title: Endotoxin exposure and symptoms in wastewater treatment workers.
abstract: BACKGROUND
  Wastewater treatment workers can be exposed to biological and chemical agents resulting in work-related health effects. The aim of this study was to investigate work-related symptoms in these workers.
  
  
  METHODS
  Questionnaire data of 468 employees from 67 sewage treatment plants is evaluated. Personal endotoxin exposure (8 hr measurements; n = 460) was measured in a sample of workers in three different periods over 1 year.
  
  
  RESULTS
  Endotoxin exposure ranged from 0.6 to 2093 endotoxin units (EU)/m(3), the geometric mean exposure was low (27 EU/m(3)). Factor analysis yielded three clusters of correlated symptoms: "lower respiratory and skin symptoms," "flu-like and systemic symptoms," and "upper respiratory symptoms." Symptoms appeared to be more prevalent in workers exposed to endotoxin levels higher than 50 EU/m(3). A significant dose-response relationship was found for "lower respiratory and skin symptoms" and "flu-like and systemic symptoms" (P < 0.05).
  
  
  CONCLUSIONS
  Wastewater treatment workers reported a wide range of symptoms that may be work-related. Microbial exposures such as endotoxin seem to play a causal role.
authors.affiliation: Division of Environmental and Occupational Health, Institute for Risk Assessment Sciences, Utrecht University, PO Box 80176, 3508 TD Utrecht, The Netherlands. l.smit@iras.uu.nl
authors.forename: Lidwien A M
authors.initials: LA
authors.lastname: Smit
authors.forename: Suzanne
authors.initials: S
authors.lastname: Spaan
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
mesh_terms: D000328:Adult; D004731:Endotoxins / Q000633:toxicity*; D016021:Epidemiologic Studies; D005260:Female; D005374:Filtration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009784:Occupational Diseases / Q000453:epidemiology* / Q000382:microbiology; D016273:Occupational Exposure / Q000009:adverse effects*; D015995:Prevalence; D012307:Risk Factors; D012722:Sewage / Q000382:microbiology*; D011795:Surveys and Questionnaires; D014865:Waste Disposal, Fluid; D014871:Water Microbiology; D014873:Water Pollutants / Q000009:adverse effects*
chemical_list: D004731:Endotoxins; D012722:Sewage; D014873:Water Pollutants