Persistent radiological changes following miliary tuberculosis in miners exposed to silica dust


Charalambous, S; Churchyard, GJ; Murray, J; de Cock, KM; Corbett, EL; (2001) Persistent radiological changes following miliary tuberculosis in miners exposed to silica dust. The international journal of tuberculosis and lung disease, 5 (11). pp. 1044-50. ISSN 1027-3719

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Abstract

SETTING: Silicosis leads to increased susceptibility to tuberculosis, but it has also been suggested that tuberculosis may interact with intra-pulmonary silica to exacerbate fibrotic lung disease. OBJECTIVES: To investigate the possibility that silicosis developed due to or was exacerbated by tuberculosis. METHODS: In a case series of 15 miners presenting with culture-positive miliary tuberculosis, serial radiographs taken premorbidly, at presentation, and after 2 and 6 months of standard anti-tuberculosis treatment were graded for nodularity using the International Labour Organization system. RESULTS: Increased nodule profusion (compared to premorbid film) remained in 13 (87%) and eight (53%) patients after 2 and 6 months of treatment, respectively, despite clinical improvement in all and documented bacteriological cure in eight (53%). These phenomena, observed irrespective of human immunodeficiency virus (HIV) status, were most pronounced in men with minor premorbid changes. Abnormal pulmonary collagenisation related to silica particles was apparent at post-mortem in two men who died of HIV-associated cryptococcosis after completing TB treatment. CONCLUSIONS: Previous silica exposure appears to result in delayed and potentially incomplete radiological resolution of miliary TB. We postulate that the immune response in tubercles may evoke a 'bystander' fibrotic response, as cytokines play a central role in the pathogenesis of both TB and silicosis.

Item Type: Article
Keywords: miliary, tuberculosis, silicosis, African gold miners, tumor-necrosis-factor, pulmonary, tuberculosis, hiv-infection, lung-function, fibrosis, disease, alpha, beta, mice, AIDS-Related Opportunistic Infections, complications, Adult, Cryptococcosis, complications, pathology, Gold, HIV Seropositivity, complications, Human, Lung, pathology, radiography, Male, Middle Age, Mining, Occupational Exposure, Retrospective Studies, Silicon Dioxide, Silicosis, complications, pathology, radiography, Support, Non-U.S. Gov't, Tuberculosis, Miliary, complications, drug therapy, pathology, radiography
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: TB Centre
PubMed ID: 11716341
Web of Science ID: 172014700010
URI: http://researchonline.lshtm.ac.uk/id/eprint/17506

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