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Berylliosis

A form of pneumoconiosis, berylliosis, or beryllium poisoning, is a systemic granulomatous disorder with dominant pulmonary manifestations. It occurs in two forms: acute nonspecific pneumonitis & chronic noncaseating granulomatous disease with interstitial fibrosis, which may cause death from respiratory failure & corpulmonale. Most patients with chronic interstitial disease become only slightly to moderately disabled by impaired lung function & other symptoms, but with each acute exacerbation, the prognosis worsens.

reason of Berylliosis

Berylliosis results from inhalation of beryllium or from its absorption through the skin. Its severity varies with the amount inhaled. The mechanism by which beryllium exerts its toxic effect is unknown.

This disease occurs among beryllium alloy workers, cathode ray tube makers' gas mantle makers, fluorescent light workers, missile technicians, & nuclear reactor workers; it's generally associated with the milling & use of beryllium and, less commonly, with the mining of berylore. Families of beryllium workers & people who live near plants where beryllium alloy is used are also at risk for berylliosis.

Signs & symptoms of Berylliosis

Absorption of beryllium through broken skin produces an itchy rash that usually subsides within 2 weeks after exposure. A "beryllium ulcer" results from accidental implantation of beryllium metal in the skin.

Respiratory features :- Respiratory signs & symptoms of acute berylliosis include swelling & ulceration of nasal mucosa, which may progress to septal perforation, tracheitis, & bronchitis (dry cough). Acute pulmonary disease may develop rapidly (within 3 days) or weeks later, producing a progressive dry cough, tightness in the chest, substernal pain, tachycardia, & signs of bronchitis. This form of the disease has a significant mortality related to respiratory failure.

About 10% of patients with acute berylliosis develop chronic disease 10 to IS years after exposure. The chronic form reason increasing dyspnea that becomes progressively unremitting, along with mild chest pain, dry unproductive cough, & tachypnea. Pneumothorax may occur, with pulmonary scarring & bleb formation.

CLINICAL TIP Cardiovascular complications of berylliosis include pulmonary hypertension, right ventricular hypertrophy, & cor pulmonale. Other clinical features include hepatosplenomegaly, renal calculi, lymphadenopathy, anorexia, & fatigue.

Diagnosis

The patient history reveals occupational, family, or neighborhood exposure to beryllium dust, fumes, or mist. In acute berylliosis. chest X-rays may suggest pulmonary edema, showing acute miliary process or a patchy acinus filling, & diffuse infiltrates with prominent peribronchial markings. In chronic berylliosis, X-rays show reticulonodular infiltrates, hilar adenopathy, & large coalescent infiltrates in both lungs.

Pulmonary function studies show decreased vital capacity, forced vital capacity, residual volume & total lung capacity, & diffusing capacity of the lungs for carbon monoxide as well as decreased compliance as the lungs stiffen from fibrosis. Arterial blood gas analysis shows decreased partial pressure of arterial oxygen (Pao2) & partial pressure of arterial carbon dioxide The following additional tests may be performed:

• In vitro lymphoblast transformation test diagnoses berylliosis & monitors workers for occupational exposure to beryllium.
• Beryllium patch test establishes only hypersensitivity to beryllium, not the presence of disease.
• Tissue biopsy & spectrographic analysis are positive for most exposed workers but not absolutely diagnostic.
• Urinalysis may show beryllium in urine, but this only indicates exposure.

Differential diagnosis must rule out sarcoidosis & granulomatous infections.

Treatment of Berylliosis

• Beryllium ulcer requires excision or curettage. Acute berylliosis requires prompt corticosteroid therapy.
• Hypoxia may require oxygen administration by nasal cannula or mask (1 to 2 L/minute). Severe respiratory failure requires mechanical ventilation if Pao2 can't be maintained above 40 mm Hg.
• Chronic berylliosis is usually treated with corticosteroids, although it's not certain that steroids alter the progression of the disease. Lifelong maintenance therapy may be necessary.
• Respiratory symptoms may be treated with bronchodilators, increased fluid intake (at least 3 qt [3 L] daily), & chest physiotherapy techniques. Diuretics, digitalis glycosides, & salt restriction may be useful in patients with cor pulmonale.

Special considerations & prohibition

• Teach the patient to prevent infection by avoiding crowds & persons with infection & by receiving influenza & pneumococcal vaccines.
• Encourage the patient to practice physical reconditioning, energy conservation in daily activities, & relaxation techniques.