1
|
Ito Y, Miwa S, Hayakawa H, Oshima T, Eihuku T, Iwaizumi E, Ohba H, Fujita K, Kanai M, Shirai M. Antigen avoidance and environmental inhalation challenge for successful diagnosis of fibrotic hypersensitivity pneumonitis mimicking idiopathic pulmonary fibrosis. Respir Med Case Rep 2022; 39:101737. [PMID: 36133420 PMCID: PMC9483807 DOI: 10.1016/j.rmcr.2022.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 08/21/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
A 77-year-old man was initially diagnosed with idiopathic pulmonary fibrosis (IPF) and treated with anti-fibrotic nintedanib. Despite undergoing anti-fibrotic treatment for one year, his condition remained unstable. The patient was admitted to our hospital for exertional dyspnea. We performed an exposure assessment, including 2-week antigen avoidance and an environmental inhalation challenge, and successfully re-diagnosed him with fibrotic hypersensitivity pneumonitis (HP), known as chronic farmer's lung. Adding oral glucocorticoids to the nintedanib treatment improved his condition. Although antigen avoidance and environmental inhalation challenge tests are not standardized, they may be useful for diagnosing fibrotic HP when properly applied. Clinical features of fibrotic HP and IPF are often indistinguishable. Antigen avoidance is crucial in the diagnosis and management of fibrotic HP. Environmental inhalation challenge is useful when applied properly. The seasonal change of clinical parameters helps suspecting fibrotic HP.
Collapse
Affiliation(s)
- Yasuhiro Ito
- Corresponding author. 4201-2, Hamamatsu, 434-8511, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Madsen AM, Crook B. Occupational exposure to fungi on recyclable paper pots and growing media and associated health effects - A review of the literature. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 788:147832. [PMID: 34034170 DOI: 10.1016/j.scitotenv.2021.147832] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
Different types of pots and growing and casing media, including biodegradable materials, are used for plant and mushroom production. The fungus Peziza ostracoderma has gained attention for its visible growth on growing media for plants and casing media for mushrooms. Through a review of the literature we aim to evaluate whether exposure to fungi from recyclable pots and different growing and casing media occurs and causes occupational health effects. Based on the published papers, specific fungal species were not related to a specific medium. Thus P. ostracoderma has been found on paper pots, peat, sterilized soil, vermiculite, and rockwool with plants, and on peat, pumice, and paper casing for mushrooms. It has been found in high concentrations in the air in mushroom farms. Also Acremonium spp., Aspergillus niger, A. fumigatus, Athelia turficola, Aureobasidium pullulans, Chaetomium globosum, Chrysonilia sitophila, Cladosporium spp., Cryptostroma corticale, Lecanicillium aphanocladii, Sporothrix schenckii, Stachybotrys chartarum, and Trichoderma spp. have been found on different types of growing or casing media. Most of the fungi have also been found in the air in greenhouses, but the knowledge about airborne fungal species in mushroom farms is very limited. Eight publications describe cases of health effects associated directly with exposure to fungi from pots or growing or casing media. These include cases of hypersensitivity pneumonitis caused by exposure to: A. fumigatus, A. niger, Au. pullulans, Cr. corticale, P. ostracoderma, and a mixture of fungi growing on different media. Different approaches have been used to avoid growth of saprophytes including: chemical fungicides, the formulation of biodegradable pots and growing media and types of peat. To increase the sustainability of growing media different types of media are tested for their use and with the present study we highlight the importance of also considering the occupational health of the growers who may be exposed to fungi from the media and pots.
Collapse
Affiliation(s)
- Anne Mette Madsen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark.
| | - Brian Crook
- Health and Safety Executive, Science and Research Centre, Buxton SK17 9JN, UK
| |
Collapse
|
3
|
Costabel U, Miyazaki Y, Pardo A, Koschel D, Bonella F, Spagnolo P, Guzman J, Ryerson CJ, Selman M. Hypersensitivity pneumonitis. Nat Rev Dis Primers 2020; 6:65. [PMID: 32764620 DOI: 10.1038/s41572-020-0191-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2020] [Indexed: 02/06/2023]
Abstract
Hypersensitivity pneumonitis (HP) is a complex syndrome caused by the inhalation of a variety of antigens in susceptible and sensitized individuals. These antigens are found in the environment, mostly derived from bird proteins and fungi. The prevalence and incidence of HP vary widely depending on the intensity of exposure, the geographical area and the local climate. Immunopathologically, HP is characterized by an exaggerated humoral and cellular immune response affecting the small airways and lung parenchyma. A complex interplay of genetic, host and environmental factors underlies the development and progression of HP. HP can be classified into acute, chronic non-fibrotic and chronic fibrotic forms. Acute HP results from intermittent, high-level exposure to the inducing antigen, usually within a few hours of exposure, whereas chronic HP mostly originates from long-term, low-level exposure (usually to birds or moulds in the home), is not easy to define in terms of time, and may occur within weeks, months or even years of exposure. Some patients with fibrotic HP may evolve to a progressive phenotype, even with complete exposure avoidance. Diagnosis is based on an accurate exposure history, clinical presentation, characteristic high-resolution CT findings, specific IgG antibodies to the offending antigen, bronchoalveolar lavage and pathological features. Complete antigen avoidance is the mainstay of treatment. The pharmacotherapy of chronic HP consists of immunosuppressive drugs such as corticosteroids, with antifibrotic therapy being a potential therapy for patients with progressive disease.
Collapse
Affiliation(s)
- Ulrich Costabel
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany.
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Annie Pardo
- Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Dirk Koschel
- Department of Internal Medicine and Pneumology, Fachkrankenhaus Coswig, Centre for Pulmonary Diseases and Thoracic Surgery, Coswig, Germany.,Division of Pneumology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumology Department, Ruhrlandklinik, University Hospital, University of Essen, Essen, Germany
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Josune Guzman
- General and Experimental Pathology, Ruhr-University, Bochum, Germany
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Mexico City, Mexico
| |
Collapse
|
4
|
Feeney P, Rodríguez SF, Molina R, McGillicuddy E, Hellebust S, Quirke M, Daly S, O'Connor D, Sodeau J. A comparison of on-line and off-line bioaerosol measurements at a biowaste site. WASTE MANAGEMENT (NEW YORK, N.Y.) 2018; 76:323-338. [PMID: 29477650 DOI: 10.1016/j.wasman.2018.02.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 01/09/2018] [Accepted: 02/15/2018] [Indexed: 06/08/2023]
Abstract
An air measurement campaign was carried out at a green-waste composting site in the South of Ireland during Spring 2016. The aim was to quantify and identify the levels of Primary Biological Aerosol Particles (PBAP) that were present using the traditional off-line, impaction/optical microscopy method alongside an on-line, spectroscopic approach termed WIBS (Wideband Integrated Bioaerosol Sensor), which can provide number concentrations, sizes and "shapes" of airborne PBAP in real-time by use of Light Induced Fluorescence (LIF). The results from the two techniques were compared in order to validate the use of the spectroscopic method for determining the releases of the wide-range of PBAP present there as a function of site activity and meteorological conditions. The seven-day monitoring period undertaken was much longer than any real-time studies that have been previously performed and allowed due comparison between weekday (working) activities at the site and weekend (closed) releases. The time-span also allowed relationships between site activities like turning, agitation or waste delivery and the WIBS data to be determined in a quantitative manner. This information cannot be obtained with the Andersen Sampling methods generally employed at green-waste management sites. Furthermore, few specific bioaerosol types other than Aspergillus fumigatus, are identified using the traditional protocols employed for site licensing purposes. Here though the co-location of WIBS with the impaction instrument made it possible to identify the real-time release behaviour of a specific plant pathogenic spore, Ustilago maydis, present after green-waste deliveries were made by a local distillery.
Collapse
Affiliation(s)
- Patrick Feeney
- School of Chemistry and Environmental Research Institute, University College Cork, Cork, Ireland
| | | | - Rafael Molina
- Faculty of Science, University of Extremadura, Badajoz, Spain
| | - Eoin McGillicuddy
- School of Chemical and Pharmaceutical Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Stig Hellebust
- School of Chemistry and Environmental Research Institute, University College Cork, Cork, Ireland
| | - Michael Quirke
- School of Chemistry and Environmental Research Institute, University College Cork, Cork, Ireland
| | - Shane Daly
- School of Chemistry and Environmental Research Institute, University College Cork, Cork, Ireland
| | - David O'Connor
- School of Chemical and Pharmaceutical Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - John Sodeau
- School of Chemistry and Environmental Research Institute, University College Cork, Cork, Ireland.
| |
Collapse
|
5
|
Kouranos V, Jacob J, Nicholson A, Renzoni E. Fibrotic Hypersensitivity Pneumonitis: Key Issues in Diagnosis and Management. J Clin Med 2017; 6:jcm6060062. [PMID: 28617305 PMCID: PMC5483872 DOI: 10.3390/jcm6060062] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 11/23/2022] Open
Abstract
The diagnosis of hypersensitivity pneumonitis (HP) relies on the clinical evaluation of a number of features, including a history of significant exposure to potentially causative antigens, physical examination, chest CT scan appearances, bronchoalveolar lavage lymphocytosis, and, in selected cases, histology. The presence of fibrosis is associated with higher morbidity and mortality. Differentiating fibrotic HP from the idiopathic interstitial pneumonias can be a challenge. Furthermore, even in the context of a clear diagnosis of fibrotic HP, the disease behaviour can parallel that of idiopathic pulmonary fibrosis in a subgroup, with inexorable progression despite treatment. We review the current knowledge on the diagnosis, management, and prognosis of HP with particular focus on the fibrotic phenotype.
Collapse
Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, Sydney Street, SW3 6NP London, UK.
| | - Joseph Jacob
- Department of Radiology, Royal Brompton Hospital, London, UK.
| | - Andrew Nicholson
- Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College, London, UK.
| | - Elizabetta Renzoni
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, Sydney Street, SW3 6NP London, UK.
| |
Collapse
|
6
|
Pearson C, Littlewood E, Douglas P, Robertson S, Gant TW, Hansell AL. Exposures and health outcomes in relation to bioaerosol emissions from composting facilities: a systematic review of occupational and community studies. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART B, CRITICAL REVIEWS 2015; 18:43-69. [PMID: 25825807 PMCID: PMC4409048 DOI: 10.1080/10937404.2015.1009961] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The number of composting sites in Europe is rapidly increasing, due to efforts to reduce the fraction of waste destined for landfill, but evidence on possible health impacts is limited. This article systematically reviews studies related to bioaerosol exposures within and near composting facilities and associated health effects in both community and occupational health settings. Six electronic databases and bibliographies from January 1960 to July 2014 were searched for studies reporting on health outcomes and/or bioaerosol emissions related to composting sites. Risk of bias was assessed using a customized score. Five hundred and thirty-six papers were identified and reviewed, and 66 articles met the inclusion criteria (48 exposure studies, 9 health studies, 9 health and exposure studies). Exposure information was limited, with most measurements taken in occupational settings and for limited time periods. Bioaerosol concentrations were highest on-site during agitation activities (turning, shredding, and screening). Six studies detected concentrations of either Aspergillus fumigatus or total bacteria above the English Environment Agency's recommended threshold levels beyond 250 m from the site. Occupational studies of compost workers suggested elevated risks of respiratory illnesses with higher bioaerosol exposures. Elevated airway irritation was reported in residents near composting sites, but this may have been affected by reporting bias. The evidence base on health effects of bioaerosol emissions from composting facilities is still limited, although there is sufficient evidence to support a precautionary approach for regulatory purposes. While data to date are suggestive of possible respiratory effects, further study is needed to confirm this and to explore other health outcomes.
Collapse
Affiliation(s)
- Clare Pearson
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health & NIHR HPRU in Health Impact of Environmental Hazards, Imperial College London, London, United Kingdom
| | - Emma Littlewood
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health & NIHR HPRU in Health Impact of Environmental Hazards, Imperial College London, London, United Kingdom
| | - Philippa Douglas
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health & NIHR HPRU in Health Impact of Environmental Hazards, Imperial College London, London, United Kingdom
| | - Sarah Robertson
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire, United Kingdom
| | - Timothy W. Gant
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Harwell Campus, Didcot, Oxfordshire, United Kingdom
| | - Anna L. Hansell
- Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health & NIHR HPRU in Health Impact of Environmental Hazards, Imperial College London, London, United Kingdom
- Public Health and Primary Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| |
Collapse
|
7
|
Hagemeyer O, Bünger J, van Kampen V, Raulf-Heimsoth M, Drath C, Merget R, Brüning T, Broding HC. Occupational allergic respiratory diseases in garbage workers: relevance of molds and actinomycetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 788:313-20. [PMID: 23835992 DOI: 10.1007/978-94-007-6627-3_42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Exposures to molds and bacteria (especially actinomycetes) at workplaces are common in garbage workers, but allergic respiratory diseases due to these microorganisms have been described rarely. The aim of our study was a detailed analysis of mold or bacteria-associated occupational respiratory diseases in garbage workers. From 2002 to 2011 four cases of occupational respiratory diseases related to garbage handling were identified in our institute (IPA). Hypersensitivity pneumonitis (HP) was diagnosed in three subjects (cases 1-3, one smoker, two non-smokers), occupational asthma (OA) was diagnosed in one subject (case 4, smoker), but could not be excluded completely in case 2. Cases 1 and 2 worked in composting sites, while cases 3 and 4 worked in packaging recycling plants. Exposure periods were 2-4 years. Molds and actinomycetes were identified as allergens in all cases. Specific IgE antibodies to Aspergillus fumigatus were detected exclusively in case 4. Diagnoses of HP were essentially based on symptoms and the detection of specific IgG serum antibodies to molds and actinomycetes. OA was confirmed by bronchial provocation test with Aspergillus fumigatus in case 4. In conclusion, occupational HP and OA due to molds occur rarely in garbage workers. Technical prevention measures are insufficient and the diagnosis of HP is often inconclusive. Therefore, it is recommended to implement the full repertoire of diagnostic tools including bronchoalveolar lavage and high resolution computed tomography in the baseline examination.
Collapse
Affiliation(s)
- O Hagemeyer
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany,
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Poole CJM, Wong M. Allergic bronchopulmonary aspergillosis in garden waste (compost) collectors--occupational implications. Occup Med (Lond) 2013; 63:517-9. [PMID: 23975883 DOI: 10.1093/occmed/kqt097] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The separation of rotting garden material from general domestic waste and its collection for processing in industrial composting sites is a relatively new industry in the UK. Two cases of allergic bronchopulmonary aspergillosis and the results of health surveillance are described in a team of 28 garden waste (compost) collectors. A few cases of extrinsic allergic alveolitis due to Aspergillus fumigatus have previously been reported in compost workers. In the absence of any guidance from research and to prevent similar cases of a potentially serious illness, we advise that new starters to the job of collecting or processing compost are screened for asthma and aspergillus sensitivity, cystic fibrosis, bronchiectasis and immunodeficiency if their exposure to high levels of Aspergillus sp cannot be controlled. Annual health surveillance for these workers is also recommended.
Collapse
Affiliation(s)
- C J M Poole
- Department of Occupational Health, Dudley & Walsall NHS Trust, Health Centre, Dudley DY1 1RN, UK
| | | |
Collapse
|
9
|
Hambach R, Droste J, François G, Weyler J, Van Soom U, De Schryver A, Vanoeteren J, van Sprundel M. Work-related health symptoms among compost facility workers: a cross-sectional study. ACTA ACUST UNITED AC 2012; 70:13. [PMID: 22958275 PMCID: PMC3436713 DOI: 10.1186/0778-7367-70-13] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 06/12/2012] [Indexed: 12/02/2022]
Abstract
Background Industrial composting is a relatively new and expanding activity. Several studies indicate that compost workers are at risk to develop health symptoms. The aim of this study was to assess the prevalence of work-related health symptoms among compost workers compared with control subjects. Methods A questionnaire was distributed among 62 workers (31 exposed and 31 non-exposed workers). Data were analyzed using simple and multiple logistic regression analyses. Results Workers exposed to organic dust reported significantly more often respiratory, irritation (e.g., eyes, nose and throat), gastrointestinal, and skin symptoms than the non-exposed group. Moreover, all work-related symptoms were significantly more often reported by exposed than non-exposed workers. After adjustment for smoking status and age, the associations between exposure and respiratory, gastrointestinal, and skin symptoms remained statistically significant, in particular if these symptoms were work-related. Conclusions This study confirms that workers at compost facilities are at risk to develop occupational health problems, most likely related to organic dust exposure.
Collapse
Affiliation(s)
- Ramona Hambach
- Department of Epidemiology and Social Medicine, Occupational and Environmental Medicine, Faculty of Medicine and Health Sciences, Campus Drie Eiken, University of Antwerp, Universiteitsplein 1, BE-2610, Antwerp, Belgium.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Perrott JK, Armstrong DP. Aspergillus fumigatus densities in relation to forest succession and edge effects: implications for wildlife health in modified environments. ECOHEALTH 2011; 8:290-300. [PMID: 22076057 DOI: 10.1007/s10393-011-0716-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 10/05/2011] [Accepted: 10/06/2011] [Indexed: 05/31/2023]
Abstract
The hihi (or stitchbird, Notiomystis cincta) is a New Zealand endemic nectivorous forest bird now restricted to one pristine island. Relocation to establish viable hihi populations on other islands has been the main conservation action since the early 1980s. To date, hihi reintroductions to young growth islands have had poor success despite the absence of mammalian predators. It was thought that past failures were due to food limitation, but research suggests that food limitation alone cannot account for their poor survivorship. Post-mortems of dead hihi has shown that aspergillosis caused by Aspergillus fumigatus is a major mortality factor and there is current concern regarding their susceptibility to this fungal disease. In this paper we develop and assess the hypothesis that A. fumigatus limits hihi population viability on modified islands, and suggest that A. fumigatus is a potential indicator species for habitat disturbance. We report that the prevalence of A. fumigatus spores in the soil is much higher in young growth forests and forest edge habitats. Results suggest that hihi mortality rates between islands are potentially due to differential exposure to A. fumigatus spores. We assess relationships between habitat disturbance, A. fumigatus contamination and hihi mortality rates by testing the following predictions: (1) that densities of A. fumigatus spores will be higher on modified islands, (2) that densities of A. fumigatus spores on islands will be correlated with hihi mortality rates and (3) that densities of A. fumigatus spores will be higher at the forest edge than in the interior. We test each of these predictions using soil samples, air samples and samples of nectar from plant species fed on by hihi.
Collapse
Affiliation(s)
- John K Perrott
- Wildlife Ecology Group, Institute of Natural Resources, Massey University, Private Bag 11-222, Palmerston North, New Zealand.
| | | |
Collapse
|
11
|
Schlosser O, Huyard A, Cartnick K, Yañez A, Catalán V, Quang ZD. Bioaerosol in composting facilities: occupational health risk assessment. WATER ENVIRONMENT RESEARCH : A RESEARCH PUBLICATION OF THE WATER ENVIRONMENT FEDERATION 2009; 81:866-77. [PMID: 19860143 DOI: 10.2175/106143009x407258] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
This research found evidence of an association between occupational exposure to bioaerosols in composting plants and health outcome occurrence in exposed workers. An occupational exposure assessment in six composting plants was performed to better characterize personal exposure levels and evaluate associated health risk in workers. Sampling results showed large ranges of concentrations of dust, bacteria, molds, and endotoxin in ambient air and in personal samples, both when driving a front-end loader and when cleaning, monitoring, and performing maintenance tasks. Mean personal exposure levels were high at 100 to more than 10,000 times higher than outdoor background levels and fully consistent with occurrence of inflammatory and allergic respiratory outcomes among workers. Engineering control, personal protection, and education and training programs for employees, health, and safety officials, and occupational physicians are being developed and implemented.
Collapse
Affiliation(s)
- Olivier Schlosser
- SUEZ ENVIRONNEMENT, CIRSEE, 38 rue du President Wilson, 78230 Le Pecq, France.
| | | | | | | | | | | |
Collapse
|
12
|
Martinez KF, Seitz TA, Lonon MK, Weber AM. Application of Culturable Sampling Methods for the Assessment of Workplace Concentrations of Bioaerosols. Inhal Toxicol 2008. [DOI: 10.3109/08958379509012802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
13
|
Thaon I, Reboux G, Moulonguet S, Dalphin J. Les pneumopathies d’hypersensibilité en milieu professionnel. ARCH MAL PROF ENVIRO 2007. [DOI: 10.1016/s1775-8785(07)78223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
14
|
|
15
|
Thaon I, Reboux G, Moulonguet S, Dalphin JC. Les pneumopathies d’hypersensibilité en milieu professionnel. Rev Mal Respir 2006; 23:705-25. [PMID: 17202974 DOI: 10.1016/s0761-8425(06)72084-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) is a granulomatous disease of the lungs due to immune reactions following chronic inhalation of organic dusts or chemicals especially encountered in the occupational environment. The main purpose of this review is to report current concepts regarding aetiologies, epidemiology, diagnosis, treatment as well as legal aspects of HP. STATE OF THE ART The following aspects will be focused: (1) increase in new etiological circumstances, especially occupational and news antigens, (2) for diagnosis, the major contribution of chest high resolution CT scan which often shows characteristic images but also recent developments in simple diagnostic criteria that may be used for an epidemiological approach, (3) importance of bronchial obstruction and even emphysema as a long term sequelae, finally (4) the possibility of continuing occupational activities in certain circumstances where preventive measures can be used. PERSPECTIVES The increasing knowledge of etiological agents and circumstances as well as the development of secondary and especially primary preventive measures should lead to reduce the frequency of this disease and of its medico-social consequences.
Collapse
Affiliation(s)
- I Thaon
- Service des Maladies Professionnelles, CHU de Besançon, France
| | | | | | | |
Collapse
|
16
|
Bünger J, Schappler-Scheele B, Hilgers R, Hallier E. A 5-year follow-up study on respiratory disorders and lung function in workers exposed to organic dust from composting plants. Int Arch Occup Environ Health 2006; 80:306-12. [PMID: 16897096 DOI: 10.1007/s00420-006-0135-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2006] [Accepted: 07/10/2006] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate acute and chronic effects of long-term exposure to organic dust on respiratory disorders and lung function among employees at 41 composting facilities in Germany. METHODS A total of 218 compost workers and 66 control subjects were enrolled in the cohort. They were evaluated using a standardized questionnaire, a clinical examination, and spirometric measurements. Changes of symptoms, respiratory disorders, and lung function were determined in a first survey after 5 years of exposure in 123 compost workers and 48 controls. Exposure measurements were performed at six composting facilities for respirable dust, cultivable microorganisms, and endotoxins. RESULTS Exposure measurements revealed high concentrations of thermo-tolerant/thermophilic actinomycetes and filamentous fungi in the bio-aerosols at the composting sites. A significantly higher job fluctuation was observed among the compost workers compared to control subjects (95 vs. 18; p < 0.05). Compost workers reported a significantly higher prevalence of mucosal membrane irritation (MMI) of the eyes and upper airways than control subjects. Conjunctivitis was diagnosed significantly more often in compost workers. Forced vital capacity in percent of predicted (FVC%) of the non-smoking compost workers declined significantly (-5.4%) during the observation period compared to control subjects. The decline of FVC% in 16 compost workers exceeded 10% of initial values. A significant increase was observed in the number of compost workers suffering from chronic bronchitis (RR = 1.41; 95% CI = 1.28-1.55). Allergic alveolitis was diagnosed clinically in two compost workers. CONCLUSIONS The exposure to organic dust at workplaces of composting facilities is associated with adverse acute and chronic respiratory health effects, including MMI, chronic bronchitis, and an accelerated decline of FVC%. The pattern of health effects differs from those at other workplaces with exposures to organic dust possibly due to high concentrations of thermo-tolerant/thermophilic actinomycetes and filamentous fungi at composting plants.
Collapse
Affiliation(s)
- Jürgen Bünger
- Research Institute for Occupational Medicine of the Institutions for Statutory Accident Insurance and Prevention (BGFA), Institute of the Ruhr University Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
| | | | | | | |
Collapse
|
17
|
Herr CEW, Zur Nieden A, Jankofsky M, Stilianakis NI, Boedeker RH, Eikmann TF. Effects of bioaerosol polluted outdoor air on airways of residents: a cross sectional study. Occup Environ Med 2003; 60:336-42. [PMID: 12709518 PMCID: PMC1740528 DOI: 10.1136/oem.60.5.336] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Bioaerosol pollution of workplace and home environments mainly affects airways and mucous membranes. The effect of environmental outdoor residential bioaerosol pollution, for example, livestock holdings, farming, and waste disposal plants, is unclear. AIMS To investigate the perceived health of residents living in areas with measurable outdoor bioaerosol pollution (for example, spores of Aspergillus fumigatus and actinomycetes), and effects of accompanying odours. METHODS In a cross sectional study, double blinded to ongoing microbial measurements, doctors collected 356 questionnaires from residents near a large scale composting site, and from unexposed controls in 1997. Self reported prevalence of health complaints during the past year, doctors' diagnoses, as well as residential odour annoyance were assessed. Microbiological pollution was measured simultaneously in residential outdoor air. RESULTS Concentrations of >10(5) colony forming units of thermophilic actinomycetes, moulds, and total bacteria/m(3) air were measured 200 m from the site, dropping to near background concentrations within 300 m. Positive adjusted associations were observed for residency within 150-200 m from the site versus unexposed controls for self reported health complaints: "waking up due to coughing", odds ratio (OR) 6.59 (95% confidence interval (CI) 2.57 to 17.73); "coughing on rising or during the day", OR 3.18 (95% CI 1.24 to 8.36); "bronchitis", OR 3.59 (95% CI 1.40 to 9.4); and "excessive tiredness", OR 4.27 (95% CI 1.56 to 12.15). Reports of irritative airway complaints were associated with residency in the highest bioaerosol exposure, 150-200 m (versus residency >400-500 m) from the site, and period of residency more than five years, but not residential odour annoyance. Lifetime prevalence of self reported diseases did not differ with exposure. CONCLUSIONS Bioaerosol pollution of residential outdoor air can occur in concentrations found in occupational environments. For the first time residents exposed to bioaerosol pollution were shown to report irritative respiratory complaints similar to mucous membrane irritation independently of perceived odours.
Collapse
Affiliation(s)
- C E W Herr
- Institute of Hygiene and Environmental Medicine, Medical Centre, Faculty of Medicine, Justus-Liebig-University of Giessen, Germany.
| | | | | | | | | | | |
Collapse
|
18
|
Aebischer CC, Frey U, Schöni MH. Hypersensitivity pneumonitis in a five-year-old boy: an unusual antigen source. Pediatr Pulmonol 2002; 33:77-8. [PMID: 11747264 DOI: 10.1002/ppul.10020] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- C Casaulta Aebischer
- Department of Pediatrics, University Children's Hospital, University of Berne, Berne, Switzerland
| | | | | |
Collapse
|
19
|
Bünger J, Antlauf-Lammers M, Schulz TG, Westphal GA, Müller MM, Ruhnau P, Hallier E. Health complaints and immunological markers of exposure to bioaerosols among biowaste collectors and compost workers. Occup Environ Med 2000; 57:458-64. [PMID: 10854498 PMCID: PMC1739988 DOI: 10.1136/oem.57.7.458] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In a cross sectional study, work related health complaints and diseases of 58 compost workers and 53 biowaste collectors were investigated and compared with 40 control subjects. Levels of specific IgG antibodies to moulds and bacteria were measured as immunological markers of exposure to bioaerosols. METHODS With a standardised protocol, the participants of the study were interviewed for work related symptoms, conditions of exposure to bioaerosols at their workplaces, exposure to bioaerosols from other sources, atopic diseases, and smoking habits. They were clinically examined by physicians specialised in occupational medicine. Also, concentrations of specific IgG antibodies against antigens of moulds and actinomycetes occurring regularly at these workplaces were measured and compared with the health complaints of the workers. RESULTS Compost workers had significantly more symptoms and diseases of the airways (p=0.003) and the skin (p=0.02) than the control subjects. Health complaints of biowaste collectors did not differ significantly from those of the control group. Subjects with atopic diseases were underrepresented in the compost workers (p=0.003). Significantly increased antibody concentrations against fungi and actinomycetes were measured in workers at composting plants. The concentrations in biowaste collectors did not differ significantly from those in the control subjects. A significant association between the diseases and increased antibody concentrations were found in the compost workers. CONCLUSION The high exposure to bioaerosols of compost workers is significantly associated with a higher frequency of health complaints and diseases as well as higher concentrations of specific antibodies against moulds and actinomycetes. A healthy worker effect is indicated by the underrepresentation of atopic diseases among the compost workers compared with biowaste collectors and the control group.
Collapse
Affiliation(s)
- J Bünger
- Department of Occupational and Social Medicine, Centre of Environmental and Occupational Medicine, Georg-August-University, Waldweg 37, D-37073 Göttingen, Germany.
| | | | | | | | | | | | | |
Collapse
|
20
|
De Lucca AJ, Walsh TJ, Daigle DJ. N-acetylcysteine inhibits germination of conidia and growth of Aspergillus spp. and Fusarium spp. Antimicrob Agents Chemother 1996; 40:1274-6. [PMID: 8723482 PMCID: PMC163307 DOI: 10.1128/aac.40.5.1274] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
N-Acetylcysteine inhibited hyphal growth and germination of conidia of Aspergillus spp. and Fusarium spp. N-Acetylcysteine inhibited conidial germination as well as or better than L-cysteine. Cysteine-related compounds may provide a potential therapeutic strategy against agriculturally and medically important fungal pathogens.
Collapse
Affiliation(s)
- A J De Lucca
- Southern Regional Research Center, U.S. Department of Agriculture, New Orleans, Louisiana, USA
| | | | | |
Collapse
|
21
|
Poulsen OM, Breum NO, Ebbehøj N, Hansen AM, Ivens UI, van Lelieveld D, Malmros P, Matthiasen L, Nielsen BH, Nielsen EM. Sorting and recycling of domestic waste. Review of occupational health problems and their possible causes. THE SCIENCE OF THE TOTAL ENVIRONMENT 1995; 168:33-56. [PMID: 7610383 DOI: 10.1016/0048-9697(95)04521-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
In order to reduce the strain on the environment from the deposition of waste in landfills and combustion at incineration plants, several governments throughout the industrialized world have planned greatly increased recycling of domestic waste by the turn of the millennium. To implement the plans, new waste recycling facilities are to be built and the number of workers involved in waste sorting and recycling will increase steadily during the next decade. Several studies have reinforced the hypothesis that exposure to airborne microorganisms and the toxic products thereof are important factors causing a multitude of health problems among workers at waste sorting and recycling plants. Workers at transfer stations, landfills and incineration plants may experience an increased risk of pulmonary disorders and gastrointestinal problems. High concentrations of total airborne dust, bacteria, faecal coliform bacteria and fungal spores have been reported. The concentrations are considered to be sufficiently high to cause adverse health effects. In addition, a high incidence of lower back injuries, probably due to heavy lifting during work, has been reported among workers at landfills and incineration plants. Workers involved in manual sorting of unseparated domestic waste, as well as workers at compost plants experience more or less frequent symptoms of organic dust toxic syndrome (ODTS) (cough, chest-tightness, dyspnoea, influenza-like symptoms such as chills, fever, muscle ache, joint pain, fatigue and headache), gastrointestinal problems such as nausea and diarrhoea, irritation of the skin, eye and mucous membranes of the nose and upper airways, etc. In addition cases of severe occupational pulmonary diseases (asthma, alveolitis, bronchitis) have been reported. Manual sorting of unseparated domestic waste may be associated with exposures to large quantities of airborne bacteria and endotoxin. Several work functions in compost plants can result in very high exposure to airborne fungal spores and thermophilic actinomycetes. At plants sorting separated domestic waste, e.g. the combustible fraction of waste composed of paper, cardboard and plastics, the workers may have an increased risk of gastrointestinal symptoms and irritation of the eyes and skin. At such plants the bioaerosol exposure levels are in general low, but at some work tasks, e.g. manual sorting and work near the balers, exposure levels may occasionally be high enough to be potentially harmful. Workers handling the source-sorted paper or cardboard fraction do not appear to have an elevated risk of occupational health problems related to bioaerosol exposure, and the bioaerosol exposure is generally low.(ABSTRACT TRUNCATED AT 400 WORDS)
Collapse
Affiliation(s)
- O M Poulsen
- National Institute of Occupational Health, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Sumi Y, Nagura H, Takeuchi M, Miyakawa M. Granulomatous lesions in the lung induced by inhalation of mold spores. Virchows Arch 1994; 424:661-8. [PMID: 8055161 DOI: 10.1007/bf00195782] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The health hazards associated with grain dust exposure have been recognized as a cause of lung diseases. In the present study, we used germ-free rats exposed to Aspergillus versicolor to elucidate the mechanism for the lung damage induced by grain dust exposure. One month after exposure to the mold, remarkable proliferation of bronchus-associated lymphoid tissues with germinal centres was induced by aspiration of mold spores. After 1 month, alveolar macrophages increased, becoming foamy macrophages by ingestion and digestion of mold spores. They expressed interleukin (IL)-1, Ia antigens and intercellular adhesion molecule-1 intensely and occasionally bound lymphocytes. Numerous lymphocytes infiltrated the granulomatous lesions which consisted of accumulated foamy macrophages and some T lymphocytes which carried IL-2 receptor. Granulomatous lesions were identified in the entire lung, especially around bronchioles. They extended from alveolar ducts to alveolar spaces for 6 months after exposure to the mold. The macrophage appears to be a key effector cell in granulomatous reactions to inhaled molds.
Collapse
Affiliation(s)
- Y Sumi
- Laboratory of Germfree Life, Nagoya University School of Medicine, Japan
| | | | | | | |
Collapse
|
23
|
Jiva TM, Kallay MC, Marin MG, Poe RH. Simultaneous legionellosis and invasive aspergillosis in an immunocompetent patient newly treated with corticosteroids. Chest 1993; 104:1929-31. [PMID: 8252995 DOI: 10.1378/chest.104.6.1929] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Invasive pulmonary aspergillosis (IPA), although unusual, has been recognized in the immunocompetent host. Several cases of IPA with rapidly progressive respiratory failure have been reported in patients receiving short-term corticosteroid therapy for chronic obstructive pulmonary disease. Atypical pneumonia caused by dual infection with Legionella pneumophila and Mycoplasma pneumoniae has also been reported. We report an unusual case of simultaneous L pneumophila pneumonia and IPA in an asthma patient with suspected allergic bronchopulmonary aspergillosis newly treated with corticosteroids.
Collapse
Affiliation(s)
- T M Jiva
- University of Rochester School of Medicine and Dentistry, NY
| | | | | | | |
Collapse
|
24
|
Yoshida K, Ueda A, Yamasaki H, Sato K, Uchida K, Ando M. Hypersensitivity pneumonitis resulting from Aspergillus fumigatus in a greenhouse. ARCHIVES OF ENVIRONMENTAL HEALTH 1993; 48:260-2. [PMID: 8357277 DOI: 10.1080/00039896.1993.9940370] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A 57-y-old female who had cultivated vegetables in a plastic greenhouse developed a case of hypersensitivity pneumonitis from Aspergillus fumigatus. This report exemplifies a potential hazard caused by a thermotolerant fungus, A. fumigatus, in a poorly constructed greenhouse.
Collapse
Affiliation(s)
- K Yoshida
- First Department of Internal Medicine, Kumamoto University School of Medicine, Japan
| | | | | | | | | | | |
Collapse
|
25
|
Affiliation(s)
- A Seaton
- Institute of Occupational Medicine, Edinburgh
| | | |
Collapse
|