Bagassosis

What is Bagassosis?

Bagassosis is a type of lung disease caused by hypersensitivity or allergic reactions. This illness is similar to other allergic lung conditions like farmer’s lung. It occurs when someone breathes in bagasse, a fibrous leftover from extracting sugar from sugarcane. Though it used to be considered waste, bagasse is now used in production of various products including building materials, biofuel, pulp, paper, furniture, bricks, ships, automobiles, and fertilizers.

The disease was first identified by two doctors named Jamison and Hopkins in 1941 at a hard-board factory in New Orleans, USA. After that, it was reported in different US states mainly in the south, and countries like Italy, India, and the Philippines. The term ‘bagassosis’ was coined by Castleden and Hamilton-Paterson in 1942 when studying four factory workers in London.

In earlier days, bagasse was processed by hand, which was quite slow. But the technological advancements in the 1950s and ’60s led to machine processing, which resulted in dusty conditions. It was soon after these machines were introduced that the first cases of bagassosis showed up, especially among those who were close to the machines like the workers running the machines and the engineers overseeing them. Interestingly, workers dealing with the end products were not affected.

What Causes Bagassosis?

Bagassosis is a disease that you can catch by breathing in fibrous cane-sugar waste, known as bagasse. This material is typically made up of around 4% ash and 2% protein, with the rest being cellulose and a mix of other plant carbohydrates. The ash in bagasse is about half silica.

Bagassosis happens when you inhale bagasse, but it’s not exactly clear how it causes the disease. This is because there might be several factors at play. Some people think it could be the irritating nature of bagasse itself, others think it may be due to microbes present in the dust, the silica in the bagasse, an allergic reaction, or a combination of these factors. The disease is most common in people who regularly come into contact with bagasse, like sugar factory workers. For example, a study found that 11 out of 21 bagasse-shredding workers got the disease over a period of 15 months.

Aerobacter cloacae is a type of microbe that could potentially cause bagassosis. However, two other microbes known as T. sacchari and T. vulgaris are believed to play a big part in causing the disease.

Risk Factors and Frequency for Bagassosis

Bagassosis is a relatively rare disease that was first identified in 1941. While this condition remains uncommon, we don’t currently have much detail on how widespread it is or the typical age or gender of those affected. Many of the earliest reported cases were noted in the southern United States, particularly in Louisiana, and a few cases were recorded in Europe and Asia.

• One example is four cases that were reported from a factory in London in 1942.
• By 1958, nearly 60 cases of bagassosis had been documented worldwide.
• The perception of the disease changed in 1960 when 69 cases appeared among 140 paper-mill workers in Puerto Rico, leading to the recognition that bagassosis was not as rare as previously believed.

According to recent studies conducted in India, it has been discovered that certain types of bacteria, specifically Thermoactinomyces sacchari and Saccharopolyspora rectivirgula, present in cane sugar mills contribute to the development of bagassosis among Indian workers. Unlike the situation in India, a study conducted in Australia in 2010 found no clear evidence that workers in the sugar industry there were developing chronic bagassosis, suggesting that this condition is not prevalent among Australian bagasse workers.

Signs and Symptoms of Bagassosis

Bagassosis is a disease usually caused by exposure to large amounts of bagasse dust. This disease can start abruptly or develop slowly. In some cases, the symptoms appear around four months to 12 years after being exposed to the dust. Typical symptoms include intensive shortness of breath, cough, fever, feeling unwell, and weight loss. Sometimes, a person might develop severe symptoms just hours after exposure. These symptoms could be similar to the flu, including fever, feeling unwell, chills, cough, shortness of breath, tightness in the chest, and headache. Normally, these symptoms will disappear within 12 hours to several days after the exposure is removed, but they might return if the person is exposed again.

When doctors examine a person with bagassosis, they often notice a crackling sound in the lungs, typically at the base, though it could be all over in severe cases. The specific findings usually depend on the stage of the disease. For example, people with acute bagassosis might have fever, rapid breathing, and fine crackling sounds in both lower lung fields. People with subacute bagassosis might have similar, but less severe symptoms that have lasted longer. Those with chronic bagassosis might show signs of muscle wasting and weight loss, and about half of the patients might have clubbing (a change in the shape of the fingers and nails). These patients usually have difficulty breathing, rapid breathing, and inspiratory crackles (a type of lung sound).

People with an acute illness against a background of chronic bagassosis often have severe symptoms and frequently require assistance breathing.

Doctors diagnose bagassosis based on the person’s work history, specific clinical features, and chest X-ray findings. They also rule out other similar conditions.

Testing for Bagassosis

If you’re thought to have bagassosis, a disease caused by inhaling the dust of molasses residue known as bagasse, several tests may be done to confirm the diagnosis. Typical blood tests might not show anything unusual, with normal white cell counts, normal PCO2, and a slightly increased ESR, which is a marker of inflammation in the body. Even though your blood tests might not tell the whole story, a chest X-ray could show some small, unusual shadows. However, this test might also look normal in some cases.

When you do a lung function test, patterns may indicate a restrictive condition, meaning your lungs can’t fully expand. This can result in lower lung volumes, less ability to take in and let out air, and lower gas transfer. Even though you might feel breathless, inhalation of a bronchodilator, a drug that helps to open up airways, won’t ease these symptoms. This response is a key sign of restrictive lung diseases like bagassosis. Furthermore, even if you’re breathing in and out as much as you can, your FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) will likely be reduced, while the FEV1/FVC ratio will be normal.

Case reports have shown that individuals with occupational exposure to bagasse often show typical changes on X-rays that point to bagassosis. These changes could include shadowing or opacities on both sides of the chest, along with irregular thickness and hazy ground-glass opacities on a CT scan. The fluid from bronchoalveolar lavage, procedure that involves washing out of the air spaces in the lungs, often reveals an increased number of immune cells called lymphocytes. This lavage fluid often contains a larger than normal number of cells, particularly neutrophils, another type of white blood cells. In addition, certain inflammatory substances such as TNF-α, IL-1β, IL-8, and IL-6 may also increase in the fluid of bagassosis patients.

A high-resolution CT scan (HRCT), which gives a detailed image of your lungs, can show various changes depending on the stage of bagassosis. In the early and middle stages, it can show small nodules and areas of opacity that look like ground glass. In contrast, the chronic phase can show signs of lung scarring or fibrosis, irregular thickness of certain lung structures, glass-like opacities, bronchiectasis (a condition where the bronchi of the lungs are abnormally widened), as well as honeycombing, a pattern that appears on a CT scan that resembles a honeycomb.

Lung biopsy, a procedure where a small piece of lung tissue is removed for testing, is not usually required unless the results of other tests are inconclusive. If needed, a bronchoscope, a thin tube with a light and camera inserted down the throat into the lungs can be used to carry out a biopsy, by taking samples from the most affected areas. If the results are still unclear, a surgical procedure might be needed for further investigation. It’s important to remember that these tests will help doctors make the most accurate diagnosis, essential for the best treatment results.

Treatment Options for Bagassosis

Catching bagassosis early is very important for preventing the disease from getting worse. Often, we can reverse the negative effects when we diagnose it promptly. Bagassosis is linked to being exposed to bagasse dust, a byproduct of sugar cane processing, so the best way to manage it is to reduce such exposure. You don’t usually need medication to manage bagassosis; however, if reducing the exposure to the dust does not help, doctors may recommend corticosteroids.

Avoiding bagasse dust is generally all it takes to treat bagassosis. But if you’re exposed to the dust again, the disease can reappear. If symptoms are present, rest, proper nutrition, staying hydrated, and possibly using medication to manage the symptoms (like cough medicine, fever reducers, and in some cases, oxygen supplements) might be needed.

In extremely severe cases, corticosteroids might be beneficial. Some have suggested the use of low-dose macrolides, a type of antibiotic, to help with inflammation, but this hasn’t been studied in humans yet. In rare cases involving children, immune-suppressing drugs like azathioprine or cyclosporine have been used, but this has not been reported in adults.

What else can Bagassosis be?

When doctors try to diagnose bagassosis, a lung condition, they consider a range of other diseases that could be causing the symptoms. These include allergy-driven lung inflammation after exposure to different types of organic dust like silicon, hay, cotton, and compost. They also look at other types of pneumonia not caused by allergies, including those caused by infections.

There are specific instances of hypersensitivity pneumonia, a severe allergic lung reaction, that have symptoms similar to bagassosis. Some of these include:

• Farmer’s lung
• Suberosis
• Pigeon breeder’s or bird fancier’s disease
• Fungal pneumonitis

Other diseases that doctors keep in mind when trying to diagnose bagassosis include:

• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Eosinophilic pneumonia
• Community-acquired pneumonia
• Miliary tuberculosis
• Silicosis
• Pulmonary edema
• Idiopathic interstitial lung disease

What to expect with Bagassosis

Once a patient stops being exposed to the bagasse dust that’s causing the issue, their symptoms usually resolve themselves within 1 to 6 months. They can expect their chest X-ray to return to normal in 2 to 6 months, while their lung function gets back to normal in about 2 to 4 months.

It’s being reported that the mortality rate of the disease they are suffering from is around 7.5%, but the reality could be lower. This is because the milder versions of the disease often go unnoticed and unrecorded.

Unfortunately, for those patients where lung fibrosis, or scarring, is found during a lung biopsy, the outlook isn’t as good as for those without such changes.

There’s a tool that can help predict the outcome – the HRCT scan. In a study which looked at 69 patients, it was discovered that the extent of scarring seen on these scans was related to their chance of dying.

The variety of effects of the disease and the risk of death can depend on different factors like the kind of exposure to the dust, the duration of exposure, and how severe it was. Genetic factors can also be an important determinant. In general, an unfortunate prognosis is common when scarring changes happen, especially in chronic or longstanding cases.

Possible Complications When Diagnosed with Bagassosis

Bagassosis is a lung condition that typically goes away on its own without causing any lasting harm. However, as with similar lung diseases, several problems could arise. These can include scarring of the lungs, chronic obstructive pulmonary disease, coughing up blood, collapsed lung, inflammation of the lining of the lung, chronic lung disease, and cancer. Some patients may also need to use oxygen therapy long-term.

Some Potential Complications include:

• Scarring of the lungs
• Chronic obstructive pulmonary disease
• Coughing up blood
• Collapsed lung
• Inflammation of the lining of the lung
• Chronic lung disease
• Cancer

Some patients may need to use long-term oxygen therapy.

Preventing Bagassosis

Teaching factory workers how to recognize the symptoms of bagassosis can play a key role in preventing this disease. Detecting the disease early can allow the affected worker to be quickly removed from the harmful dust environment, which can lead to a complete recovery. It’s important to let patients know about any symptoms that might mean the disease is coming back, or getting worse, which could be a sign of lung scarring. They should be told to seek medical help urgently in such cases. Workers should also receive training on why it’s so essential to use safety gear, and it should be required for them to use it. Work arrangements should be made in a way that limits the exposure of the patients to the potentially harmful bagasse by rotating the workers. It’s important to communicate to patients and their fellow workers that bagassosis can’t be spread from person to person. However, other workers could still be at risk if they’re exposed to the same environment.