Berylliosis is a poisoning of the human organism with the chemical element beryllium. The substance belongs to the metals and leads to acute or chronic berylliosis in certain groups of people. Substances containing beryllium may also trigger the disease. Berylliosis is one of the so-called pneumoconioses (medical term malignant pneumoconiosis).
What is berylliosis?
Basically, a distinction is made between two variants of berylliosis, the acute and chronic forms of progression. The chronic form of berylliosis is usually an occupational disease. It particularly affects people who are in contact with the metal beryllium over a long period of time. Berylliosis belongs to the category of malignant pneumoconioses. From a histological perspective, berylliosis is a disease with specific granulomas. These do not caseate and in the majority of cases are found in the lung area as well as the skin. Sometimes berylliosis is confused with sarcoidosis, which must be taken into account when making a diagnosis. The diseases cannot be differentiated clinically and by radiological examinations. For this reason, the patient’s medical history and an allergy test play an important role. In doing so, the physician primarily explores the patient’s occupational history to gather clues about berylliosis.
Causes
Berylliosis is primarily caused by prolonged exposure to the metal. Vapors containing beryllium are often responsible for sensitization to the substance. Skin contact with beryllium dust also leads to the development of the disease in some people after some time. Basically, any exposure causes a hypersensitivity reaction. As a result, so-called granulomas develop in the area of the lungs. However, berylliosis does not develop in all people who come into contact with the metal. Only one to ten percent of all exposed persons suffer from a corresponding hypersensitivity to the substance. Again, only a small proportion of these people develop the chronic form of berylliosis. However, it has been shown that those occupational sectors with the most intensive contact with beryllium have the highest risk of contracting the disease. In principle, berylliosis occurs with approximately the same frequency in female and male patients. In addition, there is a genetic predisposition to the disease. A specific major histocompatibility complex is primarily responsible. The chronic form of berylliosis occurs in people of all ages. People in certain occupations are at particular risk of contracting the disease. For example, berylliosis is most common in the aerospace industry, where the metal beryllium is used. Workers in the ceramics industry are also at increased risk for berylliosis.
Symptoms, complaints, and signs
Berylliosis causes various symptoms in patients with the disease. First, individuals suffer from a cough that irritates the throat and esophagus. Subsequently, pain develops, as well as inflammatory processes. In addition, the affected patients develop rhinitis. In the course of this, the discharge from the nose increases, and the mucous membranes of the nose also become irritated. In the further course of berylliosis, a so-called chemical pneumonia follows. In this case, the sick suffer from shortness of breath, swollen lymph nodes as well as pain in the area of the chest. Other characteristic complaints consist of dermatitis resulting from exposure of the skin to the metal. Fatigue, pain in the joints, and hepatosplenomegaly are also possible. Patients often lose weight.
Diagnosis and course
Various examination techniques are used when berylliosis is suspected. It is particularly important to differentiate the disease from the so-called sarcoidosis. The only way to make a successful differential diagnosis is to obtain a thorough occupational history. Allergy tests are also performed. Based on the information about the patient’s occupational life, the physician receives clues about potential contact with beryllium. In addition to the aviation industry, workers in nuclear power, metal processing, and electronics are at particular risk of contracting the disease. Berylliosis is diagnosed by several examination procedures.This includes blood analyses, imaging procedures and tests to check lung function. A so-called beryllium lymphocyte proliferation test is used to diagnose the chronic form of berylliosis. The test is performed only by certain specialists in specialized medical institutions. Imaging procedures include [x-ray|x-ray technical examinations]] as well as CT examinations. Here, for example, a hilar lymphadenopathy indicates the disease. In the differential diagnosis, the physician excludes idiopathic pulmonary fibrosis and allergic alveolitis in addition to sarcoidosis.
Complications
Various complications can occur as a result of berylliosis. Depending on the severity of the poisoning, nausea and vomiting may occur, as well as severe allergic reactions, skin rash, and cardiac arrhythmias. Blood pressure fluctuations and sweating may also occur. In severe cases of poisoning, disorders of consciousness, inner restlessness and concentration problems occur in the course of berylliosis. Affected persons are also increasingly tired and irritable as the disease progresses; stomach pain and rheumatic complaints and even arteriosclerosis often occur. Rarely, anxiety disorders may also occur. If the liver is affected, further problems can arise due to the disturbed detoxification. In extreme cases, berylliosis leads to memory lapses or even complete memory loss. However, it is not uncommon for severe complications of this type to develop, usually over a long period of time, and are not always clearly attributable to the poisoning. During the treatment itself, allergic reactions, rejection reactions of the body and other complications may occur within the framework of the therapeutic options (blood washing, lipid therapy, activated charcoal treatment, etc.). If treatment is delayed or not carried out at all, berylliosis can develop into further current complaints and chronic secondary diseases. In severe cases, these can also lead to death.
When should you go to the doctor?
Beryllium poisoning that is not recognized in time or treated too late results in a number of serious complications and long-term damage. The metal usually causes irreversible damage to the lungs. If treatment is not initiated promptly, the risk of the lung losing its ability to function increases considerably. In this case, the patient can only be cured by a lung transplant. Even if the poisoning is less dramatic, other very serious long-term consequences can be expected in the absence of or inadequate treatment. In particular, permanent memory lapses or even complete memory loss may occur. Members of at-risk groups should therefore consult a specialist, preferably a pulmonary specialist or a toxicologist, at the first signs. Risk groups include aerospace workers, people who work in nuclear power plants or visit them regularly for research purposes, and workers in the electronics, electrical engineering, and metalworking industries. Typical symptoms, which the aforementioned group of people should immediately consult a specialist for, are in particular frequent coughing, respiratory problems and rhinitis. In the advanced stage, shortness of breath, pain in the chest area and usually pneumonia are added. However, affected persons should not wait until it gets to that point, but should go to the doctor immediately.
Treatment and therapy
A complete cure of berylliosis is usually not possible. This is because the disease irreversibly damages the tissues of the lungs. Corticosteroids are used for therapy. In order to curb any undesirable side effects that may occur, treatment with the active substance methotrexate may be necessary. Regular pulmonary function tests are indicated to monitor the success of drug therapy. Avoidance of contact with beryllium plays an essential role in therapy in all cases of the disease. In some patients, lung transplantation is necessary as a result of berylliosis and hypoxia.
Outlook and prognosis
The prognosis of chronic berylliosis is essentially poor. It is a progressively progressive disease. Unfortunately, there is no curative therapy.As part of the therapy, an attempt is made to alleviate the symptoms and slow down the course of the disease. The immune system attempts to remove the beryllium dusts inhaled over a long period of time from the lungs. In the process, cytotoxic T lymphocytes are produced, which fight the affected cells. However, when almost the entire lung is affected, massive remodeling processes occur, accompanied by chronic inflammation. As the destroyed cells are replaced by new cells, nodular tissue neoplasms, also known as granulomas, are formed. In themselves, the tissue neoplasms are benign. However, they occur in clusters and thus alter the structure of the lungs by increasing the formation of connective tissue. Chronic shortness of breath, increased respiratory frequency, constant dry cough and also fever occur. Immunosuppressants such as corticosteroids or, in more severe cases, azathioprine are used to alleviate the inflammatory processes. Often, lung transplantation also becomes necessary. Without treatment, chronic berylliosis leads to death. However, there is no exact information on life expectancy. The course of acute berylliosis depends on the amount of dust inhaled once. Immunosuppressants are also used to alleviate the symptoms, as these are also immune reactions of the body.
Prevention
Effective prevention of berylliosis is to avoid exposure to the metal beryllium.
Aftercare
Unfortunately, berylliosis cannot be cured, so sufferers must follow up regularly throughout their lives. The lungs are irreversibly damaged as a result of the disease. After treatment with corticosteroids, or the active ingredient methotrexane, regular monitoring of lung function is necessary to see whether the medication is having its effect. In addition, sufferers must strictly avoid contact with beryllium, which for many means changing jobs or places of residence. In some cases, there is an undersupply of oxygen to the body, making a lung transplant necessary. Often, the doctor will recommend exercise as part of the aftercare, which can range from light gymnastics to a more demanding workout. It is possible to join a lung sports group, which is specifically designed for respiratory patients. Here there is also the possibility of exchanging ideas with others. Sufferers must be aware that they will be affected by berylliosis for the rest of their lives and that their own aftercare can only alleviate the symptoms. However, if this is done carefully, there is a good chance of living a reasonably regular and fulfilling life.
Here’s what you can do yourself
Berylliosis usually cannot be completely cured. However, affected individuals can do a few things themselves to make living with the disease easier. The first step should be to take the condition to a pulmonary or toxicology specialist. Under the doctor’s guidance, appropriate steps can be worked out and taken without the risk of complications. In the case of berylliosis, the physician will first recommend exercise. Sufferers should start with light exercises from physiotherapy and then, depending on the severity of tissue damage, move on to more demanding training. Suitable activities include walking, running, swimming, hiking or dancing, as well as “smaller” activities such as stair climbing or knee bends. Those affected can obtain further information and opportunities for exercise from lung sports groups, for example. Participation in outpatient sports groups also serves to exchange information with other patients. Since berylliosis is not normally curable, long-term management of the disease can also be learned through discussions with therapists and other sufferers. The responsible physician can point out further possibilities how to live with berylliosis and its manifestations.
