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Metal worker’s lung; spatial association with Mycobacterium avium

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Title: Metal worker’s lung; spatial association with Mycobacterium avium
Authors: Moffatt, MF
Cullinan, P
James, PL
Cannon, J
Barber, C
Crawford, L
Hughes, H
Jones, M
Szram, J
Cowman, S
Cookson, WOC
Item 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.
Issue Date: 29-Aug-2017
Date of Acceptance: 15-Jul-2017
URI: http://hdl.handle.net/10044/1/50132
DOI: https://dx.doi.org/10.1136/thoraxjnl-2017-210226
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/
Sponsor/Funder: Wellcome Trust
Royal Brompton & Harefield NHS Foundation Trust
Wellcome Trust
National Institute for Health Research
Funder's Grant Number: 096964/Z/11/Z
BRU 6279
Keywords: allergic alveolitis
hypersensitivity pneumonitis
occupational lung disease
1103 Clinical Sciences
Respiratory System
Publication Status: Published
Appears in Collections:National Heart and Lung Institute