Beryllium Disease

(Berylliosis)

The acute and chronic beryllium disease caused by inhalation of dust or fumes of beryllium and products. Acute beryllium disease is rare; Hallmark of chronic beryllium disease is the granuloma formation in the area of ??the entire body, esp. In the lung, intrathoracic lymph nodes and skin. Chronic beryllium disease causing increasing dyspnea, cough and fatigue. The diagnosis is made by history, the beryllium lymphocyte proliferation test and biopsies. v therapeutic. a. Corticosteroids used.

The acute and chronic beryllium disease caused by inhalation of dust or fumes of beryllium and products. Acute beryllium disease is rare; Hallmark of chronic beryllium disease is the granuloma formation in the area of ??the entire body, esp. In the lung, intrathoracic lymph nodes and skin. Chronic beryllium disease causing increasing dyspnea, cough and fatigue. The diagnosis is made by history, the beryllium lymphocyte proliferation test and biopsies. v therapeutic. a. Corticosteroids used. Etiology Berylliumexposition is a common but often unrecognized cause of disease in many industries, u. a. in Berylliumabbau and in the Berylliumgewinnung, in the manufacture and processing of beryllium-containing alloys, in the electronics, telecommunications, Nuklearwaffenmanufaktur-, defense, aircraft, automobile and aerospace industry, as well as part of the recycling of scrap metal, computers, and electrical appliances. Since small amounts of beryllium are poisonous and are added to many copper, aluminum, nickel and magnesium alloys, workers often are unaware of their exposure and their risks. Pathophysiology Acute beryllium disease is a chemically induced pneumonitis, the parenchymal to diffuse inflammatory infiltrates and to a non-specific intra-alveolar pulmonary edema. Other fabrics (eg., Skin, conjunctiva) may be affected. Acute beryllium disease is now rare, as most industries have reduced their exposure levels. However, between 1940 and 1970, there were numerous cases of illness, many of which cases are progressed from acute to chronic beryllium disease. In industries that use beryllium and beryllium alloys, chronic beryllium disease is still a common disease. Unlike most pneumoconiosis is a cell-mediated hypersensitivity reaction. Beryllium is presented to CD4 + T lymphocytes of antigen presenting cells, mostly in HLA-DP molecules. T lymphocytes in the blood, lungs or other organs recognize the beryllium, proliferate and form T lymphocyte clones. The clones then put proinflammatory cytokines such as TNF-?, IL-2 and IFN-? free. These cytokines enhance the immune response, resulting in the formation of mononuclear infiltrates and nichtverkäsenden granulomas in the target organs in which beryllium has been deposited. An average of about 2% -6% of beryllium-exposed people develop sensitization to beryllium (defined as a positive blood lymphocyte proliferation test for beryllium in vitro). Most of them fall ill. In certain high-risk groups, such as in workers who process beryllium and its alloys, the prevalence of chronic beryllium disease is> 17%. Not directly exposed employees such as secretaries and security forces develop rare sensitization and disease. Pathophysiologically there is typically a diffuse granulomatous reaction of pulmonary, hilar and mediastinal lymph nodes, which is histologically indistinguishable from sarcoidosis. Early formation of granulomas with mononuclear and giant cells may also occur. Be at a bronchoscopy cells from the lungs washed (bronchoalveolar lavage [BAL]), there are many lymphocytes. These T-lymphocytes proliferate as well as blood cells, when they are exposed in vitro with beryllium (beryllium lymphocyte proliferation assay called [BeLPT]). Symptoms and discomfort patients with chronic beryllium disease often suffer from shortness of breath, coughing, weight loss and have different chest X-ray findings, which typically have nodular opacities in the middle and upper lung fields, often with hilar and mediastinal lymphadenopathy. Patients complain of severe progressive exertional dyspnea, cough, chest pain, weight loss, night sweats and fatigue. The symptoms may develop within months after initial exposure or> 40 years after the last exposure. Some people remain asymptomatic. Diagnostic beryllium lymphocyte proliferation assay (with blood or bronchoalveolar lavage cells) chest x-ray or CT Diagnosis is made on the basis of the exposure history, the corresponding clinical manifestation and pathological a blood or BAL-BeLPT or both. The BAL BeLPT is highly sensitive and specific and helps chronic beryllium disease from sarcoidosis and other diffuse lung diseases delineate. Chest x-ray image can be subtle or diffuse nodular or reticular infiltrates, some with frosted glass opacity, show, often in conjunction with hilar lymphadenopathy, similar to the pattern in sarcoidosis. A miliary distribution pattern occurs. A high-resolution CT (thin film) is more sensitive than a normal X-ray, although cases of biotic proven disease even in people occur with normal results of imaging tests. Prognosis The acute beryllium disease can be fatal, but the prognosis is usually excellent, unless it enters the progression to chronic beryllium disease. Chronic beryllium disease often leads to progressive lung function restrictions. Among the early changes include obstruction and decreased oxygen saturation in the BGA at rest and during exercise testing. Limitations of CO diffusion capacity (DLco) and restriction occur later. In about 10% of cases, pulmonary hypertension and right heart failure develop fatal by the pulmonary heart disease. From sensitized to beryllium, a chronic beryllium disease develops at a rate of about 6% / year after initial diagnosis in the context of occupational medical examinations. Subcutaneous granulomatous node, caused by inoculation of Berylliumsplittern or dust, normally remain until they are excised. Corticosteroids therapy in acute beryllium disease, sometimes artificial ventilation in chronic beryllium disease, sometimes in addition O2, pulmonary rehabilitation and treatment for right heart failure in end-stage chronic beryllium disease, sometimes lung transplantation in acute disease often leads to pulmonary edema and bleeding. Critically ill patients must be artificially ventilated. Some patients with chronic beryllium disease never need treatment, as the disease progresses relatively slowly. If necessary, by a treatment with corticosteroids, which reduce the symptoms and oxygenation improved. The treatment is usually initiated only in patients who show significant symptoms and evidence of a pathological gas exchange or an accelerated decline in lung function or oxygenation. In symptomatic patients with abnormal pulmonary function, prednisone 40 to 60 mg p.o. given once / day or every other day for 3 to 6 months. Then, measures of pulmonary physiology and gas exchange to be repeated in order to document a response to therapy, and the medication dosage is gradually up to the lowest dose that maintains the symptomatic and objective improvement, tapered off (usually about 10 to 15 mg po once / day or every other day). Normally a lifelong corticosteroid therapy is needed. There are individual case reports, that the addition of methotrexate (10-25 mg po 1 times / week) similar to sarcoidosis helps save corticosteroids. Spontaneous remission of chronic beryllium disease is rare. In patients with end-stage disease, a lung transplant can be life saving. More symptomatic measures such as additional O2 therapy, pulmonary rehabilitation and medical treatment of right heart failure take place if necessary. Prevention Staubreduzierende industry actions are the basis for the prevention of Berylliumexposition. The exposure must be reduced to the lowest possible levels – preferably by more than 50 times the current “Occupational Safety and Health Administration (OSHA)” – typical values ??- to minimize the risk of sensitization and chronic beryllium disease a. Occupational health surveillance using the blood-BeLPT and chest x-ray images are all exposed workers, including those recommended by indirect contact. Both acute and chronic illness must quickly identified and affected workers are protected from further Berylliumexposition. Key points The beryllium disease is investigated and affects workers in many industries. A high-resolution CT and beryllium lymphocyte proliferation test (blood or bronchoalveolar lavage cells) should be used to confirm the diagnosis. Treatment of symptomatic patients with corticosteroids. Prevention includes suppression of beryllium dust and surveillance of exposed workers.

Health Life Media Team

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