Metal fume fever (MFF) has been recognized in the past few centuries as an important occupational disorder in the brass and welding industries (particularly in galvanized steel production), and between 1,500-2,000 workers suffer from this condition in the United States on an annual basis [1] [2] [3] [4]. Inhalation of zinc oxide (ZnO), the principal causative agent of MFF, but also iron and copper oxide in the work setting is considered to be toxic and results in the production of various symptoms [1] [4] [5] [6]. The clinical presentation is distinguished by the onset of a dry cough, dyspnea, fever, chills, headaches, myalgias, fatigue, malaise, and arthralgias within 3-12 hours after exposure to metal-containing fumes [1] [2] [3] [5]. In addition, a metallic taste in the mouth, a dry throat, and excessive salivation have been reported as potential symptoms as well [3] [6]. Complaints usually resolve after 24 hours, but they can persist throughout the initial week and completely disappear by the beginning of the next week [1] [5] [6]. The marked improvement of symptoms over the weekend, when workers are removed from the source of exposure, is often referred to as tachyphylaxis, which is not uncommon for metal fume fever [1] [2] [3] [5]. The condition is self-limiting and rarely poses a significant risk for the patient, but reports have documented the development of pericarditis, pneumonitis and even aseptic meningitis in individuals who were exposed to very high amounts of metal fumes [1] [2] [3]. Furthermore, studies have implicated a potential link between occupational asthma and metal fume fever, with further research needed to confirm these claims [2].

• Fever

  From Wikidata Jump to navigation Jump to search illness caused by exposure to metal oxide fumes when heating e.g. zinc or aluminum. brass founders' ague metal dust fever zinc shakes edit Language Label Description Also known as English metal fume fever [wikidata.org]

  The primary treatment for both metal fume fever and polymer fume fever is supportive and directed at symptom relief. [doi.org]

  Metal fume fever is also known as Monday morning fever where symptom bouts typically appear most severe at the beginning of the work week. [memicsafety.typepad.com]

  It includes brassfounder's fever (brass chill, brazier's chill) and spelter's fever (zinc chill, zinc fume fever). heavy metal one with a high specific gravity, usually defined to be above 5.0. heavy metal poisoning poisoning with any of the heavy metals [medical-dictionary.thefreedictionary.com]

• Chills

  Also called brass founder's ague, zinc chill. [medical-dictionary.thefreedictionary.com]

  The affected individual characteristically experiences the rapid onset of intense shaking chills, fever, and body aches a few hours after exposure, and symptoms dissipate spontaneously. [ncbi.nlm.nih.gov]

• Fatigue

  He was referred to the emergency department of our hospital with low-grade fever, dyspnea, headache, fatigue and myalgia. [ncbi.nlm.nih.gov]

  Abstract A 50-year-old man with a 30-year occupational history of welding presented with low-grade fever, fatigue and persistent dry cough. [doi.org]

  They include fever (rarely exceeding 102° F), chills, nausea, dryness of the throat, couch, fatigue, and general weakness and aching of the head and body. [sentryair.com]

• Malaise

  Symptoms include fever, chills, cough, dyspnea, headache, myalgia, and malaise. [ncbi.nlm.nih.gov]

  He complained of malaise, nausea, vomiting, and cough. He had no previous medical history. Examination and investigation were unremarkable. [doi.org]

• Exposure to Metal Fumes

  The diagnosis of metal fume fever is primarily based on the history of exposure to metal fumes and the occurring of symptoms shortly afterwards. [ntvg.nl]

  Key points Metal fume fever is generally a benign flu-like illness following exposure to metal fume. Severe symptoms may occur if there is poor exposure control. [doi.org]

  Copper Fume Metal fume Metal fume fever Public Health, Environmental and Occupational Health Cite this Apa Standard Harvard Vancouver BIBTEX RIS @article{ee339b9459e6404ab1a9f4585cb9056c, title = "Copper exposure and metal fume fever: Lack of evidence [utah.pure.elsevier.com]

  Metal fume fever is considered to be a reversible symptom after exposure; however, increasing clinical evidence has found that exposure to metal fumes results in adverse health effects 5, 6. [nature.com]

  fume fever is a potentially fatal form of hazardous materials exposure where people inhale toxic fumes from heated metals. [wisegeek.com]

• Cough

  The MFF is characterized by fever, cough, sputing, wheezing, chest tightness, fatique, chills, fever, myalgias, cough, dyspnea, leukocytosis with a left shift, thirst, metallic taste, and salivations. [ncbi.nlm.nih.gov]

  Clinical findings Several hours after exposure, cough, dry throat, tightness in chest, chills and fever, then sweating, weakness, nausea, myalgia, upper respiratory tract irritation, leukocytosis. [medical-dictionary.thefreedictionary.com]

  He complained of malaise, nausea, vomiting, and cough. He had no previous medical history. Examination and investigation were unremarkable. [doi.org]

• Dyspnea

  He was referred to the emergency department of our hospital with low-grade fever, dyspnea, headache, fatigue and myalgia. [ncbi.nlm.nih.gov]

• Dry Cough

  Abstract A 50-year-old man with a 30-year occupational history of welding presented with low-grade fever, fatigue and persistent dry cough. [doi.org]

  Possible MFF (at least one of fever, feelings of flu, general malaise, chills, dry cough, metallic taste, or shortness of breath) was reported by 39.2% of apprentices. [ncbi.nlm.nih.gov]

  Jeff (email: [email protected]) Don't panic, here's a fact sheet: Symptoms: flu-like illness with a metallic taste in the mouth, throat irritation, and dry cough; Signs: leucocytosis (high white blood cell count) is common; normal chest x-ray [abymc.com]

  The clinical presentation is distinguished by the onset of a dry cough, dyspnea, fever, chills, headaches, myalgias, fatigue, malaise, and arthralgias within 3-12 hours after exposure to metal-containing fumes. [symptoma.com]

• Respiratory Distress

  Although nickel compounds are particularly pernicious among the transition metals and more toxic than zinc compounds, nickel fume inhalation rarely induces lethal acute respiratory distress syndrome. [doi.org]

  Respiratory symptoms associated with inhalation to mercury vapors include coughing, breathlessness (dyspnea), tightness or burning pain in the chest, and/or respiratory distress. [rarediseases.org]

• Rales

  Clinical signs were limited to wheezing or rales in eight patients. Leukocytosis and an increase in band cell forms were noted in 21 and 20 of 24 workers, respectively. The median time interval between exposure and onset of symptoms was five hours. [ncbi.nlm.nih.gov]

• Nausea

  Clinical findings Several hours after exposure, cough, dry throat, tightness in chest, chills and fever, then sweating, weakness, nausea, myalgia, upper respiratory tract irritation, leukocytosis. [medical-dictionary.thefreedictionary.com]

  Fourteen students and staff complained of nausea, dyspnea, or respiratory irritation immediately after inhaling the gas. On arrival at Saint Luke's International Hospital, more than half of the patients presented with low-grade fever. [ncbi.nlm.nih.gov]

  Symptoms of this condition include headache, fever, chills, muscle aches, nausea, vomiting, joint pain, and lethargy. Elevated exposure to zinc oxide fumes can also cause a sweet or metallic taste in the mouth along with a dry, irritating cough. [memicsafety.typepad.com]

  He complained of malaise, nausea, vomiting, and cough. He had no previous medical history. Examination and investigation were unremarkable. [doi.org]

• Metallic Taste

  The MFF is characterized by fever, cough, sputing, wheezing, chest tightness, fatique, chills, fever, myalgias, cough, dyspnea, leukocytosis with a left shift, thirst, metallic taste, and salivations. [ncbi.nlm.nih.gov]

  Patients also frequently complain of a sweet or metallic taste in the mouth, irritated or dry throat, and chest pain. flu-like illness with a metallic taste in the mouth, leucocytosis (high white blood cell count) throat irritation, and dry cough; [online-vitamins-guide.com]

  Elevated exposure to zinc oxide fumes can also cause a sweet or metallic taste in the mouth along with a dry, irritating cough. [memicsafety.typepad.com]

  taste, and shortness of breath. [doi.org]

• Chest Pain

  It felt like a Mack truck was parked on my chest. Milk helped a lot. Hot flashes, cold flashes, sweats, chills, terrible chest pains and stomach pains. And for quite a while after, it tasted like I had a mouth full of pennies. -- Chipmaker ICK! [abymc.com]

  Forty-five minutes later, he developed flu-like symptoms, shivering, muscle stiffness, dizziness, central chest pain and a metallic taste. [doi.org]

  Patients also frequently complain of a sweet or metallic taste in the mouth, irritated or dry throat, and chest pain. flu-like illness with a metallic taste in the mouth, leucocytosis (high white blood cell count) throat irritation, and dry cough; [online-vitamins-guide.com]

  Some patients report a metallic taste in their mouths, chest pain, changes in urinary output, and an unusually high white blood cell count. A blood test can reveal abnormally high concentrations of metals in the blood. [wisegeek.com]

  They include fever, chills, nausea, headache, fatigue, muscle aches, joint pains, lack of appetite, shortness of breath, pneumonia, chest pain, change in blood pressure, and coughing. [en.wikipedia.org]

• Tachycardia

  By 18 h, he was apyrexial with residual mild tachycardia, right basal crepitations, right basal shadowing on chest X-ray and a leucocytosis of 13 000 white blood cells/μl. Electrocardiogram, Doppler and computed tomography brain scan were normal. [doi.org]

  In some cases, affected individuals may exhibit increased salivation; yellowing of the teeth; an unusually rapid heart beat (tachycardia); low levels of iron within the red blood cells (anemia); bluish discoloration (cyanosis) of the skin and mucous membranes [rarediseases.org]

• Skin Disease

  And it doesn’t even begin to stop there; additional health issues that research has found to relate to welding include skin diseases, heart disease, loss of hearing, chronic gastritis and gastoduodentitis (which causes the stomach to become inflamed), [forsteramerica.com]

  Other health problems that appear to be related to welding include heart disease; skin diseases; hearing loss; chronic gastritis (stomach inflammation); gastroduodenitis (stomach and small intestine inflammation); and stomach and small intestine ulcers [thefabricator.com]

• Arthralgia

  The clinical presentation is distinguished by the onset of a dry cough, dyspnea, fever, chills, headaches, myalgias, fatigue, malaise, and arthralgias within 3-12 hours after exposure to metal-containing fumes. [symptoma.com]

  He also complained of myalgia, arthralgia, feverish sensation, thirst, and general weakness. Symptoms worsened after repeated copper welding on the next day and subsided gradually following two weeks. [jpmph.org]

  Fever Chills Nausea Fatigue Muscle Ache Joint Pain Thirst “The initial symptoms include a sweet metallic taste associated with throat irritation, dyspnea [shortness of breath] and thirst followed by chills, a low-grade fever, myalgia [muscle pain], arthralgias [sentryair.com]

  VPIC diagnostic criteria for metal fume fever History of exposure to metal fumes within previous 48 hours AND Febrile illness OR respiratory symptoms PLUS at least one symptoms of: malaise myalgias arthralgias headache nausea AND Other illnesses less [racgp.org.au]

• Headache

  He was referred to the emergency department of our hospital with low-grade fever, dyspnea, headache, fatigue and myalgia. [ncbi.nlm.nih.gov]

  Symptoms of this condition include headache, fever, chills, muscle aches, nausea, vomiting, joint pain, and lethargy. Elevated exposure to zinc oxide fumes can also cause a sweet or metallic taste in the mouth along with a dry, irritating cough. [memicsafety.typepad.com]

  Treatment of mild metal fume fever consists of bedrest, keeping the patient well hydrated, and symptomatic therapy (e.g. aspirin for headaches) as indicated. [en.wikipedia.org]

• Tremor

  The symptom most frequently associated with the disease is tremors, although 25 percent of patients report little to no tremors. Some patients report impaired reflexes, gait disturbances, and the loss of balance. [thefabricator.com]

  Long term exposure to mercury fumes is known to cause tremors, emotional problems, and hearing and vision loss. [atlenv.com]

  Overexposure to tin may damage the nervous system and cause psychomotor disturbances including tremor, convulsions, hallucinations, and psychotic behavior. [rarediseases.org]

  Long-term exposure may produce tremors, emotional instability, and hearing damage. Manganese Fume From welding processes involving high-tensile strength steel. Acute: Irritation of lungs and difficulty breathing. [sigmaaldrich.com]

• Encephalopathy

  Diabetes, hypopigmentation/ hyperkeratosis, cancer: lung, bladder, skin, encephalopathy 24-h urine: ≥50 µg/L urine, or 100 µg/g creatinine BAL (acute, symptomatic) Succimer DMPS (Europe) Bismuth Renal failure; acute tubular necrosis Diffuse myoclonic [emedicine.medscape.com]

  Overexposure to aluminum may cause brain damage (encephalopathy). [rarediseases.org]

  Common short-term effects range from eye, nose, ear, throat and chest irritations to coughing and shortness of breath, bronchitis, pneumonitis (the inflammation of the lungs), encephalopathy (a syndrome that results in brain dysfunction) and nausea. [forsteramerica.com]

• Insomnia

  Symptoms associated with mad hatter syndrome include memory loss, excessive shyness, abnormal excitability, and/or insomnia. This syndrome was described in workers with occupational exposure to mercury in the felt-hat industry. [rarediseases.org]

Recognition of metal fume fever may significantly improve the quality of the patient's life and a comprehensive workup is necessary in order to make the diagnosis. A detailed patient history is perhaps the single most important component of the workup, as identification of the patient's occupancy, exact job description, and confirmation regarding the substances and risks the patient is exposed to is vital in raising clinical suspicion toward MFF [1] [3] [6]. Furthermore, the rapid onset and resolution of symptoms can point to an occupational disease. A complete physical examination that will document all typical signs and symptoms should follow, after which several laboratory studies may be performed. As many patients will have a high leukocyte count and an elevated erythrocyte sedimentation rate (ESR), a complete blood count (CBC) and evaluation of serum inflammatory markers are recommended tests [1] [2] [5]. In addition, serum and urine levels of zinc are often elevated [1]. If an occupational etiology is suspected in patients with constitutional symptoms, plain radiography of the chest is mandatory, and normal findings are observed in most cases, but a diffuse patchy infiltration is seen in severe cases [5]. Because direct tests to confirm MFF do not exist, the physician must gather all the necessary information through history taking, physical examination and laboratory studies and make the diagnosis based on his/her clinical judgment [1] [6].

• Pulmonary Infiltrate

  Pulmonary infiltrates and hypoxemia are not consistent with pure metal fume fever. [accessmedicine.mhmedical.com]

• X-Ray Abnormal

  Chest X-ray abnormalities may also be present.An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [en.wikipedia.org]

  Chest X-ray abnormalities may also be present. [10] An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [everything.explained.today]

• Chest X-Ray Abnormal

  Chest X-ray abnormalities may also be present.An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [en.wikipedia.org]

  Chest X-ray abnormalities may also be present. [10] An interesting feature of metal fume fever involves rapid adaptation to the development of the syndrome following repeated metal oxide exposure. [everything.explained.today]

Treatment. The primary treatment for both metal fume fever and polymer fume fever is supportive and directed at symptom relief. [doi.org]

The treatment of MFF is entirely symptomatic, no specific treatment is indicated for MFF. The mainstay of management of MFF is prevention of sub-sequent exposure to harmful metals. [ncbi.nlm.nih.gov]

Fresh air and treatment of symptoms usually alleviate the conditions. [medical-dictionary.thefreedictionary.com]

Prognosis. Metal fume fever is typically a benign and self-limited disease entity that resolves over 12–48 h following cessation of exposure. Conclusions. [doi.org]

PROGNOSIS: Metal fume fever is typically a benign and self-limited disease entity that resolves over 12-48 h following cessation of exposure. [ncbi.nlm.nih.gov]

Prognosis The symptoms of metal fume fever are usually self-limiting, and dissipate rapidly upon removal from the source of metal fumes. [everything2.com]

Its etiology is uncertain, and its diagnosis is difficult because symptoms resemble a number of pulmonary illnesses. Supportive treatment, with bed rest, analgesics, and fever control is used for symptomatic relief. [ncbi.nlm.nih.gov]

If an occupational etiology is suspected in patients with constitutional symptoms, plain radiography of the chest is mandatory, and normal findings are observed in most cases, but a diffuse patchy infiltration is seen in severe cases. [symptoma.com]

Mill fever Symptoms: flu-like illness with rhinitis; Signs: leucocytosis; normal chest x-ray; Onset after exposure; 1-6 hours; Heavy exposure to: dusts of cotton, flax, soft hemp, or kapok; Resolution: few hours to few days; Comments: A common etiology [haz-map.com]

Epidemiology. Metal fume fever occurs most commonly as an occupational disease in individuals who perform welding and other metal-joining activities for a living. [doi.org]

This review is followed by a description of MFF cases reported by the Louisiana Poison Control Center to the Louisiana Office of Public Health's Section of Environmental Epidemiology and Toxicology during a two-year period. [ncbi.nlm.nih.gov]

Subjects: Public Health and Epidemiology. See all related items in Oxford Index » Users without a subscription are not able to see the full content. Please, subscribe or login to access all content. [oxfordindex.oup.com]

Initial manifestations of the two forms are similar but their pathophysiologies and managements are different. Mild MFF patients recover within 48 hours and rarely require hospitalization. [ncbi.nlm.nih.gov]

Cadmium also injures the renal tubules resulting in acute renal dysfunction. 1 Preventative strategies for MFF are aimed at reducing fume exposure concentrations. 7 “Toxic” levels have not been established. [doi.org]

Despite preventative strategies sporadic cases are likely to continue to present to emergency departments. [ncbi.nlm.nih.gov]

1. Wardhana, Datau EA. Metal fume fever among galvanized welders. Acta Med Indones. 2014;46(3):256-262.
2. El-Zein M, Infante-Rivard C, Malo J, Gautrin D. Is metal fume fever a determinant of welding related respiratory symptoms and/or increased bronchial responsiveness? A longitudinal study. Occup Environ Med. 2005;62(10):688-694.
3. Hassaballa HA, Lateef OB, Bell J, Kim E, Casey L. Metal fume fever presenting as aseptic meningitis with pericarditis, pleuritis and pneumonitis. Occup Med (Lond). 2005;55(8):638-641.
4. Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson J, Loscalzo J. eds. Harrison's Principles of Internal Medicine, 19e. New York, NY: McGraw-Hill; 2016.
5. Greenberg MI, Vearrier D. Metal fume fever and polymer fume fever. Clin Toxicol (Phila). 2015;53(4):195-203.
6. Kaye P, Young H, O’Sullivan I. Metal fume fever: a case report and review of the literature. Emerg Med J. 2002;19(3):268-269.