Metal worker’s lung; spatial association with Mycobacterium avium
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background Outbreaks of hypersensitivity pneumonitis
(HP) are not uncommon in workplaces where metal
working fluid (MWF) is used to facilitate metal turning.
Inhalation of microbe-contaminated MWF has been
assumed to be the cause, but previous investigations
have failed to establish a spatial relationship between a
contaminated source and an outbreak.
Objectives After an outbreak of five cases of HP in
a UK factory, we carried out blinded, molecular-based
microbiological investigation of MWF samples in order
to identify potential links between specific microbial taxa
and machines in the outbreak zone.
Methods Custom-quantitative PCR assays, microscopy
and phylogenetic analyses were performed on blinded
MWF samples to quantify microbial burden and identify
potential aetiological agents of HP in metal workers.
Measurements and main results MWF from
machines fed by a central sump, but not those with an
isolated supply, was contaminated by mycobacteria. The
factory sump and a single linked machine at the centre of
the outbreak zone, known to be the workstation of the
index cases, had very high levels of detectable organisms.
Phylogenetic placement of mycobacterial taxonomic
marker genes generated from these samples indicated
that the contaminating organisms were closely related to
Mycobacterium avium.
Conclusions We describe, for the first time, a close
spatial relationship between the abundance of a
mycobacterium-like organism, most probably M. avium,
and a localised outbreak of MWF-associated HP.
The further development of sequence-based analytic
techniques should assist in the prevention of this
important occupational disease.
(HP) are not uncommon in workplaces where metal
working fluid (MWF) is used to facilitate metal turning.
Inhalation of microbe-contaminated MWF has been
assumed to be the cause, but previous investigations
have failed to establish a spatial relationship between a
contaminated source and an outbreak.
Objectives After an outbreak of five cases of HP in
a UK factory, we carried out blinded, molecular-based
microbiological investigation of MWF samples in order
to identify potential links between specific microbial taxa
and machines in the outbreak zone.
Methods Custom-quantitative PCR assays, microscopy
and phylogenetic analyses were performed on blinded
MWF samples to quantify microbial burden and identify
potential aetiological agents of HP in metal workers.
Measurements and main results MWF from
machines fed by a central sump, but not those with an
isolated supply, was contaminated by mycobacteria. The
factory sump and a single linked machine at the centre of
the outbreak zone, known to be the workstation of the
index cases, had very high levels of detectable organisms.
Phylogenetic placement of mycobacterial taxonomic
marker genes generated from these samples indicated
that the contaminating organisms were closely related to
Mycobacterium avium.
Conclusions We describe, for the first time, a close
spatial relationship between the abundance of a
mycobacterium-like organism, most probably M. avium,
and a localised outbreak of MWF-associated HP.
The further development of sequence-based analytic
techniques should assist in the prevention of this
important occupational disease.
Date Issued
2017-08-29
Date Acceptance
2017-07-15
Citation
Thorax, 2017, 73, pp.151-156
ISSN
1468-3296
Publisher
BMJ Publishing Group
Start Page
151
End Page
156
Journal / Book Title
Thorax
Volume
73
Copyright Statement
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
License URL
Sponsor
Wellcome Trust
Royal Brompton & Harefield NHS Foundation Trust
Wellcome Trust
National Institute for Health Research
Grant Number
096964/Z/11/Z
B0479
097117/Z/11/Z
BRU 6279
Subjects
allergic alveolitis
hypersensitivity pneumonitis
occupational lung disease
1103 Clinical Sciences
Respiratory System
Publication Status
Published