title: Respiratory symptoms, immunology and organism identification in contaminated metalworking fluid workers. What you see is not what you get.
abstract: BACKGROUND
  Metal working fluids (MWF) constitute a significant respiratory hazard, although symptoms experienced by workers are often poorly investigated and attributed.
  
  
  OBJECTIVE
  A single possible case of extrinsic allergic alveolitis (EAA) led to a formal workplace investigation. It was clear that other exposed workers were affected. The aim of this study was to accurately quantify the clinical, immunological and microbiological findings in MWF workers following presentation of a sentinel case.
  
  
  METHODS
  Eleven of 21 individuals participated; eight were assessed by symptom questionnaire, spirometry and serology and three workers provided blood samples only. The microbes cultured from MWF and air samples were used to determine the presence of precipitating antibodies.
  
  
  RESULTS
  Work-related respiratory symptoms were reported in six of eight individuals questioned, two of these complaining of 'flu-like' symptoms. Personal breathing zone measures identified 2.1 x 10(3) to 1.1 x 10(5) colony-forming units/m3 air (CFU/m3). Pseudomonas fluorescens was isolated from air samples. Despite visible 'fungal' contamination of MWF, airborne fungi were detectable in only one sample, at 486 CFU/m3 air. MWF cultured Eurotium sp., Fusarium sp. and Pseudomonas sp. Precipitating IgG antibodies to Pseudomonas sp. were identified in 4/11 and to an extract of the MWF in 3/11. IgG to Pseudomonas was elevated in the two individuals who had the strongest precipitating bands to Pseudomonas sp.
  
  
  CONCLUSIONS
  Workplaces with possible EAA must be investigated promptly, thus allowing clinical assessment to be contemporary to exposures and accurate microbiological profiling included to identify the likely cause.
authors.affiliation: D.Fishwick@sheffield.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Fishwick
authors.forename: Paul
authors.initials: P
authors.lastname: Tate
authors.forename: Joanne
authors.initials: J
authors.lastname: Elms
authors.forename: Edward
authors.initials: E
authors.lastname: Robinson
authors.forename: Brian
authors.initials: B
authors.lastname: Crook
authors.forename: Frank
authors.initials: F
authors.lastname: Gallagher
authors.forename: Roderick
authors.initials: R
authors.lastname: Lennox
authors.forename: Andrew
authors.initials: A
authors.lastname: Curran
mesh_terms: D000328:Adult; D000542:Alveolitis, Extrinsic Allergic / Q000175:diagnosis* / Q000276:immunology; D000907:Antibodies, Bacterial / Q000097:blood; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007219:Industrial Oils / Q000382:microbiology*; D008297:Male; D008669:Metallurgy; D008875:Middle Aged; D009784:Occupational Diseases / Q000175:diagnosis* / Q000276:immunology; D011549:Pseudomonas / Q000276:immunology / Q000302:isolation & purification
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G