A systematic review of work-related health problems of factory workers in the textile and fashion industry.

OBJECTIVES: The purpose of this study was to present a systematic review of the health-related problems of factory workers in the textile and fashion industry. These workers endure long sitting postures, poor workspace conditions, and long working hours to complete their overload of tasks. This situation results in several health problems that affect the productivity, mental health, and well-being of the workers. METHODS: The relevant data (21 article publications) were obtained from the Scopus database. Analysis of the 21 articles was grouped under 3 research themes based on the critical reading of the content and abstracts: respiratory problems, musculoskeletal disorders, and psychological stressors and other health issues. RESULTS: The findings show that factory workers are exposed to dust particles of cotton and other raw materials, fumes, and chemicals from manufacturing processes. This prolonged exposure without the use of personal protective equipment (PPE) leads to respiratory diseases like byssinosis that affect the workers' health. Additionally, working in a particular posture due to the workstation design for prolonged hours causes musculoskeletal disorders or pains. Workers also suffer from anxiety, depression, and stress from workload and pressure, hence making them unstable with reduced productivity. CONCLUSIONS: The findings of the study reinforce the need for a safe workspace and spacious work environment, provision of PPE, training in occupational hazards, frequent health checks, and ergonomic assessment of workstations to reduce prolonged work postures. Stakeholders, employers, policymakers, and governments should collaborate to safeguard and protect the well-being and health of the workers at these factories.

Metal-oxide inhalation induced fever - Immuntoxicological aspects of welding fumes.

Metal fume fever is a well-known occupational disease that arises from prolonged exposure to subtoxic levels of zinc oxide-containing fumes or dust. This review article aims to identify and examine the possible immunotoxicological effects of inhaled zinc oxide nanoparticles. The current most widely accepted pathomechanism for the development of the disease involves the formation of reactive oxygen species following the entry of zinc oxide particles into the alveolus resulting the release of pro-inflammatory cytokines by activation of the Nuclear Factor Kappa B transcriptional signal, thus evoking the symptoms. The role of metallothionein in inducing tolerance is believed to be a key factor in mitigating the development of metal fume fever. The other, poorly proven hypothetical route is that zinc-oxide particles bind to an undefined protein in the body as haptens to form an antigen and act as an allergen. After activation of the immune system, primary antibodies and immune complexes are developed and type 1. hypersensitivity reaction occurs, that can cause asthmatic dyspnoea, urticaria and angioedema. The development of tolerance is explained by the formation of secondary antibodies against primary antibodies. Oxidative stress and immunological processes cannot be completely separated from each other, as they can induce each other.

Effect Of Cotton Dust Exposure On Respiratory Health Outcomes Among Textile Workers.

BACKGROUND: Cotton dust is generated during various textile manufacturing processes. Only a few studies from Pakistan assessed cotton dust exposure and explored the relationship of duration of work in the textile industry with respiratory health outcomes. We aimed to assess cotton dust exposure and its association with lung function and respiratory symptoms among textile workers in Pakistan. METHODS: We report findings from the baseline survey of the larger study, MultiTex, among 498 adult male textile workers from six mills conducted between October 2015-March 2016 in Karachi, Pakistan. Data collection included the use of standardized questionnaires; spirometry, and area dust measurements through UCB-PATS. Multivariable logistic and linear regression models were developed to assess the association of risk factors with respiratory symptoms and illnesses. RESULTS: We found the mean age of workers to be 32.5 (±10) years; around 25% were illiterate. The prevalence of COPD, asthma, and byssinosis was 10%, 17%, and 2%, respectively. The median cotton dust exposure was 0.33 mg/m3 (IQR: 0.12-0.76). Increased duration of work among non-smokers was associated with a decline in lung function, FVC (-245 ml; 95% CI: -385.71, -104.89) and FEV1 (-200 ml; 95% CI: -328.71, -841.1). Workers with certain job titles (machine operators, helpers, and jobbers), those with greater duration of work, and higher dust exposure, were more likely to report respiratory symptoms and illnesses. CONCLUSIONS: We report a high prevalence of asthma and COPD and a low prevalence of byssinosis. Cotton dust exposure and duration of employment were associated with respiratory health outcomes. Our findings highlight the need for preventive interventions in the textile industry in Pakistan.

Byssinosis and lung health among cotton textile workers: baseline findings of the MultiTex trial in Karachi, Pakistan.

OBJECTIVES: To assess the association of exposure in cotton mills in Karachi with different definitions of byssinosis and lung health. METHODS: This cross-sectional survey took place between June 2019 and October 2020 among 2031 workers across 38 spinning and weaving mills in Karachi. Data collection involved questionnaire-based interviews, spirometry and measurements of personal exposure to inhalable dust. Byssinosis was defined using both WHO symptoms-based (work-related chest tightness), and Schilling's criteria (symptoms with decreased forced expiratory volume in 1 s (FEV1). Values of FEV1/forced vital capacity ratio below the lower limit of normality on postbronchodilator test were considered as 'chronic airflow obstruction' (CAO). RESULTS: 56% of participants had at least one respiratory symptom, while 43% had shortness of breath (grade 1). Prevalence of byssinosis according to WHO criteria was 3%, it was 4% according to Schilling's criteria, and likewise for CAO. We found low inhalable dust exposures (geometric mean: 610 µg/m3). Cigarette smoking (≥3.5 pack-years), increasing duration of employment in the textile industry and work in the spinning section were important factors found to be associated with several respiratory outcomes. CONCLUSION: We found a high prevalence of respiratory symptoms but a low prevalence of byssinosis. Most respiratory outcomes were associated with duration of employment in textile industry. We have discussed the challenges faced in using current, standard guidelines for identifying byssinosis.

A proposed synergetic mechanism for metal fume fever involving ZnO and Fe3O4 nanoparticles.

Metal fumes fever (MFF) is an inflammatory condition, whose mechanism is yet unclear, associated with the inhalation of metal fumes, particularly zinc. In this study we investigate experimentally the hypothesis of a two-step mechanism of MFF onset: (1) the photocatalytic production of airborne hydrogen peroxide (H2O2) via ZnO and (2) the production of hydroxyl radicals (HOׄ) through Fenton reaction via magnetite (Fe3O4) nanoparticles. Photocatalysis and Fenton reaction products were measured using a multiscattering-enhanced absorbance device and assessing the degradation of bromophenol blue with microplate photometry, respectively. We observed that in the presence of UV, ZnO produces 3 to 4-times more H2O2 than UV alone or that non-UV irradiated ZnO. In the presence of biologically-relevant ligands, we also measured a Fenton reaction at physiological pH with either Fe(II), Fe(III) or Fe3O4 nanoparticles. Our results support the hypothesis of a two-step mechanism of MFF onset, in which the prior presence of Fe in the lungs exacerbates the oxidative stress, triggered by the photocatalysis of ZnO, a situation that could occurs when welding galvanized steel. More broadly, this raises the question of the role of the Fenton mechanism in respiratory exposure to metal particles and its possible contribution to other lung diseases.

Chemical Pneumonitis Caused by the Inhalation of Zinc Oxide Fumes in an Arc Welder.

Acute respiratory illness caused by exposure to welding-associated zinc oxide fumes is known as metal fume fever (MFF). MFF is generally characterized as a self-limiting disease. Few studies have reported chemical pneumonitis associated with zinc fume inhalation. We report a case study involving severe episodes of MFF accompanied by chemical pneumonitis due to the inhalation of zinc oxide fumes while operating an arc welder. A 54-year-old man developed flu-like symptoms after arc welding galvanized steel in a poorly ventilated area. Despite intravenous antibiotics therapy, his clinical course worsened, and his urine zinc concentration was remarkably elevated (3579 µg/24 h; reference range, 0-616 µg/24 h). A chest computed tomography revealed extensive consolidation, ground-glass opacity in the lungs, and right pleural effusion. After corticosteroid treatment, the patient's symptoms and radiologic findings significantly improved. It should be noted that the inhalation of zinc oxide fumes can occasionally induce acute lung injury via inflammatory responses and oxidative stress.

Health Concerns of Textile Workers and Associated Community.

BACKGROUND: Workers in the textile industry risk developing various respiratory and pulmonary diseases due to exposure to cotton dust. The particles from the cotton lint are inhaled by the workers and results in the breathing problems including asthma, shortness of breath, cough and tightness in the chest. The poor health of labor contributes to the low productivity of the labor and in serious cases loss of jobs leading to the poverty. OBJECTIVE: To assess the prevalence of respiratory symptoms among the textile workers and associated community. To contrast the health profiles of the textile workers, associated community and the control group to factor out any confounding factors. METHODS: This study explores the health profiles of the textile workers and associated community and contrast them against the health profile of the control group to factor out any confounding factors. The study is conducted on cotton industry in Kasur, Pakistan. We interviewed 207 workers, 226 people from associated community (living in vicinities of weaving units) and 188 people for control group (from areas far away from weaving units and people are not associated with weaving industry) based on stratified random sampling technique. We employed descriptive methods and logistic regression to explore the association between respiratory diseases and weaving workers. RESULTS: Overall, prevalence of postnasal drip, byssinosis, asthma, and chronic bronchitis were 47%, 35%, 20%, and 10%, respectively, among the workers. These percentages are significantly higher than the control group. An additional year of work increase the risk of postnasal drip, byssinosis, asthma, and chronic bronchitis by 5-6%. Among workers, 43% and 21% feel difficulty in hearing against noisy background and at low volume, respectively. Due to bad light arrangements at workstations, 21% and 31% workers are suffering from myopia and hyperopia, respectively. Proportions of the workers suffering from continuous headache, skin infection, depression, and low back pain are 28%, 29%, 27%, and 44%, respectively. Chi-square test results confirms that no confounding factor like air pollution is involved in this cause-and-effect study implying the association between the cotton dust and associated diseases is not spurious. CONCLUSION: Respiratory symptoms were statistically significantly more common in the weaving workers compared to control group. Better environment at workstations, use of protective gears and education are the factors which reduce the risk of associated diseases among workers.

Contemporary Prevalence of Byssinosis in Low- and Middle-Income Countries: A Systematic Review.

We aimed to identify the contemporary prevalence of byssinosis through a systematic review. Medline, Web of Science, Embase, and Global Health databases were used to identify studies published in any language between 2000 and 2019, reporting primary data on byssinosis among adults. We used the Joanna Briggs Institute checklist to estimate the risk of bias in studies and undertook a qualitative, narrative data analysis. The review considered the prevalence of byssinosis, chest tightness, and airflow obstruction in textile workers in low- and middle-income countries (LMICs). We found 26 relevant studies that included 6930 workers across 12 countries. Most of the studies (n = 19) were from Asia, and seven from African countries. Twenty-five studies were cross-sectional surveys while one was a cohort study. The prevalence of byssinosis was reported by 18 studies, and ranged from 8% to 38%, without any clear associations, at the group level, between the prevalence of byssinosis and durations of workers' exposures. Prevalence of chest tightness ranged between 4% and 58% and that of airflow obstruction between 10% and 30%. A strong correlation (r = 0.72) was found between prevalence of byssinosis and cotton dust levels. Our findings indicate that byssinosis remains a significant, contemporary problem in some parts of the textile sector in LMICs.

Impact of using different predictive equations on the prevalence of chronic byssinosis in textile workers in Pakistan.

OBJECTIVE: Byssinosis remains a significant problem among textile workers in low/middle-income countries. Here we share our experience of using different prediction equations for assessing 'chronic' byssinosis according to the standard WHO classification using measurements of forced expiratory volume in 1 s (FEV1). METHODS: We enrolled 1910 workers in a randomised controlled trial of an intervention to improve the health of textile workers in Pakistan. We included in analyses the 1724 (90%) men who performed pre-bronchodilator spirometry tests of acceptable quality. We compared four different equations for deriving lung function percentage predicted values among those with symptoms-based byssinosis: the third US National Health and Nutrition Examination Survey (NHANES-III, with 'North Indian and Pakistani' conversion factor); the Global Lung Function Initiative (GLI, 'other or mixed ethnicities'); a recent equation derived from survey of a western Indian population; and one based on an older and smaller survey of Karachi residents. RESULTS: 58 men (3.4%) had symptoms-based byssinosis according to WHO criteria. Of these, the proportions with a reduced FEV1 (<80% predicted) identified using NHANES and GLI; Indian and Pakistani reference equations were 40%, 41%, 14% and 12%, respectively. Much of this variation was eliminated when we substituted FEV1/forced vital capacity (FVC) ratio (

Epidemiology of respiratory diseases and associated factors among female textile workers in Pakistan.

Objective. The study aimed to estimate the prevalence of byssinosis and other respiratory symptoms among women textile workers and the associated risk factors in 18 spinning mills of Faisalabad and Lahore districts of Punjab, Pakistan. Method. In this case-control study of 1054 female workers, we used the dose-response function to measure the association between dust level and respiratory disorders in cotton textile workers. Results. Working overtime and long working hours per week are significantly associated with self-reported symptoms of byssinosis. Women's age, marital status and wages were significantly associated with mitigating actions (seeing the doctor), while the education of the women was significantly associated with averting action (use of a mask). Conclusion. Regulating working hours and ensuring employees' compliance with the safety standards are expected to mitigate the health problems of female workers.

A very unusual case of interstitial lung disease.

Cotton dust exposure has been implicated in causing diseases like byssinosis and obstructive airway diseases like COPD and asthma. Long-term exposure to cotton dust causing interstitial lung disease and pulmonary fibrosis has been sparsely reported in the literature. Here, we report a case of an individual with long-term cotton dust exposure who presented with typical symptoms of interstitial lung disease and was managed conservatively.

COVID 19 - Possible interrelations with respiratory comorbidities caused by occupational exposure to various hazardous bioaerosols. Part I. Occurrence, epidemiology and presumed origin of the pandemic.

The occupational bioaerosols containing viruses, bacteria, fungi, microbial toxins and plant or animal particles, may evoke infectious, allergic or immunotoxic diseases which may co-exist as comorbidities with COVID-19 and exacerbate the course of disease. They include hypersensitivity pneumonitis (HP) caused mostly by bacteria, fungi, and particles containing animal proteins, and immunotoxic diseases such as organic dust toxic syndrome (ODTS) and byssinosis, caused mostly by bacterial and fungal toxins. The two most probable scenarios of possible interrelations between these three comorbidities (CM) and COVID-19 are: 1) 'Triggering' - when infection with SARS-CoV-2 triggers severe CM after bioaerosol exposure; 2) 'Reverse triggering' when exposure to bioaerosol exacerbates a symptomless or mild course of COVID-19, and evokes a severe disease. The occupations mostly endangered by COVID-19 as the result of exposure to SARS-CoV-2 bioaerosol, or to other bioaerosols which may exacerbate this disease, include: health care workers, social workers, breeders of fur animals, slaughterhouse workers, workers engaged in the processing and selling of seafood, and probably also agricultural workers, mainly in the developing countries. The authors present a hypothesis for the origin of the present pandemic. It assumes that a mild form of the present SARS-CoV-2 that is supposedly circulating among the Chinese population in the eastern part of the country, mutated under the influence of as yet unknown factor(s) present in the Chinese seafood markets, probably component(s) of bioaerosols, into the virulent and highly contagious form, known as the present SARS-CoV-2, under a scenario similar to that the authors have named 'Reverse triggering'.

MultiTex RCT - a multifaceted intervention package for protection against cotton dust exposure among textile workers - a cluster randomized controlled trial in Pakistan: study protocol.

BACKGROUND: In the Pakistani textile industry the prevalence of workplace respiratory illnesses, including byssinosis, is high. The MultiTex RCT study aims to determine the effectiveness of a multifaceted intervention package in reducing dust levels in cotton mills, decreasing the frequency of respiratory symptoms among cotton textile workers, and improving their lung function. METHODS/DESIGN: We will conduct a cluster-randomized controlled trial at 28 textile mills in Karachi. The intervention will comprise: training in occupational health for all workers and managers reinforced by regular refresher sessions; the formation of workplace committees to draw up, agree and promote a health and safety plan that includes wet mopping, safe disposal of cotton dust, and the use of simple face-masks, as well as further publicity about the risks from cotton dust; and provision of adequate supplies of face-masks to support the health and safety plan. Participating mills will be randomized to intervention and control arms following a baseline survey. The impact of the intervention will be determined through follow-up surveys conducted at 3, 12 and 18 months. Data collection in the surveys will include spirometry, questionnaire-based interviews and cotton-dust measurements. DISCUSSION: If successful, the study may pave the way for simple, low-cost interventions that can help reduce cotton-dust levels in textile mills, and improve the respiratory health of textile workers in developing countries such as Pakistan. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03738202. Registered on 12 November 2018.

Byssinosis and tuberculosis amongst "home-based" powerloom workers in Madhya Pradesh State, India.

BACKGROUND: Byssinosis is an occupational lung disease observed among workers exposed to cotton, flax, and hemp dust. The severity and extent of Byssinosis are well recognised in the high-income countries and control measures have been implemented to prevent the disease. In India, there are conflicting evidence on burden estimation of the disease, followed by inadequate prevention and control of Byssinosis. DESIGN/METHODS: We did a cross-sectional study to assess the prevalence of Byssinosis in "home-based" power-loom workers in Mominpura, an administrative ward of Burhanpur Municipality with 2800 population in the state of Madhya Pradesh, India. 290 adults working from "home-based" power loom units were randomly selected, profiled and screened for Byssinosis like symptoms with the help of a semi-structured questionnaire and simple hand-held peak expiratory flow monitor. For epidemiological purposes the symptoms were classified based on Schilling's classification. Chest x-rays were done for selected subjects. Sputum smear microscopy for detecting TB was done for those who had Byssinosis like symptoms. RESULTS: Prevalence of Byssinosis among "home based" powerloom workers was found to be 98% [n = 283, 95 CI (95.65-98.96)]. Peak expiratory flow rate (PEFR) was reduced in 44% (n = 124), of which 81 (29%) had more than 50% PEFR reduction, and of these, 69 (29%) were in early stage of Byssinosis (Grade 0.5). 11% of study participants who had Byssinosis like symptoms, also had TB. CONCLUSIONS: Byssinosis is highly prevalent in "home-based" power loom units in Madhya Pradesh. Adequate advocacy on awareness and prevention; prompt diagnosis and linkages to treatment services in "home-based" power loom units are urgently required to address Byssinosis at an early disease stage.

Environmental Causes of Asthma.

Environmental factors which cause asthma are those that induce airway inflammation with eosinophils (more common) or neutrophils along with airway hyperresponsiveness (AHR). The most common of these (indeed the most common cause of asthma) are IgE-mediated inhalant allergen exposures. Allergen-induced AHR and inflammation are both associated with the allergen-induced late asthmatic response (LAR). Although allergens were previously recognized only as causes of symptoms and bronchoconstriction in asthmatics, we now appreciate them as causes of the fundamental pathophysiologic features of asthma. Low-molecular-weight chemical sensitizers, causes of occupational asthma, also cause asthma in a manner analogous to allergen. Acute irritant-induced asthma (reactive airways dysfunction syndrome) following a very heavy irritant exposure and chronic irritant-induced asthma following repeated high exposures can also induce persistent or permanent changes (inflammation and AHR) consistent with asthma. Textile dust exposure produces a different form of airway disease (byssinosis) which is less frequently observed currently. Environmental exposure to tobacco smoke facilitates the development of asthma in children. Personal smoking and environmental air pollution have an inconsistent and likely generally small effect in causing asthma.

Byssinosis and COPD rates among factory workers manufacturing hemp and jute.

OBJECTIVES: Prior studies have been performed on cotton textile plants throughout the world. This study was planned to identify the rate of byssinosis and chronic obstructive pulmonary disease (COPD) in hemp and jute workers and those who worked with both of them. MATERIAL AND METHODS: The study was realized in a factory which consecutively processed hemp and jute. The study enrollment included 266 people, 164 of whom were active workers and 102 were retired. A questionnaire, plain chest X-rays, physical examination and pulmonary function tests were performed. Dust levels were measured in various sections of the factory during 8 h work shifts. Endotoxin levels of various quality hemp fibers and dusts were measured. RESULTS: The rate of byssinosis (28.2%) was higher among the workers that who exposed to both jute and hemp dust. The frequency of chronic bronchitis in retired workers who previously smoked was higher (20%) as compared to currently smoking workers (17%). High dust levels were measured in some parts of the factory (mean (M) = 2.69 mg/m3). Working in dense dust areas, active smoking, being older than 40 years of age, being an ex-smoker, and working in the factory for a period exceeding 15 years were significantly associated with bronchitis and emphysema development. High endotoxin levels were determined for fine hemp dust (605 EU/mg), coarse hemp dust (336 EU/mg) and poor quality hemp fibers (114 EU/mg), whereas in fresh hemp stalks the level of endotoxin was determined to be lower (0.27 EU/mg). CONCLUSIONS: Because of high exposures to jute and hemp dusts that are associated with high byssinosis rates, personal protection and environmental hygiene is crucial to prevention of byssinosis.

Pantoea agglomerans: a marvelous bacterium of evil and good.Part I. Deleterious effects: Dust-borne endotoxins and allergens - focus on cotton dust.

The ubiquitous Gram-negative bacterium Pantoea agglomerans (synonyms: Enterobacter agglomerans, Erwinia herbicola) is known both as an epiphytic microbe developing on the surface of plants and as an endophytic organism living inside the plants. The bacterium occurs also abundantly in plant and animal products, in the body of arthropods and other animals, in water, soil, dust and air, and occasionally in humans. From the human viewpoint, the role of this organism is ambiguous, both deleterious and beneficial: on one side it causes disorders in people exposed to inhalation of organic dusts and diseases of crops, and on the other side it produces substances effective in the treatment of cancer and other diseases of humans and animals, suppresses the development of various plant pathogens, promotes plant growth, and appears as a potentially efficient biofertilizer and bioremediator. P. agglomerans was identified as a predominant bacterium on cotton plant grown all over the world, usually as an epiphyte, rarely as pathogen. It is particularly numerous on cotton bract after senescence. During processing of cotton in mills, bacteria and their products are released with cotton dust into air and are inhaled by workers, causing respiratory and general disorders, usually defined as byssinosis. The most adverse substance is endotoxin, a heteropolymer macromolecule present in the outermost part of the cell wall, consisting of lipopolysaccharide (LPS) as a major constituent, phospholipids and protein. The numerous experiments carried out in last quarter of XXth century on laboratory animals and human volunteers supported a convincing evidence that the inhaled endotoxin produced by P. agglomerans causes numerous pathologic effects similar to those elicited by cotton dust, such as influx of free lung cells into airways and activation of alveolar macrophages which secrete mediators (prostaglandins, platelet-activating factor, interleukin-1, tumor necrosis factor) that cause accumulation of platelets in pulmonary capillaries initiating an acute and chronic inflammation resulting in endothelial cell damage and extravasation of cells and fluids into the lung interstitium. These changes cause bronchoconstriction, the decrement of lung function expressed as reduction of forced expiratory volume in one second (FEV1) and/or diffusion capacity, increase in the airway hyperreactivity and subjective symptoms such as fever, airway irritation and chest tightness. The conclusions from these experiments, performed mostly 2-3 decades ago, did not loose their actuality until recently as so far no other cotton dust component was identified as a more important work-related hazard than bacterial endotoxin. Though also other microbial and plant constituents are considered as potential causative agents of byssinosis, the endotoxin produced by Pantoea agglomerans and other Gram-negative bacteria present in cotton dust is still regarded as a major cause of this mysterious disease.

Metal fume fever and polymer fume fever.

INTRODUCTION: Inhalational exposure to metal-containing fumes generated by welding and related processes may result in the development of the clinical syndrome known as "metal fume fever." Polymer fume fever is a separate and distinct but related disorder that has been associated with inhalational exposure to specific fluorinated polymer products, such as polytetrafluoroethylene or Teflon(®). We undertook a review of the peer-reviewed medical literature as it relates to these two disease entities in order to describe their epidemiology, pathophysiology, clinical presentation, diagnosis, treatment, prevention, and prognosis. METHODOLOGY: We performed a search of the PubMed ( www.pubmed.com ) and Ovid MEDLINE (ovidsp.tx.ovid.com) databases for keywords "metal fume fever," "polymer fume fever," and "fume fever," covering the period 1946 to September 2014, which resulted in a total of 141 citations. Limiting the search to articles published in the English language yielded 115 citations. These 115 articles were manually reviewed for relevance. In addition, the reference lists in each article retrieved were reviewed for additional relevant references. This left 48 relevant citations. EPIDEMIOLOGY: Metal fume fever occurs most commonly as an occupational disease in individuals who perform welding and other metal-joining activities for a living. It is estimated that 1,500-2,500 cases of metal fume fever occur annually in the United States. Polymer fume fever was initially identified as an occupational disease but increased regulations have resulted in decreased incidence in the occupational setting. Overheating of Teflon(®)-coated cookware is one of the more common mechanisms for exposure. PATHOPHYSIOLOGY: While the precise pathophysiology associated with the development of metal fume fever is yet to be elucidated, suggested pathophysiologic mechanisms include pro-inflammatory cytokine release, neutrophil activation, and oxygen radical formation. The pathophysiologic mechanism for polymer fume fever has not been definitively elucidated but may involve similar mechanisms to those proposed for metal fume fever. CLINICAL PRESENTATION: Metal fume fever typically presents with generally non-specific complaints including influenza-like symptoms, fever, shaking chills, arthalgias, myalgias, headache, and malaise. Onset of symptoms typically occurs 4-10 h following the exposure to metal-containing fumes. While metal fume fever is typically benign and self-limited, severe cases of the disease have been reported. In patients with ongoing metal fume exposure over the course of a workweek, tachyphylaxis occurs resulting in improvement in symptoms over the course of the workweek and maximal symptoms occurring after an exposure-free period such as a weekend. The clinical presentation of polymer fume fever is indistinguishable from metal fume fever, with an exposure history being necessary to distinguish the two entities. DIAGNOSIS: Chest radiographs are typically normal in cases of metal fume fever and polymer fume fever; however, mild vascular congestion may be demonstrated and severe cases may feature diffuse patchy infiltrates. Laboratory studies are typically not necessary but may demonstrate leukocytosis with leftward shift or an elevated erythrocyte sedimentation rate. TREATMENT: The primary treatment for both metal fume fever and polymer fume fever is supportive and directed at symptom relief. Oral hydration, rest, and the use of antipyretics and anti-inflammatory medications (e.g., non-steroidal anti-inflammatory drugs and aspirin) are recommended. A careful workplace exposure assessment analysis conducted by an occupational medicine specialist or clinical toxicologist in concert with a qualified industrial hygienist should be performed. PREVENTION: A careful workplace exposure assessment including measurement of ambient zinc and other metal (e.g., chrome, nickel, copper and manganese) fume concentrations or concentrations of fluorocarbon polymer decomposition products at different locations within the workplace should be performed. PROGNOSIS: Metal fume fever is typically a benign and self-limited disease entity that resolves over 12-48 h following cessation of exposure. CONCLUSIONS: Metal and polymer fume fevers generally follow a benign course with spontaneous resolution of symptoms, though both have the potential to be serious, especially in those with significant preexisting cardiorespiratory disease.

The prevalence of byssinosis among cotton workers in the north of Benin.

BACKGROUND: Cotton is the main agricultural export product in Benin. Cotton dust is thus present in the air during the handling and processing of cotton. This dust contains a mixture of substances including ground up plant matter, fibres, bacteria, fungi, soil, pesticides, noncotton matter, and other contaminants. While cotton processing is decreasing in industrialized countries, it is increasing in developing countries. Cotton processing, particularly in the early processes of spinning, can cause byssinosis. OBJECTIVE: To determine the respiratory effects of cotton dust exposure among cotton mill workers in Benin. METHODS: In a cross-sectional study, 109 workers exposed to cotton dust and 107 unexposed workers were studied. The International Commission on Occupational Health (ICOH) questionnaire was used for data collection on respiratory symptoms. For each worker, crossshift pulmonary function was performed with a dry spirometer. Based on the severity of respiratory symptoms and spirometry byssinosis was defined and classified according to the criteria of Schilling, et al. RESULTS: The mean ± SD age of the exposed and unexposed workers was 46.3 ± 7.8 and 37.0 ± 8.3 years, respectively (p<0.001). The mean FEV1 predicted value for the exposed and unexposed workers was 76.3% and 77.3%, respectively. The prevalence of grade 3 byssinosis was 21.1% (95% CI: 13.4-28.9) in exposed workers and 8.4% (95% CI: 3.1-13.7) in unexposed workers (p=0.006). On Mondays, the exposed workers had more respiratory symptoms than unexposed workers; for grade 3 byssinosis, the prevalence was 13.8% in exposed and 4.7% in unexposed workers (p=0.011). CONCLUSION: The prevalence of respiratory symptoms and byssinosis among cotton mill workers in Benin is high and needs prompt attention of health care workers and policymakers.