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Streptococcus suis as threat to pig-farmers and abattoir workers
of the 5 g hydroxocobalamin dose regimen, our results are reinforced by the findings of Astier and Baud.’ Despite the blood cyanide concentrations of up to 260 fLmol/L, including three cases of pure cyanide ingestion and four of smoke inhalation, the maximum measured concentration of cyanocobalamin did not exceed 275 fLmol/L. These patients were also treated with a 5 g dose of hydroxocobalamin. In our own study we outlined that in patient eight, who received a second 5 g dose, the maximum measured concentration of cyanocobalamin went from 288 jjbmoI/L after the first dose to 544 limol/L after 10 g. Because of the rapidity of formation of cyanocobalamin, the rate of administration of hydroxocobalamin can obviously greatly alter the maximum measured concentration of cyanocobalamin. We suggest that a study of in-vivo binding capacity would be useful. *P
other cases of occupational asthma due this contention. Fidias E Leon-S Department of Neurology, University of Alabama Birmingham, AL 35294, USA 1 2
at
to
moulds,2 supports
Birmingham,
UAD Station,
Sherson D, Hansen I, Sissgaard T. Occupationally related respiratory symptoms in trout-processing workers. Allergy 1989; 44: 336-41. Klaustermeyer WB, Bardana EJ, Hale C. Pulmonary hypersensitivity to Alternaria and Aspergillus in baker’s asthma. Clin Allergy 1977; 7: 227-33.
3 4
Leon-S FE. Bacteria no! Fungus yes!. J Clin Epidemiol 1995; 48: 1183-84. Leon-S FE, Zaninovic V. Sindrome de neuromicotoxicosis humana: la otra posibilidad en enfermedades neurodegeneratives. Acta Neurol Col
(in press). 5
Baur X, Frauhman
G, Haug B, Raache B, Reiher W, Weiss W. Role of aspergillus amylase in baker’s asthma. Lancet 1986; i: 43.
Houeto, J R Hoffman, M Imbert, P Levillain, F J Baud
Laboratoire et Réanimation Toxicologique, Hôpital Fernand Widal, 75475 Paris, France
Streptococcus suis as threat to pig-farmers 1
2
FJ. Simultaneous determination of hydroxocobalamin and its cyanide complex cyanocobalamin in human plasma by high-
and abattoir workers
performance liquid chromatography. Application to pharmacokinetic studies after high-dose hydroxocobalamin as an antidote for severe cyanide poisoning. J Chromatogr 1995; 667: 129-35. Houeto P, Buneaux F, Galliott-Guilley M, Baud FJ, Levillain P. Determination of hydroxocobalamin by derivative spectrophotometry in cyanide poisoning. J Anal Toxicol 1994; 18: 154-58.
and colleagues, in their Nov 11 describe a farmer with due to commentary, meningitis suis. is often a This commensal Streptococcus microorganism in pigs but can lead to disease in these animals (meningitis, bronchopneumonia, arthritis, endocarditis, and sepsis). They suggest that S suis produces only a purulent meningitis in man, very occasionally with a fatal outcome. However, arthritis, pneumonia, endophthalmitis, and endocarditis are also seen.’ More important is the fact that S suis can lead to a fulminant sepsis.!,2 Bungener and Bialek3 described an abattoir worker with chills and high fever who died of septic shock 4 h after hospital admission. Blood culture revealed S suis type II and numerous bacteria were found in the small vessels of many organs at necropsy. There was no meningitis but there were many fresh cuts and abrasions on the hands. We reported4 a 26-year-old pig farmer who had abdominal pain with diarrhoea and vomiting a few hours before admission. On arrival the patient had high fever and hypotension. There were no meningeal signs. The skin of the finger tips was split. Despite immediate fluid and antibiotic therapy, the patient developed multiple organ failure with adult respiratory distress syndrome, cardiac failure, intravascular coagulation, rhabdomyolysis, and acute renal failure. The shock proved to result from septicaemia with S suis type II. The patient recovered completely after intensive therapy. S suis infection is a zoonosis. Human beings usually develop meningitis. Septic shock is rare but fulminant and commonly fatal.’" Early recognition in pig farmers and abattoir personnel is of utmost importance. In addition to therapy for shock, immediate intravenous penicillin is mandatory. Infection could possibly be prevented by prompt disinfection of skin injuries in persons at risk.
Astier A, Baud
Salmon, ventilation, and mycotoxin inhalation SiR-Douglas and colleagues (Sept 16, p 737) report that occupational asthma was present in workers at a factory processing salmon with the ventilation system enclosed and that it decreased "after fitting an exhaust ventilation system". Sherson and colleagues’ reported a similar situation and the respiratory problems they described were thought to be caused by a bacterial endotoxin present in the environment. Interestingly, the clinical pictures resemble respiratory problems associated with the grain industry, poultry-processing, and silo unloading, and can also be compared with old-book disease, sick-building syndrome, and baker’s asthma, among other, all of which are thought to be promoted by closed environments.’-’ It is important to emphasise that closed environments not only affect the biologically respirable dust-containing bacterial endotoxins but also allow moulds to grow easily. 3,-1 Penicillium, asperqillus, and alternaria are most commonly found, and some have the capability of producing mycotoxins such as ochratoxins, tricothecens, and aflatoxins. These have been found both in the air of closed places and in patients with occupational asthma.’,2 Even though Douglas and colleagues record a direct correlation between IgE and cigarette consumption, it is noteworthy that Baur and co-workers5 also found IgEmediated sensitisation in their patients, but they thought that this was attributable to the allergenic effects of Aspergillus amilase. It should be remembered that moulds and their related mycotoxins can produce type I and type III hypersensitiVity,2 as well as immunodeficiency in exposed individuals.’ This fact is very important because mycotoxins might act as an important cofactor not only in occupational asthma but also in allowing other pathogenic to act retroviruses, microorganisms, including there was an the fact that opportunistically.4 Finally, in from of transferred improvement high symptoms people to low exposure areas in Douglas’ study, as also described in
SiR-Perseghin
*A K M Bartelink, E
van
Kregten
Departments of *Intensive Care and Microbiology, Eemland Hospital, 3816 CP Amersfoot, Netherlands
1 2 3 4
Kay R, Cheng AF, Tse CY. Streptococcus suis infection in Hong Kong. Q J Med 1995; 88: 39-47. Zanen HC, Engel HWB. Porcine streptococci causing meningitis and septicaemia in man. Lancet 1975; i: 1286-88. Bungener W, Bialek R. Fatal Streptococcus suis septicemia in an abattoir worker. Eur J Clin Microbiol Infect Dis 1989; 8: 306-08. Kregten E van, Jaarsveld B van, Rozenberg-Arska M, Bartelink A. Fulminant sepsis with Streptococcus suis type 2. In: Orefici G, ed. New perspectives on streptococci and streptococcal infections. Stuttgart: Gustav Fisher Verlag, 1992: 39-40. 1707
other cases of occupational asthma due this contention. Fidias E Leon-S Department of Neurology, University of Alabama Birmingham, AL 35294, USA 1 2
at
to
moulds,2 supports
Birmingham,
UAD Station,
Sherson D, Hansen I, Sissgaard T. Occupationally related respiratory symptoms in trout-processing workers. Allergy 1989; 44: 336-41. Klaustermeyer WB, Bardana EJ, Hale C. Pulmonary hypersensitivity to Alternaria and Aspergillus in baker’s asthma. Clin Allergy 1977; 7: 227-33.
3 4
Leon-S FE. Bacteria no! Fungus yes!. J Clin Epidemiol 1995; 48: 1183-84. Leon-S FE, Zaninovic V. Sindrome de neuromicotoxicosis humana: la otra posibilidad en enfermedades neurodegeneratives. Acta Neurol Col
(in press). 5
Baur X, Frauhman
G, Haug B, Raache B, Reiher W, Weiss W. Role of aspergillus amylase in baker’s asthma. Lancet 1986; i: 43.
Houeto, J R Hoffman, M Imbert, P Levillain, F J Baud
Laboratoire et Réanimation Toxicologique, Hôpital Fernand Widal, 75475 Paris, France
Streptococcus suis as threat to pig-farmers 1
2
FJ. Simultaneous determination of hydroxocobalamin and its cyanide complex cyanocobalamin in human plasma by high-
and abattoir workers
performance liquid chromatography. Application to pharmacokinetic studies after high-dose hydroxocobalamin as an antidote for severe cyanide poisoning. J Chromatogr 1995; 667: 129-35. Houeto P, Buneaux F, Galliott-Guilley M, Baud FJ, Levillain P. Determination of hydroxocobalamin by derivative spectrophotometry in cyanide poisoning. J Anal Toxicol 1994; 18: 154-58.
and colleagues, in their Nov 11 describe a farmer with due to commentary, meningitis suis. is often a This commensal Streptococcus microorganism in pigs but can lead to disease in these animals (meningitis, bronchopneumonia, arthritis, endocarditis, and sepsis). They suggest that S suis produces only a purulent meningitis in man, very occasionally with a fatal outcome. However, arthritis, pneumonia, endophthalmitis, and endocarditis are also seen.’ More important is the fact that S suis can lead to a fulminant sepsis.!,2 Bungener and Bialek3 described an abattoir worker with chills and high fever who died of septic shock 4 h after hospital admission. Blood culture revealed S suis type II and numerous bacteria were found in the small vessels of many organs at necropsy. There was no meningitis but there were many fresh cuts and abrasions on the hands. We reported4 a 26-year-old pig farmer who had abdominal pain with diarrhoea and vomiting a few hours before admission. On arrival the patient had high fever and hypotension. There were no meningeal signs. The skin of the finger tips was split. Despite immediate fluid and antibiotic therapy, the patient developed multiple organ failure with adult respiratory distress syndrome, cardiac failure, intravascular coagulation, rhabdomyolysis, and acute renal failure. The shock proved to result from septicaemia with S suis type II. The patient recovered completely after intensive therapy. S suis infection is a zoonosis. Human beings usually develop meningitis. Septic shock is rare but fulminant and commonly fatal.’" Early recognition in pig farmers and abattoir personnel is of utmost importance. In addition to therapy for shock, immediate intravenous penicillin is mandatory. Infection could possibly be prevented by prompt disinfection of skin injuries in persons at risk.
Astier A, Baud
Salmon, ventilation, and mycotoxin inhalation SiR-Douglas and colleagues (Sept 16, p 737) report that occupational asthma was present in workers at a factory processing salmon with the ventilation system enclosed and that it decreased "after fitting an exhaust ventilation system". Sherson and colleagues’ reported a similar situation and the respiratory problems they described were thought to be caused by a bacterial endotoxin present in the environment. Interestingly, the clinical pictures resemble respiratory problems associated with the grain industry, poultry-processing, and silo unloading, and can also be compared with old-book disease, sick-building syndrome, and baker’s asthma, among other, all of which are thought to be promoted by closed environments.’-’ It is important to emphasise that closed environments not only affect the biologically respirable dust-containing bacterial endotoxins but also allow moulds to grow easily. 3,-1 Penicillium, asperqillus, and alternaria are most commonly found, and some have the capability of producing mycotoxins such as ochratoxins, tricothecens, and aflatoxins. These have been found both in the air of closed places and in patients with occupational asthma.’,2 Even though Douglas and colleagues record a direct correlation between IgE and cigarette consumption, it is noteworthy that Baur and co-workers5 also found IgEmediated sensitisation in their patients, but they thought that this was attributable to the allergenic effects of Aspergillus amilase. It should be remembered that moulds and their related mycotoxins can produce type I and type III hypersensitiVity,2 as well as immunodeficiency in exposed individuals.’ This fact is very important because mycotoxins might act as an important cofactor not only in occupational asthma but also in allowing other pathogenic to act retroviruses, microorganisms, including there was an the fact that opportunistically.4 Finally, in from of transferred improvement high symptoms people to low exposure areas in Douglas’ study, as also described in
SiR-Perseghin
*A K M Bartelink, E
van
Kregten
Departments of *Intensive Care and Microbiology, Eemland Hospital, 3816 CP Amersfoot, Netherlands
1 2 3 4
Kay R, Cheng AF, Tse CY. Streptococcus suis infection in Hong Kong. Q J Med 1995; 88: 39-47. Zanen HC, Engel HWB. Porcine streptococci causing meningitis and septicaemia in man. Lancet 1975; i: 1286-88. Bungener W, Bialek R. Fatal Streptococcus suis septicemia in an abattoir worker. Eur J Clin Microbiol Infect Dis 1989; 8: 306-08. Kregten E van, Jaarsveld B van, Rozenberg-Arska M, Bartelink A. Fulminant sepsis with Streptococcus suis type 2. In: Orefici G, ed. New perspectives on streptococci and streptococcal infections. Stuttgart: Gustav Fisher Verlag, 1992: 39-40. 1707