Beryllium Case Registry Research Articles

Recent Chronic Beryllium Disease in Residents Surrounding a Beryllium Facility

Between 1948 and 1969, cases of community-acquired chronic beryllium disease (CA-CBD) were reported in neighborhoods surrounding beryllium facilities. Further surveillance was not performed in these communities, and additional cases have not been reported. To increase awareness of recently diagnosed cases of CA-CBD in residents surrounding a beryllium facility. Medical records were reviewed from individuals in a community surrounding a beryllium manufacturing facility in Reading, Pennsylvania. Definite cases of CBD required (1) an abnormal beryllium lymphocyte proliferation test in blood or bronchoalveolar lavage and (2) biopsy evidence of granulomatous inflammation. Probable cases of CBD either displayed an abnormal blood test to beryllium and radiographic evidence consistent with disease, or met epidemiologic criteria for CBD based on the Beryllium Case Registry criteria. Cases with occupational or potential paraoccupational exposure were excluded. Sixteen cases of potential community-acquired CBD were evaluated. From these, eight cases of community-acquired CBD were identified (five definite and three probable). The cases' initial year of residence began between 1943 and 1953 and continued until 1956-2001. Six of the eight cases required medical treatment and three of the cases died since diagnosis. Cases of CBD meeting current immunologic diagnostic criteria and attributable to industry-associated environmental exposure were detected among residents of a community surrounding a beryllium manufacturing facility. Most were diagnosed years after exposure cessation. The frequency and extent of beryllium disease in this community are unknown. We anticipate that not only have cases been misdiagnosed in this community but that more cases of CBD will be diagnosed in the future.

Beryllium and Lung Disease

Beryllium metal, first discovered in France in 1798, has proved to be of great value to the aerospace, nuclear, electronics, and computer industries. Its light weight, stability, considerable hardness, lack of magnetic qualities, and electrical and thermal conductivity properties make beryllium an ideal substance for various “high technology” applications. 1 Stonehouse AJ Zenczak S Properties, production processes, and applications.. in: Rossman MD Preuss OP Powers MB Beryllium: biomedical and environmental aspects. Williams & Wilkins, Baltimore1991: 27-55 Google Scholar However, over 50 years ago, it was recognized that inhaled beryllium dusts or fumes can cause lung injury. First reported in Germany in 1933, 2 Weber HH Englehardt WE Über eine Apparatur zur Erzeugung niedriger Staubkonzentrationen von grosser Konstanz und eine Methode zur mikrogravinctrischen Staubbestemmung. Anwendung bei der Untersuchung von Stauben aus der Berylliumsgewinnung.. Zentbl GewHyg Unfallerhüt. 1933; 10: 41-47 Google Scholar beryllium-induced lung disease was recognized as the cause of numerous cases of disability and death among workers in the fluorescent lamp industry in Massachusetts in the 1930s and 1940s. 3 Hardy H Beryllium disease: a clinical perspective.. Environ Res. 1980; 21: 1-9 Crossref PubMed Scopus (35) Google Scholar It is now recognized that beryllium can cause two types of lung injury: (1) an acute chemical pneumonitis, and (2) a chronic inflammatory lung lesion characterized by granuloma formation which is indistinguishable histopathologically from sarcoidosis. 4 Freiman DG Hardy HL Beryllium disease: the relation of pulmonary pathology to clinical course and prognosis based on a study of 130 cases from the U.S. Beryllium Case Registry.. Hum Pathol. 1970; 1: 25-44 Abstract Full Text PDF PubMed Scopus (130) Google Scholar , 5 Kriebel D Brain JD Sprince NL Kazemi H The pulmonary toxicity of beryllium.. Am Rev Respir Dis. 1988; 137: 464-473 Crossref PubMed Scopus (76) Google Scholar The majority of cases of beryllium lung disease have been reported in North America with some 900 cases reported in the USA Case Register since it was established in 1951, 6 Eisenbud M Lisson J Epidemiological aspects of beryllium induced non malignant lung disease: a 30 year update.. J Occup Med. 1983; 25: 196-202 Crossref PubMed Scopus (110) Google Scholar and numerous cases have also been reported in the United Kingdom. 7 Jones-Williams W Nosworthy SE Williams WR UK beryllium case registry.. in: Jones-Williams W Davies BH Eighth international conference on sarcoidosis and other granulomatous diseases. Alpha Omega Publishing Limited, Cardiff, Wales1980: 771 Google Scholar

Beryllium disease.

The increasing use of beryllium in a variety of industries continues to be a hazard. New cases are still being reported to the UK Beryllium Case Registry, now numbering 60 in the period 1945-1988. The majority of cases follow inhalation which results in acute beryllium disease (chemical pneumonitis) or more commonly chronic beryllium disease--a granulomatous pneumonitis. Granulomatous skin nodules also occur following local implantation. The clinical and radiological features are briefly described with the emphasis on pathology and immunology. Laser microprobe mass spectrometry analysis of tissue sections is a major advance in diagnosis. Detection of beryllium distinguishes the granulomas of chronic beryllium disease from other diseases, in particular sarcoidosis. The role of beryllium lymphocyte transformation tests is discussed. Chronic beryllium disease is steroid dependent and local excision of skin lesions appears to be curative. There is no evidence that beryllium is carcinogenic.

Mortality patterns from lung cancer and nonneoplastic respiratory disease among white males in the Beryllium Case Registry

Study was undertaken of mortality patterns among white males entered into the Beryllium Case Registry (BCR) while alive with a diagnosis of beryllium-related nonneoplastic respiratory symptoms or disease. Analyses demonstrate an excessive risk of lung cancer among those subjects in the BCR who had been previously diagnosed with acute chemical pneumonitis or bronchitis secondary to short-term beryllium exposure. In the evaluation of the excessive lung cancer risk in this population, consideration should be given to the competing effects from the high case fatality rate of nonneoplastic respiratory disease. This excessive risk of lung cancer could not be explained on the basis of cigarette smoking per se. The findings of the present study utilizing subjects in the BCR are consistent with results of animal studies that over 30 years ago first demonstrated beryllium to be a carcinogen and with numerous epidemiologic studies demonstrating an increased risk of lung cancer among workers occupationally exposed to beryllium and its compounds.

U.S. Beryllium Case Registry through 1977

A synopsis of the cases reported to the Beryllium Case Registry between 1973 and 1977 is presented. As of 1973, there were 832 cases of beryllium disease entered into the Registry. In the five years since that report, 55 additional cases have been added, 40 men and 15 women. Exposures occured in the electronics and nuclear industries in the production and use of beryllium containing alloys and beryllium oxide ceramis. Pathological changes in the lung tissue are described. Cases continue to be reported in which the diagnosis was sarcoidosis until the history of beryllium exposure led to the finding of beryllium in the lung tissue or mediastinal lymph node biopsy. Data from the Registry support the fact that chronic beryllium disease is a continued occupational hazard.

Chronic Beryllium Disease: A Continuing Epidemiologic Hazard

New cases of chronic beryllium disease are appearing. Seventy-six cases have been reported to the Beryllium Case Registry since 1966, of which 36 patients were exposed to beryllium after 1949, a time when industrial controls were established. Seven symptomatic patients were still being exposed to beryllium in 1972, one of whom died at 26 years of age with pneumonitis, hepatitis and a pneumothorax. Most of these patients (81 percent) were exposed in the aviation industry, gyroscopes and nuclear reactors. The majority of patients were men (53). There were 23 women. They were somewhat younger, mean age 46 years vs 12 years in cases reported before 1966. Clinical presentation was similar to that already reported, with exertional dyspnea in 61.7 percent of cases. The occurrence of four cases of bilateral hilar enlargement as the only radiographic finding should bring chronic beryllium disease in the differential diagnosis of bilateral lymphadenopathy, even when the patient is asymptomatic. In these patients data may suggest that a mediastinoscopy may offer a higher tissue beryllium yield than an open thoracotomy for a lung biopsy. Incidence of lung cancer was higher than expected (four cases), although the small series does not allow a definitive conclusion.

Beryllium disease: The relation of pulmonary pathology to clinical course and prognosis based on a study of 130 cases from the U.S. Beryllium Case Registry

A group of 130 cases examined by biopsy or autopsy from the U.S. Beryllium Registry was reviewed and the histological findings in the lung correlated with the clinical course and prognosis. The appearance of the six acute cases studied was nonspecific, and it was impossible to correlate specific histological features with clinical course or intensity of exposure. The remaining 124 chronic cases were divisible into two moderately overlapping histological groups based on the degree of interstitial cellular infiltration. The largest group, representing 80 per cent of the total could be divided into two subgroups based on the absence or presence of a distinct granulomatous reaction. Although the mean course of illness in both subgroups was about eight years from the time of onset, 85 per cent of the first were already dead at the time of study, whereas only 60 per cent of the second had died. In contrast, the second group, representing 20 per cent of the total, showed minimal interstitial cellular infiltration and prominent granuloma formation resembling and often indistinguishable from sarcoidosis. In this group, the mean course to date was over 11 years and all but one patient was still alive. These findings suggest a distinct relation between the intensity of interstitial cellular infiltration and prognosis and may provide additional insight into the clinical behavior of patients presenting with a histological picture resembling sarcoidosis. No relationship could be found between the histological pattern and the effect of steroids, the character of the industrial exposure, or the length of the latent period prior to the onset of clinical symptoms.

BERYLLIUM LUNG DISEASE AND ITS REGISTRY.

The authors' experience with beryllium lung disease dates from 1941 and consists of 174 cases (93 acute, 81 chronic). The acute form of the disease is characterized histologically by predominantly intra-alveolar mononuclear infiltration whereas the chronic form is predominantly interstitial and granulomatous. The clinical pictures are also different. Hypersensitivity appears to be a significant factor in both forms of the disease. Use of steroid therapy is highly effective.Some 700 cases of beryllium lung disease have been recorded in the Beryllium Case Registry, which was established in 1952. Information about its services is presented.

Beryllium Case Registry progress report: 1962.

The Beryllium Case Registry was initiated in 1952 to develop knowledge of Be poisoning. A review of accumu lated data suggests that Be in all forms must be considered potentially harmful. (C.H.)

A histological study of the lungs in 52 cases of chronic beryllium disease.

Beryllium disease is a term used to describe the systemic effects of exposure, usually by inhalation, to beryllium and certain of its compounds and it can be subdivided into an acute and a chronic variety. This paper deals with the histological findings in the lungs in chronic beryllium disease. I agree with Hardy (1956) that the alternative term chronic pulmonary beryllium disease is unsuitable as it tends to obscure the essentially systemic nature of the disease, though the primary manifestations are usually in the lung. Beryllium was first identified by Louis Nicolas Vacquelin in 1797. Until recently it was valued only as a component of precious stones but it is now used increasingly in industry, for example, in the pro duction of such metal alloys as stainless steel and chromium and for the screening of uranium in atomic power stations. Other occupations where beryllium is a risk are the making of cathode tubes and x-ray machine windows, ceramics, beryllium extraction from ore, and certain experimental work. Beryllium has not been used since 1948 in the manufacture of fluorescent lamps. Beryllium was soon found to produce toxic effects on inhalation and the earlier papers describe the acute manifestations of a metal-fume type of illness (Weber and Engelhardt, 1933; Fabroni, 1935; Gelman, 1936; Berkovitz and Israel, 1940). One of the earliest North American reports is that of Van Ordstrand, Hughes, and Carmody (1943) who described three acute cases. The earliest reports of a chronic pulmonary disease caused by beryllium came from the U.S.A. (Hardy and Tabershaw, 1946; Gardner, 1946; Higgins, 1947). The disease was the subject of a Saranac Symposium (Vorwald, 1950) and this report provides an excellent summary of knowledge up to that date. Since then a beryllium case registry has been started by Hardy (1955a) which up to date (personal communication) includes 500 cases, 287 chronic and 213 acute, with an overall mortality of 27 %. Very few British cases have been reported. The first was by Agate (1948), an example of the chronic type, in a physicist working with fluorescent lamps. Royston (1949) has reported the only acute case to occur in Britain. Sneddon (1955) described a chronic case in a woman of 25 working with 2% beryllium-copper alloy. The only other report in the British literature is of a skin granu loma caused by a fluorescent tube fragment (Lederer and Savage, 1954). There are two other unpublished British chronic cases, namely, by Teare (1955) in a fluorescent lamp worker and by Rannie (1956) in an experimental chemist.

Beryllium case registry at Massachusetts General Hospital.

Beryllium case registry at Massachusetts General Hospital.

BERYLLIUM POISONING REGISTRY

To the Editor:— A man-made illness of considerable interest has been reported in the medical literature in this country since 1943 under various titles, in general referring to its association with exposure to certain beryllium compounds. As the years go by, more cases appear from a variety of industrial and research operations using beryllium compounds. With funds supplied by the Atomic Energy Commission, it is planned to develop a beryllium case registry at the Massachusetts General Hospital. The purpose of the registry is to facilitate a study of the epidemiology of this disease, an evaluation of the beryllium hazard of incriminated operations, and dissemination of knowledge of the clinical course of beryllium poisoning, especially in relationship to its medical management. The material collected is to be available for study, and from time to time data will be sent to participating physicians summarizing facts that have been established. This description is