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Tuesday, 15 February 2011 21:29

Biological Hazards

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“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

 

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