title: An outbreak of extrinsic alveolitis at a car engine plant.
abstract: BACKGROUND
  Twelve workers from a car engine-manufacturing plant presented with extrinsic allergic alveolitis (EAA), with heterogeneous clinical, radiological and pathological findings. They were exposed to metalworking fluids (MWF) that cooled, lubricated and cleaned the machines.
  
  
  METHODS
  They were characterized by history, examination, lung function testing, radiology, bronchoscopic lavage, lung biopsy and serology. Sera were tested for precipitins to a crude extract of used MWF and to reference cultures of bacteria suspected to be implicated.
  
  
  RESULTS
  All were males and none were current smokers. All had dyspnoea, many had weight loss and cough, but only half had influenza-like symptoms. Only half had auscultatory crackles. Five had peak flow variability, four with an occupational component. There was overall restrictive spirometry, decreased lung volumes and reduced gas transfers. Ten had radiological evidence of interstitial lung disease. Seven (of eight) had lymphocytosis on bronchial lavage, including the two with inconclusive radiology. Seven (of 11) had lung biopsies showing inflammatory infiltrates, two with fibrosis and one with granulomas. Three (of 11) had strong positive precipitins to an extract of the used MWF from the plant. Molecular biological analysis of the MWF revealed Acinetobacter and Ochrobactrum. Precipitins to Acinetobacter were detected in seven of 11 workers tested (and four of 11 control workers). Precipitins to Ochrobactrum were detected in three of 11 workers tested (and three of 11 control workers).
  
  
  CONCLUSIONS
  This is the largest series reported in Europe of EAA due to an aerosol of microbiologically contaminated MWF in heavy manufacturing industry.
authors.affiliation: Occupational Lung Disease Service, Birmingham Chest Clinic (Heart of England NHS Trust), Great Charles Street, Birmingham B3 3HX, UK. paul.dawkins@uhb.nhs.uk
authors.forename: Paul
authors.initials: P
authors.lastname: Dawkins
authors.forename: Alastair
authors.initials: A
authors.lastname: Robertson
authors.forename: Wendy
authors.initials: W
authors.lastname: Robertson
authors.forename: Vicky
authors.initials: V
authors.lastname: Moore
authors.forename: John
authors.initials: J
authors.lastname: Reynolds
authors.forename: Gerald
authors.initials: G
authors.lastname: Langman
authors.forename: Edward
authors.initials: E
authors.lastname: Robinson
authors.forename: Joanne
authors.initials: J
authors.lastname: Harris-Roberts
authors.forename: Brian
authors.initials: B
authors.lastname: Crook
authors.forename: Sherwood
authors.initials: S
authors.lastname: Burge
mesh_terms: D000542:Alveolitis, Extrinsic Allergic / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D001336:Automobiles; D004196:Disease Outbreaks; D004655:Emulsions / Q000633:toxicity; D006801:Humans; D008153:Lubrication; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D009161:Mycobacterium / Q000302:isolation & purification; D009784:Occupational Diseases / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D016273:Occupational Exposure / Q000009:adverse effects; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed / Q000379:methods; D006113:United Kingdom
chemical_list: D004655:Emulsions