Chest
Original ResearchOccupational and Environmental Lung DiseasesArtificial Stone Silicosis: Disease Resurgence Among Artificial Stone Workers
Section snippets
Study Population
We conducted a retrospective analysis of all patients referred to our outpatient LTX evaluation center with a diagnosis of silicosis from January 1997 through December 2010. This is the sole national referral site for LTX in Israel. All case subjects received a diagnosis prior to LTX during the initial evaluation, which included biopsy material in all but two cases. Histologic reconfirmation in all transplanted cases was carried out using explanted lung tissue. In addition to analyzing our own
Results
During the 14-year study period, we gave 25 patients a diagnosis of silicosis. All cases were diagnosed based on detailed occupational history. Histologic confirmation that relied solely on the NIOSH algorithm was also obtained in all but two cases. Of these, 15 (60%) were determined to be potential candidates for LTX, 12 were listed, and 10 (40%) ultimately underwent transplant. Among them were a father and son, both of whom developed silicosis after working together. The father underwent LTX,
Discussion
We report here an unusually high incidence of advanced, life-threatening silicosis linked to a specific, relatively new, engineered product with a high silica content. This cause-and-effect relationship is supported by the extraordinary case incidence we observed over a short period linked to a single exposure scenario, a nearly 15-fold increase in the expected transplant rate for this condition. This relationship is strengthened by the similar occupational histories of the patients; the known
Conclusions
In summary, we report an outbreak of end-stage silicosis leading to LTX, a disease epidemic caused by dust generated through dry cutting engineered decorative stone with very high silica content. Strict enforcement of occupational safety and health regulations could have prevented this needless tragedy. Appropriate public health interventions to prevent future occurrences should be undertaken.
Acknowledgments
Author contributions: Dr Shitrit is the guarantor of the paper. He had full access to all of the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Kramer: contributed to the study design, data collection, and manuscript review and approval.
Dr Blanc: contributed to the data analysis and manuscript writing and approval.
Dr Fireman: contributed to the data collection and manuscript review and approval.
Dr Amital: contributed to the data
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.