Case History: Is it the Flu?

A Midlands dairy farmer suffering from flu-like symptoms was referred to the Agromedicine Program by his county extension agent. The farmer had been sick for three days with fever, myalgia, and a productive cough. He said that he was feeling better after being in bed for the past two days. He asked Dr. Schuman, "Do I have the flu or is something on the farm making me ill?"

It was learned that the farmer became ill a few hours after feeding his cows. He described how he fed the cows and stated that he had been exposed to moldy hay in a silage wagon.

The case described above is a classic presentation of organic dust toxic syndrome (ODTS). This syndrome is an acute inflammatory process triggered by inhalation of moldy hay or grain dust. It is not an immunological response as seen in farmer's lung disease. The precise mechanism of ODTS has not yet been established although it is suspected that fungal and bacterial components of the dust may be responsible.1

ODTS resolves spontaneously within a few days and only supportive care is required. There are no longterm health effects from the illness.

Listed below are prominent features of the syndrome.

· Most cases of ODTS occur July through September.

· ODTS usually occurs four to six hours after exposure to hay or grain silage or sometimes after exposure to moldy grain.

· The leading ODTS complaints include cough, fever, shortness of breath, chills, myalgia, and malaise.

The farmer was advised to avoid exposure to the silage for the next 24-48 hours. Dr. Schuman also consulted with the farmer's family physician.

1Schenker M et al. Respiratory risks associated with agriculture. In Cordes DH and Rea DF (eds):Health Hazards of Farming, State of the Art Reviews. Philadelphia, Hanley & Belfus, 1991;6(3):415- 428.

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