These results correspond well with our results Unlike B��nger an

These results correspond well with our results. Unlike B��nger and colleagues, however, we found a significantly higher prevalence of work-related gastroenterological symptoms among exposed subjects. Gastroenterological symptoms among compost workers were also reported by other authors [3,7]. Furthermore, we found significantly more irritation symptoms of the eyes and upper airways in the exposed than in the non-exposed group, which is in line with results of B��nger et al. (2007) [6]. As far as we are aware of, only one longitudinal study on health problems in the compost industry has recently been published [6]. This five-year follow-up study showed that the number of compost workers with chronic bronchitis doubled during the observation period.

Some authors reported a healthy-worker effect in subjects occupationally exposed to bioaerosols, suggesting that health risks may even be underestimated [2,13]. The mechanisms that may induce these health effects are still unclear [5,6]. According to Jaakkola et al. (2002), several possible mechanisms have been put forward such as IgE-mediated hypersensitivity reactions, toxic reactions due to mycotoxins and irritative reactions due to volatile organic compounds (MVOC) emitted by microorganisms [14]. The authors stress that it is probable that different microorganisms have their influence by different mechanisms. Wouters and colleagues (2002) underline that non-allergic inflammatory reactions may be important, especially due to dust containing endotoxins and �� (1�C3)-glucans, two known proinflammatory cell wall components of gram-negative bacteria and most fungi [15].

The most common fungi abundantly present in compost piles are Aspergillus spp., Penicillium spp., Cladosporium spp., and Alternaria spp. Some of these fungi (e.g., Aspergillus spp. and Penicillium spp.) can produce mycotoxins, which are harmful to human health [3]. Furthermore, case reports have shown the occurrence of hypersensitivity pneumonitis, allergic bronchopulmonary aspergillosis, and asthma in compost workers exposed to high concentrations of organic dust [16,17]. Moulds and thermophilic bacteria are well-known sources of allergens that may play a role in the development of hypersensitivity pneumonitis [18]. However, as cited by Wouters et al. (2002), ��allergic diseases are rarely reported in surveys and are unlikely to explain the occurrence of most respiratory symptoms�� [15].

A relationship between endotoxin exposure and fever, respiratory problems and gastroenterological problems is described in several studies [19,20]. Tolvanen et al. (2005) concluded that compost workers were working in poor hygienic conditions [3]. Therefore Cilengitide the authors recommend that workers should wear personal protective equipment (e.g., gloves and a respiratory mask class P3).

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