airway protection proved efficient to avoid development of ODTS. Work with reference seeds did not cause workers to develop ODTS. Exposure was during work with the problematic seeds higher than suggested occupational exposure limits but lower than in studies where researchers for some minutes have repeated a single task expected to cause ODTS. In this study, many different bioaerosol components were measured during a whole working day. We cannot know, whether it is the combination of different bioaerosol components or a single component which is responsible for the development of ODTS. In conclusion, workers developed specific health symptoms due to the high bioaerosol exposure and were diagnosed with ODTS. Exposure to high concentrations of endotoxin, actinomycetes, fungi, hyphal fragments, β-glucan, and A. fumigatus occurred when working with a dusty lot of grass seed. Suspicion should be elicited by seeds stored without being properly dried and by seeds producing more dust than usually.

Variable beta-glucans production by different states of Eurotium amstelodami explains differences in inflammatory responses in airway cells

Eurotium amstelodami, a mold frequently identified in housing and farm air samples, is a suspected cause of respiratory diseases such as allergic alveolitis, atopic asthma, and organic dust toxic syndrome. This fungus is present in the air in three different states (ascospores, conidia, and hyphae). The aim of this study was to test in vitro the differential inflammatory response of airway cells exposed to 1,3 betaglucanase-treated protein extract (BGPE), from E. amstelodami ascospores, conidia, and hyphae. Confluent cells from the A549 cell line were inoculated with calibrated BGPE issued from the three fungal forms. The levels of eight cytokines and chemokines involved in inflammatory responses were measured after 8 h of exposure. Beta-d-glucan (BDG) was quantified in total fungal extract as well as in the BGPE from the three fungal states. Hyphal BGPE were the only ones to induce a marked inflammatory response and they contain higher quantities of BDG. The present study adds to the growing body of evidence that beta-glucan from fungal hyphae play a crucial role in respiratory diseases.

Respiratory health of two cohorts of terminal grain elevator workers studied 30 years apart

INTRODUCTION

We evaluated the respiratory health of two cohorts of grain terminal elevator workers who participated in one of either respiratory health surveys undertaken in 1978 and 2008.

METHODS

Questionnaire and spirometry data from 584 workers from the 1978 survey and 215 workers from the 2008 survey were compared using logistic regression and general linear modeling.

RESULTS

The geometric means of area samples of grain dust averaged 8.28 mg/m(3) in 1978 and 2.06 mg/m(3) in 2008. Workers in the 1978 survey had a significantly higher prevalence of respiratory symptoms (with the largest adjusted odds ratio of 3.78, 95% CI 2.07-7.25, for shortness of breath), a lower prevalence of atopic conditions and lower mean lung function.

CONCLUSION

Current grain workers had a lower risk of respiratory health consequences and a greater prevalence of atopic conditions than workers surveyed 30 years prior, most likely associated with reduced exposure to grain dust in the terminal elevator environment.

Workers' exposure to dust, endotoxin and β-(1-3) glucan at four large-scale composting facilities

OBJECTIVES

To characterise compost workers' exposure to dust, endotoxin and β-(1-3) glucan during various operational practices and investigate whether dust concentrations are a useful indicator of endotoxin exposure in compost workers.

METHODS

This study assessed inhalable dust fractions, bacterial endotoxin and β-(1-3) glucan in 117 personal samples and 88 ambient samples from four large-scale composting facilities.

RESULTS

Employees' exposures to inhalable dust, endotoxin and β-(1-3) glucan exhibited a large range. Inhalable dust was found to be generally low (GM 0.99 mg/m(3), GSD 2.99 mg/m(3)). Analysis of the biological component of the dust showed that employees' exposures to endotoxin were elevated (GM 35.10 EU/m(3), GSD 9.97 EU/m(3)). Employees' exposure to β-(1-3) glucan was low (GM 0.98 ng/m(3), GSD 13.39 ng/m(3)). Dust levels were elevated during manual sorting and screening of waste and high levels of endotoxin and β-(1-3) glucan were observed during all practices involving the movement of waste. A significant correlation was observed between the personal dust levels and personal endotoxin concentrations (r=0.783, p<0.05) and that personal inhalable dust concentration may be a valuable predictor for personal endotoxin concentration in the sites studied.

CONCLUSIONS

Workers at composting sites are exposed to high levels of bacterial endotoxin consistent with adverse respiratory outcomes even though in most cases, their personal dust exposure is below the suggested regulatory levels. Dose-response data for the biological components present in the dust encountered at composting sites are not well established at this time and site operators should adopt precautionary measures when assessing and managing these potential risks.

Murine models of airway fungal exposure and allergic sensitization

Inhalation of common indoor filamentous fungi has been associated with the induction or exacerbation of allergic respiratory disease. The understanding of fungal inhalation and allergic sensitization has significantly advanced with the use of small animal models, especially mouse models. Numerous studies have employed different animal exposure and sensitization techniques, each with inherent advantages and disadvantages that are addressed in this review. In addition, most studies involve exposure of animals to fungal spores or spore extracts while neglecting the influence of hyphal or subcellular fragment exposures. Recent literature examining the potential for hyphae and fungal fragments to induce or exacerbate allergy is discussed. Innate immune recognition of fungal elements and their contribution to lung allergic inflammation in animal models are also reviewed. Though physical properties of fungi play an important role following exposure, host immune development is also critical in airway inflammation and allergy. We discuss the importance of environmental factors that influence early immune development and subsequent susceptibility to allergy. Murine studies that examine the role of intestinal microflora and prenatal or early life environmental factors that promote allergic sensitization are also evaluated. Future studies will require animal models that accurately reflect natural fungal exposures and identify environmental factors that influence immune development and thus promote respiratory fungal allergy and disease.

Exposure to bioaerosols during the growth season of tomatoes in an organic greenhouse using Supresivit (Trichoderma harzianum) and Mycostop (Streptomyces griseoviridis)

In working environments, especially in confined spaces like greenhouses, elevated concentrations of airborne microorganisms may become a problem for workers' health. Additionally, the use of microbial pest control agents (MPCAs) may increase exposure to microorganisms. The aim of this study was to investigate tomato growers' exposure to naturally occurring bioaerosol components [dust, bacteria, fungi, actinomycetes, (1-->3)-beta-D-glucans, and endotoxin] and MPCAs applied by drip irrigation. Airborne dust was collected with filter samplers and analyzed for microorganisms by plate counts and total counts using a microscope. Analysis of (1-->3)-beta-D-glucan and endotoxin content was performed by kinetic, chromatic Limulus amoebocyte lysate tests. The fungal strain (Trichoderma harzianum) from the biocontrol product Supresivit was identified by PCR analysis. Measurements were performed on the day of drip irrigation and 1 week, 1 month, and 3 months after the irrigation. T. harzianum from Supresivit could be detected only on the day of treatment. Streptomyces griseoviridis, an applied MPCA, was not detected in the air during this investigation. We found that bioaerosol exposure increases during the growth season and that exposure to fungi, bacteria, and endotoxin can reach levels during the harvest period that may cause respiratory symptoms in growers. The collected data indicate that MPCAs applied by drip irrigation do not become airborne later in the season.

The utility of antifungal agents for asthma

PURPOSE OF REVIEW

Recent work demonstrates that patients with refractory asthma are likely to be sensitized to environmental fungi and that specific antifungal treatments may be of benefit to this group.

RECENT FINDINGS

The relationships among fungal sensitization, exposure and asthma severity are imperfectly understood. Exposure to environmental fungi occurs ubiquitously and there is emerging evidence that internal airways colonization could be a source of ongoing exposure. Antifungal treatments appear to improve asthma-related quality of life. Such treatments are generally well tolerated but there are potential side-effects. The mechanisms behind the clinical improvements are not yet fully established.

SUMMARY

Antifungal treatments are used in some centres for patients with refractory asthma. Further research needs to explore the questions of patient selection, optimum duration of therapy and the prediction and management of azole-corticosteroid drug interactions. Advances in our understanding of the fungal molecular allergome and in our understanding of the allergic importance of small hyphal fragments may help to more precisely define the relationships among fungal sensitization, exposure and asthma severity.

beta-(1,3)-Glucan exposure assessment by passive airborne dust sampling and new sensitive immunoassays

Associations between house dust-associated beta-(1,3)-glucan exposure and airway inflammatory reactions have been reported, while such exposures in early childhood have been suggested to protect against asthma and wheezing. Most epidemiological studies have used reservoir dust samples and an inhibition enzyme immunoassay (EIA) for beta-(1,3)-glucan exposure assessment. The objective of this study was to develop inexpensive but highly sensitive enzyme immunoassays to measure airborne beta-(1,3)-glucans in low-exposure environments, like homes. Specificities of available anti-beta-(1,3)-glucan antibodies were defined by direct and inhibition experiments. Three suitable antibody combinations were selected for sandwich EIAs. beta-(1,3)-Glucans in passive airborne dust collected with an electrostatic dust fall collector (EDC) and floor dust from seven homes were measured with the three EIAs. Floor dust samples were additionally analyzed in the inhibition EIA. The sandwich EIAs were sensitive enough for airborne glucan measurement and showed different specificities for commercial glucans, while the beta-(1,3)-glucan levels in house dust samples correlated strongly. The feasibility of measuring glucans in airborne dust with the recently introduced EDC method was further investigated by selecting the most suitable of the three EIAs to measure and compare beta-(1,3)-glucan levels in the EDC and in floor and actively collected airborne dust samples of the previously performed EDC validation study. The EDC beta-(1,3)-glucan levels correlated moderately with beta-(1,3)-glucans in actively collected airborne dust and floor dust samples, while the glucan levels in the airborne dust and floor dust samples did not correlate. The combination of the newly developed beta-(1,3)-glucan sandwich EIA with EDC sampling now allows assessment in large-scale population studies of exposure to airborne beta-(1,3)-glucans in homes or other low-exposure environments.

Surveillance of Fungal Allergic Sensitization Using the Fluorescent Halogen Immunoassay

OBJECTIVE: Conidia derived from a small number of common fungal genera are widely accepted as the etiological agents responsible for fungal allergic sensitization. The contribution of fungal conidia, spores, airborne hyphae, and subcellular fragments from other uncharacterized fungal genera remains unclear. In this proof-of-concept study, we examined the composition of mycoaerosols that atopic women were exposed and sensitized to in their own indoor environment using the fluorescent halogen immunoassay (fHIA). PATIENTS AND METHODS: Mycoaerosols were collected onto mixed cellulose ester protein binding membranes (PBMs) for 30 minutes with volumetric air sampling pumps. The PBMs were laminated with an adhesive cover slip and indirectly immunostained with individual patient serum IgE using the fHIA. Samples were examined using confocal laser scanning microscopy and immunostained particles were expressed as a percentage of total particles. RESULTS: All air samples contained a broad spectrum of fungal spores, conidia, hyphae, and other fungal particulates. Airborne concentrations varied between individual study participant environments. Positively immunostained conidia belonging to moniliaceous amerospores, Cladosporium, Alternaria, and many unknown species were observed in the majority of air samples. Other fungal genera including Bipolaris, Curvularia, Pithomyces, and Stachybotrys, in addition to, ascospore genera and dematiaceous hyphal fragments released detectable allergen. Twelve percent of all fHIA haloes quantified in the analysis were directed towards fungal particles. No immunostaining was detected to conidia belonging to Epicoccum, Fusarium, and Spegazzinia species. CONCLUSION: In addition to characterized fungal aeroallergens, we observed a wider composition of fungi that bound human IgE. Field surveillance studies that utilize immunodiagnostic techniques such as the fHIA will provide further insight into the diversity of fungi that function as aeroallergen sources in individual study participant environments.

Airborne fungal and bacterial components in PM1 dust from biofuel plants

Fungi grown in pure cultures produce DNA- or RNA-containing particles smaller than spore size (<1.5 microm). High exposures to fungi and bacteria are observed at biofuel plants. Airborne cultivable bacteria are often described to be present in clusters or associated with larger particles with an aerodynamic diameter (d(ae)) of 2-8 microm. In this study, we investigate whether airborne fungal components smaller than spore size are present in bioaerosols in working areas at biofuel plants. Furthermore, we measure the exposure to bacteria and fungal components in airborne particulate matter (PM) with a D(50) of 1 microm (called PM(1) dust). PM(1) was sampled using Triplex cyclones at a working area at 14 Danish biofuel plants. Millipore cassettes were used to sample 'total dust'. The PM(1) particles (29 samples) were analysed for content of 11 different components and the total dust was analysed for cultivable fungi, N-acetyl-beta-D-glucosaminidase (NAGase), and (1 --> 3)-beta-D-glucans. In the 29 PM(1) samples, cultivable fungi were found in six samples and with a median concentration below detection level. Using microscopy, fungal spores were identified in 22 samples. The components NAGase and (1 --> 3)-beta-D-glucans, which are mainly associated with fungi, were present in all PM(1) samples. Thermophilic actinomycetes were present in 23 of the 29 PM(1) samples [average = 739 colony-forming units (CFU) m(-3)]. Cultivable and 'total bacteria' were found in average concentrations of, respectively, 249 CFU m(-3) and 1.8 x 10(5) m(-3). DNA- and RNA-containing particles of different lengths were counted by microscopy and revealed a high concentration of particles with a length of 0.5-1.5 microm and only few particles >1.5 microm. The number of cultivable fungi and beta-glucan in the total dust correlated significantly with the number of DNA/RNA-containing particles with lengths of between 1.0 and 1.5 microm, with DNA/RNA-containing particles >1.5 microm, and with other fungal components in PM(1) dust. Airborne beta-glucan and NAGase were found in PM(1) samples where no cultivable fungi were present, and beta-glucan and NAGase were found in higher concentrations per fungal spore in PM(1) dust than in total dust. This indicates that fungal particles smaller than fungal spore size are present in the air at the plants. Furthermore, many bacteria, including actinomycetes, were present in PM(1) dust. Only 0.2% of the bacteria in PM(1) dust were cultivable.

Exposure to inhalable dust, endotoxins, beta(1->3)-glucans, and airborne microorganisms in horse stables

OBJECTIVES

Workers in horse stables are likely exposed to high levels of organic dust. Organic dusts play a role in increased risk of inflammatory reactions and are associated with respiratory diseases. The aim of this study was to investigate dust, endotoxin, beta(1-->3)-glucan, and culturable microorganisms exposure levels in horse stables.

METHODS

Ambient (n = 38) and personal (n = 42) inhalable dust samples were collected using PAS-6 sampling heads. As a special measurement, we included sampling near the horses' heads. Samples were analyzed for endotoxin and beta(1-->3)-glucan by Limulus amebocyte lysate assay and an inhibition enzyme immunoassay, respectively. Culturable bacteria and fungi were collected with an Anderson impactor.

RESULTS

Geometric means (GMs) of personal exposure to dust, endotoxin, and beta(1-->3)-glucan were 1.4 mg m(-3) (range 0.2-9.5), 608 EU m(-3) (20-9846), and 9.5 microg m(-3) (0.4-631 microg m(-3)), respectively. Exposure levels in the morning shift were higher compared to other shifts. The GMs (ranges) of culturable bacteria and fungi were 3.1 x 10(3) colony-forming unit (CFU) m(-3) (6.7 x 10 to 1.9 x 10(4)) and 1.9 x 10(3) CFU m(-3) (7.4 x 10 to 2.4 x 10(4)), respectively. Variance components for endotoxin and beta(1-->3)-glucan were considerably higher than for dust. Based on dummy variable in a mixed regression analysis, the predominant task explaining exposure levels of dust, endotoxin, and beta(1-->3)-glucan was sweeping the floor. For beta(1-->3)-glucan, feeding the horse was also an important determinant.

CONCLUSION

Dust, endotoxin, and beta(1-->3)-glucan exposure are considerable in horse stables. Bacterial and fungal exposure levels were moderate. Endotoxin exposures were above the Dutch proposed standard limits, suggesting workers in horse stables to be at risk of adverse health effects.

Working conditions and exposure to dust and bioaerosols in sisal processing factories in Tanzania

Information was collected on working conditions and personal exposures to dust, bacteria, and fungi in sisal fiber processing factories in Tanzania to identify health hazards and possible needs for preventive measures. Walkthrough surveys were performed in the brushing and decorticating departments of six sisal factories. The number of departments showing adequate scores for ergonomics and work organization, physical working environment, and occupational health items were determined. Personal thoracic dust samples were collected during sisal processing and analyzed for concentration of dust (n = 24) and for fungi and bacteria (n = 32). In both departments, most items considered to be a prerequisite for a good working environment were either missing or inadequate. Ergonomic and physical hazards were observed. Repetitive strenuous tasks, awkward work postures, and high noise levels were found. Visible dust and inadequate ventilation were seen in the brushing departments, and wet floors were observed in the decortication departments. Personal protective equipment was hardly used. The arithmetic mean exposure of sisal processors was 1.2 mg thoracic dust/m(3), 43 x 10(6) bacteria/ m(3), and 2.35 x 10(6) fungal spores/m(3). The highest exposure levels were measured in the decortication departments when machines were cleaned of waste. Significant differences were found for mean thoracic dust exposure and bacteria counts between the brushing and decortication departments and the security guards. Within individual departments, there were no significant differences in exposures between the different work tasks. A linear mixed effect model of thoracic dust including department as fixed effect explained 65% of the between-worker variability for thoracic dust exposure. The study shows that workers in sisal processing in Tanzania are exposed to bioaerosols, and suitable control measures should be implemented. More exposure studies are needed in this type of industry.

Prevalence of asthma among youth on Hispanic-operated farms in the United States-2000

The objective of this study was to estimate prevalence of asthma and asthma attacks among youth (0-19 years old) working and/or living on Hispanic-operated farms. The 2000 U.S. Minority Farm Operator Childhood Agricultural Injury Survey (M-CAIS) data were used to calculate prevalence of asthma, asthma attacks and serious asthma attacks among youth (0 to 19 years) living on Hispanic-operated farms. Age-specific asthma prevalence rates with corresponding 95% confidence intervals (CIs) were calculated for working and nonworking youth. In 2000, an estimated 17,573 youth lived on Hispanic-operated farms; 7.4% had asthma ever diagnosed, 8.1% had an asthma attack while at work in the last year, and 1.4% had a serious asthma attack. Asthma prevalence was highest among youth aged 16-19 (9.1%), males (8.6%), and those driving tractors (9.7%). Serious asthma attacks that required an emergency room visit or hospitalization in the last year were most prevalent among youth aged 0-9 years (1.8%), males (1.7%), and those riding horses (1.7%). Compared with nonworking youth, prevalence of asthma (8.9% versus 6.1%; <i>p</i> < .05) and serious asthma attacks (1.6% versus 1.3%; <i>p</i> > .05) was higher among working youth. Prevalence of asthma attacks in the last year while at work was also significantly higher among males than females (8.6% versus 6.0%; <i>p</i> < .05) and among youth living on livestock farms than among youth on crop farms (9.4% versus 7.4%; <i>p</i> < .05). These findings contribute to the limited information on asthma among youth working on Hispanic-operated farms, and indicate the need for asthma prevention programs on farms and intervention studies targeting farming youth populations.

The concentration of no toxicologic concern (CoNTC) and airborne mycotoxins

The threshold of toxicologic concern (TTC) concept was developed as a method to identify a chemical intake level that is predicted to be without adverse human health effects assuming daily intake over the course of a 70-yr life span. The TTC values are based on known structure-activity relationships and do not require chemical-specific toxicity data. This allows safety assessment (or prioritization for testing) of chemicals with known molecular structure but little or no toxicity data. Recently, the TTC concept was extended to inhaled substances by converting a TTC expressed in micrograms per person per day to an airborne concentration (ng/m(3)), making allowance for intake by routes in addition to inhalation and implicitly assuming 100% bioavailability of inhaled toxicants. The resulting concentration of no toxicologic concern (CoNTC), 30 ng/m(3), represents a generic airborne concentration that is expected to pose no hazard to humans exposed continuously throughout a 70-yr lifetime. Published data on the levels of mycotoxins in agricultural dusts or in fungal spores, along with measured levels of airborne mycotoxins, spores, or dust in various environments, were used to identify conditions under which mycotoxin exposures might reach the CoNTC. Data demonstrate that airborne concentrations of dusts and mold spores sometimes encountered in agricultural environments have the potential to produce mycotoxin concentrations greater than the CoNTC. On the other hand, these data suggest that common exposures to mycotoxins from airborne molds in daily life, including in the built indoor environment, are below the concentration of no toxicologic concern.

Species-specific fungal DNA in airborne dust as surrogate for occupational mycotoxin exposure?

Possible health risks associated with occupational inhalation of mycotoxin-containing dust remain largely unknown, partly because methods for mycotoxin detection are not sensitive enough for the small dust masses obtained by personal sampling, which is needed for inhalable exposure measurements. Specific and sensitive PCR detection of fungi with mycotoxin-producing potential seem to be a good surrogate for occupational exposure measurements that include all fungal structures independent of morphology and cultivability. Results should, however, be interpreted with caution due to variable correlations with mycotoxin concentrations.