Persistent radiological changes following miliary tuberculosis in miners exposed to silica dust
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.
Document Type: Regular Paper
Affiliations: 1: Aurum Health Research, Welkom, South Africa 2: National Centre for Occupational Health, Department of Community Health, University of Witwatersrand, Johannesburg, South Africa 3: Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
Publication date: 2001-11-01
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