Answers to Agricultural Health Questions

(on sorting hogs and cleaning grain bins)

 

Answers and Comments:

 

1. E. Organic Dust Toxic Syndrome (ODTS), complicated by emphysema.  The history of flu-like febrile event following high organic dust exposure is very characteristic of ODTS. Also, the history of previous ODTS incident with hog dust exposure is characteristic with increasing severity of symptoms with additional exposures. The neutrophilic response is also characterized of ODTS as well as the obstructive pulmonary function symptoms (low FEV). The x-ray showing evidence of infiltrate and radiolucent areas in the lung are consistent with both ODTS and emphysema. A smoking history, especially with agricultural dust exposure, is a risk for emphysema.

 

2. E. All of the above

The history of previous febrile illness following a high organic dust concentration exposure (moving and sorting hogs). The history of moldy grain exposures – cleaning grain bins is probably the most common source of ODTS. The blood count, BAL, and x-ray are all colored.

 

3. This could have been prevented by wearing a more protective mask, such as a half–faced mask or a powered air supplying respirator (air stream) helmet. As this person already had emphysema, the air stream helmet would be much better, because it will not add additional stress having to breath through a filter. Using a grain vac is a great idea, which we usually recommend to cut down on dust generation. This person would have been much worse off using a shovel.

 

4. The fact that the patient has evidence of emphysema, the prognosis is questionable. Likely, the effects of ODTS will wane, but perhaps not enough to wean him off oxygen. If he does get off oxygen, extra care should be used to assure he is protected from future organic dust exposures.