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Bielsa S, Guitart A, Esquerda A, Fernández-Pacheco R, Baranguán MT, Ibarra A, Porcel JM. Some pleural effusions labeled as idiopathic could be produced by the inhalation of silica. Pleura Peritoneum 2022; 7:27-33. [PMID: 35602920 PMCID: PMC9069498 DOI: 10.1515/pp-2021-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/15/2021] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Exposure to silica nanoparticles has been associated with pleural effusions (PEs) in animal models and case series. We hypothesized that some PEs labelled as “idiopathic” could, in fact, be secondary to inhalation of silica.
Methods
A retrospective case control study was designed utilizing a prospectively maintained pleural database. Cases, represented by idiopathic PEs, were matched by age and gender to control patients who had been diagnosed with malignant, cardiac, or infectious PEs. A survey consisting of questions about occupational life and possibility of silica inhalation was conducted. In a subgroup of patients, pleural fluid concentrations of silica were quantified by plasma atomic emission spectrometry analysis. Also, the pleural biopsy of a silica-exposed case was subjected to an energy dispersive X-ray spectroscopy (EDX) to identify the mineral, the size of which was determined by electron microscopy.
Results
A total of 118 patients (59 cases and 59 controls) completed the survey. There were 25 (42%, 95% CI 31–55%) and 13 (22%, 95% CI 13–34%) silica-exposed workers in case and control groups, respectively. The exposure attributable fraction was 0.62 (95% CI 0.14–0.83). Four of eight exposed cases showed detectable levels of silica in the pleural fluid (mean 2.37 mg/L), as compared to none of 16 tested controls. Silica nanoparticles of 6–7 nm were identified in the pleural biopsy of an exposed case patient.
Conclusions
It is plausible that some idiopathic PEs could actually be caused by occupational silica inhalation.
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Affiliation(s)
- Silvia Bielsa
- Department of Internal Medicine , Pleural Medicine Unit, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida (IRBLleida), University of Lleida , Lleida , Spain
| | - Ana Guitart
- Chemical Analysis Service , Science Faculty, Zaragoza University, Zaragoza , Spain
| | - Aureli Esquerda
- Department of Laboratory Medicine , Arnau de Vilanova University Hospital, IRBLleida , Lleida , Spain
| | - Rodrigo Fernández-Pacheco
- Aragon Nanoscience Institute , Advanced Microscopy Laboratory, Zaragoza University , Zaragoza , Spain
| | | | - Alfonso Ibarra
- Aragon Nanoscience Institute , Advanced Microscopy Laboratory, Zaragoza University , Zaragoza , Spain
| | - José M. Porcel
- Department of Internal Medicine , Pleural Medicine Unit, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida (IRBLleida), University of Lleida , Lleida , Spain
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Okamoto S, Kobayashi I, Moriyama H, Tanimura M, Kadoya K, Ienaga H, Kikuchi T, Takahashi K. Silicosis-related pleural effusion diagnosed using elemental analysis of the pleural fluid cell block: A case report. Respir Med Case Rep 2022; 37:101665. [PMID: 35601868 PMCID: PMC9117916 DOI: 10.1016/j.rmcr.2022.101665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/22/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Pleural disease in silicosis remains an underrecognized entity. Herein, we describe the case of an 85-year-old man with a 20-year history of silica exposure between the ages of 9–28 years. He presented with bilateral exudative pleural effusions, and chest computed tomography revealed typical silicosis findings. Thoracentesis was performed thrice, but did not reveal the cause of effusion. However, pleural fluid cell-block elemental analysis revealed a silicon compound, suggesting that silicosis-related pleural effusion had developed after a long latency period. Therefore, elemental analysis of the pleural fluid cell block may help diagnose occupational lung diseases with pleural effusion.
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Affiliation(s)
- Craig A. Poland
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Institute of Occupational Medicine, Edinburgh, UK
| | - Rodger Duffin
- Centre for Inflammation Research, Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK
- Concept Life Sciences, Dundee, UK
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Fassina A, Corradin M, Murer B, Furlan C, Guolo A, Ventura L, Montisci M. Detection of Silica Particles in Lung Tissue by Environmental Scanning Electron Microscopy. Inhal Toxicol 2009; 21:133-40. [DOI: 10.1080/08958370802294647] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gulumian M, Borm PJA, Vallyathan V, Castranova V, Donaldson K, Nelson G, Murray J. Mechanistically identified suitable biomarkers of exposure, effect, and susceptibility for silicosis and coal-worker's pneumoconiosis: a comprehensive review. J Toxicol Environ Health B Crit Rev 2006; 9:357-95. [PMID: 16990219 DOI: 10.1080/15287390500196537] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Clinical detection of silicosis is currently dependent on radiological and lung function abnormalities, both late manifestations of disease. Markers of prediction and early detection of pneumoconiosis are imperative for the implementation of timely intervention strategies. Understanding the underlying mechanisms of the etiology of coal workers pneumoconiosis (CWP) and silicosis was essential in proposing numerous biomarkers that have been evaluated to assess effects following exposure to crystalline silica and/or coal mine dust. Human validation studies have substantiated some of these proposed biomarkers and argued in favor of their use as biomarkers for crystalline silica- and CWP-induced pneumoconiosis. A number of "ideal" biological markers of effect were identified, namely, Clara cell protein-16 (CC16) (serum), tumor necrosis factor-alpha (TNF-alpha) (monocyte release), interleukin-8 (IL-8) (monocyte release), reactive oxygen species (ROS) measurement by chemiluminescence (neutrophil release), 8-isoprostanes (serum), total antioxidant levels measured by total equivalent antioxidant capacity (TEAC), glutathione, glutathione peroxidase activity, glutathione S-transferase activity, and platelet-derived growth factor (PDGF) (serum). TNF-alpha polymorphism (blood cellular DNA) was identified as a biomarker of susceptibility. Further studies are planned to test the validity and feasibility of these biomarkers to detect either high exposure to crystalline silica and early silicosis or susceptibility to silicosis in gold miners in South Africa.
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Affiliation(s)
- M Gulumian
- Department of Toxicology and Biochemistry Research, National Institute for Occupational Health, Johannesburg, South Africa.
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Abstract
A 57-year-old man with a history of exposure to silica for 32 years presented with pleural thickening of the lower lobe of the left lung and a chronic right-sided pleural effusion without any radiographic evidence of parenchymal nodules in either lung. Light microscopic examination of a left visceral pleural biopsy specimen revealed markedly thickened pleura with fibrosis and macrophages containing birefringent silica and silicates. Occasional rounded intrapleural silicotic nodules were present. The underlying lung tissue did not show fibrosis or silicotic nodules. An energy-dispersive x-ray analysis confirmed the presence of silica. In the absence of lung involvement, this case represents a very unusual pathologic reaction caused by silica and silicates and adds to the clinical differential diagnosis of chronic pleuritis and malignant mesothelioma.
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Affiliation(s)
- E H Zeren
- Department of Pathology, Cukurova University, Balcali, Adana, Turkey
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Gregorini G, Tira P, Frizza J, D'Haese PC, Elseviers MM, Nuyts G, Maiorca R, De Broe ME. ANCA-associated diseases and silica exposure. Clin Rev Allergy Immunol 1997; 15:21-40. [PMID: 9209799 DOI: 10.1007/bf02828275] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- G Gregorini
- Department of Nephrology, Spedali Civili, University of Brescia, Italy
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Ferrer Sancho J. Estudio mineralógico pleural. Arch Bronconeumol 1995; 31:49-50. [DOI: 10.1016/s0300-2896(15)30962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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