Chest
Volume 142, Issue 2, August 2012, Pages 419-424
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Original Research
Occupational and Environmental Lung Diseases
Artificial Stone Silicosis: Disease Resurgence Among Artificial Stone Workers

https://doi.org/10.1378/chest.11-1321Get rights and content

Background

Silicosis is a progressive, fibrotic, occupational lung disease resulting from inhalation of respirable crystalline silica. This disease is preventable through appropriate workplace practices. We systematically assessed an outbreak of silicosis among patients referred to our center for lung transplant.

Methods

This retrospective cohort analysis included all patients with a diagnosis of silicosis who were referred for evaluation to the National Lung Transplantation Program in Israel from January 1997 through December 2010. We also compared the incidence of lung transplantation (LTX) due to silicosis in Israel with that of the International Society for Heart and Lung Transplantation (ISHLT) registry.

Results

During the 14-year study period, 25 patients with silicosis were referred for evaluation, including 10 patients who went on to undergo LTX. All patients were exposed by dry cutting a relatively new, artificial, decorative stone product with high crystalline silica content used primarily for kitchen countertops and bathroom fixtures. The patients had moderate-to-severe restrictive lung disease. Two patients developed progressive massive fibrosis; none manifested acute silicosis (silicoproteinosis). Three patients died during follow-up, without LTX. Based on the ISHLT registry incidence, 0.68 silicosis cases would have been expected instead of the 10 observed (incidence ratio, 14.6; 95% CI, 7.02-26.8).

Conclusions

This silicosis outbreak is important because of the worldwide use of this and similar high-silica-content, artificial stone products. Further cases are likely to occur unless effective preventive measures are undertaken and existing safety practices are enforced.

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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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

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