Workplace Medical Mystery Solved: Influenza-like Illness Sickens Golf Course Worker

Workplace Medical Mystery Solved: Golf Course Worker Becomes Ill with an Influenza-like Illness

With five golf course maintenance staff sick, the golf course superintendent was suspicious. Either something really contagious is going around or there is something at the course making the staff sick, he thought. Not taking any chances, the superintendent informed the course’s general manager who called the local health department.

A day earlier, course maintenance worker Chris and four of his colleagues helped to unload a trailer of wood chips to spread around trees and shrubs on the golf course. Within about 5 hours Chris became so ill and short of breath he went to the local emergency room. All five workers who helped unload the trailer became ill within 4-14 hours and two workers were too sick to work the next day. Those who just helped spread the wood chips around the course were not sick.

Physicians from the local health department examined and tested all golf course employees who were sick. They called the National Institute for Occupational Safety and Health for additional help with the outbreak. Investigators inspected the unloaded wood chips, collected samples, and interviewed the wood chips vendor.

The investigators found that although fresh wood chips had been ordered, the vendor included old chips that had been stored in the front of the truck for approximately 1 year. Unloaded chips from the front were grossly moldy, and cultures revealed a wide variety of bacteria and fungi.

It was determined the outbreak may have been pulmonary mycotoxicosis, or Organic Dust Toxic Syndrome (ODTS), which is an acute respiratory illness in workers who inhale dust from contaminated organic materials. In the case of the golf course workers, the five who became ill worked in dusty conditions without respiratory protection while unloading the trailer that included moldy wood chips.

ODTS usually disappears within 24 hours to a few days after the worker is removed from the exposure. All of the golf course workers were well within 3 days. There is no specific treatment for ODTS, however, it can often be misdiagnosed as acute bronchitis, influenza, or farmer’s lung disease, which may lead to the unnecessary prescription of antibiotics or anti-inflammatory medicines.

A common illness, ODTS can affect many types of workers including those who handle grain, pig farmers and those who work with poultry, handle compost, sort garbage or process cotton.

Employers and workers should be aware of the health effects of breathing organic dust and you should inform your doctor about recent dust exposure when seeking treatment for respiratory illness. When possible, you should use automated or mechanized equipment to move decayed materials and/or use local exhaust ventilation and wet methods of dust suppression to minimize exposure to organic dusts. When exposure to organic dust cannot be avoided, it can be prevented or minimized by using appropriate respirators approved by NIOSH.

Stephanie Stevens, MA, is a Health Communication Specialist in the NIOSH Office of the Director.

Sources:

National Institute for Occupational Safety and health. (1994). Request for Assistance in Preventing Organic Dust Toxic Syndrome.

Centers for Disease Control and Prevention. (1986). Acute Respiratory Illness Following Occupational Exposure to Wood Chips — Ohio. MMWR 35(30);483-4,489-90.

Von Essen SG, Andersen CI, Smith LM. Organic dust toxic syndrome: A noninfectious febrile illness after exposure to the hog barn environment. (2005). J Swine Health Prod 13(5):273-276.