KOTIMAA MH, HUSMAN KH, TERHO EO, MUSTONEN MH. Airborne molds and actinomycetes in the work environment of farmer's lung patients in Finland. Scand J Work Environ Health 10 (1984) 115-1 19. Occurrence of molds and actinomycetes in the breathing zone of farmers during the handling of hay, straw, or grain was studied with the use of an Andersen sampler on 35 farms in Finland. On 24 farms there was a person with recently diagnosed farmer's lung disease, and on 11 farms people were free of the disease. The total spore concentration and the concentrations of the spores of Thermoactinomyces (7) vulgaris, Micropolyspora ( M ) faeni, and Aspergillus ( A ) umbrosus were statistically significantly higher on the farms of patients with farmer's lung than on the disease-free farms. The mean proportions of the spores of thermotolerant and thermophilic microbes were greater on the farms of farmer's lung patients than on the reference farms. T vulgaris was the predominant actinomycete species. Both T vulgaris and A umbrosus were found on all farms of farmer's lung patients, but M faeni on only about half of such farms. The findings match the results of previous microbiological analyses of Finnish moldy hay and serological analyses of Finnish farmer's lung patients. It seems that T vulgaris, not Mfaeni, may be the main causative agent of farmer's lung in Finland. The possible etiologic role of A umbrosus requires further investigation. Because the farmers often failed to identify the moldiness of the plant material in contrast to researchers, it might be possible, through training, to improve farmers' ability to identify moldiness.

We describe a military hospital building with severe, repeated and enduring water and mold damage, and the symptoms and diseases found among 14 persons who were employed at the building. The exposure of the employees was evaluated by measuring the serum immunoglobulin G (IgG)-antibodies against eight spieces of mold and yeast common in Finnish water and mold damaged buildings and by sampling airborne viable microbes within the hospital. The most abundant spieces was Sporobolomyces salmonicolor. All but one of the employees reported some building-related symptoms, the most common being a cough which was reported by nine subjects. Four new cases of asthma, confirmed by S. salmonicolor inhalation provocation tests, one of whom was also found to have alveolitis, were found among the hospital personnel. In addition, seven other workers with newly diagnosed rhinitis reacted positively in nasal S. salmonicolor provocation tests. Skin prick tests by Sporobolomyces were negative among all 14 workers. Exposure of the workers to mold and yeast in the indoor air caused an outbreak of occupational diseases, including asthma, rhinitis and alveolitis. The diseases were not immunoglobulin E (IgE)-mediated but might have been borne by some other, as yet unexplained, mechanism.

ABSTRACr A total of 57 subjects who had been exposed to mould dust in the tobacco industry were studied. Their working environment showed exposure to spores of different moulds, and 29 subjects (51 %) showed antibodies against one or more of the microbes. Fifteen (26%) had work related respiratory symptoms. Eight (14%) showed slight radiographic pulmonary fibrosis. Spirometry showed a tendency toward restriction and obstruction, especially in small airways. Diffusion capacity was decreased in 18% of the workers. Three clinical cases of typical allergic alveolitis were also found. All this suggests that exposure of spores of different moulds (especially Aspergillus fumigatus) in the manufacture of tobacco products may induce symptoms and signs relating to extrinsic allergic alveolitis.

Objectives-To determine whether occupational exposure to raw tobacco causes respiratory or allergic diseases, an excess of respiratory symptoms, a decrease in lung function, or parenchymal changes in chest radiography among Finnish cigar workers. Methods-This cross sectional study included all Finnish cigar workers (n=106) exposed to raw tobacco and also a group of unexposed matched referents. Data were collected with a self administered questionnaire, flow volume spirometry, measurements of diVusing capacity of the lung for carbon monoxide, chest radiography and skin prick tests. A questionnaire was also sent to former workers of the factory. Results-There were no significant diVerences between the groups in the prevalence of respiratory symptoms and chest radiography findings. Nine of 102 tobacco workers had pulmonary fibrosis of at least 1/0 (according to the International Labour Organisation (ILO) 1980 classification) and the corresponding figure was five for the referents. The tobacco workers tended to have a low forced vital capacity (FVC), and they had impaired forced expiratory volume in 1 second and lower means of the maximal expiratory flow at 25% of the FVC significantly more often than the referents. DiVusing capacity tended to be lower among the referents. The referents more often had atopy and earlier atopic diseases than the exposed workers. These results indicate the possibility of selection among the exposed workers. Conclusions-No excess of prevalence of respiratory symptoms in the tobacco workers was found. According to the questionnaire episodes of allergic alveolitis may have occurred in the cigar factory workers. However, in the absence of impairments in lung function and radiological changes it was not possible to distinguish humidifier fever and allergic alveolitis. In exposure conditions that include humidification of the air humidifier, fever and allergic alveolitis constitute a risk for tobacco workers. No eVects were shown of exposure to tobacco dust on lung function. (Occup Environ Med 1998;55:834-839)

Extrinsic allergic alveolitis in a sawmill worker. A case report. by Terho EO, Husman K, Kotimaa M, Sjöblom T