Organic Dust Toxic Syndrome

(aka Pulmonary Mycotoxicosis, Silo Unloader’s Syndrome, Mill Fever)

Exposure

  • Cotton Mill Exposure
    • Large outbreak has been reported in stained cotton mattress workers
  • Silo Exposure
  • Industrial Agriculture
  • Animal Farming: with confinement

Physiology

  • Inhalational Exposure to Thermophilic Bacteria and Fungal Spores: these can contaminate wood chips, straw, silage, grains, flour, and textile raw materials
    • Possibly cytokine-mediated

Diagnosis

  • CXR/Chest CT: usually normal (if infiltrates are present, should suggest alternative diagnosis)
  • CBC: leukocytosis may be seen
  • ABG: hypoxemia is usually absent
  • FOB: marked influx of neutrophils

Clinical

(onset of symptoms 4-8 hrs after acute inhalation of dust)

  • Mild Dyspnea (see Dyspnea, [[Dyspnea]])
  • Cough (see Cough, [[Cough]])
  • Fever (see Fever, [[Fever]])
    • “Monday Morning Fever”: tachyphylaxis (blunted response) may occur after repeated exposures throughout the week, so symptoms are worse on first day of the workweek
  • Flu-Like Syndrome: malaise, chills, myalgias

Treatment

  • Self-Limited: usually spontaneously resolves within 12-48 hrs

References

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