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

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

  Metal fume fever, also known as brass founders' ague, brass shakes, zinc shakes, galvie flu, metal dust fever, Welding Shivers, or Monday morning fever, is an illness primarily caused by exposure to chemicals such as zinc oxide (ZnO), aluminium oxide [en.wikipedia.org]

  After 24 hrs of symptomatic treatment (oxygen therapy and acetaminophen), the fever was subsided and the patient discharged home in a good clinical condition. The presented symptoms could be interpreted as a form of metal fume fever. [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]

  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]

  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]

• Malaise

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

  Metal fume fever Metal fume fever includes a variety of symptoms like general feeling of ill health (malaise), chills, and fever. Individuals affected may have excessive thirst and a metallic taste in their mouth. [imedpub.com]

  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]

  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]

  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]

  Risks were highest for recent exposure to ferrous metal fume with lobar pneumonia as the outcome 16. The health effects of welding have recently been reviewed 17. The mechanism by which metal fume promotes pneumonia remains unclear. [erj.ersjournals.com]

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

• Metal Worker

  Metal fume fever is an ancient occupational disease still encountered among metal workers. The delay between exposure and onset of non-specific symptoms makes this an elusive diagnosis. [ncbi.nlm.nih.gov]

  Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitizers. [hse.gov.uk]

  Protective clothing should be worn by workers welding, cutting or brazing. [ehs.ua.edu]

• 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]

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

  Symptoms of Metal Fume Fever MFF is a self-limited illness characterized by fever, chills, cough, dyspnea, headache, myalgias, and malaise, most commonly occurring within 4-12 hours of exposure to zinc, copper, or iron oxide fumes. [online-vitamins-guide.com]

• 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]

  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]

  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]

• 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]

  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]

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

• Metallic Taste

  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]

  Metal fume fever Metal fume fever includes a variety of symptoms like general feeling of ill health (malaise), chills, and fever. Individuals affected may have excessive thirst and a metallic taste in their mouth. [imedpub.com]

  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]

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

• Chest Pain

  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]

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

  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]

  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]

• 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]

• 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]

• Painful Muscle Cramps

  Other symptoms include joint pain, muscle cramp, fatigue, malaise, headache, vomiting and a metallic taste [ 4 ]. Clinical signs are often minimal but may include pulmonary rhonchi and/or crepitations. [doi.org]

• Headache

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

  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]

  Treatment Treatment of metal fume fever consists of bedrest, and symptomatic therapy (e.g. aspirin for headaches) as indicated. [everything2.com]

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]

State Medical Society describes the following as treatment of metal fume fever: “Treatment of mild MFF consists of bed rest and symptomatic therapy (eg, analgesics, oxygen therapy, and antipyretics) as indicated. [sentryair.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]

PATHOPHYSIOLOGY: While the precise pathophysiology associated with the development of metal fume fever is yet to be elucidated, suggested pathophysiologic mechanisms include pro-inflammatory cytokine release, neutrophil activation, and oxygen radical [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]

It does not prevent you getting metal fume fever." [en.wikipedia.org]

Workplace safety and education is key to prevention of metal fume fever. Medical profession education may help prevent occurrences of metal fume fever at home, at school and in the workplace. [ncbi.nlm.nih.gov]

It is desirable to prevent exposure to such fume altogether by the use of efficient fume extraction. Any surface coatings on steel must be identified before welding or cutting. [slideshare.net]

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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.