Berylliosis

Berylliosis

Beryllium is an alkaline earth metal utilized in various industries. ^[1] Inhalation or skin implantation of this metal result to a poisoning called berylliosis. ^[2]

Epidemiology

There are no racial and gender predilection. Since berylliosis is commonly associated to occupation, adults are the mostly affected although children can also get it. Around 1-10% of exposed people develop hypersensitivity to the metal. ^[2]

Causes

Berylliosis is often due to inhalation of beryllium or skin exposure to the metal especially when an individual has an open wound. ^[3]

People at risk are those working in manufacturing or processing companies of aircraft brakes, engines and landing gears, bearings, ceramics, gears, laser tubes, turbines and welding electrodes. Workers involved in nuclear power plants, oil refineries and natural gas industries also have increased the likelihood of getting berylliosis. ^[4]

Signs and Symptoms

Manifestations of berylliosis depend on the degree of exposure. There are two types of berylliosis: acute and chronic. Acute type is very rare and caused by brief exposure while the chronic one sets in when the person has been exposed to the metal for a long time. ^[3]

Acute berylliosis presents with sudden, rapid onset of symptoms including coughing, difficulty of breathing and severe inflammation of the lungs (pneumonitis). The skin and the eyes may also be affected. The chronic type which has gradual development is characterized by a certain formation of tissue inflammation called granuloma and interstitial pulmonary fibrosis which is scarring and thickening of lung tissues. Patients have dry cough, weakness, weight loss, chest pain and shortness of breath. ^[5]

Physical signs include inspiratory crackles, lymph node enlargement, skin rashes and enlargement of liver and spleen. ^[2]

Diagnosis

Occupational history is extremely significant since the symptoms may not appear until years after exposure. Along with getting the patient history, physical exam is done. Tests that may be recommended are chest x-ray, pulmonary function test, lung biopsy and a specialized blood test that will determine allergic sensitivity of an individual to beryllium called Beryllium Lymphocyte Proliferation Test (BeLPT). ^[3] A patient is considered to have chronic berylliosis if he or she has all of the following: beryllium exposure, positive BeLPT and noncaseating granuloma on lung biopsy. ^[6]

Treatment

Drug of choice is a corticosteroid like prednisone.  Patient may also be given cytotoxic agent such as methotrexate. In some cases, lung transplantation may be necessary. ^[4]

References:

1. http://www.uptodate.com/contents/chronic-beryllium-disease-berylliosis

2. http://emedicine.medscape.com/article/296759-overview#a0199

3. http://www.thirdage.com/hc/c/berylliosis-causes

4. http://www.mesothelioma-asbestosis.info/Lung-Diseases/berylliosis-chronic-beryllium-disease-cbd-acute-chemical-pneumonitis

5. http://www.webmd.com/a-to-z-guides/berylliosis

6. http://www.uptodate.com/contents/chronic-beryllium-disease-berylliosis#H7

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