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An outbreak of recurrent acute and chronic hypersensitivity pneumonitis in office workers.

Hodgson-MJ; Morey-PR; Simon-JS; Waters-TD; Fink-JN
Am J Epidemiol 1987 Apr; 125(4):631-638
An outbreak of recurrent acute and chronic hypersensitivity in office workers was described. Three episodes of an acute flu like illness occurred among occupants of a seven story office building in the summer and early fall of 1981. The building was constructed in the 1930s and leased by the Tennessee Valley Authority (TVA). The episodes were associated with manipulations of the air handling system. Two questionnaires designed by TVA investigators to obtain information on type and number of symptoms, time of onset, location of employees within the building, and their proximity to open windows were distributed 2 days and 6 months after the first outbreak. Medical records of 28 individuals who sought treatment from the TVA medical office after the second outbreak were reviewed. Serum samples were collected from these patients and from 28 age and sex matched non ill individuals from the same building and from 28 persons from another office building. Serum reactivity to agents cultured in the building and to a standard diagnostic panel of hypersensitivity pneumonitis agents was evaluated. Environmental samples were analyzed for fungi and thermotolerant bacteria. The patients reported symptoms indicative of hypersensitivity pneumonitis. Breathing air not supplied by the building air handling system seemed to protect against the disease. Symptomatic subjects had significantly more precipitins to fungal agents cultured from the building than did the comparisons. Symptoms suggestive of chronic hypersensitivity pneumonitis were also reported. Airborne fungal and bacterial concentrations approached but did not exceed 1000 colony forming units per cubic meter. A wide variety of fungi and bacteria were recovered from air samples and from dust and slime in the air handling system. The authors conclude that the outbreaks were clearly associated with the air handling system, although no single etiologic agent could be identified.
NIOSH-Author; Epidemiology; Respiratory-hypersensitivity; Disease-incidence; Microorganisms; Environmental-factors; Ventilation-systems; Environmental-exposure; Lung-disorders; Office-workers
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American Journal of Epidemiology