Case History: "Isn't there anything I can do?"

In last month's newsletter a case history involving a Midlands dairy farmer with organic dust toxic syndrome (ODTS) was presented. This syndrome presents with flu-like symptoms following respiratory exposure to moldy grain or hay. After a few days the symptoms resolve spontaneously and there are no long-term health effects. OTDS is not an allergic response as seen in farmer's lung disease.

In early October, a MUSC pulmonary specialist diagnosed farmer's lung disease in a Pee Dee farmer. Over the past several years the patient has had repeated episodes of flu-like symptoms and dry cough following exposure to corn dust. The symptoms became worse with each episode. He now has labored breathing and decreased lung function. The farmer consulted with Dr. Schuman following the diagnosis. He wanted to know what he could do to prevent the recurrence of symptoms so that he would be able to continue to farm. The specialist had recommended that he give up farming.

Dr. Schuman advised the farmer that avoidance was key to prevention and that further exposure to moldy crops could result in more debilitating symptoms. Some farmers have been able to return to work by wearing a dust respirator with high efficiency particulate filters whenever they are exposed to crop dust. Also, these farmers must ensure that crops are adequately dried before storage, are stored with less than 20% water content, and are well ventilated while in storage. The farmer was urged to discuss these options with his physician.

Farmer's lung, also known as hypersensitivity pneumonitis or extrinsic allergic alveolitis, is an inflammatory reaction caused by a cellmediated immune response to moldy crops. It usually occurs four to six hours after handling a stored crop in a poorly ventilated confined area.

In the acute stage of farmer's lung disease, the patient will develop fever, chills, malaise, myalgias, dyspnea, and dry cough. Crackles are heard in the lungs and hypoxemia may be present. Usually pulmonary function will be reduced and WBC count will be elevated. Chest x-ray may show diffuse alveolar and interstitial infiltrates.

The symptoms will resolve on their own four to six days after exposure is stopped. In the chronic stage of the disease, chest x-ray will show fibrosis and dyspnea, fatigue, and weight loss are common.

"Since this syndrome can be progressive and lead to a severe restrictive pulmonary disease, farmers at risk should be encouraged to avoid exposure to contaminated materials."1

1Schenker M et al. Respiratory risks associated with agriculture. In Cordes DH and Rea DF (eds): State of the art reviews: Health hazards of farming. Philadelphia, Hanley & Belfus, 1991, p. 422.

MUSC DEPARTMENT OF FAMIILY MEDIICIINE – DIIVIISIION OF PUBLIIC HEALTH AND PUBLIIC SERVIICE

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