“A biological hazardous material can be defined as a biological material capable of self-replication that can cause harmful effects in other organisms, especially humans” (American Industrial Hygiene Association 1986).
Bacteria, viruses, fungi and protozoa are among the biological hazardous materials that can harm the cardiovascular system through contact that is intentional (introduction of technology-related biological materials) or unintentional (non-technology-related contamination of work materials). Endotoxins and mycotoxins may play a role in addition to the infectious potential of the micro-organism. They can themselves be a cause or contributing factor in a developing disease.
The cardiovascular system can either react as a complication of an infection with a localized organ participation—vasculitis (inflammation of the blood vessels), endocarditis (inflammation of the endocardium, primarily from bacteria, but also from fungus and protozoa; acute form can follow septic occurrence; subacute form with generalization of an infection), myocarditis (heart muscle inflammation, caused by bacteria, viruses and protozoa), pericarditis (pericardium inflammation, usually accompanies myocarditis), or pancarditis (simultaneous appearance of endocarditis, myocarditis and pericarditis)—or be drawn as a whole into a systemic general illness (sepsis, septic or toxic shock).
The participation of the heart can appear either during or after the actual infection. As pathomechanisms the direct germ colon- ization or toxic or allergic processes should be considered. In addition to type and virulence of the pathogen, the efficiency of the immune system plays a role in how the heart reacts to an infection. Germ-infected wounds can induce a myo- or endo- carditis with, for example, streptococci and staphylococci. This can affect virtually all occupational groups after a workplace accident.
Ninety per cent of all traced endocarditis cases can be attributed to strepto- or staphylococci, but only a small portion of these to accident-related infections.
Table 1 gives an overview of possible occupation-related infectious diseases that affect the cardiovascular system.
Table 1. Overview of possible occupation-related infectious diseases that affect the cardiovascular system
|
Disease |
Effect on heart |
Occurrence/frequency of effects on heart in case of disease |
Occupational risk groups |
|
AIDS/HIV |
Myocarditis, Endocarditis, Pericarditis |
42% (Blanc et al. 1990); opportunistic infections but also by the HIV virus itself as lymphocytic myocarditis (Beschorner et al. 1990) |
Personnel in health and welfare services |
|
Aspergillosis |
Endocarditis |
Rare; among those with suppressed immune system |
Farmers |
|
Brucellosis |
Endocarditis, Myocarditis |
Rare (Groß, Jahn and Schölmerich 1970; Schulz and Stobbe 1981) |
Workers in meatpacking and animal husbandry, farmers, veterinarians |
|
Chagas’ disease |
Myocarditis |
Varying data: 20% in Argentina (Acha and Szyfres 1980); 69% in Chile (Arribada et al. 1990); 67% (Higuchi et al. 1990); chronic Chagas’ disease always with myocarditis (Gross, Jahn and Schölmerich 1970) |
Business travelers to Central and South America |
|
Coxsackiessvirus |
Myocarditis, Pericarditis |
5% to 15% with Coxsackie-B virus (Reindell and Roskamm 1977) |
Personnel in health and welfare services, sewer workers |
|
Cytomegaly |
Myocarditis, Pericarditis |
Extremely rare, especially among those with suppressed immune system |
Personnel who work with children (especially small children), in dialysis and transplant departments |
|
Diphtheria |
Myocarditis, Endocarditis |
With localized diphtheria 10 to 20%, more common with progressive D. (Gross, Jahn and Schölmerich 1970), especially with toxic development |
Personnel who work with children and in health services |
|
Echinococcosis |
Myocarditis |
Rare (Riecker 1988) |
Forestry workers |
|
Epstein-Barr virus infections |
Myocarditis, Pericarditis |
Rare; especially among those with defective immune system |
Health and welfare personnel |
|
Erysipeloid |
Endocarditis |
Varying data from rare (Gross, Jahn and Schölmerich 1970; Riecker 1988) to 30% (Azofra et al. 1991) |
Workers in meatpacking, fish processing, fishers, veterinarians |
|
Filariasia |
Myocarditis |
Rare (Riecker 1988) |
Business travelers in endemic areas |
|
Typhus among other rickettsiosis (exclud- ing Q fever) |
Myocarditis, Vasculitis of small vasa |
Data varies, through direct pathogen, toxic or resistance-reduction during fever resolution |
Business travelers in endemic areas |
|
Early summer meningo-encephalitis |
Myocarditis |
Rare (Sundermann 1987) |
Forestry workers, gardeners |
|
Yellow fever |
Toxic damage to vasa (Gross, Jahn and Schölmerich 1970), Myocarditis |
Rare; with serious cases |
Business travelers in endemic areas |
|
Haemorrhagic fever (Ebola, Marburg, Lassa, Dengue, etc.) |
Myocarditis and endocardial bleedings through general hemorrhage, cardiovascular failure |
No information available |
Health service employees in affected areas and in special laboratories, and workers in animal husbandry |
|
Influenza |
Myocarditis, Hemorrhages |
Data varying from rare to often (Schulz and Stobbe 1981) |
Health service employees |
|
Hepatitis |
Myocarditis (Gross, Willensand Zeldis 1981; Schulzand Stobbe 1981) |
Rare (Schulz and Stobbe 1981) |
Health and welfare employees, sewage and waste-water workers |
|
Legionellosis |
Pericarditis, Myocarditis, Endocarditis |
If occurs, probably rare (Gross, Willens and Zeldis 1981) |
Maintenance personnel in air conditioning, humidifiers, whirlpools, nursing staff |
|
Leishmaniasis |
Myocarditis (Reindell and Roskamm 1977) |
With visceral leishmaniasis |
Business travelers to endemic areas |
|
Leptospirosis (icteric form) |
Myocarditis |
Toxic or direct pathogen infection (Schulz and Stobbe 1981) |
Sewage and waste-water workers, slaughterhouse workers |
|
Listerellosis |
Endocarditis |
Very rare (cutaneous listeriosis predominant as occupational disease) |
Farmers, veterinarians, meat-processing workers |
|
Lyme disease |
In stage 2: Myocarditis Pancarditis In stage 3: Chronic carditis |
8% (Mrowietz 1991) or 13% (Shadick et al. 1994) |
Forestry workers |
|
Malaria |
Myocarditis |
Relatively frequent with malaria tropica (Sundermann 1987); direct infection of capillaries |
Business travelers in endemic areas |
|
Measles |
Myocarditis, Pericarditis |
Rare |
Personnel in health service and who work with children |
|
Foot-and-mouth disease |
Myocarditis |
Very rare |
Farmers, animal husbandry workers, (especially with cloven- hoofed animals) |
|
Mumps |
Myocarditis |
Rare—under 0.2-0.4% (Hofmann 1993) |
Personnel in health service and who work with children |
|
Mycoplasma- pneumonia infections |
Myocarditis, Pericarditis |
Rare |
Health service and welfare employees |
|
Ornithosis/Psittacosis |
Myocarditis, Endocarditis |
Rare (Kaufmann and Potter 1986; Schulz and Stobbe 1981) |
Ornamental bird and poultry raisers, pet shop workers, veterinarians |
|
Paratyphus |
Interstitial myocarditis |
Especially among older and very sick as toxic damage |
Development aid workers in tropics and subtropics |
|
Poliomyelitis |
Myocarditis |
Common in serious cases in the first and second weeks |
Health service employees |
|
Q fever |
Myocarditis, Endocarditis, Pericarditis |
Possible to age 20 after acute disease (Behymer and Riemann 1989); data from rare (Schulz and Stobbe 1981; Sundermann 1987) to 7.2% (Conolly et al. 1990); more frequent (68%) among chronic Q-fever with weak immune system or pre-existing heart disease (Brouqui et al. 1993) |
Animal husbandry workers, veterinarians, farmers, possibly also slaughterhouse and dairy workers |
|
Rubella |
Myocarditis, Pericarditis |
Rare |
Health service and child care employees |
|
Relapsing fever |
Myocarditis |
No information available |
Business travelers and health service workers in tropics and subtropics |
|
Scarlet fever and other streptococcal infections |
Myocarditis, Endocarditis |
In 1 to 2.5% rheumatic fever as complication (Dökert 1981), then 30 to 80% carditis (Sundermann 1987); 43 to 91% (al-Eissa 1991) |
Personnel in health service and who work with children |
|
Sleeping sickness |
Myocarditis |
Rare |
Business travelers to Africa between 20° Southern and Northern parallels |
|
Toxoplasmosis |
Myocarditis |
Rare, especially among those with weak immune systems |
People with occupational contact with animals |
|
Tuberculosis |
Myocarditis, Pericarditis |
Myocarditis especially in conjunction with miliary tuberculosis, pericarditis with high tuberculosis prevalence to 25%, otherwise 7% (Sundermann 1987) |
Health service employees |
|
Typhus abdominalis |
Myocarditis |
Toxic; 8% (Bavdekar et al. 1991) |
Development aid workers, personnel in microbiological laboratories (especially stool labs) |
|
Chicken pox, Herpes zoster |
Myocarditis |
Rare |
Employees in health service and who work with children |