Investigation of contact dermatitis caused by hard metal dust / 中华劳动卫生职业病杂志

Objective@#To investigate the incidence of contact dermatitis among workers in cemented carbide production enterprises.@*Methods@#From October 1997 to October 2017, an occupational epidemiological survey was conducted on a large-scale cemented carbide production enterprise, and occupational health examinations were conducted for employees. 152 people were exposed to hard metal dust (hard metal raw material dust and alloy dust) . The employees in the work group were contact groups, and 142 employees in the non-dusting operation of the company were in the control group. A detailed retrospective survey of hard metal production workers with contact dermatitis history in the two groups was conducted to analyze the risk factors of contact dermatitis exposure to hard metal dust.@*Results@#The incidence of allergic diseases in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ2=23.793, P<0.05) . The incidence of contact dermatitis in the exposed group was significantly higher than that in the control group. The difference was statistically significant (χ2=24.659, P<0.05) ; the changes of contact dermatitis in the contact group were mainly allergic contact dermatitis, and some showed irritative contact dermatitis; the operator had respiratory symptoms (including work-related nasal congestion, cough, wheezing) , difficulty breathing may be the influencing factors of contact dermatitis (RR=2.60, 95%CI: 1.10-6.20, P<0.05) .@*Conclusion@#Hard metal alloy enterprises are exposed to hard metal dust. The incidence of contact dermatitis is high in workers, and the occurrence of contact dermatitis may be associated with those with respiratory symptoms.

Occupational hard metal lung disease: a case report / 中国职业医学

OBJECTIVE: To report the clinical manifestations,chest imaging,pathological changes,diagnosis and treatment on one case of hard metal lung disease( HMLD).METHODS: The occupational history,clinical manifestations,chest computed tomography and lung histopathological examinations of a case with pathologically confirmed HMLD were summarized.RESULTS: The patient began to cough and have dyspnea on exertion after 7 years of hard metal dust exposure of cobalt and tungsten, and pulmonary function test showed a restrictive ventilation dysfunction.Chest computed tomography showed bilateral areas of diffuse lesions,including ground-glass attenuation,areas of consolidation,diffuse small nodules, extensive reticular opacities and traction bronchiectasis.The lung histopathological changes include macrophage interstitial pneumonia,which is macrophages and a large number of multinucleated giant cells in the alveolar space.CONCLUSION: A clear history of hard metal dust exposure and the pathological examination of lung tissue are helpful for the diagnosis of HMLD.

Hard metal lung disease: a case series / Doença pulmonar por metal duro: uma série de casos

ABSTRACT Objective: To describe diagnostic and treatment aspects of hard metal lung disease (HMLD) and to review the current literature on the topic. Methods: This was a retrospective study based on the medical records of patients treated at the Occupational Respiratory Diseases Clinic of the Instituto do Coração, in the city of São Paulo, Brazil, between 2010 and 2013. Results: Of 320 patients treated during the study period, 5 (1.56%) were diagnosed with HMLD. All of those 5 patients were male (mean age, 42.0 ± 13.6 years; mean duration of exposure to hard metals, 11.4 ± 8.0 years). Occupational histories were taken, after which the patients underwent clinical evaluation, chest HRCT, pulmonary function tests, bronchoscopy, BAL, and lung biopsy. Restrictive lung disease was found in all subjects. The most common chest HRCT finding was ground glass opacities (in 80%). In 4 patients, BALF revealed multinucleated giant cells. In 3 patients, lung biopsy revealed giant cell interstitial pneumonia. One patient was diagnosed with desquamative interstitial pneumonia associated with cellular bronchiolitis, and another was diagnosed with a hypersensitivity pneumonitis pattern. All patients were withdrawn from exposure and treated with corticosteroid. Clinical improvement occurred in 2 patients, whereas the disease progressed in 3. Conclusions: Although HMLD is a rare entity, it should always be included in the differential diagnosis of respiratory dysfunction in workers with a high occupational risk of exposure to hard metal particles. A relevant history (clinical and occupational) accompanied by chest HRCT and BAL findings suggestive of the disease might be sufficient for the diagnosis.

RESUMO Objetivo: Descrever aspectos relacionados ao diagnóstico e tratamento de pacientes com doença pulmonar por metal duro (DPMD) e realizar uma revisão da literatura. Métodos: Estudo retrospectivo dos prontuários médicos de pacientes atendidos no Serviço de Doenças Respiratórias Ocupacionais do Instituto do Coração, localizado na cidade de São Paulo, entre 2010 e 2013. Resultados: Entre 320 pacientes atendidos no período do estudo, 5 (1,56%) foram diagnosticados com DPMD. Todos os pacientes eram do sexo masculino, com média de idade de 42,0 ± 13,6 anos e média de tempo de exposição a metal duro de 11,4 ± 8,0 anos. Os pacientes foram submetidos a avaliação clinica, história ocupacional, TCAR de tórax, prova de função pulmonar, broncoscopia com LBA e biópsia pulmonar. Todos apresentaram distúrbio ventilatório restritivo. O achado de imagem à TCAR de tórax mais frequente foi de opacidades em vidro fosco (em 80%). Em 4 pacientes, o LBA revelou presença de células gigantes multinucleadas. Em 3, foi diagnosticada pneumonia intersticial por células gigantes na biópsia pulmonar. Houve o diagnóstico de pneumonia intersticial descamativa associada à bronquiolite celular em 1 paciente e de pneumonite de hipersensibilidade em 1. Todos foram afastados da exposição e tratados com corticoide. Houve melhora em 2 pacientes e progressão da doença em 3. Conclusões: Apesar de ser uma entidade rara, a DPMD deve ser sempre considerada em trabalhadores com risco ocupacional elevado de exposição a metais duros. A história clínica e ocupacional associada a achados em TCAR de tórax e LBA sugestivos da doença podem ser suficientes para o diagnóstico.

Clinical analysis on hard metal lung disease / 中国职业医学

OBJECTIVE: To analyze the clinical features,and diagnostic and therapeutic method of hard metal lung disease( HMLD). METHODS: By using literature metrology method,the open published case reports associated with HMLD from January 1980 to October 2015 were searched using the China Hospital Knowledge Database,Wanfang Database and Pub Med Database. The data of patients with hard metal dust exposure history were collected and analyzed based on the inclusive and exclusive criteria. RESULTS: Thirty-six cases of HMLD were collected. The onset age of patients was 21. 0-63. 0( 37. 2 ± 11. 7) years old. The median exposure time was 6. 0( 0. 6-43. 0) years,and the major working type was hard metal grinder. The main clinical type of HMLD maily was giant cell interstitial pneumonia( GIP),hypersensitivity pneumonitis and occupational asthma were also seen. HMLD was lack of characteristic clinical manifestation. The clinical symptoms of HMLD mainly included dry cough,dyspnea on exertion,restrictive pulmonary ventilation,and diffuse pulmonary dysfunction. The imaging study showed ground-glass opacity,diffuse small nodule shadow and reticular opacity shadow,which were mainly seen in the lower lobes of both lungs. There were 24 cases( 66. 7%) showed GIP in the lung tissue in pathological examination. The tungsten and cobalt elements were detected in lung tissue and bronchoalveolar lavage fluid in some cases. Among 22 patients treated with glucocorticoid after keeping away from hard metal dust exposure,the treatment was effective in 19 patients. The clinical symptoms of 6 patients were improved by avoiding hard metal dust exposure. CONCLUSION: HMLD belongs to the interstitial lung disease and there is no specific clinical manifestation. Glucocorticoid therapy is effective in most of the patients. The history of exposure to hard metal dust has important significance in making the diagnosis.

A case of cobalt-induced occupational asthma / 천식및알레르기

Cobalt is known as a hard metal used in cement and various household products. Occupational exposure occurs during the production of cobalt powder, the processing of hard metals, the polishing of diamonds, and the processing of cobalt alloys. There have been cases of cobalt induced interstitial pneumonitis, occupational asthma, and allergic dermatitis. We report a 21-year-old patient with rhinitis and asthma induced by cobalt in a factory manufacturing diamond-cutter made from hard metal. The patient complained of rhinorrhea, sneezing, and dyspnea 5 months after working in the diamond-cutting industry. Skin prick test and patch test with cobalt(CoCl2) showed negative responses. Bronchoprovocation with CoCl2 showed a early asthamtic response. In conclusion, we report a case of cobalt-induced occupational rhinitis and asthma who worked in a factory manufacturing diamond-cutter. Further studies will be needed to investigate the pathogenesis of bronchoconstriction induced by cobalt.

A Case of Giant Cell Interstitial Pneumonia / 결핵

Giant cell interstitial pneumonia, a synonym of (for) hard metal pneumoconiosis, is a unique form of pulmonary fibrosis resulting from an exposure to hard metal dust. A case of biopsy-proved giant cell interstitial pneumonia in the absence of appropriate history of exposure to hard metal dust is reported. The patient presented with clinical features of chronic interstitial lung disease or idiopathic pulmonary fibrosis. He worked in a chemical laboratory at a fertilizer plant(,)where he had been exposed to various chemicals such as benzene and toluene. He denied having any other hobby in his house or job at work which may have exposed him hard metal dust(.) High-resolution CT scan revealed multi-lobar distribution of ground glass opacity with peripheral and basal lung predominance. The retrieved fluid of bronchoalveolar lavage contained asbestos fiber and showed neutrophil predominance. Surgical lung biopsy was performed for a definite diagnosis. Lung specimen showed alveolar infiltration of numerous multinucleated giant cells with mild interstitial fibrosis. Upon detailed examination of the lung tissue, one asbestos body was found. An analysis for mineral contents in lung tissue was performed. Compared to with the control specimen, the amount of cobalt and several hard metal components in the lung tissue of this patient was ten times higher. We speculated that the inconsistency between occupational history and the findings of pathologic and mineralogical analyses could be explained by the difference in individual immunologic reactivity to hard metal dust despite the relatively small amount of unrecognized environmental exposure (ED: It's hard to understand what this phrase is trying to say).