Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany,
Adv Exp Med Biol. 2013;788:313-20. doi: 10.1007/978-94-007-6627-3_42.
Exposures to molds and bacteria (especially actinomycetes) at workplaces are common in garbage workers, but allergic respiratory diseases due to these microorganisms have been described rarely. The aim of our study was a detailed analysis of mold or bacteria-associated occupational respiratory diseases in garbage workers. From 2002 to 2011 four cases of occupational respiratory diseases related to garbage handling were identified in our institute (IPA). Hypersensitivity pneumonitis (HP) was diagnosed in three subjects (cases 1-3, one smoker, two non-smokers), occupational asthma (OA) was diagnosed in one subject (case 4, smoker), but could not be excluded completely in case 2. Cases 1 and 2 worked in composting sites, while cases 3 and 4 worked in packaging recycling plants. Exposure periods were 2-4 years. Molds and actinomycetes were identified as allergens in all cases. Specific IgE antibodies to Aspergillus fumigatus were detected exclusively in case 4. Diagnoses of HP were essentially based on symptoms and the detection of specific IgG serum antibodies to molds and actinomycetes. OA was confirmed by bronchial provocation test with Aspergillus fumigatus in case 4. In conclusion, occupational HP and OA due to molds occur rarely in garbage workers. Technical prevention measures are insufficient and the diagnosis of HP is often inconclusive. Therefore, it is recommended to implement the full repertoire of diagnostic tools including bronchoalveolar lavage and high resolution computed tomography in the baseline examination.
在垃圾处理工人的工作场所中，暴露于霉菌和细菌（尤其是放线菌）中很常见，但由于这些微生物引起的过敏性呼吸道疾病却很少见。我们的研究目的是详细分析与垃圾处理相关的垃圾工人职业性呼吸道疾病。在我们的研究所（IPA）中，从 2002 年到 2011 年，共确定了 4 例与垃圾处理相关的职业性呼吸道疾病（案例 1-4）。有 3 例（病例 1-3，1 例吸烟者，2 例不吸烟者）被诊断为过敏性肺炎（HP），1 例（病例 4，吸烟者）被诊断为职业性哮喘（OA），但在病例 2 中不能完全排除。病例 1 和 2 在堆肥场工作，而病例 3 和 4 在包装回收厂工作。暴露时间为 2-4 年。所有病例均鉴定出霉菌和放线菌作为过敏原。仅在病例 4 中检测到对烟曲霉的特异性 IgE 抗体。HP 的诊断主要基于症状和对霉菌和放线菌的特异性 IgG 血清抗体的检测。在病例 4 中，通过用烟曲霉进行支气管激发试验来确认 OA。总之，垃圾处理工人中很少发生职业性 HP 和 OA。技术预防措施不足，HP 的诊断往往不明确。因此，建议在基线检查中实施包括支气管肺泡灌洗和高分辨率计算机断层扫描在内的全套诊断工具。
