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Metal fume fever is an occupational disease caused by inhalation of particles and fumes of metallic oxides. Fumes are formed by evaporation at very high temperature and condensation in air into fine particles. The most common modern industrial activity associated with zinc oxide fume inhalation is electric arc welding on galvanized (zinc-coated) steel.
The galvanizing process itself, which involves dipping steel in molten zinc, does not normally occur at a temperature high enough to generate dense concentrations of zinc oxide.
The typical symptoms of metal fume fever are chills, fever, and malaise. Minor respiratory and gastrointestinal complaints can also accompany the syndrome. A transient leukocytosis is common, but the chest radiograph should be clear. There is no routine test for measuring blood zinc levels.
Although it is often stated that only freshly formed zinc oxide fume induces inhalation fever, there have been well-documented, albeit infrequent, case reports of fume fever after heavy exposure to finely ground zinc oxide dust in the absence of a fresh fume exposure. It is also important to note that although inhalation fever is by far the most common response to zinc oxide inhalation, other syndromes may occur. These include bronchospasm, contact urticaria, and hypersensitivity-like responses associated with exposure to zinc oxide fumes; although all are limited to a few case reports.
Zinc oxide ingestion can cause gastroenteritis, but does not induce the metal fume fever syndrome.
Even though many reviews and textbooks state that a number of metal oxides in addition to zinc oxide cause metal fume fever, the data to support this are sparse. The metals cited include magnesium, copper, cadmium, chromium, antimony, and iron. There is human experimental data from the 1920s indicating that magnesium oxide inhalation can cause fume fever, although there is limited epidemiologic data to support this association. Industrial exposure to magnesium oxide fumes is extremely uncommon. Copper may be a potential cause of metal fume fever, but data in this regard are limited. There are occasional citations in the scientific literature describing a copper-associated febrile response. Inhalation fever from other metal oxides has not been documented.