Robert R. Jacobs*

Common names for disease: Cotton dust—byssinosis and brown lung. Additionally, an active febrile response to endotoxin has been given many names depending on the source of exposure such as mattress maker’s fever, mill fever, and card room fever.


Agricultural workers and processors of vegetable fibers are most likely to be at risk. Workplaces with potentially high airborne concentrations of endotoxins include cotton and flax mills, grain storage and handling operations, poultry houses and processing plants, saw and paper mills, sewage treatment plants, and swine confinement buildings. Workers may also be exposed during animal handling in various facilities or during composting operations. Contamination of cutting fluids used in machining operations, workplace humidifying systems, or biotechnology processes using Gram-negative bacteria can also result in significant exposure.


Occupational exposures are predominantly by inhalation. Significant exposure can occur wherever aerosols of materials contaminated with Gram-negative bacteria are generated, including office buildings and residential structures. There is no evidence to support a dermal route of exposure for endotoxins.


Endotoxin refers to the lipopolysaccharide (LPS) complex and associated proteins found in the outer layer of the cell wall of Gram-negative bacteria. Although the lipid component (lipid A) is responsible for most ...

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