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Ramkissoon C, Song Y, Yen S, Southam K, Page S, Pisaniello D, Gaskin S, Zosky GR. Understanding the pathogenesis of engineered stone-associated silicosis: The effect of particle chemistry on the lung cell response. Respirology 2024; 29:217-227. [PMID: 38043119 DOI: 10.1111/resp.14625] [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: 06/20/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The resurgence of severe and progressive silicosis among engineered stone benchtop industry workers is a global health crisis. We investigated the link between the physico-chemical characteristics of engineered stone dust and lung cell responses to understand components that pose the greatest risk. METHODS Respirable dust from 50 resin-based engineered stones, 3 natural stones and 2 non-resin-based materials was generated and analysed for mineralogy, morphology, metals, resin, particle size and charge. Human alveolar epithelial cells and macrophages were exposed in vitro to dust and assessed for cytotoxicity and inflammation. Principal component analysis and stepwise linear regression were used to explore the relationship between engineered stone components and the cellular response. RESULTS Cutting engineered stone generated fine particles of <600 nm. Crystalline silica was the main component with metal elements such as Ti, Cu, Co and Fe also present. There was some evidence to suggest differences in cytotoxicity (p = 0.061) and IL-6 (p = 0.084) between dust samples. However, IL-8 (CXCL8) and TNF-α levels in macrophages were clearly variable (p < 0.05). Quartz explained 11% of the variance (p = 0.019) in macrophage inflammation while Co and Al accounted for 32% of the variance (p < 0.001) in macrophage toxicity, suggesting that crystalline silica only partly explains the cell response. Two of the reduced-silica, non-engineered stone products induced considerable inflammation in macrophages. CONCLUSION These data suggest that silica is not the only component of concern in these products, highlighting the caution required as alternative materials are produced in an effort to reduce disease risk.
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Affiliation(s)
- Chandnee Ramkissoon
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Yong Song
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Seiha Yen
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Katherine Southam
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Simone Page
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Dino Pisaniello
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Sharyn Gaskin
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Graeme R Zosky
- Menzies Institute for Medical Research, College of Health and Medicine, University of Tasmania, Hobart, Australia
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Surasi K, Ballen B, Weinberg JL, Materna BL, Harrison R, Cummings KJ, Heinzerling A. Elevated exposures to respirable crystalline silica among engineered stone fabrication workers in California, January 2019-February 2020. Am J Ind Med 2022; 65:701-707. [PMID: 35899403 DOI: 10.1002/ajim.23416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Workers fabricating engineered stone face high risk for exposure to respirable crystalline silica (RCS) and subsequent development of silicosis. In response, the California Division of Occupational Safety and Health (Cal/OSHA) performed targeted enforcement inspections at engineered stone fabrication worksites. We investigated RCS exposures and employer adherence to Cal/OSHA's RCS and respiratory protection standards from these inspections to assess ongoing risk to stone fabrication workers. METHODS We extracted employee personal air sampling results from Cal/OSHA inspection files and calculated RCS exposures. Standards require that employers continue monitoring employee RCS exposures and perform medical surveillance when exposures are at or above the action level (AL; 25 μg/m3 ); exposures above the permissible exposure limit (PEL; 50 μg/m3 ) are prohibited. We obtained RCS and respiratory protection standard violation citations from a federal database. RESULTS We analyzed RCS exposures for 152 employees at 47 workplaces. Thirty-eight (25%) employees had exposures above the PEL (median = 89.7 μg/m3 ; range = 50.7-670.7 μg/m3 ); 17 (11%) had exposures between the AL and PEL. Twenty-four (51%) workplaces had ≥1 exposure above the PEL; 7 (15%) had ≥1 exposure between the AL and PEL. Thirty-four (72%) workplaces were cited for ≥1 RCS standard violation. Twenty-seven (57%) workplaces were cited for ≥1 respiratory protection standard violation. CONCLUSIONS Our investigation demonstrates widespread RCS overexposure among workers and numerous employer Cal/OSHA standard violation citations. More enforcement and educational efforts could improve employer compliance with Cal/OSHA standards and inform employers and employees of the risks for RCS exposure and strategies for reducing exposure.
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Affiliation(s)
- Krishna Surasi
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, Georgia, USA
| | - Brittany Ballen
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Justine L Weinberg
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- Public Health Institute, Richmond, Richmond, USA
| | - Barbara L Materna
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Robert Harrison
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Kristin J Cummings
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
| | - Amy Heinzerling
- Occupational Health Branch, California Department of Public Health, Richmond, California, USA
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Thredgold L, Ramkissoon C, Kumarasamy C, Gun R, Rowett S, Gaskin S. Rapid Assessment of Oxidative Damage Potential: A Comparative Study of Engineered Stone Dusts Using a Deoxyguanosine Assay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106221. [PMID: 35627757 PMCID: PMC9140999 DOI: 10.3390/ijerph19106221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 11/21/2022]
Abstract
The popularity of engineered stone (ES) has been associated with a global increase in occupational lung disease in workers exposed to respirable dust during the fabrication of benchtops and other ES products. In this study, the reactivity and subsequent oxidative reduction potential of freshly generated ES dusts were evaluated by (i) comparing different engineered and natural stones, (ii) comparing settled and respirable stone dust fractions and (iii) assessing the effect of ageing on the reactivity of freshly generated stone dust. An established cell-free deoxyguanosine hydroxylation assay was used to assess the potential for oxidative DNA damage. ES dust exhibited a higher relative reactivity than two of the three natural stones tested. Respirable dust fractions were found to be significantly more reactive than their corresponding settled fraction (ANOVA, p < 0.05) across all stone types and samples. However, settled dust still displayed high relative reactivity. The lower reactivity of the settled dust was not due to decay in reactivity of the respirable dust when it settled but rather a result of the admixture of larger nonrespirable particles. No significant change in respirable dust reactivity was observed for three ES samples over a 21-day time period, whereas a significant decrease in reactivity was observed in the natural stone studied. This study has practical implications for dust control and housekeeping in industry, risk assessment and hazard management.
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Affiliation(s)
- Leigh Thredgold
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Chandnee Ramkissoon
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Chellan Kumarasamy
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Richard Gun
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
| | - Shelley Rowett
- SafeWork SA, Government of South Australia, Adelaide, SA 5035, Australia;
| | - Sharyn Gaskin
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA 5005, Australia; (L.T.); (C.R.); (C.K.); (R.G.)
- Correspondence:
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García-Núñez A, Jiménez-Gómez G, Hidalgo-Molina A, Córdoba-Doña JA, León-Jiménez A, Campos-Caro A. Inflammatory indices obtained from routine blood tests show an inflammatory state associated with disease progression in engineered stone silicosis patients. Sci Rep 2022; 12:8211. [PMID: 35581230 PMCID: PMC9114118 DOI: 10.1038/s41598-022-11926-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/25/2022] [Indexed: 02/08/2023] Open
Abstract
Patients with silicosis caused by occupational exposure to engineered stone (ES) present a rapid progression from simple silicosis (SS) to progressive massive fibrosis (PMF). Patient classification follows international rules based on radiology and high-resolution computed tomography (HRCT), but limited studies, if any, have explored biomarkers from routine clinical tests that can be used as predictors of disease status. Our objective was thus to investigate circulating biomarker levels and systemic inflammatory indices in ES silicosis patients whose exposure to ES dust ended several years ago. Ninety-one adult men, ex-workers in the manufacturing of ES, 53 diagnosed with SS and 38 with PMF, and 22 healthy male volunteers (HC) as controls not exposed to ES dust, were recruited. The following circulating levels of biomarkers like lactate dehydrogenase (LDH), angiotensin-converting-enzyme (ACE), protein C reactive (PCR), rheumatoid factor, alkaline phosphatase and fibrinogen were obtained from clinical reports after being measured from blood samples. As biochemical markers, only LDH (HC = 262 ± 48.1; SS = 315.4 ± 65.4; PMF = 337.6 ± 79.3 U/L), ACE (HC = 43.1 ± 18.4; SS = 78.2 ± 27.2; PMF = 86.1 ± 23.7 U/L) and fibrinogen (HC = 182.3 ± 49.1; SS = 212.2 ± 43.5; PMF = 256 ± 77.3 U/L) levels showed a significant sequential increase, not been observed for the rest of biomarkers, in the HC → SS → PMF direction. Moreover, several systemic inflammation indices neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), aggregate index of systemic inflammation (AISI) derived from whole blood cell counts showed significant differences between the HC, SS and PMF groups. All these biomarkers were analyzed using receiver operating characteristic (ROC) curves, and the results provided moderately high sensitivity and specificity for discriminating between ES silicosis patient groups and healthy controls. Our study reveals that some inflammatory biomarkers, easily available from routine blood analysis, are present in ES silicosis patients even several years after cessation of exposure to ES silica dust and they could help to know the progression of the disease.
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Affiliation(s)
- Alejandro García-Núñez
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009, Cádiz, Spain.,Research Unit, Puerta del Mar University Hospital, 11009, Cádiz, Spain
| | - Gema Jiménez-Gómez
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009, Cádiz, Spain.,Research Unit, Puerta del Mar University Hospital, 11009, Cádiz, Spain
| | - Antonio Hidalgo-Molina
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009, Cádiz, Spain.,Pulmonology, Allergy and Thoracic Surgery Department, Puerta del Mar University Hospital, 11009, Cádiz, Spain
| | - Juan Antonio Córdoba-Doña
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009, Cádiz, Spain.,Department of Preventive Medicine and Public Health, Jerez University Hospital, 11407, Jerez de la Frontera, Spain
| | - Antonio León-Jiménez
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009, Cádiz, Spain.,Pulmonology, Allergy and Thoracic Surgery Department, Puerta del Mar University Hospital, 11009, Cádiz, Spain
| | - Antonio Campos-Caro
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009, Cádiz, Spain. .,Research Unit, Puerta del Mar University Hospital, 11009, Cádiz, Spain. .,Genetics Area, Biomedicine, Biotechnology and Public Health Department, School of Marine and Environmental Sciences, University of Cadiz, 11510, Cádiz, Spain.
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Characterisation of dust emissions from machined engineered stones to understand the hazard for accelerated silicosis. Sci Rep 2022; 12:4351. [PMID: 35288630 PMCID: PMC8921240 DOI: 10.1038/s41598-022-08378-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/04/2022] [Indexed: 12/22/2022] Open
Abstract
Engineered stones are novel construction materials associated with a recent upsurge in silicosis cases among workers in the stonemason industry. In order to understand the hazard for the short latency of lung disease among stonemasons, we simulated real-time dust exposure scenario by dry-machining engineered stones in controlled conditions, capturing and analysing the respirable dust generated for physical and chemical characteristics. Natural granite and marble were included for comparison. Cutting engineered stones generated high concentrations of very fine particles (< 1 µm) with > 80% respirable crystalline silica content, in the form of quartz and cristobalite. Engineered stones also contained 8–20% resin and 1–8% by weight metal elements. In comparison, natural stones had far lower respirable crystalline silica (4- 30%) and much higher metal content, 29–37%. Natural stone dust emissions also had a smaller surface area than engineered stone, as well as lower surface charge. This study highlighted the physical and chemical variability within engineered stone types as well as between engineered and natural stones. This information will ultimately help understand the unique hazard posed by engineered stone fabrication work and help guide the development of specific engineering control measures targeting lower exposure to respirable crystalline silica.
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Kumarasamy C, Pisaniello D, Gaskin S, Hall T. OUP accepted manuscript. Ann Work Expo Health 2022; 66:937-945. [PMID: 35411922 PMCID: PMC9357346 DOI: 10.1093/annweh/wxac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Artificial stone (AS) is a composite material that has seen widespread use in construction, particularly for kitchen benchtops. However, fabrication processes with AS have been associated with serious lung disease. Safety data sheets (SDSs) aim to provide important information pertaining to composition and health risks. In the case of a complex mixture, SDSs may be problematic in terms of specific information on overall health risks. To assess this issue, we compared empirically determined mineral, metallic, and organic resin content of 25 individual AS products across six suppliers, with the corresponding SDS information. X-ray diffraction was used to quantitate the mineralogical components of AS samples, and X-ray fluorescence was used to estimate the metallic components. Organic material (resin content) was estimated using weight loss during calcination. Although the resin content for all AS samples was within the SDS-reported ranges, there was considerable variability in the crystalline silica content when comparing with supplier’s SDS. Potentially toxicologically relevant metallic and mineral constituents were not reported. Some supplier SDSs were found to provide more information than others. Only one of the six suppliers provided crystalline mineral content other than silica, and only two suppliers provided any information about metals. There remains a limited understanding of lung pathogenesis from AS, and this study highlights the need for more comprehensive and standardized SDS information for risk assessment and management.
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Affiliation(s)
| | - Dino Pisaniello
- Author to whom correspondence should be addressed. Tel: +61 8 83133571; e-mail:
| | - Sharyn Gaskin
- Adelaide Exposure Science and Health, School of Public Health, University of Adelaide, Adelaide, SA, Australia
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Tony Hall
- Department of Earth Sciences, School of Physical Sciences, University of Adelaide, Adelaide, SA, Australia
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Compositional and structural analysis of engineered stones and inorganic particles in silicotic nodules of exposed workers. Part Fibre Toxicol 2021; 18:41. [PMID: 34809667 PMCID: PMC8607701 DOI: 10.1186/s12989-021-00434-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background Engineered stone silicosis is an emerging disease in many countries worldwide produced by the inhalation of respirable dust of engineered stone. This silicosis has a high incidence among young workers, with a short latency period and greater aggressiveness than silicosis caused by natural materials. Although the silica content is very high and this is the key factor, it has been postulated that other constituents in engineered stones can influence the aggressiveness of the disease. Different samples of engineered stone countertops (fabricated by workers during the years prior to their diagnoses), as well as seven lung samples from exposed patients, were analyzed by multiple techniques. Results The different countertops were composed of SiO2 in percentages between 87.9 and 99.6%, with variable relationships of quartz and cristobalite depending on the sample. The most abundant metals were Al, Na, Fe, Ca and Ti. The most frequent volatile organic compounds were styrene, toluene and m-xylene, and among the polycyclic aromatic hydrocarbons, phenanthrene and naphthalene were detected in all samples. Patients were all males, between 26 and 46 years-old (average age: 36) at the moment of the diagnosis. They were exposed to the engineered stone an average time of 14 years. At diagnosis, only one patient had progressive massive fibrosis. After a follow-up period of 8 ± 3 years, four patients presented progressive massive fibrosis. Samples obtained from lung biopsies most frequently showed well or ill-defined nodules, composed of histiocytic cells and fibroblasts without central hyalinization. All tissue samples showed high proportion of Si and Al at the center of the nodules, becoming sparser at the periphery. Al to Si content ratios turned out to be higher than 1 in two of the studied cases. Correlation between Si and Al was very high (r = 0.93). Conclusion Some of the volatile organic compounds, polycyclic aromatic hydrocarbons and metals detected in the studied countertop samples have been described as causative of lung inflammation and respiratory disease. Among inorganic constituents, aluminum has been a relevant component within the silicotic nodule, reaching atomic concentrations even higher than silicon in some cases. Such concentrations, both for silicon and aluminum showed a decreasing tendency from the center of the nodule towards its frontier.
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Metal Ion Release from Engineered Stone Dust in Artificial Lysosomal Fluid-Variation with Time and Stone Type. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126391. [PMID: 34204842 PMCID: PMC8296209 DOI: 10.3390/ijerph18126391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022]
Abstract
Inhalational exposure to dust from engineered stone (ES), also known as artificial or composite stone, is associated with a specific disease profile, namely accelerated silicosis, and scleroderma. The pathogenic mechanisms are poorly understood, particularly the role of resin and metal ions. Metal ions are present in pigments and constituent minerals and may be considered potential contributors to toxicity. The aim of this preliminary study was to understand the solubility of ES-containing metals in artificial lysosomal fluid (ALF) simulating the acidic intracellular environment of the lung macrophage lysosome. Differences with respect to ES types and temporal release were explored. Ten ES products of variable colour and company origin were comminuted and assessed for four different metals, solubilized into ALF solutions at 1,2,4 and 8 weeks at 37 °C. There was significant variability in metal release, particularly with regard to iron and manganese, which could be correlated with the reflected brightness of the stone. A majority of the available Mn, Fe, Al and Ti was solubilized. Time trends for metal release varied with ES type but also with metal ion. The data suggest a high metal ion bioavailability once engulfed by lung macrophages. There is a need to investigate a wider range of ES dust and relate metal content to markers of ES toxicity.
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Abstract
PURPOSE OF REVIEW This review details recent findings related to the health effects of occupational exposure to artificial stone dust and the rapid increase in cases of artificial stone associated silicosis around the world. RECENT FINDINGS High crystalline silica content artificial stone is now commonly used for the production of kitchen benchtops. Reports of artificial stone silicosis from many countries have noted that workers were typically employed at small workplaces and were often diagnosed in their 30s or 40s. Poor exposure control measures were common, including the practice of 'dry processing'. Dust generated from artificial stone has been noted to have properties that influence toxicity, including high silica content, generation of nanosized particles and presence of metals and resins. Artificial stone silicosis differs from silicosis associated with other occupational settings including shorter latency and rapid disease progression. High-resolution computed tomography (CT) chest imaging of artificial stone silicosis has often noted the presence of ground glass opacities, which may not be detected in chest x-ray screening. Increased prevalence of autoimmune disease, such as scleroderma, has also been reported in this industry. SUMMARY Further evaluation of the safety of work with artificial stone is required, including the effectiveness of dust control measures. Current reports of artificial stone silicosis indicate the potential for widespread undiagnosed respiratory disease in this industry. Provision of more sensitive health screening methods for all at-risk workers and the development of new treatment options particularly for this form of silicosis is urgently required.
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Affiliation(s)
- Ryan F Hoy
- School of Public Health & Preventive Medicine Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Hoy RF, Chambers DC. Silica-related diseases in the modern world. Allergy 2020; 75:2805-2817. [PMID: 31989662 DOI: 10.1111/all.14202] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/20/2019] [Accepted: 01/08/2020] [Indexed: 11/28/2022]
Abstract
Silicosis is an ancient and potentially fatal pneumoconiosis caused by exposure to respirable crystalline silica. Silicosis is historically a disease of miners; however, failure to recognize and control the risk associated with silica exposure in contemporary work practices such as sandblasting denim jeans and manufacturing of artificial stone benchtops has led to re-emergence of silicosis around the world. This review outlines the mineralogy, epidemiology, clinical and radiological features of the various forms of silicosis and other silica-associated diseases. Perspective is provided on the most recent studies shedding light on pathogenesis, including the central role of innate immune effector cells and subsequent inflammatory cascades in propagating pulmonary fibrosis and the extrapulmonary manifestations, which uniquely characterize this pneumoconiosis. Clinical conundrums in differential diagnosis, particularly between silicosis and sarcoidosis, are highlighted, as is the importance of obtaining a careful occupational history in the patient presenting with pulmonary infiltrates and/or fibrosis. While silicosis is a completely preventable disease, unfortunately workers around the world continue to be affected and experience progressive or even fatal disease. Although no treatments have been proven, opportunities to intervene to prevent progressive disease, founded in a thorough cellular and molecular understanding of the immunopathology of silicosis, are highlighted.
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Affiliation(s)
- Ryan F. Hoy
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne VIC. Australia
- Department of Respiratory Medicine Alfred Hospital Melbourne VIC. Australia
| | - Daniel C. Chambers
- School of Clinical Medicine The University of Queensland Brisbane QLD Australia
- Queensland Lung Transplant Program The Prince Charles Hospital Brisbane QLD Australia
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León-Jiménez A, Hidalgo-Molina A, Conde-Sánchez MÁ, Pérez-Alonso A, Morales-Morales JM, García-Gámez EM, Córdoba-Doña JA. Artificial Stone Silicosis. Chest 2020; 158:1060-1068. [DOI: 10.1016/j.chest.2020.03.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/26/2020] [Accepted: 03/01/2020] [Indexed: 11/30/2022] Open
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Guarnieri G, Salasnich M, Lucernoni P, Sbaraglia M, Putzu MG, Zuliani P, Rossi F, Vio S, Bianchi L, Martinelli A, Gottardo O, Bizzotto R, Maestrelli P, Mason P, Carrieri M. Silicosis in finishing workers in quartz conglomerates processing. LA MEDICINA DEL LAVORO 2020; 111:99-106. [PMID: 32352423 PMCID: PMC7810008 DOI: 10.23749/mdl.v111i2.9115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/14/2020] [Accepted: 03/19/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Outbreaks of silicosis have bene recently reported in artificial stone workers. AIM To describe the features of silicosis in quartz conglomerate workers in North-Eastern Italy. METHODS Active search of pneumoconiosis was performed in 11 companies of North-Eastern Italy involved in the fabrication of quartz conglomerate countertops. Occupational history, lung function tests, chest X-ray and high resolution computed tomography (HRCT) were performed. In selected cases, trans-bronchial biopsies were taken for histological evaluation and identification of silica crystals in the tissue. Cumulative exposure to crystalline silica was estimated. RESULTS We recruited 45 workers and 24 cases of silicosis were diagnosed. Mean age at diagnosis was 43 years and duration of exposure to quartz conglomerate dust was 3.5 to 20 years. The average silica cumulative exposure was 4.3 mg/m3/y. Abnormal findings were detected in 42% of chest X-rays, in 33% of spirometry and 50% of carbon monoxide lung diffusion (DLco). HRCTs were abnormal in all cases showing well-defined rounded opacities, irregular/linear intralobular opacities and bilateral enlarged mediastinal lymph-nodes. Histological findings consistent with silicosis were observed in 24 cases. Numerous silica particles (diameter 0.1-5 µm) were identified in lung tissue. CONCLUSIONS We reported an unexpected high incidence of silicosis in Italian workers exposed to quartz conglomerate dust. The results suggest that chest HRCT is indicated for screening of workers with high exposure to silica and DLco should be added to spirometry in health surveillance. More rigorous application of safety regulations and more effective preventive interventions at work are necessary.
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Affiliation(s)
- Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Mauro Salasnich
- Respiratory Unit, Ca' Foncello Hospital, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy.
| | - Paolo Lucernoni
- Respiratory Unit, Ca' Foncello Hospital, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy.
| | - Marta Sbaraglia
- Pathology Unit, Ca' Foncello Hospital, Azienda ULSS 2 Marca Trevigiana, Treviso, Italy.
| | - Maria Grazia Putzu
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
| | - Paolo Zuliani
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
| | - Federica Rossi
- Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy.
| | - Stefania Vio
- Radiology Unit, University Hospital, Padua, Italy.
| | - Leonardo Bianchi
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Andrea Martinelli
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | | | | | - Piero Maestrelli
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Paola Mason
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| | - Mariella Carrieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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