Complicated silicotuberculosis in a South African gold miner: A case report.

We present a case of complicated silicotuberculosis in a former gold miner with a sufficiently heavy silica dust exposure to cause International Labor Organization grade 2/2 silicosis after a cumulative exposure duration of 11 years. We describe a cascade of complications-active pulmonary tuberculosis despite recent isoniazid prophylactic therapy, non-tuberculous mycobacterial disease, chronic airways obstruction, and spontaneous pneumothorax-and the difficulties, which arose, in diagnosis and management of such combined disease. We highlight three implications of such cases: the need to understand the interaction of silicosis and tuberculosis in this setting, the importance of maintaining continuity of care in the management of these conditions in miners and former miners, and control of silica dust exposure as a primary form of prevention of tuberculosis.

[Silicoproteinosis: a specific clinical and radiological entity]. / La silicoprotéinose : une entité radioclinique à part.

INTRODUCTION: Silicoproteinosis is a rare disease, which can cause the rapid onset of respiratory failure following massive exposure to silica dust. CASE REPORT: A 25-year-old patient presented with altered state and dyspnea. The diagnosis of military pulmonary tuberculosis was first considered and antituberculous treatment was started. The diagnosis was reconsidered due to a lack of improvement and the discovery of an 18-month history of exposure to silica. The patient had stopped work 6 months prior to hospitalization. High-resolution CT showed air space condensation associated to centrilobular nodules throughout the lungs and multiple mediastinal lymph nodes, suggesting sarcoidosis. Bronchoalveolar lavage (BAL) suggested the diagnosis of lipoproteinosis. Because of discordance between the bacteriological, radiological and the BAL results, a surgical lung biopsy was performed which led to the diagnoses of a secondary lipoproteinosis. The diagnosis of silicoproteinosis was then considered. Over a one-year follow up, the patient's respiratory failure has progressed markedly despite treatment with corticosteroids. CONCLUSION: Silicoproteinosis is a distinct pathological entity, the diagnosis of which depends on clinical and radiological features as well as BAL findings, which may avoid the need for more invasive investigations.

[Erasmus' syndrome with pseudo-tumour masses]. / Un syndrome d'Erasmus avec des masses pseudo-tumorales.

INTRODUCTION: Erasmus' syndrome involves the association of systemic scleroderma (SS) and exposure to silica. Silicosis may precede the SS but the latter may be the presentation, in which case a history of exposure to silica should be sought as part of the diagnosis. CASE REPORT: A 46-year-old man with history of pulmonary tuberculosis presented with dyspnoea and dysphagea. Clinical examination revealed thickening of the facial skin with a pointed nose, erythema and telangiectasia, Raynaud's syndrome and sclerodactyly. A thoracic CT scan revealed bilateral, fibrotic, pseudo-tumoural masses. Antinuclear antibodies, anti-topoisomerase 1 and antihistone were positive. CONCLUSION: The clinical presentation of Erasmus' syndrome associating systemic scleroderma and pulmonary pseudo-tumours may pose a problem of differential diagnosis from lung cancer. This condition requires regular clinical and radiological monitoring, particularly as both scleroderma and silicosis increase the risk of lung cancer.

[Somatic diseases as cause of death of patients with active tuberculosis]. / Somaticheskie zabolevaniia kak prichina smerti bol'nykh aktivnym tuberkulezom.

Two hundred and fifteen case histories were studied to clarify causes of death in patients with active tuberculosis who had died from it. Males accounted for the largest proportion (86%) (n = 185). Patients above 50 years were 63.3% (n = 136). Two thirds were patients with restrictive tuberculosis without destruction and bacterial isolation. A hundred and fifty (70%) and 30% patients died from somatic diseases and other causes (sequels to alcohol abuse, violent death, suicide, etc.), respectively. Of the somatic diseases, cardiovascular diseases head the list, cancer ranks next to it, nonspecific respiratory diseases occupy the third place.

[Pulmonary fibrosis caused by inhalation: silicosis]. / Fibrosis pulmonares por inhalación: silicosis.

Silicosis is an important disease not only for its prevalence and the degree of pulmonary insufficiency it entails but also because it provides a natural model of interstitial fibrotic disease in the lung which is of known origin. This can, in turn, help us understand the pathogenic nature of a great number of pulmonary fibroses whose cause is unknown. The fifty postmortem studies which we describe correspond to miners who had worked in underground mines in the mountainous region near Cartagena (SE Spain) for times ranging from 5 to 36 years. The autopsies showed that they had been exposed to dust containing abundant metallic particles, particularly iron oxide (mixed dust). Although the pathogenic action was related with silica, it was also clearly modified by the composition of the dust associated with it. The basic lesions which are produced in the lung after inhalation of silica (< 5 microns diameter) are coniosis, fibroconiosis and sclerohyalinosis. The sclerohyalino nodules are characterized by abundant collagenization and hyalinization, different types of which can be distinguished according to the disposition of the collagenous fibres. Nodular lesions gradually grow in size even when exposure to dust has ceased. As they grow they get nearer until they join to form conglomerate masses. When the diameter exceeds 3 cm this is called massive fibrosis. Pulmonary tuberculosis was found in 27% of cases. This took the form of lesions, which could be associated to or independent of silicotic lesions. Besides evolutive nodular lesions, a patient suffering from silicosis may show other unspecific lesions which must be correctly evaluated for a more correct clinical-pathological assessment, since, clinically, the respiratory function may be profoundly affected although such silicotic damage may be not very noticeable by radiological examination. Silicosis of the liver and spleen was not infrequent in the autopsies carried out, with basic lesions in all evolutive states being observed, the most evolved in the spleen. This means that silicosis should be considered as a systemic illness.

[Bronchoscopic diagnosis of central peribronchial lung cancer in silicosis and silicotuberculosis]. / Bronkhoskopicheskaia diagnostika tsentral'nogo peribronkhial'nogo raka legkogo pri silikoze i silikotuberkuleze.

Examination of 315 lung cancer patients with silicosis or silicotuberculosis gave grounds for recognition of 3 variants of bronchial stenosis. The efficacy of bronchoscopic techniques was related both to anatomic variant of the tumor and primary tumor position against the involved bronchus lumen. Central peribronchial cancer in silicosis and silicotuberculosis has specific features: combination of true tumor stenosis with false rigidity of the trachea and large bronchi, advanced scar anthracotic deformity of the bronchi and diffuse atrophy of bronchial mucosa, distinctive pattern of metastatic spreading.

[Ganglio-esophageal fistula revealed by hematemesis: a rare complication of silicotuberculosis]. / Fistule ganglio-oesophagienne révélée par une hématémèse: complication rare d'une silico-tuberculose.

We report a case of fistula between a silicotic mediastinal lymph node and the esophagus with protrusion of a stiff and darkish concretion into the oesophageal lumen. The patient, a 68-year-old coal miner, presented with cough since a few months and the lesion was revealed by haematemesis. The general course was rapidly favourable. Association with tuberculosis was recognized only a few months later.

[Causes of mortality among workers exposed to inorganic dust containing crystalline silica]. / Przyczyny umieralnosci osób zawodowo narazonych na pyly nieorganiczne zawierajace krystaliczna krzemionke.

The authors briefly comment on the characteristics and results of recent epidemiological studies devoted to the reasons of mortality in persons exposed to dusts containing crystalline silica. The most important data concerning these studies are presented in the table accompanied by an author commentary which discusses results obtained by various authors and justification behind this subject in Poland.

[Broncholithiasis in a case of silicotuberculosis]. / Broncholithiase au cours d'une silico-tuberculose.

Broncholithiasis is usually a late complication of tuberculous lymphadenopathy. Clinical symptoms are not suggestive of the condition in most cases, except for lithoptysis which occurs in 5 to 34% of the patients. Owing to the currently low frequency of tuberculosis, broncholithiasis is a rare and sometimes surprising diagnosis, as in the case reported here. In this 65-year old silicotic man, broncholithiasis was manifested by blood-stained expectoration. Fibroscopy established the diagnosis by showing 2 broncholiths, about 1 cm wide, which were endoscopically extracted. The second peculiarity of this case is that broncholithiasis was associated with active tuberculosis.

[Lung diseases associated with silicosis. Study of 618 cases]. / Pneumopatie associate a silicosi. Indagine su 618 casi.

Retrospective research has been carried out on the clinical reports of 618 cases of patients suffering from silicosis admitted to the S. Luigi Gonzaga Hospital in 1973-1987 (1.4% of all pneumopathy admittances). A comparative evaluation of the five-year periods 1973-77, 1978-82, 1983-87 showed a steady reduction in the percentage of silicosis to total cases (from 1.62% to 1.55% and 1.16%). Among the 618 cases assessed, the following pneumopathies were associated with silicosis either alone or in combination: chronic obstructive bronchopneumopathy (89.4%), pulmonary tuberculosis (22.2%), bronchogenic carcinoma (8.4%), acute aspecific infections (26.1%), mycosis (0.6%), sarcoidosis (0.3%), other pneumopathies (1.1%). Comparison between the three five-year periods shows an increase in the frequency of the silicosis-carcinoma association and a fall in the silicosis-tuberculosis and silicosis-COLD associations.

[Aspergillotic septic endocarditis of the mitral and trigeminal valves as a complication of silicotuberculosis]. / Aspergilleznyi septicheskii éndokardit mitral'nogo i trekhstvorchatogo klapanov kak oslozhnenie silikotuberkuleza.

Fungal endocarditis is caused by fungi Candida and Aspergillus. Continuous intravenous infusions, catheterization, open-heart surgery, tracheal injuries, artificial heart valves can serve as predisposing factors. Aspergillus endocarditis is more common in severe infectious diseases after a prolonged use of antibiotics, cytostatics, glucocorticoids. A case of aspergillus endocarditis of mitral and tricuspid valves is described in a 55-year old patient. The man had been long suffering from silicotuberculosis and had been on a prolonged antibacterial therapy. The aspergillus endocarditis must have developed in the patient due to marked dysbacteriosis.