RESUMEN
OBJECTIVES: The silica industry is rapidly expanding in Sri Lanka. The main objective of this study was to assess the prevalence of silicosis among workers exposed to silica dust, and to describe the disease pattern of the affected. We also screened the affected workers for tuberculosis. METHODS: Employees of a silica factory (n=250) were screened using a questionnaire. Details of duration of silica exposure and work category within the industry were recorded. All symptomatic workers were investigated with chest radiography and screened for tuberculosis. International Labour Organisation criteria for diagnosis of silicosis were used for diagnosis. RESULTS: Of the 250 employees 25 (10%) had respiratory symptoms. Chest radiographs of 14 workers (5.6%) showed abnormalities diagnostic of silicosis. The mean age of the affected workers was 29 years. One worker had radiological changes suggestive of progressive massive fibrosis. Of 14 patients, 13 had duration of exposure less than 10 years suggestive of accelerated silicosis. Among the 14 workers diagnosed with silicosis five (35.7%) had Mantoux induration of more than 10 mm suggestive of latent tuberculesis. CONCLUSIONS: Silica workers at the investigated industrial facility are at a significant risk of developing accelerated silicosis. Prevalence of infection with mycobacteria was high. Education of workers, improvement of protective measures and regular monitoring of the work environment should be undertaken to avert this deadly disease.
Asunto(s)
Tuberculosis Latente/epidemiología , Exposición Profesional/efectos adversos , Silicosis/epidemiología , Adulto , Femenino , Humanos , Masculino , Prevalencia , Radiografía Torácica , Silicosis/diagnóstico por imagen , Sri Lanka/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Hemophagocytic lymphohistiocytosis is a frequently fatal and likely underdiagnosed disease. It is a rare occurrence in adults and usually secondary to an insult such as viral infections, bacterial infections, autoimmune connective tissue disorders, malignancies and immunocompromised states, in contrast to its childhood counterpart, which is due to a genetic defect but may share some of same genetic etiologies. It is characterized by multisystem inflammation due to unregulated proliferation and infiltration of macrophages and CD8 T cells in the bone marrow, which leads to phagocytosis of red blood cells, platelets, lymphocytes and their precursors. CASE PRESENTATION: A 40-year-old Sri Lankan woman presented with a high-grade fever of 2 weeks' duration and the initial workup, including a thorough clinical examination, and all the investigations, including a septic screen, were normal. On the 18th day of hospital admission, she was found to have yellowish retinal lesions, which were confirmed as choroid tubercles by the consultant eye surgeon. Two days later she became pancytopenic and a bone marrow biopsy confirmed the diagnosis of hemophagocytic lymphohistiocytosis. She was treated with conventional category-1 antituberculous drugs and an initial 2 weeks with high-dose oral dexamethasone. All the choroid tubercles gradually disappeared and she recovered completely without any complications. CONCLUSIONS: In an adult patient with hemophagocytic lymphohistiocytosis, it is pivotal to understand the underlying etiology, as it needs extensive immunosuppression. If this patient had been treated with immunosuppressants without antituberculous medications, it would have been lethal with disseminated or central nervous system tuberculosis. So, in areas where tuberculosis is endemic, if no underlying cause is found, it may be worth considering antituberculous treatment for these patients. Re-evaluation with thorough clinical examination is of utmost importance in any patient with pyrexia of unknown origin as well as in any disease with unusual manifestations.