Severe Silicosis in Engineered Stone Fabrication Workers - California, Colorado, Texas, and Washington, 2017-2019.

Silicosis is an incurable occupational lung disease caused by inhaling particles of respirable crystalline silica. These particles trigger inflammation and fibrosis in the lungs, leading to progressive, irreversible, and potentially disabling disease. Silica exposure is also associated with increased risk for lung infection (notably, tuberculosis), lung cancer, emphysema, autoimmune diseases, and kidney disease (1). Because quartz, a type of crystalline silica, is commonly found in stone, workers who cut, polish, or grind stone materials can be exposed to silica dust. Recently, silicosis outbreaks have been reported in several countries among workers who cut and finish stone slabs for countertops, a process known as stone fabrication (2-5). Most worked with engineered stone, a manufactured, quartz-based composite material that can contain >90% crystalline silica (6). This report describes 18 cases of silicosis, including the first two fatalities reported in the United States, among workers in the stone fabrication industry in California, Colorado, Texas, and Washington. Several patients had severe progressive disease, and some had associated autoimmune diseases and latent tuberculosis infection. Cases were identified through independent investigations in each state and confirmed based on computed tomography (CT) scan of the chest or lung biopsy findings. Silica dust exposure reduction and effective regulatory enforcement, along with enhanced workplace medical and public health surveillance, are urgently needed to address the emerging public health threat of silicosis in the stone fabrication industry.

Ooh-rah! An unusual cause of spontaneous pneumomediastinum.

Spontaneous pneumomediastinum (SPM) with associated subcutaneous emphysema is an uncommon and generally benign condition. We describe an occurrence of SPM that occurred from yelling in a U.S. Marine Corps Drill Instructor. The patient describes yelling at Marine recruits the day prior when he felt a pop "behind his nose." Upon arrival to the Emergency Department, the patient was normotensive, afebrile, and maintaining an oxygen saturation of 100% on room air. Chest films demonstrated pneumomediastinum and subcutaneous emphysema. A computed tomography scan of the head, neck, and chest showed pneumomediastinum and air tracking along the trachea, great vessels, and esophagus with subcutaneous emphysema and without pneumothorax or esophageal injury. The patient was admitted to internal medicine and discharged after 24 hours of observation with improved pain and decreased subcutaneous air. Pneumomediastinum is commonly associated with blunt and penetrating trauma, infection, and esophageal rupture. Life-threatening complications include tension pneumomediastinum/pneumothorax and rupture of intrathoracic viscus. Treatment includes rest, oxygen therapy, and analgesia. SPM has never been described as a result of a yelling, and persistent yelling is common for a drill instructor. SPM can present in primary care and operational settings, and recognition and prompt treatment is crucial for these patients.