is a group of immunologically mediated lung ailments associated with repeated exposures to smalldiameter biological aerosols that affect alveoli (site of gas exchange). Classic symptoms occur after immunological sensitization is induced. They may include fever
chills
nonproductive cough
shortness of breath
myalgia (ache all over)
and malaise. Onset occurs within hours of exposure
with spontaneous recovery in 18 to 24 h. In office and industrial environments
symptoms diminish as the workweek progresses and increase in severity at the beginning of a new week. Chronic exposures cause irreversible lung tissue damage
progressive shortness of breath
cough
malaise
weakness
and weight loss. Outbreaks of hypersensitivity pneumonitis in buildings have been associated with contaminated components of heating
ventilating
and air-conditioning (HVAC) systems (including condensate drip pans and ductwork) and a variety of moldinfested materials. Hypersensitivity pneumonitis appears to be caused by exposures to very high air concentrations of bacteria (particularly Actinomycetes) or smalldiameter mold spores (e.g.
those of Penicillium and Aspergillus). Humidifier fever is a respiratory ailment not easily distinguished from hypersensitivity pneumonitis. Clinical manifestations include fever
chest tightness
increased respiratory rate
airway hyperreactivity
and bronchitis. Symptoms are produced as a result of inflammatory responses of lung tissue on exposure to bacterial endotoxins. Gram-negative bacterial contamination of cool-mist humidifiers (commonly used in European office buildings) in mechanically ventilated buildings is believed to be the cause of humidifier fever. 11.3.6.1.4 Infectious Diseases A number of infectious diseases are transmitted in building environments as a result of inhalation exposures. These include viral diseases such as colds and influenza
bacterial diseases such as TB and Legionnairesâ disease
and fungal diseases such as aspergillosis. Of major IAQ concern are TB and Legionnairesâ disease. Until the early 20th century
TB was one of the major causes of death in the U.S. and many other countries. As a result of advances in diagnosis
prevention
and treatment
the prevalence of TB dramatically declined. It has experienced a small resurgence as a result of an influx of immigrants from countries where it is endemic
increases in susceptible populations (e.g.
those immunocompromised)
and development of antibiotic resistance by the causal bacterium. Recent outbreaks of TB have occurred in hospitals
nursing homes
homeless shelters
correctional facilities
and residential AIDS care centers. The risk of exposure and subsequent infection among health care workers may be high in health care facilities treating patients with undiagnosed TB. Legionnairesâ disease has been reported in a number of indoor environments. The disease syndrome is characterized by cough
fever
shortness of breath
chest pain
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