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.