Berylliosis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at November 28, 2016
StartDiseasesBerylliosis

Berylliosis is a disease of the lungs as a result of poisoning by the metal, beryllium. There are two types - acute and chronic, but both are acquired by exposure to the metal, either by absorption or inhalation

Contents

Definition & Facts

Berylliosis is defined as beryllium poisoning in which beryllium or beryllium compounds have either been absorbed by the skin or inhaled and resulted in fibrosis of the lungs.

This disease is considered an occupational disease because the most common places for exposure to the metallic element are workplaces that extract metals or create items such as electronics, dental alloys, and high-tech ceramics.

Berylliosis presents as either acute or chronic. Acute berylliosis is not as common as it once was now that measures have been taken to protect workers exposed to beryllium. Chronic berylliosis is a systemic, hypersensitive reaction to beryllium that results in an unnatural, magnified immune response.

Symptoms & Complaints

Acute berylliosis presents severely and suddenly. The lungs become inflamed, breathing becomes difficult, and coughing ensues.

The cough will be dry and non-productive. The patient may also suffer from a severe sore throat. In some cases, the eyes and skin are also affected. The lung tissue becomes thick from scarring. Unexplained weight loss, chest pain, and fatigue may also ensue.

If prompt treatment is not given, the patient with acute berylliosis may develop life-threatening complications. However, if properly treated, patients can have a full recovery.

Chronic berylliosis develops slowly, sometime taking years before symptoms arise. This form is characterized by the development of granulomas, also known as inflammatory masses or nodules. In addition to affecting the lungs, inflammation can occur in other tissues such as lymph nodes, skin, liver, and other internal organs.

Deep in the lungs, prolific and pervasive scarring thickens tissue and is termed interstitial pulmonary fibrosis. Symptoms include dry coughing, swollen lymph nodes, shortness of breath, decreased or no appetite, chest pains, night sweats, fever, weight loss, fatigue, patchy redness on the skin, and small, raised areas on the skin. Among other complications of chronic berylliosis, severe lung damage, liver damage, and difficult, labored breathing may result in death. 

Causes

Berylliosis is caused by inhaling beryllium, or compounds containing beryllium in dust particulate or vapor. Beryllium can also be absorbed through the skin. Exposure generally occurs in industrial environments where the element is commonly used in dental compounds, high tech ceramics, aerospace technology, electronics manufacturing, and manufacturing nuclear structures. In the 1950s, beryllium was used to manufacture fluorescent lighting.

Chronic berylliosis (CBD) is caused by an irregular and profuse immune response known as delayed-type hypersensitivity reaction resulting from a slowly developing allergic reaction to beryllium. CBD is progressive and systemic.

CBD's exaggerated immune response releases unusually high numbers of white blood cells, specifically macrophages which "eat" invaders by surrounding them in a process known as phagocytosis, and lymphocytes which initiate immune response, among other functions. This response causes nodules to develop and may cause damage to otherwise normal tissue and organs. The areas most affected are the alveoli (air sacs).

Because only a small percentage of those exposed develop CBD, researchers believe there is a genetic component involved that causes the chronic form of berylliosis.

Diagnosis & Tests

Physicians rely on patients disclosing their exposure to beryllium to help them diagnose patients experiencing shortness of breath, weight loss, fatigue, and possibly a rash. Doctors will listen to the lungs using a stethoscope to discover any abnormal breathing sounds.

Pulmonary function tests to determine lung function may be ordered along with X-rays to see if there are any abnormalities in structure. Imaging studies can also help rule out other disorders like lung cancer. However, these tests are not definitive, and in some cases of berylliosis, the X-rays may not detect the condition and appear normal.

To determine what disorder is affecting the lungs, a biopsy and visual examination of the tissue under a microscope can help physicians in attaining a correct diagnosis. Patients with CBD will have tissue that presents with granuloma, but this is also seen in cancer patients, so more tests are needed, such as specialized blood tests. The BeLPT (beryllium lymphocyte proliferation test) examines white blood cells' sensitivity to beryllium. Tissue from a lung biopsy may also be used to perform the BeLPT.

Treatment & Therapy

Berylliosis is commonly treated using corticosteroids, breathing treatments and support such as ventilators and oxygen. If treated with the onset of symptoms, most who have acute berylliosis experience a full recovery.

In addition to corticosteroids, methotrexate and azathioprine are sometimes used to treat chronic berylliosis. Clinical trials are currently being conducted to find additional medications to treat chronic berylliosis, and the drug infliximab has shown promise.

Anyone exposed to beryllium and diagnosed with sensitivity but who hasn't developed the disease should visit their physician on a regular basis, and get treatment immediately if symptoms develop. They should also avoid any further exposure to beryllium.

Prevention & Prophylaxis

Prevention is the best treatment so those exposed should shower after their shift at work if possible. If not, then simply changing into clean clothes may help prevent the transfer of metal into the home environment.

Some workplaces have initiated screening employees with BeLPT and assigning employees whose results show sensitivity to beryllium in areas where exposure is unlikely. However, the test is not a definitive predictor of the disease. Researchers are working to develop a more accurate predictive test. The best way to prevent berylliosis is to avoid exposure to the metal element.