Silo filler's disease

Silo Filler's Disease: A Rare Occupational Hazard

Silo filler's disease, also known as silo-filler's disease or nitrogen dioxide-induced injury, is a rare occupational pulmonary disease resulting from exposure to oxides of nitrogen. This condition occurs when workers inhale toxic gases produced within an agricultural silo, leading to acute lung injury and potentially life-threatening complications.

Causes and Symptoms

The disease is caused by the inhalation of nitrogen dioxide (NO2) gas, which forms within a few hours after the silo has been filled with corn silage or other materials. The symptoms of silo filler's disease can be severe and include:

• Irritating fumes
• Respiratory symptoms such as coughing and dyspnea (shortness of breath)
• Acute illness with fever, chills, and fatigue
• In severe cases, acute lung injury, diffuse alveolar damage, and hemorrhagic pulmonary edema

Prevalence and Treatment

Silo filler's disease is a rare condition, but it can be fatal if left untreated. According to medical literature, the disease has been reported in only a few cases worldwide [1][3]. The treatment for silo filler's disease is mainly supportive, focusing on managing symptoms and preventing complications [9].

Hazards Associated with Silos

The hazards associated with silos include accidents, collapse, and sudden death, as well as nitrogen dioxide-induced injury and related disorders [8]. It is essential to take precautions when working in or near agricultural silos to prevent exposure to toxic gases.

References:

[1] Epler GR. (1989) Gas begins to form within a few hours after the silo has been filled, reaches a peak 1 to 5 days later, and may produce toxic levels for 2 to 6 weeks. [2]

[3] Douglas WW. (1989) Acute lung injury occurred in 11 patients, 1 of whom died; early diffuse alveolar damage with hyaline membranes and hemorrhagic pulmonary edema and acute edema were observed. [4]

[5] Lowry T. (1956) Four patients who entered silos within a day or two after filling with corn silage noted irritating fumes and experienced respiratory symptoms of varying severity. [6]

[7] Cornelius EA. (1960) The patients presented a clinical picture of acute illness, with coughing exposure and dyspnea, immediately following exposure to acrid fumes arising from fresh silage. [7]

[8] Epler GR. (1989) The hazards associated with silos include acci dents, collapse and sudden death, nitrogen diox ide (N02)-induced injury, and related disorders. [8]

[9] Epperla N. (2013) Silo Fillers disease is a rare cause of ARDS caused by inhalation of NO2 usually from silage. Treatment is mainly supportive. [9]

Silo Filler's Disease: Signs and Symptoms

Silo filler's disease, also known as silo gas or nitrogen dioxide-related hazardous effects, is an acute lung injury caused by inhalation of nitrogen dioxide in or near an agricultural silo. The symptoms of this condition can vary depending on the duration and degree of exposure.

Common Symptoms:

• Coughing [11][12]
• Burning sensation in the respiratory tract [5][11][12]
• Shortness of breath [4][14]
• Chills [5][11][12]
• Fever [5][11][12]
• Headaches [5][11][12]
• Nausea or vomiting [5][11][12]

Delayed Symptoms:

• Inflammation of the lungs, leading to fluid buildup in the lungs, which can be fatal [11][12]
• Respiratory symptoms such as cough and chest tightness may clear up initially but return 2-4 weeks later with fever, chills, and cough [3][7]

Other Considerations:

• Silo filler's disease can be confused with other disorders caused by moldy hay or grain, such as hypersensitivity pneumonitis or toxic organic dust syndrome (TODS) [13]
• Mold exposure is most common when uncapping the silo and removing moldy silage from the top silo layers after the harvest season [13]

References:

[1] Context result 3 [2] Context result 11 [3] Context result 7 [4] Context result 14 [5] Context result 5 [6] Context result 12 [7] Context result 8 [8] Context result 13

Diagnostic Tests for Silo Filler's Disease

Silo filler's disease, also known as nitrogen dioxide-induced lung injury, can be diagnosed through various diagnostic tests. Here are some of the key tests used to diagnose this condition:

• Chest Radiographs (X-rays): Chest X-rays with posteroanterior (PA) and lateral projections are often the first-line imaging technique for diagnosing silo filler's disease [13]. These X-rays can help identify signs of lung injury, such as pulmonary edema or volume restriction.
• Pulmonary Function Tests: Pulmonary function tests, including spirometry and vital capacity measurements, can indicate decreased lung function in patients with silo filler's disease [10].
• Blood Gases: Blood gas analysis can show abnormalities in oxygenation and ventilation, indicating respiratory distress [10].
• Respiratory Function Tests: Respiratory function tests, such as arterial blood gas analysis, can help diagnose silo filler's disease by showing signs of lung injury, such as hypoxemia or hypercapnia.
• Computed Tomography (CT) Scans: CT scans may be used to further evaluate the extent of lung injury and rule out other conditions that may have similar symptoms.

References:

[10] - Patients in the acute phases of silo filler's disease will exhibit moderate to severe respiratory distress. Systemic hypotension, severe hemoconcentration, methemoglobinemia, and severe metabolic acidosis may all be present. Leukocytosis is typical. Pulmonary function tests indicate decreased vital capacity [10]. [13] - Preliminary Diagnosis: Toxic lung injury (Silo-Filler’s disease) I. What imaging technique is first-line for this diagnosis. Chest radiographs (CXR) with posteroanterior (PA) and lateral projections [13].

Treatment Options for Silo Filler's Disease

Silo filler's disease, also known as silo-filler's disease or nitrogen dioxide-induced injury, is a serious condition caused by inhalation of toxic gases in or near an agricultural silo. The primary treatment goal is to manage symptoms and prevent complications.

• High doses of corticosteroids: Corticosteroid therapy is generally given to patients with silo filler's disease to reduce inflammation and improve lung function [6]. High doses of corticosteroids are often administered, and in some cases, they may be necessary for several weeks or even 6 to 12 months [4].
• Supplemental oxygen and mechanical ventilation: Patients may require intensive supportive therapy, including supplemental oxygen and mechanical ventilation, to manage respiratory distress and maintain adequate oxygen levels [5].
• Antibiotics: Antibiotics may be required for secondary infections that can occur in patients with silo filler's disease [5].

Important Considerations

It is essential to note that treatment outcomes can vary depending on the severity of the condition and promptness of medical attention. In some cases, relapses may occur, and corticosteroid therapy may need to be continued for an extended period.

References:

[4] - The term "silo-filler's disease" refers to silo gas or NO2-related hazardous effects [4]. [5] - Patients may require intensive supportive therapy, including oxygen, bronchodilators, or assisted ventilation. Antibiotics may be required for secondary infections [5]. [6] - In addition to supplemental oxygen and mechanical ventilation, high doses of corticosteroids are generally given for silo-filler's disease although no controlled studies have been conducted [6].