Occupational Medicine Advance Access originally published online on November 9, 2006
Occupational Medicine 2006 56(8):559-565; doi:10.1093/occmed/kql110
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An outbreak of extrinsic alveolitis at a car engine plant
Occupational Lung Disease Service, Birmingham Chest Clinic (Heart of England NHS Trust), Great Charles Street, Birmingham B3 3HX, UK
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).
Conclusion This is the largest series reported in Europe of EAA due to an aerosol of microbiologically contaminated MWF in heavy manufacturing industry.
Keywords Extrinsic allergic alveolitis; factory; hypersensitivity pneumonitis; metal working fluids; occupational exposure; precipitins
Correspondence to: Paul Dawkins, University Hospital Birmingham—Respiratory Medicine, Lung Investigation Unit, Nuffield House, Queen Elizabeth Hospital, Edgbaston Birmingham B15 2TH, UK. Tel: +44 121 4721311; fax: +44 121 6272012; e-mail: paul.dawkins{at}uhb.nhs.uk