Journal Article

Notes from the Field: Fatal Anthrax Pneumonia in Welders and Other Metalworkers Caused by Bacillus cereus Group Bacteria Containing Anthrax Toxin Genes — U.S. Gulf Coast States, 1994–2020

Balsamo, Gary A., Schrodt, Caroline A., Hendricks, Kate, Bower, William A., Negrón, María E., Hoffmaster, Alex R., Marston, Chung K., Dawson, Patrick, Gulvik, Christopher A., O’Sullivan, Briana, Traxler, Rita M., Kolton, Cari B., Feldmann, Karl, Long, Stephen, Gee, Jay E., Byers, Paul, Zaheer, Saad, McQuiston, John R., Antonini, James M., de Perio, Marie A., Sokol, Theresa, Salzer, Johanna S., Taylor, Kathryn, Weiner, Zachary

2021

Overview

Long-term exposure to welding and metalworking fumes is associated with various forms of lung injury that can cause changes in lung function and increase susceptibility to pulmonary infections, including fatal pneumonia.§ An investigation by CDC at one patient’s worksite in Louisiana (patient F) identified a bacterial isolate in a soil sample that genetically matched a clinical isolate from the patient. Several actions can decrease risk for lung injury or infection, including anthrax pneumonia caused by B. cereus group bacteria, among welders and other metalworkers. Because of the association between welding or metalworking and pulmonary infections or injury, it is important that employers educate workers regarding hazards associated with welding and measures they can take to minimize potential exposures. [...]employers should conduct a hazard assessment at worksites and consider the use of National Institute for Occupational Safety and Health–approved respirators as part of a written respiratory protection program.¶,** Clinicians should consider B. cereus group bacteria in the differential diagnosis when treating welders and other metalworkers with severe, rapidly progressive pneumonia or other anthrax-like disease.†† B. cereus group bacteria identified on culture are not always contaminants; when B. cereus with anthrax toxin is suspected, laboratorians and clinicians should pursue additional testing through their state Laboratory Response Network laboratory.§§ Regional health departments and the Laboratory Response Network serve pivotal roles in pathogen detection and procuring anthrax antitoxin for confirmed cases.

• Publisher: U.S. Center for Disease Control,Centers for Disease Control and Prevention
• Subject: Anthrax / Antitoxins / Bacteria / Bacterial diseases / Contaminants / Differential diagnosis / Employers / Fumes / Genomes / Hazard assessment / Infections / Injuries / Lungs / Medical laboratories / Metal workers / Metal working / Notes from the Field / Occupational exposure / Occupational safety / Pathogens / Patients / Pneumonia / Protective equipment / Respirators / Respiratory function / Soil contamination / Toxins / Welding / Welding machines