« Previous AbstractPotted plants do not improve indoor air quality: a review and analysis of reported VOC removal efficiencies    Next AbstractRecombinant production and structural studies of the Aplysia water-borne protein pheromone enticin indicates it has a novel disulfide stabilized fold »

Am J Ind Med

Title:		"Severe lung disease characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE) in industrial machine-manufacturing workers"
Author(s):		Cummings KJ; Stanton ML; Nett RJ; Segal LN; Kreiss K; Abraham JL; Colby TV; Franko AD; Green FHY; Sanyal S; Tallaksen RJ; Wendland D; Bachelder VD; Boylstein RJ; Park JH; Cox-Ganser JM; Virji MA; Crawford JA; Green BJ; LeBouf RF; Blaser MJ; Weissman DN;
Address:		"Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia. Department of Medicine, New York University School of Medicine, New York, New York. Department of Pathology, State University of New York Upstate Medical University, Syracuse, New York. Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Arizona. Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada. Occupational Health Clinic, St. Luke's Hospital, Duluth, Minnesota. Pulmonary Medicine Associates, St. Luke's Hospital, Duluth, Minnesota. Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia"
Journal Title:		Am J Ind Med
Year:		2019
Volume:		20190828
Issue:		11
Page Number:		927 - 937
DOI:		10.1002/ajim.23038
ISSN/ISBN:		1097-0274 (Electronic) 0271-3586 (Print) 0271-3586 (Linking)
Abstract:		"BACKGROUND: A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. METHODS: Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. RESULTS: Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV(1) = 44% predicted) and reduced diffusing capacity (mean = 53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. CONCLUSION: This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention"
Keywords:		"Adult Air Pollutants, Occupational/adverse effects/analysis Bronchiolitis/*etiology Endotoxins/analysis Humans Lung/*pathology Male *Manufacturing Industry Manufacturing and Industrial Facilities Middle Aged Occupational Diseases/*etiology Occupational Ex;"
Notes:		"MedlineCummings, Kristin J Stanton, Marcia L Nett, Randall J Segal, Leopoldo N Kreiss, Kathleen Abraham, Jerrold L Colby, Thomas V Franko, Angela D Green, Francis H Y Sanyal, Soma Tallaksen, Robert J Wendland, Douglas Bachelder, Vance D Boylstein, Randy J Park, Ju-Hyeong Cox-Ganser, Jean M Virji, M Abbas Crawford, Judith A Green, Brett James LeBouf, Ryan F Blaser, Martin J Weissman, David N eng R01 GM063270/GM/NIGMS NIH HHS/ U54 GM104942/GM/NIGMS NIH HHS/ C& D Fund/International R01 DK090989/DK/NIDDK NIH HHS/ R01GM63270/NH/NIH HHS/ K23 AI102970/AI/NIAID NIH HHS/ Research Support, N.I.H., Extramural Research Support, N.I.H., Intramural Research Support, Non-U.S. Gov't 2019/08/29 Am J Ind Med. 2019 Nov; 62(11):927-937. doi: 10.1002/ajim.23038. Epub 2019 Aug 28"