Inhalation Fever

1
Inhalation Fever

• By
• A. H. Mehrparvar, M.D.

2
Background

• Various causes
• Similar features
• Flu-like symptoms
• Self-limited
• Temporarily debilitating
• Important differential diagnosis
• - Inhalational lung injury
• - HP
• - Infections

3
Causes

• Metal fumes
• Contaminated water sources
• Contaminated agricultural dusts
• Other causes

4
Differential diagnosis(inhalation fever Vs.
inhalational injury)

• Similarities
• - acute high intensity exposure
• - Fever
• - acute onset (within hours)
• - leukocytosis
• Differences
• -Dyspnea
• - CXray infiltrates
• - Hypoxemia
• - Chronic sequelae

5
Characteristics

• Without sensitization
• High attack rate with heavy exposure
• 4-12h. After exposure
• Tachyphylaxis
• PMN pulmonary infiltrates

6
Characteristics

• Symptoms fever, chills, headache, cough, chest
  tightness, minimal dyspnea, malaise, myalgia
• Signs fever, tachycardia, tachypnea,
  occasionally crackles
• Self-limiting 24-48h.

7
Metal fume fever

• Causes
• - Zinc oxide
• - Other metals Mg, Cu, Cd (acute lung
  injury), Cr, Ir, Ni, Ag, Al, Hg
• - ZnCl2 acute lung injury
• Jobs Brass foundry, Welding or Flame-cutting of
  galvanized metal
• Constitutional symptoms metallic taste

8
Contaminated Water Sources

• Humidifier Fever
• Pontiac Fever

9
Humidifier Fever

• Causes microorganisms in humidification systems
  (pseudomonas, and), endotoxins
• Mostly in winter
• Jobs printing, operating rooms, offices, textile
  manufacturing
• DD Humidifier lung (HP) (Repeated exposure,
  attack rate low, latency weeks to years,
  crackles, infiltrates, PFT, pathology)

10
Pontiac Fever

• Identical to HF, aerosols of contaminated water
  (coolant systems, pools, whirlpools)
• Cause Legionella pneumophila
• 5 h. to less than 3 days
• DD. Legionnaires dis. (low attack rate, latency
  5-6 days, multisystem invasive dis.)
• Serologic tests (Ab against Legionella)

11
Contaminated Agricultural dusts

• Mill Fever
• Organic Dust Toxic Syndrome (ODTS)

12
Mill Fever

• Vegetable dusts of cotton, flax, hemp
• DD. byssinosis (latency more than 10 years,
  chest tightness and dyspnea)
• Cause endotoxin

13
Organic Dust Toxic Syndrome (ODTS)

• Causes moldy or damp silage, hay, moldy wood
  chips
• Silo unloaders syndrome (Vs. silo fillers
  disease)
• Summer and fall
• Atopy a risk factor
• DD farmers lung (HP)

14
Polymer Fume Fever

• Causes pyrolysis (300 750ºC) products of
  tetrafluoroethylene resins (e.g. Teflon) and PVF
• Jobs welding or flame-cutting of metals coated
  with PTFE, molding or extruding machines,
  cigarette smoking
• No tolearnace
• DD acute lung injury