Metal Fume Fever - Diagnosis

Diagnosis

Diagnosis primarily depends upon a good occupational history. Diagnosis of metal fume fever can be easily missed, as the complaints are non-specific, resemble a number of other common illnesses, and presentation occurs typically 1-2 days after the exposure. When respiratory symptoms are prominent, metal fume fever may be confused with acute bronchitis or pneumonia. The diagnosis is based primarily upon a history of exposure to metal oxide fumes. Cain and Fletcher (2010) report a case of metal fume fever that was diagnosed only by taking a full occupational history and by close collaboration between primary and secondary health care personnel.

Physical examination findings vary among persons exposed, depending largely upon the stage in the course of the syndrome during which examination occurs. Patients may present with wheezing or crackles in the lungs. They typically have an increased white blood cell count, and urine, blood plasma and skin zinc levels may (unsurprisingly) be elevated. Chest X-ray findings 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. Workers with a history of recurrent metal fume fever often develop a tolerance to the fumes. This tolerance, however, is transient, and only persists through the work week. After a weekend hiatus, the tolerance has usually disappeared. This phenomenon of tolerance is what led to the name "Monday Fever".

In 2006, there were approximately 700 metal fume exposures reported to United States Poison control center. The American Welding Society estimated that 2500 employees in the steel industry develop metal fume fever in the US each year since the majority of the cases are not reported.