Metal fume fever

• Published in: The Lancet (British edition) 2013-06, Vol.381 (9885), p.2298-2298
• Main Authors: Malaguarnera, Michele, PhD, Drago, Filippo, Prof, Malaguarnera, Giulia, PhD, Volti, Giovanni Li, MD, Salomone, Salvatore, MD, Caraci, Filippo, MD, Galvano, Fabio, PhD, Vacante, Marco, PhD, Bucolo, Claudio, MD, Malaguarnera, Mariano, MD
• Format: Article
• Language: English
• Subjects: Adult; Arsenic; Biological and medical sciences; Bisphosphonates; Bone density; Bone mineral density; Boron; Cadmium; Cadmium Poisoning - diagnosis; Cadmium Poisoning - etiology; Chemical and industrial products toxicology. Toxic occupational diseases; Chromium; Environmental stress; Fever; Fever - chemically induced; Fever - diagnosis; Fumes; General aspects; Heat shock proteins; Humans; Immune system; Inhalation; Inorganic dusts (pneumoconiosises) and organic dusts (byssinosis etc.); Internal Medicine; Magnesium; Male; Manganese; Medical sciences; Metals; Nickel; Occupational Diseases - chemically induced; Occupational exposure; Older people; Osteoporosis; Toxic substances; Toxicology; Toxins; Vitamin D; Welding
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)60689-3

Cadmium is a metal with high toxic effects, which accumulates in the body, such that 24 h urinary excretion is a biomarker of lifetime exposure.1 Workers in the non-ferrous industry are exposed to high amounts of cadmium, mainly through inhalation of contaminated dust or fumes, and frequently in the presence of other toxic substances.1 As do many toxins, cadmium may induce renal damage; osteoporosis and osteomalacia in people with Itai-Itai disease in Japan were a result of both direct effect of cadmium on bone and indirect effects via the kidney.2 Epidemiological studies provide repeated demonstrations of heightened cadmium exposure correlating with decreased bone mineral density and increased osteoporosis and osteomalacia.1 Diagnosis of metal fume fever is based on exposure to metal fumes within the last 48 h and development of influenza-like symptoms with resolution within 24-48 h. Clinical diagnosis based on a combination of symptoms, metal exposure, exposure time, and resolution increases the likelihood of a diagnosis of metal fume fever.3 Although exposure to cadmium oxide fumes is the most frequent and best characterised cause of metal fume fever, other metal oxides such as arsenic, boron, zinc, chromium, copper, magnesium, manganese, nickel, and titanium are also suggested causes.2 The pathogenesis of fever is unknown. Heat shock proteins are cellular chaperone proteins, which can be induced by hyperthermia and several environmental stresses; after cadmium exposure, overexpression of the genes encoding heat shock proteins has been noted in the cytosol of prokaryotic and eukaryotic cells.4 Symptomatic care for metal fume fever includes bed rest and antipyretics; treatment for osteoporosis includes calcium, bisphosphonates, vitamin D, and parathyroid hormone.