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Sharma S, Nayak S, R B, Singh K. Silico-tuberculosis: An updated review. Indian J Tuberc 2024; 71:471-475. [PMID: 39278682 DOI: 10.1016/j.ijtb.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 09/18/2024]
Abstract
Silico-Tuberculosis (silico-TB) is a severe combination of tuberculosis and silicosis, caused by occupational exposure to fine crystalline silica dust, which has become a global health concern. This comprehensive review compiles the updated knowledge regarding pathophysiology, clinical manifestations, important diagnostic techniques, treatment aspects, and challenges in understanding silico-TB. The review compiles the disease's history and epidemiology, highlighting a lack of data owing to poor monitoring and healthcare particularly in low- and middle-income countries like India. Further weak safety regulations, lack of preventative measures, and inadequate education increase the rates of silico-TB. The pathophysiology shows how silica particles impair the immune system and stimulate Th2 cells and M2 macrophages, which exacerbate TB, while inhibiting Th1 cells and M1 macrophages, which fight against the disease. Subsequently, it can be difficult to distinguish current TB from pre-existing silicosis. In cases where sputum and X-ray results are negative, chest CT scans may be helpful since radiographic screening identifies TB earlier than sputum assessment. Isoniazid, rifampicin, or both minimize the risk of active tuberculosis in people with silicosis. Consistent anti-tuberculosis drug therapy is recommended for 8-9 months to stop recurrence. The assessment recommends integrating silicosis and TB control initiatives to fight this combined health issue.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India; Viral Research and Diagnostic Laboratory, Department of Virology, Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India.
| | - Snehasish Nayak
- Indian Institute of Science Education and Research, Tirupati, Andhra Pradesh, India.
| | - Bhavani R
- Department of Biotechnology and Medical Engineering, National Institute of Technology, Rourkela, Odisha, India.
| | - Kamal Singh
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India; Viral Research and Diagnostic Laboratory, Department of Virology, Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India.
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Elango R, Kailash A, Verma G, Rudhramoorty P. Silico-Tuberculosis Mimicking Malignancy. Cureus 2024; 16:e65411. [PMID: 39184669 PMCID: PMC11344886 DOI: 10.7759/cureus.65411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
Silico-tuberculosis is the combination of silicosis and tuberculosis (TB). Symptoms of TB such as dyspnea, cough, and hemoptysis may precede the diagnosis of an endo-bronchial mass lesion on chest imaging. Among workers who were exposed to silica, TB was more common, and experiments indicated that silica inhibits alveolar macrophage activity and severe exposure induces apoptosis. Endobronchial neoplasms, which are tumors primarily affecting the bronchial lumen, are uncommon and may show up in a wide variety of different ways pathologically. Cough, chest discomfort, wheezing, hemoptysis, recurrent pneumonia, and weight loss are common complaints from people with endobronchial tumors. The requirement for additional bronchoscopy and imaging examination is raised when symptoms such as hemoptysis and obstructive pneumonia are present. Endobronchial silicosis lesions are uncommon and develop as a result of broncho lithiasis, the endoluminal erosion of peri bronchial adenopathy, or local bronchial wall silica-induced fibrosis. Endobronchial TB can present in a varied manner, diagnosis is often challenging as there is no specific radiological feature, and sputum acid-fast bacilli several times come out negative. However, a bronchoscopy with or without biopsy is a useful investigation in these cases. The following case is a rare manifestation of endobronchial TB as it mimicked malignancy, describing the difficulties in diagnosis and treating a patient who had both silicosis and endobronchial TB.
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Affiliation(s)
- Ragavi Elango
- Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Ashwin Kailash
- Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
| | - Ghanshyam Verma
- Respiratory Medicine, Sree Balaji Medical College and Hospital, Chennai, IND
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Rupani MP, Nimavat P, Patel Y, Shah HD, Sau A. Framework for implementing collaborative TB-silicosis activities in India: insights from an expert panel. Arch Public Health 2024; 82:91. [PMID: 38890764 PMCID: PMC11184817 DOI: 10.1186/s13690-024-01325-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 06/15/2024] [Indexed: 06/20/2024] Open
Abstract
Tuberculosis (TB) treatment is more challenging for patients with silicosis, as it complicates the diagnosis of both diseases and increases mortality risk. Silicosis, an incurable occupational disease, confounds the diagnosis of TB and vice versa, making it more difficult to accurately identify and treat either condition. Moreover, TB appears to accelerate the progression of silicosis. Exposure to silica dust, a common cause of silicosis, can also trigger latent TB to become active TB. This correspondence outlines a proposed framework for implementing collaborative TB-silicosis activities in India, aimed at improving early diagnosis and management for both diseases. An expert panel of medical professionals developed this framework through online consultations in October and November 2022. The panel's goal was to establish a consensus on integrating TB-silicosis activities, with a focus on early detection and proper management. The framework suggests testing all patients with silicosis for active TB and screening workers exposed to silica dust for latent TB infection. It also recommends that patients with TB who have a history of occupational exposure to silica dust should be tested for silicosis. Reliable diagnostic tools, such as chest X-rays, are emphasized, providing guidance on their use for both diseases. The proposed collaborative TB-silicosis framework offers a structured approach to identifying and managing these two diseases, contributing to the global goal of eliminating silicosis by 2030 and aligning with the World Health Organization's targets for reducing TB incidence and mortality. It recommends specific strategies for implementation, including testing, referral systems, and workplace-based interventions. The framework also underscores the need for coordinated efforts among stakeholders, including the ministries of health, labor, industry, and environment. This correspondence provides valuable insights into how India can successfully implement collaborative TB-silicosis activities, serving as a model for other regions with similar challenges.
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Affiliation(s)
- Mihir P Rupani
- Clinical Epidemiology (Division of Health Sciences), ICMR - National Institute of Occupational Health (NIOH), Indian Council of Medical Research (ICMR), Meghaninagar, Ahmedabad City, Gujarat, 380016, India.
| | - Pankaj Nimavat
- State Tuberculosis Training and Demonstration Center (STDC), Civil Hospital, Asarwa, Ahmedabad City, Gujarat, 380016, India
| | - Yogesh Patel
- John Snow India (JSI) Private Limited, New Delhi, 110070, India
| | - Harsh D Shah
- Indian Institute of Public Health (IIPH), Palaj Village, Gandhinagar, 382042, Gujarat, India
| | - Arkaprabha Sau
- Deputy Director (Medical), Regional Labour Institute, Directorate General Factory Advice Service & Labour Institutes, Kanpur, Uttar Pradesh, 208005, India
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Hu X, Chen C, Gao Q, Zhou L, Shao Y, Li G, Song H, Liu Q, Han L, Zhu L. Latent tuberculosis infection and infection-associated risk factors for miner workers with silicosis in eastern China. BMC Pulm Med 2024; 24:177. [PMID: 38622607 PMCID: PMC11017624 DOI: 10.1186/s12890-024-02985-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/28/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES Silicosis people are at high risk of developing pulmonary tuberculosis. Whether silica exposure increases the likelihood of latent tuberculosis infection (LTBI) was not well understood, and potential factors involved in LTBI risk among silicosis people were not evaluated before. Thus, LTBI among silicosis people and potential risk factors for LTBI among silicosis people were evaluated in this study. METHODS A cross-sectional study was undertaken for 130 miner workers with silicosis. The QFT-GIT was performed for LTBI detection. RESULTS The LTBI was high to 31.6% (36/114) for silicosis participants, and 13.1% (13/99) had a history of tuberculosis. Drinking was associated with LTBI risk (OR = 6.92, 95%CI, 1.47-32.66, P = 0.015). Meanwhile, tunneling work was associated with an increased risk of LTBI compared with other mining occupations (OR = 3.91,95%CI,1.20-12.70, P = 0.024). CONCLUSIONS The LTBI rate of silicosis participants was high and more than 10% had a history of tuberculosis. Drinking alcohol and tunneling were independent risk factors for LTBI in silicosis participants.
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Affiliation(s)
- Xinsong Hu
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Cheng Chen
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Qianqian Gao
- Department of Occupational Disease Prevention, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Lang Zhou
- Department of Occupational Disease Prevention, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Yan Shao
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Guoli Li
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Honghuan Song
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China
| | - Lei Han
- Department of Occupational Disease Prevention, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China.
| | - Limei Zhu
- School of Public Health, Nanjing Medical University, Nanjing, China.
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China.
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Rai S, Jha RR, Prasad S, Kumar D, Rana RK. Predictors for Concurrent Diabetes in Tuberculosis Patients. Perspectives from Two Mining Districts of Eastern Tribal State Jharkhand, in India. Indian J Community Med 2024; 49:404-410. [PMID: 38665445 PMCID: PMC11042151 DOI: 10.4103/ijcm.ijcm_11_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 10/17/2023] [Indexed: 04/28/2024] Open
Abstract
Background Tuberculosis and diabetes both diseases are present in large numbers in the country and we are major contributors to both globally. With the objective to understand the various traits of patients having both tuberculosis and diabetes and to ascertain various possible predictors for such occurrence based on the public health database we carried out this study. We seek answers to questions like they have any effects? Are they having any additive role to play? Methods One-year data from the NIKSHAY portal of both districts were analyzed to look for possible associations and other variable traits. Data were analyzed using standard methods to express data in frequency and percentage. Chi-square test was used to establish association, while step-wise approach was used to calculate univariate and multivariate logistic regression analysis for knowing various predictors. P-value of <0.05 was considered statistically significant. Results Concurrent diabetes in tuberculosis patients was close to 294 (6%) in the 4933 individuals. In total, 65.2% of the study population were male. Diagnosis of tuberculosis was made most of the time by chest X-ray (49.4%) followed by Microscopy ZN staining and cartridge-based nucleic acid amplification test (CBNAAT). Death was more among diabetics (4.4%) as compared to nondiabetics (3.5%). Conclusion Diabetes is increasing in tuberculosis patients; improvement in data quality is needed. More research is required to reveal various other reasons that make tuberculosis patients more prone to develop diabetes.
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Affiliation(s)
- Sandeep Rai
- Department of Community Medicine, T S Misra Medical College and Hospitals, Amausi, Lucknow, Uttar Pradesh, India
| | - Ravi Ranjan Jha
- Department of Preventive and Social Medicine, Shaheed Nirmal Medical College and Hospital, Dhanbad, Jharkhand, India
| | - Santosh Prasad
- Department of Paediatrics, Tata Central Hospital, Jamadoba, Dhanbad, Jharkhand, India
| | - Dewesh Kumar
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Rishabh Kumar Rana
- Department of Preventive and Social Medicine, Shaheed Nirmal Medical College and Hospital, Dhanbad, Jharkhand, India
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Beigoli S, Amin F, Kazemi Rad H, Rezaee R, Boskabady MH. Occupational respiratory disorders in Iran: a review of prevalence and inducers. Front Med (Lausanne) 2024; 11:1310040. [PMID: 38390570 PMCID: PMC10881831 DOI: 10.3389/fmed.2024.1310040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
The link between occupational respiratory diseases (ORD) and exposure to harmful factors that are present in the workplace has been well shown. Factors such as physical activity, age and duration of occupational exposure playing important roles in ORD severity, should be identified in the workplace, their effects on workers health should be studied, and ultimately, exposure to them must be minimized. We carried out a literature review by searching PubMed, Scopus, and Web of Science databases to retrieve studies published from 1999 until the end of April 2023 reporting the prevalence and inducers of ORD in Iran. In Iranian workers, several ORD such as interstitial lung disease, silicosis, occupational asthma, pulmonary inflammatory diseases, chronic obstructive pulmonary diseases, and lung cancers have been reported. It was indicated that ORD mainly occur due to repeated and prolonged exposure to noxious agents in the workplace. We also extracted the prevalence of ORD in different regions of Iran from the retrieved reports. Based on our literature review, the prevalence of ORD among Iranian workers highlights the importance of regular assessment of the risk of exposure to noxious agents in the workplace to develop measures for preventing potential adverse effects.
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Affiliation(s)
- Sima Beigoli
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Amin
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hamideh Kazemi Rad
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Rezaee
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein Boskabady
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Physiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Roy P, Bardhan M, Roy S, Singh U, Suresh T, Anand A. Silico-tuberculosis amidst COVID-19 pandemic: global scenario and Indian perspective. Ann Med Surg (Lond) 2023; 85:6083-6090. [PMID: 38098595 PMCID: PMC10718399 DOI: 10.1097/ms9.0000000000001471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/24/2023] [Indexed: 12/17/2023] Open
Abstract
Inhalation of crystalline silica-rich dust particles can result in the deadly occupational lung disorder called silicosis. The risk of contracting tuberculosis (TB) and the potential for lung cancer increase due to silicosis. This review article aims to bring to light the state of silicosis and TB scenario in the world and India for evaluating hurdles in the present and future to achieve the elimination road map and assess these conditions in the backdrop of the COVID-19 pandemic. A patient with silicosis has a 2.8-2.9 times higher risk of developing pulmonary TB and 3.7 times that of extrapulmonary TB. Incidences of missed cases when TB was misdiagnosed with silicosis due to indifferent clinical manifestations of the two in the initial stages are not uncommon. The duration of silica exposure and silicosis severity are directly related to the propensity to develop TB. As per a study, an average gap of 7.6 years has been noticed in a South African population for silico-tuberculosis to develop post-silicosis. In a study done on mine workers at Jodhpur, Rajasthan, it was seen that there is no definitive relation between patients with silicosis and the possibility of having COVID-19. There is a significant need to integrate the Silicosis control program with the TB elimination program for the government. A few steps can include assessing the workplaces, periodic monitoring of the workers' health, active case surveillance, identification of hotspots, and introducing reforms to curb the spread of dust and particulate matter from industrialised areas be taken in this regard.
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Affiliation(s)
- Priyanka Roy
- Deputy Chief Inspector of Factories/ Deputy Director (Medical) and Certifying Surgeon, Directorate of Factories, Department of Labour, Government of West Bengal, West Bengal
| | - Mainak Bardhan
- Miami Cancer Institute, Baptist Health South Florida, FL, USA
| | - Shubhajeet Roy
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, India
| | - Utkarsh Singh
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, India
| | - Timil Suresh
- Faculty of Medical Sciences, King George’s Medical University, Lucknow, India
| | - Ayush Anand
- BP Koirala Institute of Health Sciences, Dharan, Nepal
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8
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Sinha R, Priya A, Ahmad A. Risk of Silico-Tuberculosis in Miners: A Systematic Review and Meta-Analysis. Indian J Occup Environ Med 2023; 27:296-302. [PMID: 38390483 PMCID: PMC10880824 DOI: 10.4103/ijoem.ijoem_287_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2024] Open
Abstract
Context Tuberculosis (TB) and Silicosis are public health problems with high morbidity and mortality. They also exist as comorbidities and are highly prevalent among mine workers. Aims This study aims to estimate the risk of TB in miners with silicosis than in miners not having silicosis. Methods and Material This systematic review was conducted by literature search using PubMed, and EMBASE for studies published from 1st Jan 2017 till 20th July 2022. From the data obtained using relevant keywords for the search, a total of 345 articles were selected for screening after applying our inclusion-exclusion criteria and removing duplicates. PRISMA guidelines were followed. items JBI critical appraisal checklist for cross-sectional studies was used for assessment of the risk of bias. The odds ratio was used to estimate the strength of the association. Results After extensive screening, four studies have met our selection criteria. The meta-analysis of those studies revealed that the prevalence of TB in miners with silicosis is 27.11% while the prevalence of TB in miners with non-silicosis is 16.75%. The estimated pooled odds ratio (fixed effect model) is 1.34 (95% CI 1.01 - 1.76). Conclusions The present study reveals that there is an increased risk of TB in miners with Silicosis. Newer initiatives must be taken to prevent TB in miners.
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Affiliation(s)
- Ratnesh Sinha
- Assistant Professor, Department of Community Medicine, Manipal TATA Medical College, Jamshedpur, Manipal Academy of Higher Education, Manipal, India
| | - Angelin Priya
- Assistant Professor, Department of Community Medicine, Manipal TATA Medical College, Jamshedpur, Manipal Academy of Higher Education, Manipal, India
| | - Absar Ahmad
- Department of Statistics, Ranchi Veterinary College, Birsa Agricultural University, Ranchi, Jharkhand, India
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Jamshidi P, Danaei B, Arbabi M, Mohammadzadeh B, Khelghati F, Akbari Aghababa A, Nayebzade A, Shahidi Bonjar AH, Centis R, Sotgiu G, Nasiri MJ, Migliori GB. Silicosis and tuberculosis: A systematic review and meta-analysis. Pulmonology 2023:S2531-0437(23)00092-2. [PMID: 37349198 DOI: 10.1016/j.pulmoe.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/03/2023] [Accepted: 05/03/2023] [Indexed: 06/24/2023] Open
Abstract
INTRODUCTION Silicosis mostly happens in workers with high silica exposure and may accompany the development of various diseases like tuberculosis, cancer, or autoimmune diseases. The term silico-tuberculosis describes a condition in which an individual is affected by both silicosis and tuberculosis at the same time. This systematic review and meta-analysis study was conducted to evaluate the risk of tuberculosis in silicosis patients and individuals exposed to silica dust. METHODS We performed a systematic search for relevant studies up to 6 September 2022 using PubMed/ Medline, and Embase with the following keywords in titles or abstracts: "silicosis" OR "silicoses" OR "pneumoconiosis" OR "pneumoconioses" AND "tuberculosis". Cohort and case-control studies containing relevant and original information about tuberculosis infection in silicosis patients were included for further analysis. Pooled estimates and 95% confidence intervals (CI) for the relative risk of tuberculosis in individuals with silicosis compared to those without; these were evaluated using the random effects model due to the estimated heterogeneity of the true effect sizes. RESULTS Out of 5352 potentially relevant articles, 7 studies were eligible for systematic review, of which 4 cohort studies were included for meta-analysis. The total population of all studies was 5884, and 90.63% were male. The mean age of participants was 47.7 years. Our meta-analysis revealed a pooled risk ratio of 1.35 (95%CI 1.18-1.53, I 2: 94.30%) which means an increased risk of silicosis patients and silica-exposed individuals to tuberculosis infection. CONCLUSION Silicosis and silica dust exposure increase the risk of tuberculosis. Therefore, we suggest that individuals with long-time silica exposure, like mine workers, be routinely considered for both silicosis and tuberculosis screening programs.
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Affiliation(s)
- P Jamshidi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Center of Public Health, Environmental and Occupational Hazards Control, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - B Danaei
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Arbabi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - B Mohammadzadeh
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Khelghati
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Akbari Aghababa
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Nayebzade
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A H Shahidi Bonjar
- Researcher at the National Institute for Medical Research Development (NIMAD), Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran; Clinician Scientist of Dental Materials and Restorative Dentistry, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - R Centis
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy
| | - G Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Italy.
| | - M J Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - G B Migliori
- Servizio di Epidemiologia Clinica delle Malattie Respiratorie, Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Italy.
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10
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Silica-associated lung disease in developing countries. Curr Opin Pulm Med 2023; 29:65-75. [PMID: 36695765 DOI: 10.1097/mcp.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW There is a considerable burden of silica-associated lung diseases in the developing world. This review summarizes the epidemiology of these diseases, especially silicosis and silico-tuberculosis, mitigative efforts and treatment, especially in the context of developing countries. RECENT FINDINGS In 2017, the highest incidence of silicosis was in China, India and Brazil among the developing countries. The prevalence of silicosis amongst exposed workers may vary from 4 to 55%; there is a risk of underestimation because of the 'healthy worker effect'. The permissible exposure limit for respirable silica adopted by governments in developing countries remains higher than the proposed 0.025 mg/m3. Silica exposure in informal or unorganized industries is challenging, as it falls outside statutory controls. Recent efforts on regulation and compensation by various governments in developing countries are encouraging but need proper implementation on the ground. Biomarkers such as club cell protein 16 and imaging methods such as computed tomography may offer earlier and easier detection of silicosis. Advanced silicosis remains incurable; novel treatments such as antifibrotics agents may be potentially effective. SUMMARY Silica-associated lung diseases are prevalent in developing countries. Efforts directed at preventing or minimizing exposure to respirable crystalline silica are required for mitigation.
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Rupani MP. A mixed-methods study on impact of silicosis on tuberculosis treatment outcomes and need for TB-silicosis collaborative activities in India. Sci Rep 2023; 13:2785. [PMID: 36797362 PMCID: PMC9935606 DOI: 10.1038/s41598-023-30012-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
Globally, silicosis and tuberculosis (TB) have been targeted for elimination by 2030. The study's objectives were to determine the association of silicosis with unfavorable TB treatment outcomes, as well as to explore experts' perspectives on improving treatment outcomes among silico-tuberculosis patients. A retrospective cohort study evaluated TB treatment outcomes in Khambhat block, the western part of India, between 138 patients with silico-tuberculosis and 2610 TB patients without silicosis in February-March 2022. 'Unfavorable TB treatment outcomes' was defined as a patient stopping treatment for at least one month, a positive sputum smear at the end of treatment, or, a patient dying while on treatment. During April-July 2022, fifteen in-depth interviews with experts in the field of silicosis/tuberculosis were audio-recorded, transcribed, and analyzed to generate codes (thematic analysis). On multivariable logistic regression analysis, patients with silico-tuberculosis had a 2.3 (95% CI 1.6-3.4) times higher odds of unfavorable treatment outcomes. The experts recommended collaborative TB-silicosis activities for improving treatment outcomes of patients with silico-tuberculosis. I conclude from the study's findings that silicosis is associated with unfavorable TB treatment outcomes in this study setting. All patients with silicosis should be screened for TB and treated according to national TB program guidelines. All patients with TB who have a history of occupational dust exposure should be evaluated for silicosis and provided appropriate pulmonary/vocational rehabilitation.
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Affiliation(s)
- Mihir P. Rupani
- grid.19096.370000 0004 1767 225XClinical Epidemiology (Division of Health Sciences), ICMR - National Institute of Occupational Health (NIOH), Indian Council of Medical Research, Meghaninagar, Ahmedabad City, Gujarat 380016 India
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12
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Abstract
Silicosis continues to be a serious health issue in many countries and its elimination by 2030 (a target set by WHO and the International Labour Organization in 1995) is virtually impossible. The risk to develop pulmonary tuberculosis for silicosis patients is higher than for non-silicosis people, and there is also an increased risk of both pulmonary and extrapulmonary tuberculosis in individuals exposed to silica. HIV coinfection adds further to the risk, and in some countries, such as South Africa, miners living with HIV are a considerable number. The diagnosis of active tuberculosis superimposed on silicosis is often problematic, especially in initial phases, and chest X-ray and smear examination are particularly important for the diagnosis of pulmonary tuberculosis. Treatment is difficult; directly observed therapy is recommended, a duration of at least eight months is probably needed, drug reactions are frequent and the risk of relapse higher than in non-silicosis patients. TB prevention in silicosis patients is essential and include active surveillance of the workers, periodic chest X-rays, tuberculin skin test or interferon-gamma releasing assay testing, and, importantly, adoption of measures to reduce the exposure to silica dust. Chemoprophylaxis is possible with different regimens and needs to be expanded around the world, but efficacy is unfortunately limited. Silico-tuberculosis is still a challenging health problem in many countries and deserves attention worldwide.
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Affiliation(s)
- Massimiliano Lanzafame
- Diagnosis and Treatment of HIV Infection Unit, "G.B. Rossi University Hospital", Verona, Italy
| | - Sandro Vento
- Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia
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Rajavel S, Raghav P, Gupta MK, Muralidhar V. Silico-tuberculosis, silicosis and other respiratory morbidities among sandstone mine workers in Rajasthan- a cross-sectional study. PLoS One 2020; 15:e0230574. [PMID: 32298271 PMCID: PMC7162522 DOI: 10.1371/journal.pone.0230574] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Exposures to respirable crystalline silica causes silicosis, pulmonary tuberculosis, chronic obstructive pulmonary disease, lung cancer, autoimmune disorders and chronic renal disease. The aim of this study was to find out the prevalence of silico-tuberculosis, silicosis and other respiratory morbidities in sandstone mine workers in Jodhpur district of Rajasthan. METHODS It was a cross-sectional study done in sandstone mines in Jodhpur. A total of 15 mines were selected. The sample size was calculated and fixed to 174 mine workers. Chi-square and t-test were applied to draw inferences. RESULTS The mean age of the mine workers was 39.13 ± 11.09 years. Three fourth (75.3%) of the workers were working for more than ten years in mines. Around 30.0% had a history of tuberculosis. Abnormal spirometry was found in 89.2% of workers. Around 42% of mine workers were found with abnormal chest x-rays. Prevalence of silicosis was 37.3%, silico-tuberculosis was 7.4%, tuberculosis was 10.0%, and other respiratory diseases like emphysema and pleural effusion were diagnosed among 4.3% workers. CONCLUSION Prevalence of silico-tuberculosis, silicosis and other respiratory morbidities are high among sandstone mine workers.
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Affiliation(s)
- Saranya Rajavel
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, India
| | - Pankaja Raghav
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, India
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences (AIIMS) Jodhpur, Jodhpur, Rajasthan, India
| | - Venkiteswaran Muralidhar
- Department of General Surgery, Chettinad Medical College and Hospital, Chennai, Tamil Nadu, India
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Liu K, Mu M, Fang K, Qian Y, Xue S, Hu W, Ye M. Occupational exposure to silica and risk of heart disease: a systematic review with meta-analysis. BMJ Open 2020; 10:e029653. [PMID: 31915156 PMCID: PMC6955526 DOI: 10.1136/bmjopen-2019-029653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To search for evidence of the relationship between occupational silica exposure and heart disease. DESIGN A systematic review and meta-analysis. BACKGROUND Growing evidence suggests a relationship between occupational silica exposure and heart disease; however, the link between them is less clear. DATA SOURCES PubMed, ScienceDirect, Springer and EMBASE were searched for articles published between 1 January 1995 and 20 June 2019. Articles that investigated the effects of occupational silica exposure on the risk of heart disease were considered. STUDY SELECTION We included cohort studies, including prospective, retrospective and retroprospective studies. DATA EXTRACTION AND SYNTHESIS We extracted data using a piloted data collection form and conducted random-effects meta-analysis and exposure-response analysis. The meta-relative risk (meta-RR), a measure of the average ratio of heart disease rates in those with and without silica exposure, was used as an inverse variance-weighted average of relative risks from the individual studies. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used for study quality assessment. OUTCOME MEASURE We calculated the risk of heart diseases such as pulmonary heart disease, ischaemic heart disease and others. RESULTS Twenty cohort studies were included. The results suggest a significant increase in the risk of overall heart disease (meta-RR=1.08, 95% CI 1.03 to 1.13). Stronger evidence of association with pulmonary heart disease was found in the risk estimate of both categories of heart disease (meta-RR=1.24, 95% CI 1.08 to 1.43) and in the exposure-response analysis (meta-RR=1.39, 95% CI 1.19 to 1.62). Our subgroup analyses also revealed that the statistical heterogeneity among studies could be attributed mainly to the diversity in reference group, occupation and study quality score. CONCLUSIONS Silica-exposed workers are at an increased risk for overall heart disease, especially pulmonary heart disease. Further research is needed to better clarify the relationship between occupational silica exposure and ischaemic heart disease. PROSPERO REGISTRATION NUMBER CRD42019124673.
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Affiliation(s)
- Kai Liu
- Department of Biomarkers and Molecular Epidemiology, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Min Mu
- Department of Public Health, School of Medicine, Anhui University of Science and Technology, Huainan, Anhui, China
| | - Kehong Fang
- Department of Nutritional Epidemiology, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuanyuan Qian
- Department of Biomarkers and Molecular Epidemiology, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Song Xue
- Department of Orthopaedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weijiang Hu
- Department of Occupational Epidemiology, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Meng Ye
- Department of Biomarkers and Molecular Epidemiology, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China
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15
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Chadha VK, Praseeja P. Active tuberculosis case finding in India - The way forward. Indian J Tuberc 2019; 66:170-177. [PMID: 30878064 DOI: 10.1016/j.ijtb.2018.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/29/2018] [Accepted: 05/16/2018] [Indexed: 11/19/2022]
Abstract
Community based active case finding (ACF) for tuberculosis (TB) has seen resurrection in the current armamentarium of many TB managers in their fight toward eliminating TB. This article explores the accuracy and approximate cost of various ACF algorithms currently in vogue in India or those which could be useful, while inputting the sensitivity and specificity of screening and diagnostic tools as estimated from recently conducted community based surveys. This analysis informs that ACF may be prioritized to higher prevalence settings and the diagnostic algorithm for specific setting may be chosen taking into account the expected prevalence, estimated accuracy of the algorithm and resource availability. Further, chest X-ray cannot be used alone as a diagnostic tool and can be relied upon for this purpose when at least one of the three sputum specimen is smear positive. Accuracy of Xpert MTB/RIF as a diagnostic tool in community situations needs to be investigated further. The review brings out significant proportions of initial default and default during treatment among cases detected through ACF thus emphasizing the need for heightened efforts toward preventing the same. The article rounds off emphasizing priority to addressing barriers to speedy scale up of more sensitive diagnostic tools for health center based case finding including in private sector and ACF in high risk clinical groups for early and efficient case detection. It concludes by putting forth certain research areas that would strengthen future efforts.
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Affiliation(s)
- V K Chadha
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India.
| | - P Praseeja
- Epidemiology and Research Division, National Tuberculosis Institute, Bangalore, Karnataka, India
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16
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Puchner KP, Rodriguez-Fernandez R, Oliver M, Solomos Z. Non-communicable diseases and tuberculosis: Anticipating the impending global storm. Glob Public Health 2019; 14:1372-1381. [PMID: 30785858 DOI: 10.1080/17441692.2019.1580760] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The epidemiological transitions that have occurred in low and middle income countries (LMIC) during the past decades have led to an increased prevalence on non-communicable diseases (NCDs) in these countries, where the burden of infectious diseases (IDs), especially tuberculosis (TB), remains high. Although the true dimensions of this comorbidity have not yet been fully understood, there is a growing amount of data, over the last 10 years, that suggest a clear association between NCDs and TB. In particular, there is a continuously increasing body of evidence that diabetes mellitus, chronic respiratory conditions, tobacco use, mental health illnesses and chronic kidney disease increase TB morbidity and mortality and vice versa. This bidirectional negative association between diseases may jeopardise the achievement of the Sustainable Development Goals (SDGs) specific TB targets, thus underlying the importance of integrated public health responses towards both epidemics. Population as well as individual based approaches are required, along with both strategic and operation integration on a global scale. This year's United Nations High Level Meetings (ΗLMs) presented a rare opportunity for the political foundations of the TB and NCD responses to be dug together, thus creating a potential breakthrough in the global response to both epidemics.
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Affiliation(s)
- Karl Philipp Puchner
- a German Leprosy and TB Relief Association , Wuerzburg , Germany.,e Medecins du Monde , Athens , Greece
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Chanda-Kapata P, Osei-Afriyie D, Mwansa C, Kapata N. Tuberculosis in the mines of Zambia: A case for intervention. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2016.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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