Silicosis Patient Research Articles

Periodontal conditions and salivary microbiota are potential indicators to distinguish silicosis: an exploratory study

BackgroundSilicosis has always been a serious global occupational health problem. Oral microbiota plays important roles in the development of lung disease. However, few studies have investigated the relationship between periodontal conditions, oral bacteria and silicosis disease.MethodA single-center and cross-sectional study was conducted in 2019 in Sichuan Province, China, including a small sample of silicosis patient group and healthy control group. Demographic data and periodontal examinations measured by clinical attachment loss (CAL), bleeding on probing (BOP) and periodontal pocket (PD) were collected from each participant. Phenotypic changes were detected by histopathological staining. Next-generation sequencing targeting 16S ribosomal RNA was targeted to decipher the salivary microbiome of the two groups. Random forest, Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression and multivariable logistic regression analysis were conducted to find potential indicators to distinguish silicosis.ResultsIn general, 29 male healthy controls and 24 male silicosis patients were included. The proportion of CAL ≥ 3 mm in silicosis group was greater than control group, while the proportion of BOP (+) and PD ≥ 4 mm was reduced in silicosis group. The α-smooth muscle actin and fibronectin expression increased in gingiva of patients. The composition of salivary microbiota exhibited significant differences between the two groups, with silicosis patients demonstrating a lower diversity of salivary microbiota. Genus of Aggregatibacter [odds ratio (OR) = 0.000, p = 0.003] and Catonella (OR = 0.000, p = 0.049) were identified as biomarkers to distinguish silicosis.ConclusionsThe silicosis group exhibited worse CAL, improved BOP and PD, which may be related to the gingival fibrosis found in this study. The composition of the oral microbiota underwent significant changes, accompanied by a decrease in diversity, in patients with silicosis. Our study indicates that respirable crystalline silica exposure affects oral health, and alterations of oral microbiota might be implicated in silicosis. We primarily identified Aggregatibacter and Catonella as the potential indicators to distinguish silicosis patients from healthy controls.

Detection and Genomic Characterization of Torque Teno Virus in Pneumoconiosis Patients in China.

Pneumoconiosis is a common occupational disease that can worsen with accompanying infection. Torque teno virus (TTV) is a prevalent human virus with multiple genotypes that can chronically and persistently infect individuals. However, the prevalence of TTV in pneumoconiosis patients is still unclear. This research aims to detect the presence and prevalence of TTV in the alveolar lavage fluid of pneumoconiosis patients in the Hunan Province of China using PCR. As a result, a 65.5% positive rate (19 out of 29) of TTV was detected. The TTV detection rate varies among different stages of silicosis and different pneumoconiosis patient ages. Nine novel TTV genomes ranging in size from 3719 to 3908 nt, named TTV HNPP1, HNPP2, HNPP3, HNPP4, HNPP5, HNPP6-1, HNPP6-2, HNPP7-1 and HNPP7-2, were identified. A genomic comparison and phylogenetic analysis indicated that these nine TTVs represent five different species with high genetic diversity which belong to the genus Alphatorquevirus. HNPP6-1 and HNPP6-2 belong to TTV3, HNPP5 belongs to TTV13, HNPP1 belongs to TTV24, HNPP4 belongs to TTV20, and the others belong to TTV19. The genomes of TTV HNPP1, HNPP6-1, and HNPP6-2 contain three putative open reading frames (ORFs) coding for proteins, ORF1, ORF2, and ORF3, while the other six TTV genomes contain two ORFs coding for proteins, ORF1 and ORF2. These results provide the first description of TTV epidemiology in pneumoconiosis patients in China. The newly identified TTV genome sequences reveal the high genetic diversity of TTV in pneumoconiosis patients and could contribute to a deeper understanding of TTV retention and infection in humans.

Immunopathogenesis of Silicotuberculosis: A Literature Review

Silicotuberculosis is a tuberculosis infection that emerges as a silicosis complication. A silicosis patient is 2.8 to 39 times more likely to develop pulmonary tuberculosis (TB). Moreover, the fibrotic condition caused by silicosis may exacerbate the symptoms and worsen the clinical outcome of silicotuberculosis patients. The current report suggests that the immune system plays an important role in the pathogenesis of this disease. Silicosis or silica exposure might interfere with the immunological response, especially the macrophages, which permit the Mycobacterium tuberculosis to infect the host. In this literature review, we will discuss the definition, epidemiology, and immunopathogenesis of silicotuberculosis.

Secondary Spontaneous Pneumothorax in Patients with Silicosis.

Background and aims: Patients with silicosis are at increased risk of pneumothorax. However, the true incidence of pneumothorax in these patients is yet unknown. Our objective was to study the proportion of secondary spontaneous pneumothorax (SSP) in patients with silicosis who present with acute respiratory deterioration. We also analyzed the risk factors, clinical course, actual management, and treatment outcomes of pneumothorax in patients with silicosis. Materials and methods: It was a hospital-based descriptive cross-sectional study. A total of hundred silicosis patients presenting with any acute worsening respiratory symptoms (dyspnea, cough, and chest pain) warranting admission were enrolled. A detailed history, clinical examination, and radiological investigations were done in all cases. Results: A total of 100 patients were included in this study. The mean age of subjects was 51.6 years. Breathlessness was the most common presenting symptom followed by chest pain. A total of 43 (43%) patients had pneumothorax at presentation. Right-sided pneumothorax was seen in 26 (26%) cases, left-sided in 11 (11%) cases, and six patients (6%) had bilateral pneumothorax. No significant correlation of smoking with pneumothorax was observed in the present study. Around 42% of patients had pulmonary tuberculosis which was microbiologically confirmed. Conclusion: The present study emphasizes that all patients of silicosis who present with acute worsening shortness of breath and or chest pain need to be evaluated for pneumothorax. How to cite this article: Bairwa M, Sharma A, Luniwal M. Secondary Spontaneous Pneumothorax in Patients with Silicosis. J Assoc Physicians India 2023;71(10):64-66.

Relationship between Body Surface Area and Pulmonary Functions in Patients of Silicosis

Relationship between Body Surface Area and Pulmonary Functions in Patients of Silicosis

Inflammatory indices obtained from routine blood tests show an inflammatory state associated with disease progression in engineered stone silicosis patients

Patients with silicosis caused by occupational exposure to engineered stone (ES) present a rapid progression from simple silicosis (SS) to progressive massive fibrosis (PMF). Patient classification follows international rules based on radiology and high-resolution computed tomography (HRCT), but limited studies, if any, have explored biomarkers from routine clinical tests that can be used as predictors of disease status. Our objective was thus to investigate circulating biomarker levels and systemic inflammatory indices in ES silicosis patients whose exposure to ES dust ended several years ago. Ninety-one adult men, ex-workers in the manufacturing of ES, 53 diagnosed with SS and 38 with PMF, and 22 healthy male volunteers (HC) as controls not exposed to ES dust, were recruited. The following circulating levels of biomarkers like lactate dehydrogenase (LDH), angiotensin-converting-enzyme (ACE), protein C reactive (PCR), rheumatoid factor, alkaline phosphatase and fibrinogen were obtained from clinical reports after being measured from blood samples. As biochemical markers, only LDH (HC = 262 ± 48.1; SS = 315.4 ± 65.4; PMF = 337.6 ± 79.3 U/L), ACE (HC = 43.1 ± 18.4; SS = 78.2 ± 27.2; PMF = 86.1 ± 23.7 U/L) and fibrinogen (HC = 182.3 ± 49.1; SS = 212.2 ± 43.5; PMF = 256 ± 77.3 U/L) levels showed a significant sequential increase, not been observed for the rest of biomarkers, in the HC → SS → PMF direction. Moreover, several systemic inflammation indices neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), aggregate index of systemic inflammation (AISI) derived from whole blood cell counts showed significant differences between the HC, SS and PMF groups. All these biomarkers were analyzed using receiver operating characteristic (ROC) curves, and the results provided moderately high sensitivity and specificity for discriminating between ES silicosis patient groups and healthy controls. Our study reveals that some inflammatory biomarkers, easily available from routine blood analysis, are present in ES silicosis patients even several years after cessation of exposure to ES silica dust and they could help to know the progression of the disease.

Provision of Occupational Health Service for Diagnosis, Treatment and Rehabilitation for the Patients of Silicosis by Department of Labor

Provision of Occupational Health Service for Diagnosis, Treatment and Rehabilitation for the Patients of Silicosis by Department of Labor

Rheumatological Diseases in Denim Sandblasters with Silicosis: What Should Pulmonologists Look for?

Silica exposure is not only the cause of silicosis, also associated rheumatological diseases like rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and systemic sclerosis (SSc). This report will reveal the rheumatological diseases of silicosis patients who were exposed to silica while working as denim sandblasters. Additionally, we will describe some clinical and laboratory findings that will help pulmonologist suspect, recognize and manage rheumatological diseases related to silica exposure in patients with silicosis. We reviewed the records of 142 sandblasters diagnosed with silicosis and found ten silicosis cases who also had rheumatological diseases between the years 2009 and 2017. The occupational characteristics, serological, functional and radiological data, were collected for patients of silicosis with rheumatological diseases. Ten silicosis patients with concomitant rheumatological diseases were found. Six patients among our cases had diagnosed SSc (4.2%), three of them had RA (2.1%), and one of them was being monitored for SLE (0.7%). The mean silica exposure time of the cases was 4.3±1.9 years (min: 1 max: 8). We also found elevated LD, sedimentation and CRP levels in our cases. It should be kept in mind that, in silicosis cases with arthralgia, joint tenderness or sclerosis at the fingertips may be indicative of rheumatological diseases related to silica exposure, and in these cases, the unexplained elevations of sedimentation and CRP levels may also be a result of silica-induced rheumatological diseases.

Clinical significance of CC16 and IL-12 in bronchoalveolar lavage fluid of various stages of silicosis.

Identification of novel biomarkers for silicosis could be helpful for disease diagnosis and pathophysiological mechanism exploration. Our study aims to investigate the Clara cell secretory 16-kd protein (CC16) and interleukin-12 (IL-12) levels in bronchoalveolar lavage fluid (BALF) in patients with silicosis at various stages. The enzyme-linked immunosorbent assay (ELISA) double antibody sandwich method was used to determine the CC16 and IL-12 in BALF levels from 79 patients with silicosis of various stages. Correlation analyses were performed between CC16 and IL-12 levels, and lung function and cytological counts in patients with silicosis at various stages. There were no significant differences in the BALF recovery volume, the number of cells, percentages of macrophages and lymphocytes in the alveolar lavage fluid of patients with silicosis in different stages (P>0.05); the percentage of neutrophils in stage I and stage II were higher than the control group (P<0.05) with statistically significant differences. The CC16 in BALF levels in stage I and II silicosis groups lower than the control group and stage III silicosis group with statistically significant differences (P<0.05), whereas CC16 levels in stage II silicosis group are higher than the stage I group (P<0.01). The IL-12 levels were higher than the control group (P<0.01), and the IL-12 levels in stage II and III silicosis group was higher than the stage I silicosis group (P<0.01). With the increase of the length of dust service, the CC16 and IL-12 levels decreased and showed a positive correlation between these indexes (correlation coefficient r=0.559, P<0.01). In addition, CC16 silicosis patient levels were positively correlated with FEV1/FVC and VCmax (r=0.242, 0.257; both P<0.05); IL-12 levels were negatively correlated with FEV1 and VC max (r=-0.250, -0.483; both P<0.05). The CC16 and IL-12 levels may have a specific reference value for the early diagnosis of silicosis and the assessment of lung function.

Nicotine induces apoptosis through exacerbation of blocked alveolar macrophage autophagic degradation in silicosis

Silica dust mainly attacks alveolar macrophages (AMs). The apoptosis of AMs is correlated with the progress of silicosis. Our previous study showed that autophagic degradation was blocked in AMs from silicosis patients. However, the effects of nicotine on AM autophagy and apoptosis in silicosis are unknown. In this study, we collected AMs from twenty male workers exposed to silica and divided them into observer and silicosis patient groups, according to the tuberous pathological changes observed by X-ray. The AMs from both groups were exposed to nicotine. We found increased levels of LC3, p62, and cleaved caspase-3, decreased levels of LAMP2, and damaged lysosomes after nicotine stimulation of the AMs from both groups. We also found that the autophagy inhibitor 3-methyladenine (3MA) inhibited nicotine-induced apoptosis in the AMs. Furthermore, 3MA reversed both the nicotine-induced decrease in Bcl-2 and the increase in Bax in both groups. These results suggest that nicotine may induce apoptosis by blocking AM autophagic degradation in human silicosis.

Trehalose alleviates apoptosis by protecting the autophagy-lysosomal system in alveolar macrophages during human silicosis

BackgroundAlveolar macrophages (AMs) are the primary targets of silicosis. Blockade of autophagy may aggravate the apoptosis of AMs. Trehalose (Tre), a transcription factor EB (TFEB) activator, may impact the autophagy-lysosomal system in AMs during silicosis. However, the mechanism by which Tre acts upon AMs in silicosis is unknown. MethodsWe collected AMs from twenty male workers exposed to silica and divided them into observer and silicosis patient groups. AMs from the two groups were then exposed to Tre. Western blot was used to measure the expression of autophagy-associated proteins. Lysosomal-associated membrane protein 1 (LAMP1) expression was observed using immunofluorescence and western blot. Apoptosis of the AMs was detected by TUNEL assay and western blot. ResultsTre induced localization of TFEB to the nucleus in the AMs of both groups. After Tre exposure, LAMP1 levels increased and LC3 levels decreased in the AMs of both groups, suggesting that Tre may increase the function of the autophagy-lysosomal system. The LC3-II/I ratio in the Tre-exposed AMs was lower than in the AMs not exposed to Tre. The LC3-II/I ratio in AMs subjected to Tre plus Bafilomycin (Baf) was higher than the ratio in cells exposed to Tre or Baf individually. Additionally, p62 levels decreased after Tre stimulation in the AMs of both groups. This indicates that Tre may accelerate the process of autophagic degradation. We also found decreased levels of cleaved caspase-3 after Tre treatment in the AMs of both groups. However, p-mTOR (Ser2448) and p-mTOR (Ser2481) levels did not change significantly after Tre treatment, suggesting that the mTOR signaling pathway was not affected by Tre treatment. ConclusionOur findings suggest that the restoration of autophagy-lysosomal function by Tre may be a potential protective strategy against silicosis.

Imunodeficience v rámci diferenciální diagnostiky intersticiálních plicních procesů

Interstitial lung processes (IPP), or diffuse parenchymal lung diseases, are a broad group of diseases characterized by varying degrees of pulmonary fibrosis and inflammation affecting predominantly, but not exclusively, pulmonary interstitium. IPP mostly occur in adulthood with maximum manifestation between 40 and 70 years of age. Although IPP mostly present as a primary diagnosis, they also belong to the portfolio of pulmonary disorders in patients with primary immunodeficiencies. The authors present case reports of patients with interstitial lung involvement and primary immunodeficiencies [particularly those manifesting also in adulthood, such as common variable immunodeficiency (CVID), and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) deficiency]. In addition, we report the case of silico-sis patient with severe lymphopenia. Therefore, in patients with newly diagnosed interstitial lung disease, congenital immune system disorder should be considered. Basic immunological laboratory examination of humoral and cellular immunity should be an essential part of the differential diagnosis algorithm for interstitial lung disease.

Renal involvement in a silicosis patient – case report and literature review

A 43-year-old Chinese man with a silicosis history was admitted to our hospital due to bilateral lower extremity edema for 1 year, exacerbating with hematuria for 2 months. He started working as a coal miner 30 years ago, and was diagnosed as silicosis 3 months ago. Lab tests revealed hematuria 3+, proteinuria 3+, and a serum creatinine value 2.47 mg/dl on routine check. He was diagnosed with focal proliferative IgA nephropathy (IgAN) and acute tubulo-interstitial nephritis by renal biopsy. He was treated with corticosteroids and got a remission 4 months later. Immunohistochemical staining showed the deposition of macrophage receptor with collagenous structure (MARCO), nod-like receptor pyrin domain-containing-3 (NLRP3), Caspase-1, apoptosis-associated speck (ASC), interleukin (IL)-1β, and IL-18 in both glomerular and tubulo-interstitial areas. We proposed that the silicon exposure could be related to his kidney disease in the patient and NLRP3 mediated inflammation might be involved in its pathogenesis which needs further explorations.

Silicosis with Bilateral Spontaneous Pneumothorax in Rajasthan.

Background and Aims:Silicosis is an occupational lung disease caused by inhalation of crystalline silica. People working in occupations like sandblasting, surface drilling, tunnelling, silica flour milling, ceramic making are predisposed to develop silicosis. Unilateral spontaneous pneumothorax is a pleural complication that can develop in such cases. Our aim is to see the prevalence of bilateral pneumothorax in silicosis in Rajasthan and associated predisposing factors.Methods:Fifty patients of silicosis prospectively reviewed by historical, clinical evaluation, and radiological evidence with increased dyspnea and chest pain in 1 year were included in the study. In all patients, chest X-ray was done immediately. Sputum for acid fast bacilli was done in all cases.Results:Cough and shortness of breath were most common symptoms and present in all cases. All cases were smokers. Chest radiograph revealed reticulonodular density with B/L pneumothorax in all patients. Tube thoracostomy was done in all cases except one in which conservative management was done.Conclusions:Cases with silicosis can develop complications like tuberculosis, lung cancer, progressive massive fibrosis, cor pulmonale, broncholithiasis, or tracheobronchial compression by lymph nodes. Pleural involvement in silicosis is rare. Spontaneous pneumothorax is a pleural complication that can develop in such cases. Usually in silicosis pneumothorax is unilateral. We report here an original article with silicosis who presented with bilateral spontaneous pneumothoraxes occurring simultaneously. The rarity of its clinical presentation in the form of bilateral simultaneous spontaneous pneumothorax combined with the typical clinical and radiological features of silicosis will make us to report this article.

Pneumothorax in the cases of silicosis in southern part of Rajasthan

Background: Silicosis is an occupational lung disease caused by inhalation of dust containing crystalline silica particles of size 0.5-5 microns in diameter. It commonly occurs in workers involved in quarrying, mining, sandblasting, tunneling, foundry work and ceramics. Pneumothorax is one of the complications of silicosis. The occurrence of pneumothorax in a patient with silicosis is a rare event, but it may be fatal. The incidence of secondary spontaneous pneumothorax (SSP) in silicosis as such is not known. This study aims to report the cases of secondary spontaneous pneumothorax in patients of silicosis in Southern part of Rajasthan.Methods: 50 patients of silicosis established by historical, clinical evaluation and radiological evidence with increased dyspnoea were included in the study. In all patients Chest X ray was done immediately.Results: Among 50 patients of silicosis with increased dyspnoea, Chest X ray showed pneumothorax in 20 patients of which 4 had bilateral pneumothorax, 7 had right pneumothorax and 9 had left pneumothorax. The mean duration of exposure to silica particles was 10 years (5 to 15 years). All the patients had various degrees of dyspnoea and chest pain. Tube thoracostomy was performed in 15 patients while 5 patients were managed conservatively with oxygen and bronchodilators.Conclusions: Our study showed an increased incidence of secondary pneumothorax in silicosis patients. The occurrence of pneumothorax, though rare in silicosis is a potentially life-threatening complication and may cause serious morbidity and mortality. The patients of silicosis who develop sudden onset of dyspnoea should be promptly investigated for this complication.

Oxidative Stress Biomarkers in Exhaled Breath of Workers Exposed to Crystalline Silica Dust by SPME-GC-MS.

Silicosis is considered an oxidative stress related disease that can lead to the development of lung cancer. In this study, our purpose was to analysis of volatile organic compounds (VOCs) in the exhaled breath of workers exposed to silica containing dust and compare peak area of these compounds with silicosis patients and healthy volunteers (smokers and nonsmokers) groups. In this cross sectional case-control study, the exhaled breath of 69 subjects including workers exposed to silica (n=20), silicosis patient (n=4), healthy non-smoker (n=20) and healthy smoker (n=25) were analyzed. We collected breath samples using 3-liter Tedlar bags. The VOCs were extracted with solid phase micro-extraction (SPME) and analyzed by gas chromatography-mass spectrometry (GC-MS). Personal exposure intensity was measured according to NIOSH 7601 method. Respiratory parameters were measured using spirometry. Seventy percent and 100% of the exposures to crystalline silica dust exceeded from 8 h TWA ACGIH TLVs in case and positive control groups, respectively. A significant negative correlation was found between dust exposure intensity and FEV1/FVC when exposure and positive control groups were studied in a group (r2=-0.601, P<0.001). Totally, forty VOCs were found in all exhaled breath samples. Among the VOCs, the mean of peak area acetaldehyde, hexanal, nonanal, decane, pentad cane, 2-propanol and 3-hydroxy-2-butanone were higher in exhaled breath of the workers exposed to silica and silicosis patient compared to the healthy smoker and nonsmoker controls. In some cases the difference was significant (P<0.05). The analysis of some VOCs in exhaled breath of subjects is appropriate biomarker to determine of exposure to silica.

Validity of Pulmonary Functional Status Including 6 Minute Walk Test in Patients of Silicosis Classified According to ILO Guidelines

Validity of Pulmonary Functional Status Including 6 Minute Walk Test in Patients of Silicosis Classified According to ILO Guidelines

Serum CA125 and NSE: Biomarkers of disease severity in patients with silicosis

BackgroundWe investigated the clinical significance of tumor markers in patients with silicosis. MethodsEighty silicosis patients without malignancy and 50 healthy volunteers were compared for serum tumor marker concentrations. Pulmonary function and several routine laboratory tests were performed. Correlation between serum tumor marker concentrations and severity markers for silicosis was analyzed. Tumor marker concentrations were detected in both blood and BALF samples in silicosis patients. The pre- and post-lavage differences in the serum tumor marker concentrations were also investigated. Immunohistochemical staining for tumor markers was performed in a lung biopsy specimen from a silicosis patient. ResultsBoth serum NSE and CA125 concentrations were significantly higher in cases compared with controls. Significant positive correlations were found between values of NSE and CA125 and LDH concentration. Significant negative correlations were also observed between values of NSE and CA125 and spirometric parameters. Patients with silicosis had higher concentrations of NSE in BALF than that in serum. 11 of 14 patients experienced a decrease in NSE concentrations following whole lung lavage. Immunohistochemical studies showed positive NSE staining in lung biopsy specimen. ConclusionsSerum NSE and CA125 concentrations would provide valuable clinical information to assess disease severity in silicosis.

Silicosis presenting with simultaneous bilateral spontaneous pneumothorax

Secondary unilateral spontaneous pneumothorax can occur in a silicosis patient. We are reporting a case of bilateral simultaneous pneumothorax in a silicosis patient.

Pulmonary Hemorrhage with Progressive Massive Fibrosis in a Silicosis Patient: An Autopsy Case

Workers exposed to free silica develop nodular or stellate fibrotic lesions in the lungs that may coalesce into conglomerate or confluent lesions called progressive massive fibrosis (PMF). This lesion also complicate other pneumoconioses, including asbestosis, coal workers’ pneumoconiosis, or mixed dust fibrosis. 3) PMF is inherently progressive, once started it tends to increase fairly rapidly. Patients with PMF are often noted to be hypoxic at rest and are prone to mycobacterial infections and spontaneous pneumothoraces and may ultimately develop fatal respiratory failure. However, massive hemoptysis is rarely associated with PMF. Massive hemoptysis, which is perhaps best defined as bleeding into the bronchial tree at a rate that poses a threat to life, is associated with considerable mortality unless treated aggressively. We herein present an autopsy case of a silicosis patient who was complicated with PMF died with massive hemoptysis and review the reported similar cases by analyzing the papers.