Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University (IPA), Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany,
Adv Exp Med Biol. 2013;788:335-40. doi: 10.1007/978-94-007-6627-3_45.
Most surveys of outbreaks of hypersensitivity pneumonitis (HP) in subjects with occupational exposure to water-based metalworking fluids (MWFs) were unable to detect a clear link between symptoms and the precise causative agents. We studied the case of a male 41-year-old industrial knife grinder with exposure to water-based MWFs since 12 years. The diagnosis of HP was made by typical work-related symptoms, the demonstration of high lymphocyte numbers in bronchoalveolar lavage and elevated IgG antibody concentrations to various molds in the patient's serum, and complete recovery after early exposure cessation. Whereas an environmental survey showed only low numbers of mold contamination in one sump sample, high antigenic activity was demonstrated in the same sample by antigen-specific IgG inhibition tests. We conclude that the detection of antigenic molds in water-based MWFs by culture methods may be limited. The link between occupational exposure to specific molds in MWFs and hypersensitivity pneumonitis can be established by the demonstration of antigenic activity by antigen-specific IgG inhibition tests.
大多数针对职业性接触水基金属加工液（MWF）的人群中发生的过敏性肺炎（HP）爆发的调查未能明确确定症状与确切病因之间的联系。我们研究了一名 41 岁男性工业刀具研磨工的病例，他接触水基 MWF 已有 12 年。HP 的诊断依据是典型的与工作相关的症状、支气管肺泡灌洗液中淋巴细胞数量升高以及患者血清中各种霉菌的 IgG 抗体浓度升高，以及早期停止暴露后完全康复。虽然环境调查仅显示一个污水池样本中的霉菌污染数量较低，但通过抗原特异性 IgG 抑制试验证明该样本具有高抗原活性。我们得出结论，通过培养方法检测水基 MWF 中的抗原性霉菌可能受到限制。通过抗原特异性 IgG 抑制试验证明抗原性活性，可以确定 MWF 中特定霉菌与过敏性肺炎之间的职业性接触。
