A Cluster of Beryllium Sensitization Traced to the Presence of Beryllium in Concrete Dust

Differential diagnosis of pulmonary sarcoidosis: a review

Diagnosing pulmonary sarcoidosis raises challenges due to both the absence of a specific diagnostic criterion and the varied presentations capable of mimicking many other conditions. The aim of this review is to help non-sarcoidosis experts establish optimal differential-diagnosis strategies tailored to each situation. Alternative granulomatous diseases that must be ruled out include infections (notably tuberculosis, nontuberculous mycobacterial infections, and histoplasmosis), chronic beryllium disease, hypersensitivity pneumonitis, granulomatous talcosis, drug-induced granulomatosis (notably due to TNF-a antagonists, immune checkpoint inhibitors, targeted therapies, and interferons), immune deficiencies, genetic disorders (Blau syndrome), Crohn's disease, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, and malignancy-associated granulomatosis. Ruling out lymphoproliferative disorders may also be very challenging before obtaining typical biopsy specimen. The first step is an assessment of epidemiological factors, notably the incidence of sarcoidosis and of alternative diagnoses; exposure to risk factors (e.g., infectious, occupational, and environmental agents); and exposure to drugs taken for therapeutic or recreational purposes. The clinical history, physical examination and, above all, chest computed tomography indicate which differential diagnoses are most likely, thereby guiding the choice of subsequent investigations (e.g., microbiological investigations, lymphocyte proliferation tests with metals, autoantibody assays, and genetic tests). The goal is to rule out all diagnoses other than sarcoidosis that are consistent with the clinical situation. Chest computed tomography findings, from common to rare and from typical to atypical, are described for sarcoidosis and the alternatives. The pathology of granulomas and associated lesions is discussed and diagnostically helpful stains specified. In some patients, the definite diagnosis may require the continuous gathering of information during follow-up. Diseases that often closely mimic sarcoidosis include chronic beryllium disease and drug-induced granulomatosis. Tuberculosis rarely resembles sarcoidosis but is a leading differential diagnosis in regions of high tuberculosis endemicity.

Contamination levels and source apportionment of potentially toxic elements in size-fractionated road dust of Moscow

The distributions of potentially toxic elements (PTEs) among PM₁, PM_1-10, PM_10-50, and PM_50-1000 fractions of the road dust were studied in the western and eastern parts of Moscow, impacted mainly by the road transport and the industrial sector, respectively. The partitioning of PTEs in road dust can provide more precise information on pollution sources and its further interpretation regarding human health risks. The concentrations of PTEs were analyzed by mass and atomic emission inductively coupled plasma spectrometry. Differences in the results between the western and eastern parts of the city were caused by the dissimilarity between traffic and industrial emissions. The source apportionment of the PTEs was carried out using absolute principal component analysis with multiple linear regressions (PCA/APCS-MLR). The contribution from anthropogenic sources was significant to PM₁ and PM_1-10 particles. In coarser fractions (PM_10-50, PM_50-1000), it decreased due to the input with the wind-induced resuspension of soil and rock particles. In the eastern part of the city, the accumulation of PTEs (especially Mo, Sb, Cd, Sn, Bi, Co, and As) is the most active in PM_1-10, while in the western part, it is most pronounced in PM₁ (especially Pb, Cu, Cr, and W) which is associated with differences in the size of particles coming from traffic and industrial sources. In the eastern part of Moscow, in comparison with the western part, the contribution from industrial sources to the accumulation of PTEs in all particle size fractions was higher by 10-30%. In the western part of Moscow, the finest particles PM₁ and PM_1-10 demonstrate the trend of rising pollution levels with the increase in road size, while in the eastern part of the city, only coarse particles PM_50-1000 show the same trend. In the fractions PM₁ and PM_1-10 of road dust, a significant contribution was made by anthropogenic sources; however, its role decreased in the coarse fractions-PM_10-50 and especially in PM_50-1000- due to the influence of roadside soils and their parent material.

Elemental analysis of contemporary dental materials regarding potential beryllium content

Exposure to beryllium (Be) can lead to lung pathologies, such as chronic beryllium disease (CBD). This occupational illness has been more prevalent among dental technicians compared to the non-exposed population. Although most manufacturers state that dental materials are Be-free, this prevalence raises the question of whether the materials are completely devoid of Be-traces. Thus, the objective of the present study was to analyze the elemental composition, with emphasis on Be, of a wide range of commercially available dental materials frequently used by dental laboratories. Samples of 32 different materials were collected and analyzed using inductively coupled plasma-optical emission spectrometry (ICP-OES) and X-ray fluorescence spectroscopy. The results showed that the Be content was below the limit of quantification in all included samples (< 0.00005 mass-%). Therefore, it can be concluded that possible traces of Be were below clinical relevance in dental materials. Exposure of dental technicians to alternative Be sources should be further evaluated.

An Exploratory Study of Beryllium and UK Soft Touch Regulation: An Enduring Example of Weaknesses of UK Occupational Health and Safety Governance

Smart regulation, better regulation, responsive regulation, business-friendly regulation and voluntary 'self-regulation' have their origins deeply embedded in UK policies in the 20th century. Their aim generally is to reduce workplace regulatory obligations on employers. This can overtly or covertly undermine efforts to improve working conditions. In the UK, the historical control and regulation of beryllium (a toxic metal used in industry) illustrates this problem, and as we illustrate through an exploratory analysis of original archival material and official publications. Soft touch regulation of the metal beryllium was developed within the UK semiconductor industry when tighter controls were proposed in the 1960s and 1970s. Historical industry, government and science responses to health and safety information about beryllium provide important lessons for current debates on occupational health and safety.

Beryllium disease among construction trade workers at Department of Energy nuclear sites: A follow-up

BACKGROUND

Construction workers at U.S. Department of Energy (DOE) nuclear weapons facilities are screened to identify DOE-related occupational illnesses, including beryllium sensitization (BeS) and chronic beryllium disease (CBD). The study objectives were to estimate beryllium disease risks and the CBD claims acceptance rate in the energy workers' benefits program.

METHODS

Workers diagnosed with BeS via beryllium lymphocyte proliferation test (BeLPT) included in screening examinations were interviewed about subsequent diagnosis of CBD. We estimated the proportion who developed CBD based on the ratio of CBD cases, based on self-reported compensation claim status, to all workers with BeS interviewed. We used stratified analyses to explore trends in disease frequency by age, race, sex, DOE employment duration, site, trade group, and cigarette smoking history.

RESULTS

Between 1998 and 2020, 21,854 workers received a BeLPT; 262 (1.20%) had BeS (two abnormals or one abnormal plus one borderline test); 212 (0.97%) had a single abnormal BeLPT. Of 177 BeS workers interviewed, 35 (19.8%) reported an accepted CBD compensation claim. The claims acceptance rate among BeS workers increased with years of DOE employment, from 8.4% with <5 years to 33.3% for >25 or more years. Five of 68 interviewed workers with a single positive BeLPT reported CBD claim acceptance; an additional CBD case was confirmed by chart review (8.8%).

CONCLUSIONS

Years of DOE work predict the risk of developing CBD among those sensitized and getting a claim for CBD accepted. Ongoing surveillance and increased awareness of the risk of beryllium exposure and CBD as an occupational disease among construction workers are needed.

Realistic biomarkers from plasma extracellular vesicles for detection of beryllium exposure

Purpose

Exposures related to beryllium (Be) are an enduring concern among workers in the nuclear weapons and other high-tech industries, calling for regular and rigorous biological monitoring. Conventional biomonitoring of Be in urine is not informative of cumulative exposure nor health outcomes. Biomarkers of exposure to Be based on non-invasive biomonitoring could help refine disease risk assessment. In a cohort of workers with Be exposure, we employed blood plasma extracellular vesicles (EVs) to discover novel biomarkers of exposure to Be.

Methods

EVs were isolated from plasma using size-exclusion chromatography and subjected to mass spectrometry-based proteomics. A protein-based classifier was developed using LASSO regression and validated by ELISA.

Results

We discovered a dual biomarker signature comprising zymogen granule protein 16B and putative protein FAM10A4 that differentiated between Be-exposed and -unexposed subjects. ELISA-based quantification of the biomarkers in an independent cohort of samples confirmed higher expression of the signature in the Be-exposed group, displaying high predictive accuracy (AUROC = 0.919). Furthermore, the biomarkers efficiently discriminated high- and low-exposure groups (AUROC = 0.749).

Conclusions

This is the first report of EV biomarkers associated with Be exposure and exposure levels. The biomarkers could be implemented in resource-limited settings for Be exposure assessment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-022-01871-7.

The emerging role of inorganic elements as potential antigens in sarcoidosis

PURPOSE OF REVIEW

Previous studies mainly described a role for organic agents as possible triggers for sarcoidosis. In this review, we address recent studies suggesting a possible role for inorganic elements, such as metals or silica in sarcoidosis pathogenesis.

RECENT FINDINGS

Several epidemiological papers suggest that inorganic agents, either by environmental exposures or occupational activities, could trigger sarcoidosis. Association between inorganics and sarcoidosis is also described in several recently published case reports and studies demonstrating immunological sensitization to inorganic agents in sarcoidosis patients.Studies comparing chronic beryllium disease (CBD) and sarcoidosis suggest that although antigenic triggers may differ, underlying processes may be comparable.Besides the fact that a growing number of studies show a possible role for inorganic triggers, it is also suggested that inorganic triggered sarcoidosis may result in a more severe phenotype, including pulmonary fibrosis.

SUMMARY

We can use the knowledge already gained on CBD pathogenesis to conduct further research into role of inorganics, such as metals and silica as antigens in sarcoidosis. Given the importance of a lymphocyte proliferation test (LPT) in diagnosing CBD, it seems obvious to also implement this test in the diagnostic work-up of sarcoidosis to identify patients with an inorganic antigenic trigger of their disease.

Pneumoconiosis with a Sarcoid-Like Reaction Other than Beryllium Exposure: A Case Report and Literature Review

Background: Chronic beryllium disease (CBD) is a granulomatous disease that resembles sarcoidosis but is caused by beryllium. Clinical manifestations similar to those observed in CBD have occasionally been reported in exposure to dusts of other metals. However, reports describing the clinical, radiographic, and pathological findings in conditions other than beryllium-induced granulomatous lung diseases, and detailed information on mineralogical analyses of metal dusts, are limited. Case presentation: A 51-year-old Japanese man with rapidly progressing nodular shadows on chest radiography, and a 10-year occupation history of underground construction without beryllium exposure, was referred to our hospital. High-resolution computed tomography showed well-defined multiple centrilobular and perilobular nodules, and thickening of the intralobular septa in the middle and lower zones of both lungs. No extrathoracic manifestations were observed. Pathologically, the lung specimens showed 5–12 mm nodules with dust deposition and several non-necrotizing granulomas along the lymphatic routes. X-ray analytical electron microscopy of the same specimens revealed aluminum, iron, titanium, and silica deposition in the lung tissues. The patient stopped smoking and changed his occupation to avoid further dust exposure; the chest radiography shadows decreased 5 years later. Conclusion: The radiological appearances of CBD and sarcoidosis are similar, although mediastinal or hilar lymphadenopathy is less common in CBD and is usually seen in the presence of parenchymal opacities. Extrathoracic manifestations are also rare. Despite limited evidence, these findings are similar to those observed in pneumoconiosis with a sarcoid-like reaction due to exposure to dust other than of beryllium. Aluminum is frequently detected in patients with pneumoconiosis with a sarcoid-like reaction and is listed as an inorganic agent in the etiology of sarcoidosis. It was also detected in our patient and may have contributed to the etiology. Additionally, our case suggests that cessation of dust exposure may contribute to improvement under the aforementioned conditions.