Agricultural
Health
By Kelley J. Donham
Director, Iowa’s Center for
Agricultural Safety and Health
Case History: J.W. is a 68-year-old
hog, corn, and soybean grower in eastern Iowa. He has farmed all his life and has always
been generally healthy. He used to smoke, but quit over 20 years ago. He did report that
he often got sick 4-6 hours following sorting and moving hogs. He could almost count on
getting ill, with muscle aches, fever, fatigue, headache, chest tightness and cough. He
would usually get over what he called, “hog flu,” in a couple of days, only to
have it repeat the next time he moved and sorted hogs.
On October 11, 2001, he was moving grain out of a bin to take to the elevator. He used a grain vacuum to move 400-500 bushels of the “musty-smelling” grain into a truck. It was quite hot while he was working inside the bin with the vacuum. He was wearing a two-strap disposable dust mask that got wet from his breathing and sweating. He raised it up for several minutes while finishing the job, so he could breathe better. By the time he got done, his shirt was soaked with sweat. He took the grain to the elevator, got a little chilled, and started to cough. When he got home he sprayed the inside of the bin with malathion.
He continued to cough through the night. The
next day he felt worse and stayed in the house. He became progressively short of breath
through the day. At 10:00 p.m., his wife took him to the emergency room. He had an 85%
oxygen saturation. An x-ray of his chest revealed a cellular infiltrate but with areas of
increased radio transparency in the distal lung fields. He had a peripheral white blood
count of 18,000 with 90% neutrophils. His pulmonary function revealed a low FEV1, and low
FVC.
The hospital placed him on oxygen and he was
hospitalized for six days. Three months later he was still on oxygen at home and not able
to work.
Questions:
1. What is the likely diagnosis?
A. Farmer’s Lung
B. Organophoshate Insecticide Poisoning
C. Infectious Swine Influenza
D. Organic Dust Toxic Syndrome (ODTS)
E. Organic Dust Toxic Syndrome (ODTS),
complicated with emphysema
2. How could this have been confirmed?
A. The history of the incident
B. X-rays showed mild infiltrate, with
radiolucent areas in the lung fields
C. Bronchial – alveolar levage showed
very
high all content with predominant
neutrophils
D. Pulmonary function showed declines in
both the flow volume and capacity
E. All of the above
F. None of the above
3. How could this have been prevented?
4. What is the prognosis?