Fact-checked by Grok 2 weeks ago

Metal fume fever

Metal fume fever, also known as brass founder's ague or Monday morning fever, is an acute, self-limited illness characterized by flu-like symptoms resulting from the inhalation of metal oxide fumes, most commonly zinc oxide generated during welding, brazing, or cutting galvanized metals.^[1] It typically affects workers in occupations involving metal fusion, such as welding, and presents with systemic inflammation triggered by ultrafine metal particles that provoke cytokine release and neutrophil recruitment in the lungs.^[1] First described in the 1830s, the condition is underdiagnosed due to its similarity to influenza, yet it impacts an estimated 2,000 of the over 420,000 U.S. metal workers annually, with about 30% of middle-aged welders experiencing at least one episode.^[1]^[2] Symptoms usually emerge 3 to 10 hours after exposure and include fever, chills, myalgias, arthralgias, headache, malaise, metallic taste in the mouth, thirst, and nonproductive cough or wheezing, with severity often peaking around 18 hours post-exposure.^[1]^[2] In severe cases, it may progress to pneumonitis, bronchospasm, or rarely acute respiratory distress syndrome (ARDS), though most cases resolve spontaneously within 24 to 48 hours without long-term sequelae.^[1] Other metals implicated include copper, cadmium, manganese, chromium, and nickel, with zinc oxide being the primary culprit due to its prevalence in galvanized coatings.^[1] The biphasic nature of symptoms—worsening after weekends and improving mid-week—further contributes to its nickname "Monday morning fever."^[1] Diagnosis relies heavily on a detailed occupational history of recent metal fume exposure, as routine laboratory tests often show nonspecific findings like leukocytosis or elevated C-reactive protein, and chest imaging is typically normal.^[1]^[2] Treatment is entirely supportive, emphasizing rest, oral hydration, antipyretics for fever and pain, and in severe respiratory cases, supplemental oxygen or bronchodilators; no specific antidote exists, and symptoms abate upon removal from exposure.^[1]^[2] Prevention is critical and involves engineering controls like local exhaust ventilation, adherence to permissible exposure limits (e.g., NIOSH's 5 mg/m³ for zinc oxide over 10 hours), and use of appropriate respiratory protection such as N95 masks or powered air-purifying respirators, alongside worker education on fume hazards.^[1]

Background

Definition

Metal fume fever is a self-limited, flu-like syndrome resulting from the inhalation of metal oxide fumes, most commonly zinc oxide, which triggers systemic inflammation.^[1]^[3] It is classified as an acute occupational illness affecting the respiratory and systemic systems, particularly among workers exposed to metal fumes during processes such as welding.^[1]^[4] The condition is historically known by alternative names such as "brass founder's ague" or "Monday morning fever," the latter reflecting its frequent occurrence after weekend breaks when workers resume exposure to accumulated fumes.^[1] Symptoms typically onset 4 to 10 hours following exposure and reach peak intensity around 18 hours, resolving spontaneously within 24 to 48 hours without long-term sequelae.^[1]^[3]^[4] As a non-infectious disorder, metal fume fever is fully reversible upon removal from the exposure source, with no evidence of chronic health effects in most cases.^[1]^[4] A common trigger includes welding galvanized metals, which releases zinc oxide vapors.^[1]

History

Metal fume fever was first medically recognized in the early 19th century among workers in brass foundries, where exposure to zinc oxide fumes from molten brass led to flu-like symptoms described as "brass founders' ague."^[1] The earliest published case dates to 1831, highlighting the acute respiratory and systemic effects observed in these occupational settings.^[5] Over time, the condition acquired several alternative names reflecting its association with specific industrial processes, including "brass chills," "galvanized poisoning," and "welder's ague," particularly as welding of galvanized steel became prevalent in the early 20th century.^[1]^[6] In the 1930s, occupational medicine literature began systematically linking the illness to inhalation of zinc oxide fumes, with key experimental studies demonstrating its induction through controlled exposures.^[7] Pioneering work by researchers such as Philip Drinker and colleagues in the late 1920s and early 1930s explored the physiological effects, including acquired resistance after repeated low-level exposures, solidifying its recognition as a distinct syndrome.^[8] Post-World War II, amid rapid industrial expansion in welding and metalworking, further studies confirmed the non-bacterial etiology of the fever, distinguishing it from infectious diseases through clinical observations and exclusion of pathogens.^[9]^[7] By the 1970s, evolving awareness prompted regulatory action, with the Occupational Safety and Health Administration (OSHA) establishing permissible exposure limits for zinc oxide fumes at 5 mg/m³ over an 8-hour period to mitigate risks in affected industries.^[10] This marked a shift from anecdotal and case-based reports to standardized occupational health protocols, enhancing prevention and surveillance.

Epidemiology

Incidence and Risk Factors

Metal fume fever exhibits an estimated annual incidence of 1,500 to 2,500 cases in the United States, primarily among the over 420,000 workers involved in welding and related metalworking activities, though significant underreporting occurs due to its self-limiting nature and mild symptoms that often resolve without medical attention.^[1]^[4] Prevalence among exposed welders ranges from 25% to 30%, with up to 35% of shipyard welders reporting symptoms in cross-sectional studies, and lifetime experience of at least one episode affecting approximately 30% of middle-aged welders.^[9]^[11] In the United Kingdom, around 40 to 50 welders require hospitalization annually due to severe cases.^[12] Higher prevalence is observed in developing countries, such as in informal metallurgical sectors in eastern India, where recent studies report exceptionally elevated rates linked to inadequate ventilation and prolonged exposure.^[13] The condition is most prevalent in industrialized regions including North America, Europe, and Asia, where welding and metal fabrication industries are concentrated, reflecting the global distribution of occupational metalworking.^[1] Symptoms often peak on Mondays and Tuesdays following weekend breaks from exposure, contributing to its colloquial name "Monday morning fever."^[1] Key risk factors include high-intensity inhalation of zinc oxide fumes, typically at concentrations exceeding 75 mg/m³ for durations of 1 to 3 hours or longer, often during welding of galvanized steel or similar processes.^[1]^[14] Pre-existing respiratory conditions, such as asthma, increase vulnerability and may exacerbate symptom severity, as metal fumes can aggravate underlying airway inflammation.^[15] Individual hypersensitivity, potentially modulated by factors like metallothionein expression, also plays a role in susceptibility.^[9] Demographically, metal fume fever predominantly affects males, who comprise 96% of reported cases, largely reflecting the gender distribution in high-risk occupations like welding.^[1] Cases are most common among adults aged 20 to 50 years, with a mean age of 37 in surveillance data, and no significant racial disparities observed, though elevated rates may occur among migrant workers in informal sectors due to inconsistent safety measures.^[10]^[16]

At-Risk Occupations

Metal fume fever primarily affects workers in occupations involving the heating, welding, or cutting of metals, particularly those coated with zinc or containing other reactive metals like magnesium and aluminum. The most common at-risk group consists of welders, especially those working on galvanized steel, where zinc oxide fumes are generated during processes such as arc welding.^[1] Metal foundry workers, who handle molten metals and produce oxide fumes during casting and pouring, also face significant exposure. Shipbuilders and galvanizers, involved in assembling or coating metal structures, are similarly vulnerable due to the thermal processing of large-scale galvanized components.^[1]^[10] Secondary occupations include jewelers, who may inhale fumes while soldering precious metals or alloys; battery manufacturers, exposed during the assembly of components involving aluminum or magnesium; and painters using metal-rich primers, such as zinc chromate, which can volatilize if heated or welded over. High-risk activities across these roles encompass arc welding, soldering, and thermal cutting of zinc-coated metals, with elevated dangers in confined or poorly ventilated spaces where fumes concentrate. Indoor settings, such as workshops or enclosed ship compartments, increase exposure intensity compared to outdoor environments due to limited natural dispersion of airborne particles.^[1]^[17] The condition can also affect non-occupational individuals, such as plumbers, pipe fitters, artists, and do-it-yourself (DIY) welders engaged in similar activities.^[1] Incidence rates among these occupational groups underscore the need for targeted monitoring, with welders experiencing episodes in up to 30% of cases over their careers.^[1]

Etiology and Pathophysiology

Causes

Metal fume fever is primarily caused by inhalation of zinc oxide (ZnO) fumes, the most common etiological agent, generated when galvanized steel or other zinc-coated metals are heated to temperatures exceeding 800°C during welding, cutting, or similar processes.^[1] These fumes arise from the pyrolysis and oxidation of the zinc coating, forming fine aerosol particles.^[18] Other metal oxides can also induce the condition, though less frequently, including magnesium oxide (MgO) produced during welding of magnesium alloys, copper oxide from heating brass or copper-containing materials, and aluminum oxide from smelting or processing aluminum; additional agents involve oxides of cadmium, iron, and nickel generated in analogous high-heat operations.^[1]^[19] The resulting fumes consist of submicron particles, typically 0.1–1 μm in diameter, which facilitate alveolar deposition and deep lung penetration upon inhalation.^[20]^[21] Exposure-response data indicate that symptoms emerge at concentrations well above occupational limits; the American Conference of Governmental Industrial Hygienists (ACGIH) sets the 2025 threshold limit value (TLV) for ZnO fumes at 2 mg/m³ as an 8-hour time-weighted average (respirable fraction), with a short-term exposure limit of 10 mg/m³, while concentrations of 15 mg/m³ or higher for 1–2 hours are associated with onset.^[22]^[23] Higher acute exposures, such as 75–600 mg/m³ for 1–3 hours, reliably provoke responses in experimental settings.^[1]

Mechanisms

Inhaled ultrafine particles of metal oxides, such as zinc oxide, deposit primarily in the alveoli due to their small size (less than 1 micron), initiating the pathophysiological process of metal fume fever.^[1] This deposition triggers the activation of alveolar macrophages, which respond by releasing pro-inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8), typically within 2-4 hours of exposure.^[1]^[24] TNF-α levels peak around 3 hours post-exposure, contributing to the rapid onset of inflammation.^[1] The released cytokines induce a systemic inflammatory response, which elevates body temperature by acting on the hypothalamus to reset the thermoregulatory set point through prostaglandin synthesis.^[1]^[9] This process is accompanied by leukocytosis, with white blood cell counts commonly exceeding 10,000/μL (often 12,000-16,000/μL), and elevated serum zinc levels.^[1]^[10]^[25] In the acute phase, oxidative stress from reactive oxygen species generated by metal oxides leads to bronchospasm and, in severe cases, chemical pneumonitis, exacerbating local pulmonary inflammation.^[1]^[26] The condition follows a biphasic pattern, with inflammatory responses and symptoms peaking at 8-10 hours post-exposure, followed by a secondary phase where re-exposure induces weaker responses due to the development of tolerance through macrophage desensitization.^[26]^[1] Resolution occurs spontaneously within 12-48 hours through mucociliary clearance of deposited particles and the action of anti-inflammatory mediators that dampen the cytokine response, resulting in no long-term pulmonary fibrosis in uncomplicated cases.^[26]^[1]

Clinical Presentation

Signs and Symptoms

Metal fume fever typically manifests as an acute, self-limited illness resembling influenza, with symptoms appearing 4 to 10 hours after inhalation of metal oxide fumes. Common systemic features include fever, chills, malaise, myalgias, arthralgias, fatigue, headache, excessive thirst, and a metallic or sweet taste in the mouth.^[1]^[10] Respiratory symptoms are prominent and may involve a nonproductive dry cough, dyspnea, chest tightness, throat irritation, and wheezing due to bronchospasm. In severe exposures, it may progress to pneumonitis.^[1]^[10] Gastrointestinal involvement often includes nausea and vomiting, frequently accompanied by diaphoresis. These symptoms contribute to the overall flu-like presentation, which can be distinguished from viral influenza by its occupational context and rapid resolution.^[10] The condition follows a characteristic timeline, with onset 4 to 10 hours post-exposure, peaking around 18 to 24 hours, and typically resolving within 24 to 48 hours, though full recovery may extend to 4 days. A pattern known as "Monday fever" arises in workers with intermittent exposure, where symptoms are most intense upon returning to work after a weekend break due to loss of short-term tolerance. Mild leukocytosis may be present.^[1]^[10] Severity varies, with over 90% of cases being mild and limited to flu-like symptoms without long-term sequelae. Severe variants, though uncommon, may feature potential complications like pericarditis or aseptic meningitis. In severe cases, transient pulmonary infiltrates may be seen on chest X-ray, resolving with symptoms.^[1]^[10]

Differential Diagnosis

Metal fume fever (MFF) presents with acute flu-like symptoms that overlap with several infectious, toxicological, and other conditions, necessitating careful differentiation based on exposure history, temporal pattern, and ancillary findings. Infectious mimics primarily include influenza, COVID-19, parainfluenza, respiratory syncytial virus, and bacterial or viral pneumonia. These are distinguished from MFF by the absence of a clear occupational exposure to metal fumes (e.g., zinc oxide during welding), lack of a characteristic "Monday morning" exacerbation pattern following weekend respite from work, and failure to resolve spontaneously within 24-48 hours without antibiotics; in contrast, infectious etiologies often persist longer and may respond to antimicrobials or show positive viral testing.^[1] Toxicological differentials encompass polymer fume fever, organic dust toxic syndrome, and cadmium fume fever. Polymer fume fever, resulting from inhalation of degraded polytetrafluoroethylene (PTFE, or Teflon) fumes, mimics MFF clinically but typically arises from non-occupational sources like overheated cookware, without the metallic taste or occupational context of MFF. Organic dust toxic syndrome shares flu-like features but stems from massive exposure to organic agricultural dusts, often with gastrointestinal symptoms. Cadmium fume fever is more severe, potentially involving chemical pneumonitis, hypoxia, renal toxicity, and pulmonary edema, unlike the self-limited course of MFF.^[1]^[27]^[10] Other considerations include acute hypersensitivity pneumonitis (triggered by organic antigens, with possible ground-glass opacities on imaging), sarcoidosis (a chronic granulomatous disorder), heat exhaustion (lacking prominent respiratory symptoms), and rare entities like sepsis (with positive blood cultures and systemic instability) or malignancy (typically insidious onset). Diagnostic clues favoring MFF include normal chest imaging without consolidation or infiltrates (versus abnormalities in pneumonia or pneumonitis) and negative microbiologic cultures. MFF is frequently underdiagnosed due to overlapping symptoms and overlooked exposure history, as highlighted in occupational health reviews and a 2023 study emphasizing its mimicry of acute respiratory infections.^[1]^[5]^[28]^[10]

Diagnosis

Approach

The diagnosis of metal fume fever begins with a thorough initial evaluation centered on a detailed occupational history to identify exposure to metal fumes within the preceding 48 hours.^[1] This includes inquiring about high-risk activities such as welding, brazing, or cutting galvanized metals, which generate inhalable oxides of zinc, copper, magnesium, or other metals.^[1] Concurrently, a precise symptom timeline assessment is essential, noting that onset typically occurs 4 to 10 hours post-exposure, with symptoms peaking around 18 hours.^[1]^[29] Exclusion of mimics forms the next critical step to differentiate metal fume fever from infectious or alternative toxicological etiologies.^[1] This entails eliciting a history absent sick contacts, recent infections, or epidemiological risks to rule out viral illnesses such as influenza.^[1] A focused physical examination screens for signs of focal infection or unrelated pathology, while in scenarios involving potential multi-metal exposures (e.g., cadmium alongside zinc), a targeted toxicology screen is advisable to exclude more severe heavy metal toxicities.^[1] Clinical diagnosis is established primarily through the triad of confirmed metal fume exposure, acute flu-like symptoms (fever, chills, myalgias, arthralgias, and metallic taste), and expected spontaneous resolution within 24 to 48 hours.^[1]^[29] No specific biomarker exists to confirm the condition, underscoring the reliance on clinical history over laboratory confirmation.^[1] Severe presentations, such as progression to respiratory failure, chemical pneumonitis, or acute respiratory distress syndrome, necessitate immediate escalation to urgent or specialized care.^[1] Such cases should prompt adherence to NIOSH protocols for occupational illness recognition and reporting to enable workplace hazard evaluations and prevention measures. Diagnostic challenges primarily stem from dependence on self-reported exposure details, which can be unreliable due to recall bias or underrecognition by patients.^[1]^[30] Updated guidelines from the American College of Occupational and Environmental Medicine emphasize incorporating occupational exposure data—such as welding history—into electronic health records to enhance diagnostic accuracy for affected workers.^[31]

Laboratory and Imaging Findings

Laboratory findings in metal fume fever are typically non-specific but can support the diagnosis through evidence of inflammation and transient exposure effects. Blood tests often reveal leukocytosis with neutrophilia, reflecting an acute inflammatory response predominantly involving polymorphonuclear leukocytes. C-reactive protein (CRP) levels are commonly elevated, indicating systemic inflammation. Transient metalemia may be detected, with serum zinc concentrations elevated up to several times the normal range following zinc oxide exposure.^[1]^[15]^[10] Pulmonary function testing is usually normal but may demonstrate mild obstructive changes or small reductions in forced expiratory volume in 1 second (FEV1) in severe cases, which resolve rapidly within hours to days. In severe cases, arterial blood gas analysis may show hypoxemia due to ventilation-perfusion mismatch.^[1]^[10] Chest radiography is usually normal but may reveal transient bilateral infiltrates in more severe presentations. Computed tomography (CT) is rarely indicated but can occasionally demonstrate ground-glass opacities or mild atelectasis. Urinalysis is typically normal, and sputum cultures remain negative, helping to rule out infectious etiologies. Bronchoalveolar lavage, when performed, shows increased total cell counts with neutrophil predominance and elevated pro-inflammatory cytokines such as interleukin-6, interleukin-8, and tumor necrosis factor-alpha.^[10]^[1]^[5]30879-0/fulltext) These findings are inherently non-specific and often normalize within 24 to 72 hours after symptom onset, limiting their diagnostic utility in isolation.^[1]^[10]

Management

Treatment

The primary treatment for metal fume fever involves immediate removal of the affected individual from the source of exposure to prevent further inhalation of metal fumes, followed by rest and adequate hydration to support recovery.^[1] Most cases are self-limiting and resolve spontaneously within 24 to 48 hours without specific interventions, as the condition is not caused by an infectious agent.^[4] Symptomatic relief focuses on alleviating fever, muscle aches, and respiratory symptoms. Antipyretics such as acetaminophen are recommended for fever management, while nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can address myalgias and arthralgias.^[4] If wheezing or bronchospasm is present, inhaled bronchodilators such as albuterol may be administered to improve airflow.^[1] In severe cases, particularly those involving hypoxemia or significant respiratory distress, supplemental oxygen therapy is indicated to maintain adequate oxygenation.^[1] Hospitalization is warranted if respiratory failure or acute distress develops, with close monitoring to assess for deterioration.^[10] Antibiotics should be avoided unless a secondary bacterial infection is suspected, as the illness is noninfectious.^[1] According to OSHA and NIOSH recommendations, management prioritizes supportive care over any specific antidotes, with an emphasis on rapid exposure cessation and symptom control to facilitate full recovery.^[32]

Prognosis

Metal fume fever is typically a self-limiting condition with full recovery occurring within 24 to 48 hours after cessation of exposure, and most cases result in no long-term sequelae.^[1]^[33] Symptoms often follow a cyclical pattern in ongoing occupational settings, improving over weekends due to reduced exposure and recurring early in the workweek.^[1] A transient tolerance to fumes may develop after an initial episode but usually dissipates after 1 to 2 days of non-exposure, leaving individuals susceptible to recurrence upon re-exposure without protective measures.^[6] Complications are rare, but can include secondary bacterial pneumonia or, in severe exposures, progression to acute respiratory distress syndrome (ARDS) requiring mechanical ventilation.^[34]^[35]^[36] Repeated low-level exposures may lead to chronic cough or persistent respiratory irritation, though these are more attributable to cumulative fume effects than isolated episodes.^[1] Prognosis improves with prompt removal from the exposure source, facilitating faster symptom resolution, while pre-existing conditions such as chronic obstructive pulmonary disease (COPD) can worsen outcomes, elevating hospitalization rates compared to healthy individuals.^[1]^[37] In heavy or prolonged exposures, supportive care accelerates recovery, but untreated persistence heightens complication risks.^[1] Long-term, chronic welding fume inhalation is linked to accelerated age-related lung function decline, which is reversible in many cases within weeks following exposure cessation.^[1] Transient reductions in pulmonary function, such as decreased forced expiratory volume, may occur but typically normalize without intervention.^[18]

Prevention

Engineering Controls

Engineering controls for metal fume fever primarily involve workplace modifications to capture and dilute metal oxide fumes, such as zinc oxide, at their source during processes like welding and metalworking. Local exhaust ventilation (LEV) systems are a cornerstone, designed to capture fumes directly from the emission point using hoods, extractor arms, or portable units positioned near the worker's breathing zone. These systems can achieve capture efficiencies of up to 90% when properly designed and maintained, with recommended capture velocities of 100–200 feet per minute (fpm) at the source to effectively remove contaminants before they disperse.^[38]^[39] General dilution ventilation complements LEV by circulating fresh air throughout the workspace to maintain overall concentrations below 5 mg/m³ for zinc oxide fumes, using fans or HVAC systems to dilute airborne particles without relying solely on source capture.^[40]^[41] Process modifications further minimize fume generation by altering materials and techniques. Substituting non-galvanized metals for galvanized steel reduces zinc oxide emissions, as the latter produces high levels of fumes during heating.^[19] Robotic welding systems allow automation of tasks, keeping human operators at a distance from the fume plume while integrating built-in extractors. Fume extractors attached directly to welding torches or guns provide on-tool capture, channeling fumes through flexible hoses to filtration units and preventing their release into the ambient air.^[41]^[42] Facility design incorporates enclosed or semi-enclosed booths to contain fumes within defined areas, equipped with high-efficiency particulate air (HEPA) filtration to trap submicron metal particles before exhausting filtered air back into the workspace or outdoors. These booths, often modular and customizable, include downdraft or cross-draft configurations to direct airflow away from workers. Real-time air quality monitoring devices, such as aerosol photometers or photoionization detectors for volatile components, enable continuous assessment of fume levels, triggering alarms or adjustments when thresholds are approached.^[43]^[44] Compliance with established standards ensures these controls are effective and safe. The Occupational Safety and Health Administration (OSHA) sets a permissible exposure limit (PEL) of 5 mg/m³ for zinc oxide fumes as an 8-hour time-weighted average (TWA), with 15 mg/m³ for total dust and 5 mg/m³ for respirable dust fractions. The National Institute for Occupational Safety and Health (NIOSH) recommends a REL of 5 mg/m³ as a 10-hour TWA, with a short-term exposure limit of 10 mg/m³ over 15 minutes. As of 2025, advancements include AI-optimized airflow systems in ventilation designs, which use sensors and algorithms to dynamically adjust extraction rates based on real-time fume detection, improving efficiency in variable welding environments.^[45]^[46]^[40]^[47] Implementation of these engineering controls has demonstrated substantial reductions in metal fume fever incidence, with studies reporting exposure decreases of 70–90% in facilities adopting comprehensive LEV and process changes, thereby preventing acute cases associated with fume inhalation.^[48]^[39]

Personal Protective Measures

Personal protective measures play a crucial role in minimizing individual exposure to metal fumes, particularly zinc oxide, which is the primary cause of metal fume fever in welding and related activities. These measures focus on respiratory protection, protective clothing, and work practices to reduce inhalation and contact risks when engineering controls alone are insufficient.^[49]^[41] Respiratory protection is essential for preventing inhalation of fine metal oxide particles. The National Institute for Occupational Safety and Health (NIOSH) recommends NIOSH-approved half-facepiece respirators equipped with P100 filters for exposures up to 50 mg/m³ of zinc oxide fumes (10 times the REL), providing an assigned protection factor (APF) of 10. For higher-risk tasks or prolonged exposure up to 125 mg/m³, powered air-purifying respirators (PAPRs) with high-efficiency particulate air (HEPA) filters are advised, offering an APF of 25. Full-facepiece respirators with P100 filters are suitable for levels up to 250 mg/m³, with an APF of 50, ensuring both respiratory and eye protection. Employers must conduct qualitative or quantitative fit-testing annually or upon changes in facial structure to ensure a proper seal, as per OSHA standard 29 CFR 1910.134.^[49]^[1]^[50] In addition to respiratory gear, other personal protective equipment (PPE) safeguards against irritants and secondary hazards. Welding helmets with auto-darkening lenses and integrated fume shields protect the eyes and face from arc flash and particulate irritants, while safety goggles provide supplemental coverage for non-welding tasks involving fumes. Leather or heat-resistant gloves prevent hand contact with hot metals and potential skin absorption of residues, and flame-resistant coveralls or aprons shield the body from sparks and minor fume deposition, reducing overall contamination. These items must meet ANSI Z87.1 standards for impact and splash resistance to effectively mitigate eye and skin irritation from metal oxides.^[51]^[41] Behavioral strategies complement PPE by limiting cumulative exposure. Workers should position themselves upwind of fumes during outdoor welding and rotate tasks to cap individual exposure at permissible limits, such as the NIOSH recommended 5 mg/m³ time-weighted average over 10 hours, often achieved through job rotation every 2-4 hours in high-fume environments. Pre-shift health assessments, including symptom checks for at-risk individuals with respiratory conditions, help identify vulnerabilities and adjust schedules accordingly. Annual medical evaluations are recommended as good practice for ongoing monitoring.^[1]^[49]^[52] Training is mandated to ensure effective use of these measures. OSHA requires employers to provide comprehensive education under 29 CFR 1910.1200 (Hazard Communication) and 29 CFR 1910.134, covering fume recognition, proper PPE donning and maintenance, and emergency response protocols, typically delivered annually or upon workplace changes. Fit-testing training emphasizes seal checks and cartridge replacement to avoid filter saturation.^[50]^[41] While effective, personal protective measures have limitations and should integrate with engineering controls like local exhaust ventilation for optimal protection. Respirators alone cannot eliminate all ultrafine particles due to potential leakage from poor fit or prolonged use, with studies indicating overall penetration rates around 20-25% in some cases for welding fumes, necessitating regular inspection and replacement. Over-reliance on PPE without ventilation backups reduces efficacy and increases discomfort, potentially leading to non-compliance.^[1]^[41]^[53]

References

[1]
Metal Fume Fever - StatPearls - NCBI Bookshelf
Metal fume fever presents as a flu-like syndrome with fever, malaise, bronchospasm, and bi-weekly variations in severity. Symptoms are classically weakest on ...Continuing Education Activity · Introduction · Pathophysiology · Evaluation
[2]
Metal Fume Fever: An Underdiagnosis - PMC - NIH
Feb 13, 2023 · MFF typically presents with non-specific complaints, including influenza-like symptoms, such as fever, shaking chills, arthralgias, myalgias, ...
[3]
Metal fume fever. - CDC Stacks
Metal fume fever is an acute self-limited illness induced most commonly by inhalation of zinc oxide fumes. The affected individual characteristically ...Missing: definition | Show results with:definition
[4]
Metal fume fever and polymer fume fever - PubMed
Treatment: The primary treatment for both metal fume fever and polymer fume fever is supportive and directed at symptom relief. Oral hydration, rest, and the ...
[5]
Metal fume fever | Radiology Reference Article - Radiopaedia.org
Feb 28, 2019 · History and etymology. The first published case of metal fume fever is from 1831 1. Metal fume fever has a very long list of historic ...On This Page · Clinical Presentation · Pathology
[6]
[PDF] Metal Fume Fever: A Review of the Literature and Cases Reported ...
Symptoms include fever, chills, cough, dyspnea, headache, myalgia, and malaise. Symptoms are self-limiting and typically resolve within. 24 hours with a ...
[7]
Metal Fume Fever - PubMed
Aug 21, 2023 · Metal fume fever presents as a flu-like syndrome occurring shortly after these activities and others where metals are bound together.
[8]
[PDF] PUBLIC HEALTH REPORTS - CDC Stacks
Aug 11, 2019 · (14) Drinker, P., Thomson, R. M., and Finn, J. L.: Metal Fume Fever: IL. Resistance Acquired by Inhalation of Zinc Oxide on Two Successive Days.
[9]
Metal-oxide inhalation induced fever - Immuntoxicological aspects of ...
Metal Fume Fever (MFF) is likely as old as the art of smelting metals, dating back to around 2500 to 3000 BC (Blount, 1990).Review · 6. Pathomechanism Factors · Competing Interests
[10]
[PDF] Metal Fume Fever: A Review of the Literature and cases Reported to ...
It was first described in the mid-1800s among brass foundry workers and in the early 1900s in welders of galvanized steel.1 Over the years, it has been ...
[11]
[PDF] TOXICOLOGICAL PROFILE FOR ZINC
A number of studies have measured exposure levels associated with metal fume fever. Workers involved in pouring molten zinc reported shortness of breath and ...
[12]
Metal fume fever – a case review of calls made to the Victorian ...
Metal fume fever is a diagnosed with exposure to metal fumes within the last 48 hours and 'flu-like' symptom development with resolution within 1–2 days. · Metal ...
[13]
Health risks from welding - HSE
Apr 4, 2025 · Metal fume fever is usually linked to welding or hot work on galvanised metals. High exposures to mild steel weld fume can also cause this ...
[14]
Prevalence of metal fume fever and its association with working ...
Oct 25, 2025 · Conclusions: Metal fume fever demonstrates an exceptionally high prevalence among metallurgical workers, acting as a sentinel for chronic ...Missing: countries | Show results with:countries
[15]
[PDF] TOXICOLOGICAL PROFILE FOR ZINC
Exposure levels associated with the development of metal fume fever have not been identified, though are generally in the range of 77–600 mg zinc/m3. Acute ...
[16]
Immune response to zinc oxide inhalation in metal fume fever, and ...
Dec 14, 2023 · We are the first to demonstrate that ZnO inhalation causes extremely increased levels of IL-17f gene expression at both sampling time points.Missing: predispositions GSTM1
[17]
Metal fume fever (review). Part 1 | Ukrainian Medical Journal
Jan 10, 2025 · MFF was observed in the mid-1800s among brass foundry workers and in the early 1900s among welders of galvanized steel [6, 19, 26]. The first ...
[18]
Metal Fume - an overview | ScienceDirect Topics
8.04. Metal fume fever occurs most frequently in welders joining or cutting through galvanized-coated steels. The condition may also be called other names, ...
[19]
Electric Vehicle Battery Makers Poised for Rapid Growth
Weld fume and dust collection is a key concern for battery manufacturers due to the health and production-related hazards posed by manufacturing processes.Missing: fever | Show results with:fever<|control11|><|separator|>
[20]
Metal Fume Fever - an overview | ScienceDirect Topics
Metal fume fever is defined as a self-limited respiratory condition characterized by an acute onset and flu-like symptoms, commonly resulting from the ...
[21]
Metal Fume Fever: Causes and Prevention - RoboVent
Aug 14, 2023 · Metal fume fever, often known as “welder's flu” or “welding fume fever,” is an occupational health hazard typically faced by people who work with metals.
[22]
Metal-Fume Fever from Inhaling Zinc Oxide | JAMA Internal Medicine
The inhalation of these causes a common, transient, benign form of metal-fume fever. ... Symptomatology During exposure to the fumes. References. 1. Hamilton ...
[23]
Comparing Inhaled Ultrafine versus Fine Zinc Oxide Particles in ...
Jun 30, 2004 · 19. Fine J, Gordon T, Chen L-C, Kinney P, Falcone G, Beckett W. Metal fume fever: characterization of clinical and plasma IL-6 responses in ...
[24]
ZINC OXIDE - ACGIH
ZINC OXIDE. CAS number: 1314–13–2. Synonyms: Zincite; Zinc white. Molecular formula: ZnO. TLV–TWA, 2 mg/m3, Respirable particulate mass. TLV–STEL, 10 mg/m3, ...
[25]
1988 OSHA PEL Project - Zinc Oxide Fume | NIOSH - CDC
The most prevalent toxic effect of zinc oxide fume is a condition known as “metal fume fever,” whose symptoms include chills, fever, muscular pain, nausea, and ...Missing: treatment | Show results with:treatment<|control11|><|separator|>
[26]
Cytokines in metal fume fever - CDC Stacks
TNF, IL-6, and IL-8 in BAL fluid supernatant concentrations increased in a time and exposure- dependent fashion after zinc oxide welding fume exposure. The ...
[27]
Elevated serum zinc levels in metal fume fever - PubMed
Metal fume fever is not an uncommon syndrome among welders following exposure to oxidized metal fumes (usually zinc). The relationship of serum zinc level ...Missing: metalloproteinemia | Show results with:metalloproteinemia
[28]
A proposed synergetic mechanism for metal fume fever involving ...
Sep 19, 2022 · Our results support the hypothesis of a two-step mechanism of MFF onset, in which the prior presence of Fe in the lungs exacerbates the oxidative stress.
[29]
Polymer Fume Fever - StatPearls - NCBI Bookshelf
Aug 4, 2023 · Polymer fume fever is an underrecognized flu-like illness associated with inhaling the thermal degradation byproducts of fluorocarbons.
[30]
Metal Fume Fever: An Underdiagnosis - PubMed
Feb 13, 2023 · Metal fume fever (MFF) is an auto-limited acute febrile respiratory syndrome that may mimic an acute viral respiratory disease after ...Missing: misdiagnosed | Show results with:misdiagnosed
[31]
[PDF] Metal fume fever - RACGP
2 Symptoms present within 48 hours of exposure and resolve by 1–2 days. Symptom recognition and occupational history taking are keys to making a diagnosis.<|control11|><|separator|>
[32]
Diagnosing metal fume fever--an integrated approach - PubMed
Failure to do this resulted in an unusual case of MFF leading to hospital admission. Diagnosis can be delayed if a full occupational history is not taken.Missing: step- step
[33]
[PDF] Electronic Health Records and Occupational Data - ACOEM
In this article, the ACOEM proposes the criteria, which EHR systems should meet to effectively share occupational health infor- mation to optimize medical care ...<|control11|><|separator|>
[34]
A Rare Cause of Respiratory Distress - Chest Journal
Oct 1, 2012 · A diagnosis of metal fume fever was made and was managed conservatively with oxygen, inhaled bronchodilators, inhaled and oral steroids.
[35]
Welding fumes - NIOSH Pocket Guide to Chemical Hazards - CDC
Symptoms vary depending upon the specific component of the welding fumes; metal fume fever: flu-like symptoms, dyspnea (breathing difficulty), cough, muscle ...
[36]
[PDF] Health Effects of Welding - CDC Stacks
The illness is self- limiting and usually resolves in 24 to 48 h after onset. Metal fume fever has been experienced on the first day of exposure by new welders ...
[37]
Acute respiratory distress syndrome in a welder exposed to metal ...
A 43-year-old man began having malaise, chills, and fever 12 hours after cutting a galvanized steel grating with an acetylene torch at work.Missing: secondary | Show results with:secondary
[38]
Deaths from pneumonia after welding
Pneumonia after exposure to fumes from welding, cutting, or grinding may require hospitalization. Doctors are also warned against dealing with metal fume fever ...Missing: ARDS | Show results with:ARDS
[39]
[PDF] Metal fume fever (review). Part 2
... bronchodilators and, if necessary, cardiovascular drugs, oxygen therapy and alkaline inhalation. In severe syndromes with reduced oxygen saturation, the ...
[40]
Metal Fume Fever: Symptoms, Causes, Treatment & Long-Term Effects
Luckily for Jayson, most cases of metal fume fever are self-limiting in nature, resolve within 48 hours, and don't carry any serious complications or long-term ...
[41]
Welding Fumes Exposure and the Risk of Head and Neck and ...
Apr 17, 2025 · We conducted a systematic review and meta-analysis on occupational exposure to welding fumes and the risk of head and neck cancer (HN, ...
[42]
[PDF] Local Exhaust Ventilation for the Control of Welding Fumes in the ...
Rec- ommended capture velocities for exterior hoods de- signed to control welding fumes are in the range of 100–170 fpm (0.51–0.87 m s 1) (ACGIH, 2010).
[43]
[PDF] Evaluation of Metals Exposure in an Architectural Metal Fabrication ...
Therefore, NIOSH recommends controlling total welding fume to the lowest feasible concentration and meeting the exposure limit for each welding fume ...<|control11|><|separator|>
[44]
[PDF] METAL FUME FEVER
Metal Fume Fever is the name for an illness that is caused primarily by exposure to zinc oxide fume (ZnO) in the workplace. ... with classic flu–like symptoms.
[45]
[PDF] Controlling Hazardous Fume and Gases during Welding | OSHA
Welding produces harmful fumes and gases. Control methods include general ventilation, local exhaust, proper positioning, and staying upwind.
[46]
Welding Fumes and Fume Extraction Guns - CDC
The NIOSH criteria document identifies arsenic, beryllium, cadmium, chromium (IV), and nickel as potential human carcinogens that may be present in welding ...
[47]
Dust Control Booths | Walk-in Filter Booths | Dust Collector Enclosures
Dust control booths isolate areas, contain dirty air, and are cost-effective. They are used for work stations, grinding, and other applications.Missing: enclosed | Show results with:enclosed
[48]
ACTion Booth Series - A.C.T. Dust Collectors
The ACTion Booth combines heavy-duty construction with multi-function design that is customizable to meet your workspace needs and CFM requirements.<|separator|>
[49]
https://www.cdc.gov/niosh/npg/npgd0675.html
[50]
[PDF] ZINC OXIDE HAZARD SUMMARY IDENTIFICATION ... - NJ.gov
* Exposure to Zinc Oxide can cause “metal fume fever.” This is a flu-like illness with symptoms of metallic taste in the mouth, headache, fever and chills, ...
[51]
AI in welding fume extraction: already reality today? - safe welding
The digitalisation of metal processing is moving forward. Some manufacturers are already talking about the use of AI in welding fume extraction.
[52]
Reduction in welding fume and metal exposure of stainless steel ...
Oct 29, 2015 · We investigated the exposure of welders before and after improvements of exhaust ventilation and personal respiratory protection in an ...<|separator|>
[53]
Zinc oxide - NIOSH Pocket Guide to Chemical Hazards - CDC
Metal fume fever: chills, muscle ache, nausea, fever, dry throat, cough; lassitude (weakness, exhaustion); metallic taste; headache; blurred vision; low back ...
[54]
https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134
[55]
https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.133
[56]
[PDF] MICHIGAN STATE
Mar 10, 2016 · An annual medical examination for individuals who are potentially exposed to welding fumes is good medical practice. Substances identified ...
[57]
Investigation of Efficiency of Iranian Respiratory Mask Used
The respirator mask filters approximately 89.95% of iron, 88.46% of titanium, and 83.93% of manganese in the welding fume. Although the concentration of ...Missing: breakthrough | Show results with:breakthrough<|control11|><|separator|>