What is Berylliosis ?
Berylliosis, also known as Chronic Beryllium Disease (CBD), is a sickness that causes lumps of inflamed cells, called granulomas, to form in the body. This disease happens when someone is exposed to a chemical element called beryllium. Symptoms of CBD often change and can include a cough, fever, night sweats, and tiredness. The best way to diagnose Berylliosis is to look at the patient’s work history, to find out if they’ve been exposed to beryllium, and to carry out certain kinds of medical tests. These tests include a blood test or a bronchoalveolar lavage (BAL), which is a procedure where a tube is passed through the mouth or nose into the lungs to collect lung cells. A lung biopsy can also be done where a small piece of lung tissue is removed for examination.
The Occupational Safety and Health Administration (OSHA), which is in charge of ensuring safe and healthful working conditions, sets the amount of beryllium a person can be exposed to. The limit is 0.2 micrograms per cubic meter over an 8-hour work shift, or less than 2 micrograms per cubic meter in any 15-minute period.
CBD is incurable, meaning it cannot be fully healed or reversed. However, the symptoms can be managed with certain medicines, such as glucocorticoids, which reduce inflammation, and immunosuppressive agents, which lower the body’s immune response.
People who are more likely to develop CBD are those who work in industries that manufacture and process beryllium. In general, Berylliosis is not unique, it is similar to many other diseases that cause lung disorders.
What Causes Berylliosis ?
Coming into contact with a chemical called beryllium is what leads to certain health problems. Beryllium is often used in industries like machinery, electronics, national defense, and companies that extract beryllium itself. Other places you might find it include ceramics, cars, airplanes, jewelry making, dental appliances, and computers. It seems that some people might be more likely to develop severe health problems from beryllium because of their genes.
Mostly, people are exposed to beryllium by breathing it in, either in smoke or dust. But it can also get into the body through the skin. Organic forms of beryllium—those that are part of a living organism—usually leave the body quickly. But inorganic forms—those not part of a living organism and that don’t dissolve in water—can stay in the body for many years.
Risk Factors and Frequency for Berylliosis
Chronic Beryllium Disease (CBD) is a type of lung condition caused by an overactive immune response and it affects around 2 to 5% of people who are exposed to the element beryllium in their work. Unfortunately, the progression of this disease doesn’t stop even when the exposure to beryllium is halted. However, unless a person lives very close to a factory or industrial site that emits beryllium, it’s unlikely that they will develop this disease. This is because the amount of beryllium found in the air we breathe under normal circumstances is usually very low (less than 0.03 ng/m3).
Signs and Symptoms of Berylliosis
Chronic Beryllium Disease (CBD) is a health condition arising from exposure to beryllium. It can set in anywhere from three months to 30 years after exposure, and its symptoms are not very distinct. People with CBD often experience fever, sweating at night, weight loss, dry cough, and fatigue. If the exposure continues, CBD leads to noncaseating inflammatory granulomas, a type of inflammation seen in other diseases like tuberculosis and sarcoidosis. CBD can restrict lung functioning (a decrease in the capacity to distribute oxygen). In some rare cases, this condition can also result in the formation of granulomas in other organs, including the liver.
When a doctor checks a patient suspected of having CBD, they might find signs that include enlarged lymph nodes, abnormal crackling sounds in the lungs, a rash, and enlarged liver or spleen.
- Fever
- Night sweats
- Weight loss
- Dry cough
- Fatigue
- Formation of granulomas due to continued exposure to beryllium
- Restricted lung functioning
- Granuloma formation in other organs such as the liver (rare)
- Enlarged lymph nodes (lymphadenopathy)
- Crackling sounds in lungs (crackles)
- Rash
- Enlarged heart or spleen (hepatosplenomegaly)
Testing for Berylliosis
Diagnosing berylliosis, a lung disease, involves several steps based primarily on medical history, blood tests, and a lung tissue sample test. It starts by identifying sensitivity to a chemical called beryllium – this is checked through a test called Beryllium Lymphocyte Proliferation Test (BeLPT). It’s done by extracting blood or fluid from tiny air sacs in your lungs and growing certain immune cells with beryllium sulfate in a lab. Technicians then count these cells. If there are too many cells, it indicates a possible sensitivity to beryllium. If your test results show an above-average number of cells twice or once with a borderline result, you’re considered to have beryllium sensitivity. The same goes for those whose single test using lung fluid shows an abnormal result.
Patients with a positive result on this test undergo bronchoscopy – a test that lets your doctor look at your airways through a thin viewing device called a bronchoscope. During bronchoscopy, the doctor collects a sample of lung cells using a technique called bronchoalveolar lavage (BAL). Finally, a small tissue sample is taken from the lung for further examination – this is a key step for making a confirmatory diagnosis of Chronic Beryllium Disease (CBD), which is a form of berylliosis.
Imaging tests like chest X-rays may also be used, but their findings are not specific to berylliosis. Early in the disease, the X-ray results are usually normal. In advanced stages, changes like scarring of lung tissue, irregularities in the lining of the lungs, enlarged lymph nodes in the chest, and strange cloud-like areas may be noticed. Computerized Tomography (CT) scans can also show certain changes in berylliosis, like small lumps in lung tissue in the early stages. CT scans may reveal more subtle changes like hazy appearances on the lung scans, which were found to be more common in berylliosis patients than in those with a disease called sarcoidosis. As the disease progresses, the CT scan could show enlarged lymph nodes in the chest, scarring of lung tissue, and a thickening of the lining of the lungs.
Additionally, other tests like blood gas tests, lung function tests, spirometry (a test that measures how much and how quickly you can move air out of your lungs), and DLCO levels (a test that measures how well oxygen passes from your lungs into your bloodstream) can also be performed as part of the diagnostic process.
Treatment Options for Berylliosis
The goal in treating a condition known as berylliosis is to lessen the symptoms and slow down how fast the disease gets worse, as there’s no known cure yet. Although there isn’t any solid evidence that stopping exposure to a metal called beryllium slows down the disease, it’s still considered a good treatment strategy.
For people in the early stages of berylliosis, who don’t have any changes in lung function or noticeable symptoms, the approach is to monitor them regularly. This includes physical exams, tests of lung function, and X-rays. It’s important for all patients to get flu and pneumonia vaccines and to get help to stop smoking if they currently smoke.
If symptoms show up or tests show significant changes in lung function, treatments like supplementary oxygen and orally-taken steroids are started, along with any other necessary supportive therapy.
Steroid drugs are typically used to treat chronic beryllium disease. Usually, a high initial dose is needed, and treatment often lasts for several months before symptoms start to get better. After symptoms lessen, the dose of steroids needs to be slowly reduced to prevent negative side effects. If a patient doesn’t respond to steroids, they may be given drugs that suppress the immune system such as methotrexate and azathioprine.
Once someone is diagnosed with chronic beryllium disease, they need to be checked on a lifelong basis. This includes regular tests of the level of gases in the blood, chest X-rays, and lung function tests.
What else can Berylliosis be?
When a doctor is trying to figure out what’s causing someone’s lung issues, they could be dealing with a number of possible conditions. These could include:
- Sarcoidosis, a disease involving abnormal collections of inflammatory cells that can form lumps known as granulomas
- Idiopathic pulmonary fibrosis, a type of chronic scarring lung disease
- Hypersensitivity pneumonitis, an allergic lung disease
- Asthma, a condition in which breathing becomes difficult due to inflamed airways
- Other diseases that cause granulomas (lumps) in the lungs, like histoplasmosis (a fungal infection), tuberculosis (a bacterial infection), or silicosis (caused by inhaling silica dust).
In about six percent of all cases, someone who seems to have sarcoidosis might actually have Chronic Beryllium Disease (CBD).
What to expect with Berylliosis
People who are sensitive to beryllium but do not have Chronic Beryllium Disease (CBD) do not need treatment. However, they should have regular check-ups as they have a higher risk of developing CBD than those who are not sensitive. Keep in mind that CBD can cause an increase in mortality rates, which can vary from 5% to 38%.
In patients with CBD, the course of the disease can vary. It’s important to note that a high percentage of a certain type of cell, lymphocytes, in the lung fluid can indicate a more severe illness. Another sad fact is that disability is common for people who already have a lung disease and for those who smoke.
CBD is associated with the formation of granulomas which are small areas of inflammation. These can lead to the development of nodules, or small lumps, which can affect how well the lungs function.
Preventing Berylliosis
The main way to manage a condition called berylliosis is to prevent it from happening in the first place. The Occupational Safety and Health Administration (OSHA), a government agency that helps keep workers safe, has some specific advice. They recommend steps to limit workers’ exposure to beryllium, which causes berylliosis. This could include setting up proper ventilation systems or structures to block exposure.
OSHA also advises providing safety equipment like breathing masks, and making sure that workers are trained about the risks of beryllium. On top of that, they recommend regular health check-ups to keep an eye on workers who might have been exposed.
In the year 2000, researchers found evidence that these preventive measures work. They discovered that workers who had gone through a full prevention program were less likely to become sensitive to beryllium than those working in the past, before these preventive measures were in place. This shows how preventive actions can help protect people from berylliosis.
