Limits...
A reconsideration of acute Beryllium disease.

Cummings KJ, Stefaniak AB, Virji MA, Kreiss K - Environ. Health Perspect. (2009)

Bottom Line: None of the measured air samples exceeded 100 microg/m(3), and most were < 10 microg/m(3), lower than usually described.Contrary to common understanding, these cases suggest that ABD and CBD represent a continuum of disease, and both involve hypersensitivity reactions to beryllium.Differences in disease presentation and progression are likely influenced by the solubility of the beryllium compound involved.

View Article: PubMed Central - PubMed

Affiliation: Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia 26505, USA. cvx5@cdc.gov

ABSTRACT

Context: Although chronic beryllium disease (CBD) is clearly an immune-mediated granulomatous reaction to beryllium, acute beryllium disease (ABD) is commonly considered an irritative chemical phenomenon related to high exposures. Given reported new cases of ABD and projected increased demand for beryllium, we aimed to reevaluate the patho physiologic associations between ABD and CBD using two cases identified from a survey of beryllium production facility workers.

Case presentation: Within weeks after exposure to beryllium fluoride began, two workers had systemic illness characterized by dermal and respiratory symptoms and precipitous declines in pulmonary function. Symptoms and pulmonary function abnormalities improved with cessation of exposure and, in one worker, recurred with repeat exposure. Bronchoalveolar lavage fluid analyses and blood beryllium lymphocyte proliferation tests revealed lymphocytic alveolitis and cellular immune recognition of beryllium. None of the measured air samples exceeded 100 microg/m(3), and most were < 10 microg/m(3), lower than usually described. In both cases, lung biopsy about 18 months after acute illness revealed noncaseating granulomas. Years after first exposure, the workers left employment because of CBD.

Discussion: Contrary to common understanding, these cases suggest that ABD and CBD represent a continuum of disease, and both involve hypersensitivity reactions to beryllium. Differences in disease presentation and progression are likely influenced by the solubility of the beryllium compound involved.

Relevance to practice: ABD may occur after exposures lower than the high concentrations commonly described. Prudence dictates limitation of further beryllium exposure in both ABD and CBD.

Show MeSH

Related in: MedlinePlus

Summary of lung function and beryllium exposure of case 2. (A) Results of pulmonary function tests before, during, and after acute work-related illness. (B) TWA and quarterly DWA airborne beryllium exposures in patient’s departments during this time period. Abbreviations: L, medical leave; M, maintenance department exposures (beryllium metal, beryllium oxide, copper-beryllium alloy); P, metals production department exposures (beryllium metal, beryllium oxide, beryllium fluoride, ammonium beryllium fluoride, ammonium fluoride, magnesium fluoride).
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2721869&req=5

f3-ehp-117-1250: Summary of lung function and beryllium exposure of case 2. (A) Results of pulmonary function tests before, during, and after acute work-related illness. (B) TWA and quarterly DWA airborne beryllium exposures in patient’s departments during this time period. Abbreviations: L, medical leave; M, maintenance department exposures (beryllium metal, beryllium oxide, copper-beryllium alloy); P, metals production department exposures (beryllium metal, beryllium oxide, beryllium fluoride, ammonium beryllium fluoride, ammonium fluoride, magnesium fluoride).

Mentions: A healthy 25-year-old male smoker began working at the beryllium production plant on 11 May 1981. His pre employment chest radiograph and pulmonary function tests were normal, including an FVC of 5.33 L (115% predicted) and a DLCO of 31.6 mL/min/mmHg (114% predicted) (Figure 3). He worked in the metal production department operating the fluoride furnace (Kent et al. 2001; Kroschwitz and Howe-Grant 1992; Stefaniak et al. 2003, 2004; White and Burke 1955). On 22 May 1981, he presented to the plant’s medical office with a new rash on the wrists and forearms and was seen multiple times for rash and skin ulcers over the next month. On 16 June 1981, a company physician evaluating him for new onset of recurrent epistaxis noted eroded nasal mucosa bilaterally.


A reconsideration of acute Beryllium disease.

Cummings KJ, Stefaniak AB, Virji MA, Kreiss K - Environ. Health Perspect. (2009)

Summary of lung function and beryllium exposure of case 2. (A) Results of pulmonary function tests before, during, and after acute work-related illness. (B) TWA and quarterly DWA airborne beryllium exposures in patient’s departments during this time period. Abbreviations: L, medical leave; M, maintenance department exposures (beryllium metal, beryllium oxide, copper-beryllium alloy); P, metals production department exposures (beryllium metal, beryllium oxide, beryllium fluoride, ammonium beryllium fluoride, ammonium fluoride, magnesium fluoride).
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2721869&req=5

f3-ehp-117-1250: Summary of lung function and beryllium exposure of case 2. (A) Results of pulmonary function tests before, during, and after acute work-related illness. (B) TWA and quarterly DWA airborne beryllium exposures in patient’s departments during this time period. Abbreviations: L, medical leave; M, maintenance department exposures (beryllium metal, beryllium oxide, copper-beryllium alloy); P, metals production department exposures (beryllium metal, beryllium oxide, beryllium fluoride, ammonium beryllium fluoride, ammonium fluoride, magnesium fluoride).
Mentions: A healthy 25-year-old male smoker began working at the beryllium production plant on 11 May 1981. His pre employment chest radiograph and pulmonary function tests were normal, including an FVC of 5.33 L (115% predicted) and a DLCO of 31.6 mL/min/mmHg (114% predicted) (Figure 3). He worked in the metal production department operating the fluoride furnace (Kent et al. 2001; Kroschwitz and Howe-Grant 1992; Stefaniak et al. 2003, 2004; White and Burke 1955). On 22 May 1981, he presented to the plant’s medical office with a new rash on the wrists and forearms and was seen multiple times for rash and skin ulcers over the next month. On 16 June 1981, a company physician evaluating him for new onset of recurrent epistaxis noted eroded nasal mucosa bilaterally.

Bottom Line: None of the measured air samples exceeded 100 microg/m(3), and most were < 10 microg/m(3), lower than usually described.Contrary to common understanding, these cases suggest that ABD and CBD represent a continuum of disease, and both involve hypersensitivity reactions to beryllium.Differences in disease presentation and progression are likely influenced by the solubility of the beryllium compound involved.

View Article: PubMed Central - PubMed

Affiliation: Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia 26505, USA. cvx5@cdc.gov

ABSTRACT

Context: Although chronic beryllium disease (CBD) is clearly an immune-mediated granulomatous reaction to beryllium, acute beryllium disease (ABD) is commonly considered an irritative chemical phenomenon related to high exposures. Given reported new cases of ABD and projected increased demand for beryllium, we aimed to reevaluate the patho physiologic associations between ABD and CBD using two cases identified from a survey of beryllium production facility workers.

Case presentation: Within weeks after exposure to beryllium fluoride began, two workers had systemic illness characterized by dermal and respiratory symptoms and precipitous declines in pulmonary function. Symptoms and pulmonary function abnormalities improved with cessation of exposure and, in one worker, recurred with repeat exposure. Bronchoalveolar lavage fluid analyses and blood beryllium lymphocyte proliferation tests revealed lymphocytic alveolitis and cellular immune recognition of beryllium. None of the measured air samples exceeded 100 microg/m(3), and most were < 10 microg/m(3), lower than usually described. In both cases, lung biopsy about 18 months after acute illness revealed noncaseating granulomas. Years after first exposure, the workers left employment because of CBD.

Discussion: Contrary to common understanding, these cases suggest that ABD and CBD represent a continuum of disease, and both involve hypersensitivity reactions to beryllium. Differences in disease presentation and progression are likely influenced by the solubility of the beryllium compound involved.

Relevance to practice: ABD may occur after exposures lower than the high concentrations commonly described. Prudence dictates limitation of further beryllium exposure in both ABD and CBD.

Show MeSH
Related in: MedlinePlus