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

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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.
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Keywords: miliary; silicosis; tuberculosis

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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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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