When beryllium disease is a poisoning of the human body with the chemical element beryllium. The substance belongs to the metals and leads to acute or chronic berylliasis in certain groups of people. Substances containing beryllium can also trigger the disease. Berylliosis is one of the so-called dust pneumonia (medical term malignant pneumoconiosis).
What is beryllium disease?
Basically, a distinction is made between two variants of berylliosis, the acute and the chronic form. The chronic form of beryllium disease is usually an occupational disease. People who have been in contact with the metal beryllium for a long period of time are particularly affected. Berylliosis belongs to the category of malignant pneumoconiosis.
From a histological perspective, berylliosis is a disease with special granulomas. These do not cheese and are found in the majority of cases in the area of the lungs and the skin. Sometimes berylliasis is confused with sarcoid, which must be taken into account when making a diagnosis.
The diseases cannot be differentiated clinically or by means of radiological examinations. For this reason, the anamnesis and an allergy test play an important role. In doing so, the doctor primarily investigates the patient’s professional history in order to collect clues about the beryllium.
Causes
Beryllium disease is primarily triggered by prolonged exposure to the metal. Vapors containing beryllium are often responsible for sensitization to the substance. Contact of the skin with beryllium dust also leads to the development of the disease in some people after a while.
Basically, every exposure causes a hypersensitivity reaction. As a result, so-called granulomas develop in the area of the lungs. However, berylliasis does not develop in everyone who comes in contact with the metal. Only one to ten percent of all exposed people suffer from a corresponding hypersensitivity to the substance.
Again only a small proportion of these people suffer from the chronic form of beryllium. It has been shown, however, that those occupational sectors with the most intensive contact with beryllium have the highest risk for the disease. In principle, beryllium disease occurs with about the same frequency in male and female patients.
There is also a genetic predisposition to the disease. A certain main histocompatibility complex is primarily responsible for this. The chronic form of beryllium disease occurs in people of all ages. People in certain occupations are exposed to a particular risk of illness.
Beryllium occurs most frequently in the aviation industry, because this is where the metal beryllium is used. Workers in the ceramics industry are also at increased risk of beryllium disease.
Symptoms, ailments & signs
Berylliosis causes various complaints in sick patients. Initially, people suffer from a cough that irritates the throat and esophagus. As a result, pain and inflammatory processes develop. 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 are irritated. In the further course of the beryllium, what is known as chemical pneumonia follows. The sick suffer from shortness of breath, swollen lymph nodes and pain in the chest area.
Other characteristic complaints are dermatitis, which results from exposure of the skin to the metal. Also, fatigue, pain in the joints and hepatosplenomegaly possible. Often times, patients lose weight.
Diagnosis & course
If berylliasis is suspected, various examination techniques are used. It is particularly important to differentiate the disease from so-called sarcoid. The only way to have a successful differential diagnosis is through a thorough professional history. Allergy tests are also carried out.
Based on the information about the patient’s professional life, the doctor receives information about potential contact with beryllium. In addition to the aviation industry, workers in the nuclear power, metalworking and electronics sectors are also at particular risk of illness.
Berylliosis is diagnosed using several diagnostic procedures. Among other things, blood analyzes, imaging procedures and tests to check lung function are carried out. A so-called beryllium lymphocyte proliferation test is used to diagnose the chronic form of beryllium disease.
The test is only carried out by certain specialists in specialized medical institutions. [X-ray | X-ray technical examinations]] and CT examinations are possible imaging methods. A hilar lymphadenopathy, for example, indicates the disease.
In the differential diagnosis, the doctor rules out sarcoid as well as idiopathic pulmonary fibrosis and allergic alveolitis.
Complications
Various complications can occur as a result of berylliasis. Depending on the severity of the poisoning, nausea and vomiting can occur, but also severe allergic reactions, skin rashes and cardiac arrhythmias. Blood pressure fluctuations and sweating can also occur. Serious poisoning leads to impaired consciousness, inner restlessness and concentration disorders in the course of berylliasis.
In addition, as the disease progresses, those affected become increasingly tired and irritable; Often there are also stomach pains and rheumatic complaints up to arteriosclerosis. Anxiety disorders can also occur rarely. If the liver is affected, the disturbed detoxification can lead to further problems.
In extreme cases, beryllium disease leads to memory gaps or even complete memory loss. However, it is not uncommon for severe complications of this type to develop over a long period of time and not always clearly related to the poisoning. The treatment itself can lead to allergic reactions, rejection reactions of the body and other complications within the scope of the therapy options (blood washing, lipid therapy, activated charcoal treatment, etc.).
If the treatment is given too late or not at all, berylliosis can develop into other current symptoms as well as 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 lungs are usually irreversibly damaged by the metal. If therapy is not initiated promptly, the risk that the lungs will lose their functionality increases considerably.
In this case, the only way to cure the patient is through 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, there can be permanent memory gaps or even complete memory loss.
Members of risk groups should therefore consult a specialist, preferably a pulmonologist or a toxicologist, at the first signs. The risk groups include employees in the aerospace industry, people who work in nuclear power plants or who visit them regularly for research purposes, and employees in the electronics, electrical engineering and metalworking industries.
Typical symptoms that the named group of people should consult a specialist immediately if they occur are, in particular, frequent coughs, respiratory problems and rhinitis. In the advanced stage, breathlessness, chest pain and usually pneumonia also occur. Those affected should not wait until it comes to that, but go to the doctor immediately.
Treatment & Therapy
A complete cure of beryllium disease is usually not possible. Because the tissue of the lungs is irreversibly damaged by the disease. Corticosteroids are used for therapy. Treatment with the active ingredient methotrexate may be necessary in order to contain any undesirable side effects that may occur.
Regular pulmonary function tests are indicated to check the success of the drug therapy. Avoiding contact with beryllium plays an essential role in therapy in all cases of illness. Some patients require a lung transplant as a result of berylliasis and insufficient oxygen supply.
Outlook & forecast
The prognosis for chronic berylliasis is generally poor. It is a progressive disease. Unfortunately, there is no curative therapy.
The therapy tries to alleviate the symptoms and slow down the course of the disease. The immune system tries to remove the beryllium dust that has been inhaled for a long time from the lungs. This creates cytotoxic T lymphocytes that fight the affected cells. However, if almost the entire lungs are affected, massive remodeling processes occur, which are accompanied by chronic inflammation.
As the destroyed cells are replaced by new cells, new nodular tissue formations, also known as granulomas, form. As such, the new tissue formations are benign. However, they occur more frequently and thus change the structure of the lungs by increasing the formation of connective tissue. Chronic shortness of breath, increased respiratory rate, constant dry cough and also fever occur.
Immunosuppressants such as corticoids or, in more severe cases, azathioprine are used to relieve the inflammatory processes. A lung transplant is also often necessary. Chronic beryllium disease leads to death if untreated. However, there is no precise information on life expectancy. The course of acute berylliosis depends on the amount of dust inhaled once. Immunosuppressants are also used here to alleviate the symptoms, as these are also immune reactions of the body.
Prevention
An effective prevention of beryllium disease is to avoid exposure to the metal beryllium.
Aftercare
Unfortunately, there is no cure for beryllium disease, so those affected have to have regular follow-up care throughout their lives. The lungs are irreversibly damaged as a result of the disease. After treatment with corticosteroids or the active ingredient methotrexan, regular lung function checks are necessary to see whether the medication is working properly.
In addition, the sick must strictly avoid contact with beryllium, which for many means a change of job or place of residence. In some cases, the body is insufficiently supplied with oxygen, so that a transplant of the lungs is necessary. Often the doctor will recommend physical activity as part of the follow-up care, which ranges from light gymnastics to demanding training.
It is possible to join a pulmonary sports group, which is specifically geared towards those with respiratory problems. Here there is also the possibility of exchanging ideas with others. Sick people must be aware that they will be affected by berylliosis for their entire life and that the symptoms can only be alleviated through their own follow-up care. However, if this is done carefully, the chance of a reasonably regulated and fulfilling life is great.
You can do that yourself
As a rule, beryllium disease cannot be completely cured. However, those affected can do a lot themselves to make life with the disease easier.
The first step should be taken to a lung disease or toxicology specialist with the condition. Under the guidance of the doctor, appropriate steps can be devised and carried out without the risk of complications. In the case of berylliosis, the doctor will first recommend physical activity.
Sick people should start with light physiotherapy exercises and then, depending on the severity of the tissue damage, switch to more demanding training. Walking, running, swimming, hiking or dancing are suitable, but also “smaller” activities such as climbing stairs or squats. Those affected can obtain further information and opportunities for physical activity from lung sports groups, for example.
Participation in outpatient sports groups also serves as an exchange with other sick people. Since berylliasis is normally not curable, discussions with therapists and other affected persons can also learn how to deal with the disease over the long term. The doctor in charge can point out other ways in which life with beryllium and its manifestations can be successful.
