Flock worker's lung: chronic interstitial lung disease in the nylon flocking industry.
BACKGROUND
Two young men working at a nylon flocking plant in Rhode Island developed interstitial lung disease of unknown cause. Similar clusters at the same company's Canadian plant were reported previously.


OBJECTIVE
To define the extent, clinicopathologic features, and potential causes of the apparent disease outbreak.


METHODS
Case-finding survey and retrospective cohort study.


METHODS
Academic occupational medicine program.


METHODS
All workers employed at the Rhode Island plant on or after 15 June 1990.


METHODS
Symptomatic employees had chest radiography, pulmonary function tests, high-resolution computed tomography, and serologic testing. Those with unexplained radiographic or pulmonary function abnormalities underwent bronchoalveolar lavage, lung biopsy, or both. The case definition of "flock worker's lung" required histologic evidence of interstitial lung disease (or lavage evidence of lung inflammation) not explained by another condition.


RESULTS
Eight cases of flock worker's lung were identified at the Rhode Island plant. Three cases were characterized by a high proportion of eosinophils (25% to 40%) in lavage fluid. Six of the seven patients who had biopsy had histologic findings of nonspecific interstitial pneumonia, and the seventh had bronchiolitis obliterans organizing pneumonia. All seven of these patients had peribronchovascular interstitial lymphoid nodules, usually with germinal centers, and most had lymphocytic bronchiolitis and interstitial fibrosis. All improved after leaving work. Review of the Canadian tissue specimens showed many similar histologic findings. Among the 165-member study cohort, a 48-fold or greater increase was seen in the sex-adjusted incidence rate of all interstitial lung disease.


CONCLUSIONS
Work in the nylon flocking industry poses substantial risk for a previously unrecognized occupational interstitial lung disease. Nylon fiber is the suspected cause of this condition.
Kern
D G
DG
Division of General Internal Medicine, Memorial Hospital of Rhode Island, Pawtucket 02860, USA. davidvkern@brown.edu
Crausman
R S
RS
Durand
K T
KT
Nayer
A
A
Kuhn
C
C
D000328:Adult; D001706:Biopsy; D002170:Canada / Q000453:epidemiology; D002908:Chronic Disease; D005260:Female; D006801:Humans; D015994:Incidence; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D009757:Nylons / Q000009:adverse effects; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D016273:Occupational Exposure / Q000009:adverse effects; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012237:Rhode Island / Q000453:epidemiology; D013783:Textile Industry; D014057:Tomography, X-Ray Computed
D009757:Nylons