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High concentrations of gram\u2010negative bacteria (GNB) (&gt;10<jats:sup>7<\/jats:sup> cfu\/ml) and endotoxin (range 34\u201046 \u03bc\/ml) were found in the water. Mist contained &gt;10<jats:sup>3<\/jats:sup> cfu\/m<jats:sup>3<\/jats:sup> of GNB, and endotoxin up to 13,900 to 27,800 ng\/m<jats:sup>3<\/jats:sup>. Few fungi and thermotolerant <jats:italic>Bacillus<\/jats:italic> species and no <jats:italic>Actinomycetes, Legionella<\/jats:italic> species, or amoeba were found in washwater. Airborne levels of fungi were of the same species and magnitudes as outdoor samples. Subjects volunteered (n = 28) because of a history of flu\u2010like symptoms or were randomly selected (n = 102) from workers with and without current exposure to the basement. No acute cases were examined. Cases did not fulfill criteria for hypersensitivity pneumonitis (HP) and high levels of IgG antibodies to water\u2010borne antigens were not observed. However, among 20 subjects indicating a history of severe flu\u2010like episodes (severe basement flu, SBF), diffusion capacity (DL<jats:sub>CO<\/jats:sub>) was significantly lower (p = 0.015) than among other workers. The prevalence of SBF was independent of smoking. Cases occurred in clusters, and SBF was more common among workers with intermittent exposure to the basement (19 cases) than with daily exposure (1 case). These findings suggest that SBF and associated chronically depressed DL<jats:sub>CO<\/jats:sub> resulted from toxic injury following high\u2010level endotoxin exposure. Asthma was prevalent in the study population, particularly among employees with daily, rather than intermittent, exposure to endotoxin\u2010containing mist (odds ratio 6.7, p = 0.02). Thus, endotoxin exposure in this study was associated with two distinct sequelae depending on the temporal pattern of exposure.<\/jats:p>","DOI":"10.1002\/ajim.4700280404","type":"journal-article","created":{"date-parts":[[2007,4,21]],"date-time":"2007-04-21T16:47:38Z","timestamp":1177174058000},"page":"469-488","source":"Crossref","is-referenced-by-count":27,"title":["Cross\u2010sectional follow\u2010up of a flu\u2010like respiratory illness among fiberglass manufacturing employees: Endotoxin exposure associated with two distinct sequelae"],"prefix":"10.1002","volume":"28","author":[{"given":"Donald K.","family":"Milton","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Amsel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles E.","family":"Reed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul L.","family":"Enright","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. 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