Late respiratory systemic syndrome

The third condition, late respiratory systemic syndrome, is characterized by cough, mucus production, occasional wheezing, and systemic symptoms of malaise, chills, fever, and aching muscles and joints, occurring 4—12 hours alter exposure. This syndrome also has been termed TMA flu and clinically resembles hypersensitivity pneumonitis with visible chest X-ray infiltrates. High levels of IgG serum antibody and total serum antibody directed against trimellityl-human protein conjugates accompany the syndrome, and a latent period of exposure before the onset of symptoms is typical. 

A follow-up study of 29 workers with TMAN-induced immunologic lung disease who had been moved to low-exposure jobs for more than 1 year revealed that workers with late asthma or late respiratory systemic syndrome had improved symptoms, improved pulmonary functions, and lower total antibody against TMAN-HSA. In contrast, 7 of 12 workers with asthma rhinitis continued to have moderate to severe symptoms, abnormal pulmonary functions, and elevated IgE against TMAN-HSA. Elevated IgE against TMAN-HSA appears to be a marker for the subpopulation of workers with asthma rhinitis that does not improve. 

Central and/or peripheral nervous system involvement is one of the most frequent features, often resulting in the neonatal period in drowsiness, poor sucking, severe hypotonia, abnormal movements, seizures, respiratory distress, and fatal keto-acidotic coma with lactic acidosis [3]. To these severe conditions echo late-onset diseases now frequently attributed to or associated with mitochondrial OXPHOS defects, such as Alzheimer s or Parkinsons disease [10]. Major neurological symptoms, in variable combinations, involve trunk hypotonia, cranial nerve and brainstem involvement (with abnormal eye movements, ophthalmoplegia, recurrent apneas), cerebellar ataxia, myoclonia, seizures, pyramidal syndrome, peripheral neuropathy, poliodystrophy, and leukodystrophy infections [27,28]. A diffuse impairment of the cerebral white matter (leukodystrophy) mostly results in motor disturbance with mental retardation and low incidence of seizures. 

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