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State-Level Health Disparity Is Associated with Sarcoidosis Mortality. J Clin Med 2021; 10:jcm10112366. [PMID: 34072248 PMCID: PMC8199085 DOI: 10.3390/jcm10112366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Sarcoidosis is associated with significant morbidity and rising health care utilization, which contribute to the health care burden and disease outcome. In the United States (US), evaluation of sarcoidosis mortality by individual states has not been investigated. METHODS We examined sarcoidosis mortality data for 1999-2018 from the Centers for Disease Control and Prevention (CDC). America's Health Rankings (AHR) assesses the nation's health on a state-by-state basis to determine state health rankings. The numbers of certified Sarcoidosis Clinics within the US were obtained from World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG) and Foundation for Sarcoidosis Research (FSR). The associations between sarcoidosis mortality and state health disparities were calculated by linear regression analyses. RESULTS From 1999 to 2018, the mean age-adjusted mortality rate (AAMR) in all populations, African Americans and European Americans were 2.9, 14.8, and 1.4 per 1,000,000 population, respectively. South Carolina had the highest AAMR for all populations (6.6/1,000,000) and African Americans (20.8/1,000,000). Both Utah and Vermont had the highest AAMR for European Americans (2.6/1,000,000). New York State and South Atlantic had the largest numbers of FSR-WASOG Sarcoidosis Clinics (6 and 13, respectively). States with better health rankings were significantly associated with lower AAMR in all population (R2 = 0.170, p = 0.003) but with higher AAMR in European Americans (R2 = 0.223, p < 0.001). CONCLUSIONS There are significant variations in sarcoidosis mortality within the US. Sarcoidosis mortality was strongly associated with state health disparities. The current study suggests sarcoidosis mortality could be an indicator to reflect the state-level health care disparities in the US.
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Immunoreactivity to metal and silica associates with sarcoidosis in Dutch patients. Respir Res 2020; 21:141. [PMID: 32513159 PMCID: PMC7282065 DOI: 10.1186/s12931-020-01409-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/26/2020] [Indexed: 01/06/2023] Open
Abstract
Background Involvement of metals or silica in the pathogenesis of sarcoidosis has been suggested by several case reports and specific epidemiological studies. However, the combination of occupational exposure and an immunological reaction has not been studied before in a group of sarcoidosis patients and non-sarcoidosis controls. Methods In 256 sarcoidosis patients and 73 control patients with obstructive sleep apnea, exposure to metal and silica was assessed using a questionnaire consisting of a complete occupational history subsequently linked to job-exposure matrices. Next, immunoreactivity to aluminium, beryllium, zirconium and silica was determined in 33 sarcoidosis and 19 control patients using a lymphocyte proliferation test. Results In sarcoidosis, 83 out 256 patients (32.4%) had occupational exposure to metals or silica, compared to 24.7% in the control group (p = 0.21). A significantly higher percentage of the sarcoidosis patients tested showed immunoreactivity to metals or silica compared to the control group (21.2 and 0% respectively, p = 0.039). Conclusions Immunoreactivity to silica and metals was only found in sarcoidosis patients, supporting the hypothesis that these antigens may be involved in the pathogenesis of a distinct subgroup of sarcoidosis patients. This indicates that when searching for causative agents in sarcoidosis patients, besides beryllium, also zirconium, aluminium and silica deserve clinical investigation.
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Blin T, De Muret A, Teulier M, Ferreira M, Vincent M, Catinon M, Legras A, Diot P, Marchand-Adam S. Desquamative interstitial pneumonia induced by metal exposure. A case report and literature review. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:79-84. [PMID: 33093772 PMCID: PMC7569535 DOI: 10.36141/svdld.v37i1.9103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/07/2020] [Indexed: 11/02/2022]
Abstract
Background Forms of interstitial pneumonia secondary to exposure to an air-contaminant are varied and so far, insufficiently described. Objectives/Methods We report here a case of a 57-year-old patient managed in our department for the exploration of MRC grade 2 dyspnoea and interstitial pneumonia. He mentioned multiple occupational and domestic exposures such as hens' excrements, asbestos and metal particles; he also had a previous history of smoking. Results High-resolution computed tomography showed ground glass opacities predominating in posterior territories and surrounding cystic lesions or emphysematous destruction. The entire etiological assessment revealed only macrophagic alveolitis with giant multinucleated cells on the bronchoalveolar lavage. A surgical lung biopsy allowed us to refine the diagnosis with evidence of desquamative interstitial pneumonia and pulmonary granulomatosis. Finally, the analysis of the mineral particles in the biopsy revealed abnormally high rates of Zirconium and Aluminium. We were therefore able to conclude to a desquamative interstitial pneumonia associated with pulmonary granulomatosis linked to metal exposure (Aluminium and Zirconium). The clinical, functional and radiological evolution was favorable after a systemic corticosteroid treatment with progressive decay over one year. Conclusion This presentation reports the first case to our knowledge of desquamative interstitial pneumonitis related to exposure to Zirconium and the third one in the context of Aluminium exposure. The detailed analysis of the mineral particles present on the surgical lung biopsy allows for the identification of the relevant particle to refine the etiological diagnosis, to guide the therapeutic management and to give access to recognition as an occupational disease. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 79-84).
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Affiliation(s)
- Timothée Blin
- Service de Pneumologie et d'explorations fonctionnelles respiratoires, CHU Bretonneau, Tours, France.,Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
| | - Anne De Muret
- Service d'anatomopathologie, CHU Bretonneau, Tours, France
| | - Marion Teulier
- Service de Pneumologie et d'explorations fonctionnelles respiratoires, CHU Bretonneau, Tours, France
| | - Marion Ferreira
- Service de Pneumologie et d'explorations fonctionnelles respiratoires, CHU Bretonneau, Tours, France.,Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
| | - Michel Vincent
- Minapath développement Insavalor cei2, Villeurbanne, France
| | - Mickaël Catinon
- Laboratory of mineral pathologies at the Saint Joseph Saint Luc Hospital Centre, Lyon, France
| | - Antoine Legras
- Thoracic and cardiovascular department, Tours University Hospital, CHRU Tours, France
| | - Patrice Diot
- Service de Pneumologie et d'explorations fonctionnelles respiratoires, CHU Bretonneau, Tours, France.,Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
| | - Sylvain Marchand-Adam
- Service de Pneumologie et d'explorations fonctionnelles respiratoires, CHU Bretonneau, Tours, France.,Centre d'Etude des Pathologies Respiratoires, UMR 1100/EA6305, Tours, France
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Sarcoidosis in a patient clinically diagnosed with silicosis; is silica associated sarcoidosis a new phenotype? Respir Med Case Rep 2019; 28:100906. [PMID: 31341766 PMCID: PMC6630015 DOI: 10.1016/j.rmcr.2019.100906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/20/2022] Open
Abstract
A diagnosis of silicosis is made on the basis of exposure and typical radiological findings, according to the ILO's International Classification of Radiographs of Pneumoconiosis. Radiological patterns of silicosis can, however, resemble sarcoidosis. Sarcoidosis is a multi-systemic disorder of unknown etiology, although a role for initiating inorganic triggers such as metals or silica has been suggested. In this case report, we illustrate a patient previously diagnosed with silicosis based on exposure and radiological features, progressive under immunosuppressive treatment. In view of these findings, an open lung biopsy was performed and revealed sarcoidosis. The patient was effectively treated with infliximab. Further analysis showed the presence of silica in the granulomas. Sensitization to silica was also demonstrated, suggesting an association between silica exposure and sarcoidosis in this patient.
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Schweitzer MD, Calzadilla AS, Salamo O, Sharifi A, Kumar N, Holt G, Campos M, Mirsaeidi M. Lung health in era of climate change and dust storms. ENVIRONMENTAL RESEARCH 2018; 163:36-42. [PMID: 29426026 DOI: 10.1016/j.envres.2018.02.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 05/04/2023]
Abstract
Dust storms are strong winds which lead to particle exposure over extensive areas. These storms influence air quality on both a local and global scale which lead to both short and long-term effects. The frequency of dust storms has been on the rise during the last decade. Forecasts suggest that their incidence will increase as a response to the effects of climate change and anthropogenic activities. Elderly people, young children, and individuals with chronic cardiopulmonary diseases are at the greatest risk for health effects of dust storms. A wide variety of infectious and non-infectious diseases have been associated with dust exposure. Influenza A virus, pulmonary coccidioidomycosis, bacterial pneumonia, and meningococcal meningitis are a few examples of dust-related infectious diseases. Among non-infectious diseases, chronic obstructive pulmonary disease, asthma, sarcoidosis and pulmonary fibrosis have been associated with dust contact. Here, we review two molecular mechanisms of dust induced lung disease for asthma and sarcoidosis. We can also then further understand the mechanisms by which dust particles disturb airway epithelial and immune cells.
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Affiliation(s)
- Michael D Schweitzer
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | | | - Oriana Salamo
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States
| | - Arash Sharifi
- Rosenstiel School of Marine and Atmospheric Science, University of Miami, Miami, FL, United States
| | - Naresh Kumar
- Department of Public Health Sciences, University of Miami, Miami, FL, United States
| | - Gregory Holt
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Michael Campos
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States; Miami VA Healthcare System, Miami, FL, United States
| | - Mehdi Mirsaeidi
- Division of Pulmonary and Critical Care, University of Miami, Miami, FL, United States; Miami VA Healthcare System, Miami, FL, United States.
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Lowers HA, Breit GN, Strand M, Pillers RM, Meeker GP, Todorov TI, Plumlee GS, Wolf RE, Robinson M, Parr J, Miller R, Groshong S, Green F, Rose C. Method to characterize inorganic particulates in lung tissue biopsies using field emission scanning electron microscopy. Toxicol Mech Methods 2018; 28:475-487. [DOI: 10.1080/15376516.2018.1449042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Heather A. Lowers
- Central Mineral and Environmental Resources Science Center, U.S. Geological Survey, Denver, CO, USA
| | - G. N. Breit
- Central Mineral and Environmental Resources Science Center, U.S. Geological Survey, Denver, CO, USA
| | - M. Strand
- Division of Biostatistics & Bioinformatics, National Jewish Health, Denver, CO, USA
| | - R. M. Pillers
- Central Mineral and Environmental Resources Science Center, U.S. Geological Survey, Denver, CO, USA
| | - G. P. Meeker
- Central Mineral and Environmental Resources Science Center, U.S. Geological Survey, Denver, CO, USA
| | - T. I. Todorov
- Central Mineral and Environmental Resources Science Center, U.S. Geological Survey, Denver, CO, USA
| | - G. S. Plumlee
- Central Mineral and Environmental Resources Science Center, U.S. Geological Survey, Denver, CO, USA
| | - R. E. Wolf
- Central Mineral and Environmental Resources Science Center, U.S. Geological Survey, Denver, CO, USA
| | - M. Robinson
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA
| | - J. Parr
- Division of Pathology, National Jewish Health, Denver, CO, USA
| | - R. Miller
- Division of Pulmonary Medicine, Vanderbilt University, Nashville, TN, USA
| | - S. Groshong
- Division of Pathology, National Jewish Health, Denver, CO, USA
| | - F. Green
- Department of Pathology, University of Calgary, Calgary, Alberta, Canada
| | - C. Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO, USA
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Abstract
The lung is constantly exposed to airborne infectious agents due to the large surface area of approximately 100 m2. Therefore pneumonia is one of the most common lung diseases. Understanding infection requires understanding the routes of infections, the way invading organisms infect epithelial cells, as well as defense mechanisms of the lung tissue acquired during evolution. Different variants of infectious and non-infectious pneumonias are discussed; special types of pneumonias such as granulomatous and fibrosing pneumonias are presented under separate sections. Causing organisms and other causes of pneumonias are included, and their mode of action is included as far as understood.
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Razak A, Ebinesan AD, Charalambous CP. Metal Hypersensitivity in Patients with Conventional Orthopaedic Implants. JBJS Rev 2016; 2:01874474-201402000-00001. [PMID: 27490934 DOI: 10.2106/jbjs.rvw.m.00082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Arif Razak
- Department of Orthopaedic Surgery, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR, United Kingdom
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Abstract
PURPOSE OF REVIEW Metals can cause disease of the upper and lower respiratory tract that mirror disease due to other causes, such as asthma, rhinosinusitis, acute bronchitis, chronic bronchitis, acute pneumonitis, bronchogenic carcinoma, and interstitial lung disease. This article will describe some uncommon and unique lung diseases that can be induced by metals. RECENT FINDINGS Our understanding of old occupational lung diseases, such as chronic beryllium disease, continues to increase. New exposures in the workplace, such as indium, have been identified as novel occupational hazards. New forms of exposure, such as titanium dioxide nanoparticles, create risk of lung disease that is not seen with larger particles. SUMMARY Knowledge of several unusual and/or unique occupational lung diseases should prompt questioning about a patient's occupational history, which may uncover an occupational, rather than an idiopathic, lung disease.
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Ryu HJ, Yoon SJ, Park JT, Kim YH, Jung JM, Park MH, Rhyu IJ, Kwon DY. Skin discolouration with acute onset parkinsonism secondary to systemic zirconium intoxication. Ann Clin Biochem 2013; 51:97-100. [PMID: 23963051 DOI: 10.1177/0004563213492312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 72-year-old woman presented with suspected parkinsonism and discolouration of the skin especially on sun-exposed areas. Thorough investigation revealed systemic zirconium intoxication due to intake of metallic colloids as a home remedy as a cause of the skin colour change. There may be an association between skin discolouration and her parkinsonism. This is unique in that various clinical manifestations developed following systemic ingestion of zirconium and this should serve as a warning on the risk of taking illicit dietary supplements.
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Affiliation(s)
- Hwa J Ryu
- Department of Dermatology, Korea University College of Medicine, Republic of Korea
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12
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Abstract
INTRODUCTION Chronic beryllium disease (CBD) is an occupational lung disease caused by the inhalation of beryllium dust, fumes or metallic salts. CURRENT DATA Beryllium affects the lungs via particles deposited in the pulmonary alveoli. These are ingested by alveolar macrophages which act as antigen presenting cells to CD4+ T lymphocytes. T lymphocytes proliferate in response to beryllium antigens and combined with macrophages produce numerous epithelioid granulomas with the release of inflammatory cytokines (IFNgamma, IL-2, TNFalpha and IL6) and growth factors. Beryllium induces macrophage apoptosis which reduces its clearance from the lung which in turn contributes to the host's continual re-exposure and thus a chronic granulomatous disorder. Pulmonary granulomatous inflammation is the primary manifestation of CBD, but the disease occasionally involves other organs such as the liver, spleen, lymph nodes and bone marrow. The clinical, radiological, and histopathological features of CBD can be difficult to distinguish from sarcoidosis. The Beryllium lymphocyte proliferation test (BeLPT) demonstrates a beryllium specific immune response, confirms the diagnosis of CBD, and excludes sarcoidosis. CONCLUSIONS AND PERSPECTIVES CBD provides a human model of pulmonary granulomatous disease produced by an occupational exposure, occurring more frequently in those with a genetic pre-disposition. It can be differentiated from sarcoidosis by specific immunological testing.
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Affiliation(s)
- S Marchand-Adam
- Service de Pneumologie, Hôpital Avicenne et EA 2363, UFR SMBH, Bobigny, France
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Maier LA. Clinical approach to chronic beryllium disease and other nonpneumoconiotic interstitial lung diseases. J Thorac Imaging 2002; 17:273-84. [PMID: 12362066 DOI: 10.1097/00005382-200210000-00004] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Exposures in the workplace result in a diverse set of diseases ranging from the pneumoconiosis to other interstitial lung diseases to acute lung injury. Physician awareness of the potential disease manifestations associated with specific exposures is important in defining these diseases and in preventing additional disease. Most occupational diseases mimic other forms of lung disease, including pulmonary fibrosis, sarcoidosis, adult respiratory distress syndrome (ARDS), and bronchiolitis. A "sarcoidosis"-like syndrome, usually limited to the lungs, may result from exposure to bioaerosols and a number of metals. Exposure to beryllium in the workplace produces a granulomatous lung disease clinically indistinguishable from sarcoidosis, chronic beryllium disease (CBD). Beryllium's ability to produce a beryllium-specific immune response is used in the beryllium lymphocyte proliferation tests to confirm a diagnosis of CBD and exclude sarcoidosis. Exposure to other metals must also be considered in the differential diagnosis of sarcoidosis. When an individual presents acutely with ARDS or acute lung injury, an acute inhalational exposure must be considered. Exposure to a number of irritant substances at high levels may cause a "chemical pneumonitis" or acute lung injury, depending on the solubility and physicochemical properties of the substance. Some of the most notable agents include nitrogen and sulfur oxides, phosgene, and smoke breakdown products. Ingestion of paraquat may also result in an ARDS syndrome, with pulmonary fibrosis eventually resulting. Bronchiolitis is a rare manifestation of inhalational exposures but must also be considered in the clinical evaluation of inhalational exposure.
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Affiliation(s)
- Lisa A Maier
- Division of Environmental and Occupational Health Sciences, Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA.
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