Discussion
Individuals working in occupations such as sandblasting, mining, quarrying, flour milling, glass manufacturing, building construction, brick manufacturing, road repairs, and concrete manufacturing often experience the adverse effects of silicosis.5The crystalline silica particles measuring less than 1 μm are widely considered to be the most pathogenic.6,7Worldwide, silicosis caused more than 12.9 thousand fatalities, and in 2019 it was responsible for 655.7 thousand disability-associated life years (DALY) .2Along the disease’s spectrum, chronic forms, accelerated forms, and acute silicosis are found.8One case report has documented similar chief complaints to those observed in our case.9Exposure to silica results in the activation of alveolar macrophages and induces reactive oxygen (ROS) and nitrogen (RNS) which results in elevated susceptibility to bacterial infections due to a decrease in antioxidant defense mechanism, particularly those caused byMycobacterium tuberculosis .10 ,11,12
According to the WHO Global TB Report 2021, 43% of people living in the South-East Asia (SEA) Region have an incidence of TB.13In this case, the patient had a previous tuberculosis diagnosis based on the disease’s prevalence and radiological features, even though the sputum test for acid-fast bacilli (AFB) and gene expert test were negative. The patient received anti-TB treatment, however, it did not relieve his symptoms. People with silicosis had a 2.8 ratio chance of developing pulmonary tuberculosis and a 3.7 ratio risk of developing extra-pulmonary tuberculosis compared to those without the condition.14However, among those who had silicosis, the prevalence of TB was significantly higher at 917 cases per 100,000 individuals.15.In this case, having a thorough occupational history is essential for establishing an accurate diagnosis. There are no specific treatment modalities for silicosis. The primary goals of treatment revolve around slowing down the progression of the disease and alleviating symptoms. Strategies include eliminating silica and lung irritants exposure, quitting smoking, oxygen therapy, and screenings.3Recently, Pirfenidone and nintedanib, both approved by the US Food and Drug Administration (FDA), have been extensively examined in silicosis models, yielding substantial evidence.16 ,17 In severe cases where the disease has significantly progressed and lung function is severely compromised, lung transplantation is done.18One of the challenges associated with silicosis and tuberculosis is the potential for misdiagnosis due to similar presentations and inadequate occupational histories. All pulmonary TB patients should have their sputum examined by microscopy/Xpert MTB/RIF to determine if they are infectious or not but in this case the sputum examination is negative, posing a diagnostic challenge and diagnosed as active TB based on X-ray abnormalities and clinical findings and had a full course of TB treatment. Chest X-ray and high-resolution computed tomography (HRCT) are usually used to diagnose pneumoconiosis but due to financial constraints, the patient did not go for HRCT and multiple differential diagnoses had been proposed based on our patient’s clinical presentation and chest x rays such as silicosis, bronchitis, bronchitis, emphysema, pulmonary tuberculosis, Sarcoidosis, and rheumatoid arthritis. Our patient’s clinical features and occupational exposure to stone crushers for 10 years, different physical findings, sputum negative for acid-fast bacilli on microscopy/Xpert MTB/RIF, which later suggests a diagnosis of silicosis.
As silicosis progresses, improper or postponed disease management can have negative effects on patients and result in treatment failure. In addition, patients’ financial, psychological, and emotional effects shouldn’t be disregarded because they could feel anxious, frustrated, or lose faith in the healthcare system. Healthcare professionals should be encouraged to improve diagnostic methods, including thorough occupational histories, and radiological imaging, and, to effectively differentiate between the two conditions in high-risk industries associated with silicosis.