Organic Dust Toxic Syndrome (ODTS) is a flu-like syndrome that can occur after inhalation of cotton, grain, wood chip dusts, or other organic dusts or aerosols. We investigated whether inflammatory pulmonary responses occur, even after relatively brief, low-level wood chip mulch exposure. Six volunteers were exposed to wood chip mulch dust. Total dust and/or endotoxin levels were measured in five subjects. Pulmonary function and peripheral blood counts were measured before and after exposure in each subject. Bronchoalveolar lavage (BAL) was performed in each subject after exposure, and cell, cytokine, and protein concentrations were measured. Control BAL without previous exposure was also performed on three of the subjects. Three of six subjects had symptoms consistent with ODTS. No clinically relevant or statistically significant changes in pulmonary function tests after exposure were found. Three subjects manifested a marked elevation in neutrophil percentage in their BAL (range, 10 to 57%). When these three subjects underwent control BAL, the postexposure comparison demonstrated an increase in neutrophil levels of 154 ± 89 x 103 /mL (mean ± standard error; P = 0.22). The mean increase in BAL interleukin-8 levels after exposure, compared with paired control values, was 11.2 ± SE 2.5 pg/mL (P = 0.047). There was also an increase in BAL interleukin-6 levels that reached borderline significance (6.4 ± SE 2.0 pg/mL; P = 0.08). Tumor necrosis factor levels were increased in all three subjects' BAL as well (0.4 ± SE 0.2 pg/mL), but this change was not statistically significant (P = 0.2). Our findings of increased BAL proinflammatory cytokine and neutrophil levels are consistent with the theory that cytokine networking in the lung may mediate ODTS.
From the Division of Occupational and Environmental Medicine (Dr Wintermeyer, Dr Kuschner, Dr D'Alessandro, Dr Blanc), the Division of Pulmonary and Critical Care Medicine (Dr Wintermeyer, Dr Kuschner, Dr Blanc), Department of Medicine, and the Cardiovascular Research Institute (Dr Wintermeyer, Dr Kuschner, Dr Wong, Dr D'Alessandro, Dr Blanc),University of California San Francisco, San Francisco, Calif.
Address correspondence to: Paul D. Blanc, MD, MSPH, Division of Occupational and Environmental Medicine, Box 0924, University of California San Francisco, San Francisco, CA 94143-0924. 1076-2752/97/3904-0308$3.00/0