K. Anderson et al., SUMP BAY FEVER - INHALATIONAL FEVER ASSOCIATED WITH A BIOLOGICALLY CONTAMINATED WATER AEROSOL, Occupational and environmental medicine, 53(2), 1996, pp. 106-111
Objective-To investigate the clinical, serological, and environmental
features of a work related inhalational fever associated with exposure
to an aerosol generated from a biologically contaminated 130 000 gall
on water pool in a building used for testing scientific equipment. Met
hod-Cross sectional survey of all exposed subjects (n = 83) by symptom
questionnaire, clinical examination, spirometry, and serology for ant
ibody to Pseudomonads, pool water extract, and endotoxin. In symptomat
ic patients diffusion capacity was measured, and chest radiology was p
erformed if this was abnormal. Serial peak flow was recorded in those
subjects with wheeze. Bacterial and fungal air sampling was performed
before and during operation of the water pool pump mechanism. Endotoxi
n was measured in the trapped waters and in the pumps. Serum cotinine
was measured as an objective indicator of smoking. Results-Of the 20 s
ymptomatic subjects, fever was most common in those with the highest e
xposure (chi(2) 42 . 7, P < 0 . 001) in the sump bay when the water wa
s (torrentially) recirculated by the water pumps. Symptoms occurred la
te in the working day only on days when the water pumps were used, and
were independent of the serum cotinine. Pulmonary function was normal
in most subjects (spirometry was normal in 79/83, diffusion capacity
was low in five subjects, chest radiology was normal). Peak flow recor
ding did not a work relation. The bacterial of the aerosol rose from 6
to > 10 000 colony forming units per cubic metre (cfu/m(3)) (predomin
antly environmental Pseudomonads) when the pumps were operating. High
endotoxin concentrations were measured in the waters and oil sumps in
the pumps. Low concentrations of antibody to the organisms isolated we
re detected (apart from two subjects with high antibody) but there was
no relation to exposure or the presence of symptoms and similar antib
ody was found in the serum samples from a nonexposed population. The f
ever symptoms settled completely with the simple expedient of changing
the water and cleaning the pumps. Conclusion-Given the results of our
study, the development of inhalational fever in this unique environme
nt and clearly restricted cohort was closely related to the degree of
exposure to contaminated aerosol and mainly occurred in the absence of
distinct serological abnormality and independent of cigarette smoking
.