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Maboso B, Te Water Naude J, Rees D, Goodman H, Ehrlich R. Difficulties in distinguishing silicosis and pulmonary tuberculosis in silica-exposed gold miners: A report of four cases. Am J Ind Med 2023; 66:339-348. [PMID: 36714961 DOI: 10.1002/ajim.23460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/25/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023]
Abstract
Silicosis and tuberculosis (TB) are both global health concerns, with high prevalence among miners from the South African gold mines. Although knowledge has accumulated about these two conditions as distinct diseases since the early 20th century, and despite progress in technology with multiple diagnostic tools and treatment options available for TB, the challenge of distinguishing and therefore efficiently managing these two conditions in this population remains as current as it was 100 years ago. To illustrate the diagnostic and health service problems of distinguishing TB and silicosis clinically and radiologically in former gold miners from the South African mines living in resource-poor areas, we discuss four cases reviewed for this report by a panel of experts. For each case, occupational history, past and current medical history, physical examination, radiological and laboratory findings are described. Common themes are: (1) poor agreement between radiological and clinical presentation; (2) poor agreement between radiology findings and detection of active TB on sputum Xpert MTB/RIF testing; and (3) difficulty in distinguishing the clinical and radiological presentations of silicosis and tuberculosis. Possible consequences at the population level are undertreatment or overtreatment of TB, and underdiagnosis or overdiagnosis of silicosis. There is a need for training of practitioners who are screening or attending to former gold miners in the clinical and radiological features of combined disease, using a curated database of miners' chest X-ray images. Investment in protocols for management of both acute and chronic silicotuberculosis in ex-miners is needed, as is clinical, epidemiologic, and operations research.
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Affiliation(s)
- Botembetume Maboso
- Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
| | | | - David Rees
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Rodney Ehrlich
- Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, Rondebosch, South Africa
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Moyo D, Ncube R, Kavenga F, Chikwava L, Mapuranga T, Chiboyiwa N, Chimunhu C, Mudzingwa F, Muzvidziwa O, Ncube P, Mando TC, Moyo F, Chigaraza B, Masvingo H, Timire C. The Triple Burden of Tuberculosis, Human Immunodeficiency Virus and Silicosis among Artisanal and Small-Scale Miners in Zimbabwe. Int J Environ Res Public Health 2022; 19:ijerph192113822. [PMID: 36360701 PMCID: PMC9657277 DOI: 10.3390/ijerph192113822] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 05/31/2023]
Abstract
Artisanal and small-scale mining is characterized by an excessive exposure to silica-containing dust, overcrowding, poor living conditions and limited access to primary health services. This poses a risk to tuberculosis, HIV infection and silicosis. The main purpose of the study is to evaluate the burden of tuberculosis, HIV and silicosis among artisanal and small-scale miners. We conducted a cross sectional study on 3821 artisanal and small-scale miners. We found a high burden of silicosis (19%), tuberculosis (6.8%) and HIV (18%) in a relatively young population, with the mean age of 35.5 years. Men were 1.8 times more likely to be diagnosed with silicosis compared to women, adjusted prevalence ratio [aPR = 1.75 (95% CI: 1.02-2.74)]. Artisanal and small-scale miners who were living with HIV were 1.25 times more likely to be diagnosed with silicosis compared to those who were negative, [aPR = 1.25 (1.00-1.57)]. The risk of silicosis increased with both duration as a miner and severity of exposure to silica dust. The risk of tuberculosis increased with the duration as a miner. Zimbabwe is currently experiencing a high burden of TB, silicosis and HIV among artisanal and small-scale miners. Multi-sectoral and innovative interventions are required to stem this triple epidemic in Zimbabwe.
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Affiliation(s)
- Dingani Moyo
- Baines Occupational Health Services, Harare 024, Zimbabwe
- Occupational Health Division, School of Public Health, University of the Witwatersrand, Johannesburg 2000, South Africa
- Faculty of Medicine and Health Sciences, The National University of Science and Technology, Bulawayo 029, Zimbabwe
- Faculty of Medicine and Health Sciences, Midlands State University, P Bag 9005, Gweru 054, Zimbabwe
| | | | | | | | | | - Nathan Chiboyiwa
- Ministry of Health and Child Care, Harare 024, Zimbabwe
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare 024, Zimbabwe
| | | | - Frank Mudzingwa
- Hospice and Palliative Care Association of Zimbabwe, Harare 054, Zimbabwe
| | | | | | - Tariro Christwish Mando
- Ministry of Health and Child Care, Harare 024, Zimbabwe
- Family Medicine, Global and Public Health Unit, Department of Primary Health Care Sciences, University of Zimbabwe, Harare 024, Zimbabwe
| | - Florence Moyo
- Baines Occupational Health Services, Harare 024, Zimbabwe
- Department of Health Sciences, Faculty of Sciences, Zimbabwe Open University, Harare 024, Zimbabwe
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Shafiei M, Ghasemian A, Eslami M, Nojoomi F, Rajabi-Vardanjani H. Risk factors and control strategies for silicotuberculosis as an occupational disease. New Microbes New Infect 2019; 27:75-77. [PMID: 30622714 PMCID: PMC6319297 DOI: 10.1016/j.nmni.2018.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 12/12/2022] Open
Abstract
Silicotuberculosis is critical in community settings among workers and employees exposed to silica dust. Older age of entry (>30 years), male sex, infection with human immunodeficiency virus (HIV), exposure duration, smoking, chronic obstructive pulmonary disease, migration, the severity of the silicosis and the intensity of the exposure are potential risk factors. Lack of timely diagnosis and treatment for tuberculosis (TB) may also raise the rate of infection; previous treatment of TB is possibly associated with the development of silicotuberculosis in more than half of patients, increasing with age (>40 years). Identification of risk factors benefits not only the academic research community, but also the workers or employees and policy making. Some strategies can be implemented, such as controlling or reducing exposure to silica dust, ensuring continuity of treatment of TB or extended anti-TB treatment, management of the situation by occupational health professionals, prevention of oscillating migration, providing workers with compensation, training and education in occupational health, improving the quality of life of miners and workers, intensive medical surveillance and TB screening in routine health check ups, and policy making for higher immunity to inhibit inhalation of dust by workers or employees.
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Affiliation(s)
- M. Shafiei
- )Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran
| | - A. Ghasemian
- )Department of Microbiology, Fasa University of Medical Sciences, Fasa, Iran
| | - M. Eslami
- )Department of Microbiology and Virology, Semnan University of Medical Sciences, Semnan, Iran
| | - F. Nojoomi
- )Microbiology Department, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
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