Organic dust exposures from compost handling: Case presentation and respiratory exposure assessment.
Weber-S; Kullman-G; Petsonk-E; Jones-WG; Olenchock-S; Sorenson-W; Parker-J; Marcelo-Baciu-R; Frazer-D; Castranova-V
Am J Ind Med 1993 Oct; 24(4):365-374
A case of acute respiratory illness resulting from occupational exposure to wood and leaf compost was examined. A 52 year old nonsmoking male landscape architect was hospitalized for progressive dyspnea, fever, headache, and myalgia. He stated that he had been shoveling composted wood chips and leaves 12 hours earlier. Examination showed the patient to be in moderate respiratory distress manifested by a respiratory rate of 30, heart rate of 120, and oral temperature of 38.8 degrees-C. Fine bibasilar crackles without wheezing were heard upon chest auscultation. A chest X-ray revealed a bilateral infiltrate. Hematology revealed a leukocyte count of 11,900 cells per milliliter. Blood gas analysis revealed hypoxemia. Therapy with systemic steroids was started. The hypoxemia and pulmonary infiltrates worsened over the next 12 hours, but gradually improved thereafter. Pulmonary function testing performed the next morning revealed a mild restrictive defect. Serum samples showed elevated titers to Aspergillus-niger and Aspergillus-flavus. Precipitating antibodies to extracts of bulk samples of the compost were detected. The patient was discharged on the third day after his symptoms improved and the amount of pulmonary infiltrates decreased. A followup examination 1 month later revealed that he had fully recovered. The compost pile was visited and bulk and air samples were collected during shoveling and analyzed for bacteria and fungal spores. The bulk samples contained high concentrations of aerobic bacteria and fungi. Shoveling produced visible clouds of particulates. The dusts contained respirable endotoxin concentrations of 636 to 16,300 endotoxin units per cubic meter (m3). Fungal spore concentrations ranged from 1.4x10(6) to 4.7x10(8) colony forming units per m3 (CFU/m3). Total bacteria counts ranged from 6.3x10(5) to 77x10(8)CFU/m3. Most of the bacteria were mesophilic and gram negative species. The authors conclude that inhalation of the compost dust has produced symptoms resembling those of hypersensitivity pneumonitis (HP) and organic dust toxic syndrome (ODTS). It was not possible to differentiate HP and ODTS in this case. HP and ODTS may represent just a portion of a wide spectrum of responses to inhalation of complex dusts.
NIOSH-Author; Organic-dusts; Respiratory-system-disorders; Case-studies; Environmental-health-monitoring; Respiratory-hypersensitivity; Microorganisms; Clinical-symptoms; Bacterial-dusts;
Author Keywords: organic dust toxic syndrome; hypersensitivity pneumonitis; wood chips; compost handling; endotoxin
American Journal of Industrial Medicine