Berylliosis

Usually berylliosis develops gradually; The first symptoms may appear 10–20 years after contact with beryllium. In some people, the disease develops suddenly, usually in the form of inflammation of the connective tissue of the lungs ( pneumonitis ). In acute berylliosis, cough , difficulty and decrease in the depth of breathing, pain in the chest area, and weight loss begin. Eyes and skin may be affected. With the chronic form in the lungs, the growth of pathological tissue begins, the lymph nodes increase, the cough and shortness of breath develop gradually.

In acute poisoning, several syndromes are distinguished: due to the irritant properties of beryllium compounds, upper respiratory tract lesions develop (rhinitis, pharyngitis, tracheitis), which disappear on their own within 24-48 hours after the elimination of contact with beryllium, even without treatment. Another possible syndrome is acute tracheobronchitis, characterized by dry cough, shortness of breath on exertion, pain behind the sternum. On the radiograph, an increase in the bronchovascular pattern is detected. With the defeat of the lower respiratory tract develop broncho-bronchiolitis and beryllium pneumonia. Patients complain of shortness of breath, cough with poor sputum, difficulty breathing, and unclear pain in the chest. In the lungs moist rales are heard. Beryllium pneumonia can begin immediately acutely, without precursors, or join the irritation of the upper respiratory tract, bronchitis or tracheobronchitis. The disease is manifested by cough with sputum, shortness of breath, cyanosis, general weakness and increased fatigue. Radiographically detected emphysema pulmonary fields, blur pulmonary pattern. Perhaps the development of acute interstitial myocarditis, which on the ECG is manifested by a decrease in voltage and inversion of the T wave in standard and chest leads. Acute poisoning, occurring in the type of bronchiolitis and pneumonia, lasts 2-3 months, then the clinical manifestations of bronchiolitis disappear, the patients feel better, the body temperature and X-ray picture are normalized.

Depending on the X-ray picture, there are two morphological forms: granulomatous and interstitial. Patients can significantly lose weight (8-10 kg), have a cast-iron shade of the face. Fever, vomiting, lymphadenopathy. During percussion, emphysematous changes in the lungs are determined (boxed sound), and auscultatory - moist rales. Also, due to the development of hypertension in the pulmonary circulation, there may be signs of pulmonary heart and right ventricular failure. Depending on the severity of chronic berylliosis, there are three stages. In stage I, small nodules in the lungs are noted. On II - clearer nodules on the background of diffuse sclerosis. III - enlarged individual nodules, diffuse fibrosis, eczematous changes and signs of pulmonary heart.

The most reliable method of protection is to prevent beryllium from entering the body at the expense of collective protection, changing technology: reducing air pollution, automating technological processes and remote control , using effective ventilation and air showers ^[4] and others. Advance (for applicants) and periodic (for workers) medical examinations.

The study of occupational morbidity in workers in various industries in the USSR and the Russian Federation showed that while the RIPME (in the Russian Federation) is now selected and used, it is extremely rare to achieve effective prevention of occupational diseases with this “ last resort ” ^[5] .

Based on finding out whether the patient has been in contact with beryllium or not, symptoms, characteristic changes in chest X-rays . However, the X-ray picture of berylliosis is very similar to that of another disease, sarcoidosis . Therefore, additional studies may be needed, including immunological studies, such as Curtis skin allergy test.

Curtis skin allergy test is performed using skin applications of soluble beryllium salts (usually 1-2% of a solution of beryllium sulfate or nitrate). In the case of sensitization of the organism to beryllium, a skin eczematous and inflammatory reaction develops at the site of application. With a positive test, erythema appears on the skin, marked infiltration and peeling. Curtis's test is quite specific, but in some cases with a relatively benign form, it can be negative.

In the most difficult cases, a lung biopsy is shown for the purpose of histological examination of the biopsy for the presence of beryllium in the granuloma.

Acute berylliosis can be quite difficult and in some cases even lead to death. However, the majority of patients are gradually recovering, although at first the condition is severe, as the lungs lose elasticity. With proper treatment, in particular, when connecting to a ventilator and prescribing corticosteroids , patients usually recover for 10-12 days without consequences.

If the lungs are significantly damaged by chronic berylliosis, the load on the heart increases and all conditions for the development of heart failure are created .

Warm alkaline inhalations are used to eliminate irritation of the upper respiratory tract. Ephedrine solution is instilled into the nose. With the development of acute broncho-bronchiolitis and pneumonitis, cardiac glycosides, aminophylline, diuretic and glucocorticoid drugs are indicated. In the absence of effect - artificial ventilation of the lungs. For the treatment of chronic berylliosis corticosteroid hormones are widely used. In case of severe disease, the therapy starts with 30–40 mg or more of prednisone per day, then gradually lowering the dose to maintenance (5–10 mg per day). Antihistamines, expectorants, bronchodilators and oxygen therapy are also widely used.