silicosis is an occupational disease

1. • A 28 year-old man with no history of smoking, presented to the
emergency department with symptoms of cough, which was initially
dry with increased intensity for the past 6 months and progressive
breathlessness for 8 months, which had increased for 1 week and
diffuse chest pain, which was more on the left side.
Case

2. • There was no history of fever, hemoptysis, joint pain or skin rashes.
He had received anti-tuberculosis treatment 1 year ago for 6 months,
which was started based on radiological findings.
• He had worked in a stone crushing factory 2 years ago for 1 year; 7–
8 h/day.
• Pre- placement examination was not done at the time of
employement.

3. • On clinical examination, the patient was malnourished, with Modified
Medical Research Council (MMRC) dyspnea scale of 4, oxygen
saturation of 82%. On examination of the chest, there was hyper-
resonant note on percussion with very faint breath sounds in both
lung fields with scattered fine crackles.

4. • The patient was admitted with provisional diagnosis of acute silicosis
with bilateral pneumothorax as evidenced by clinical examinations
and chest X-ray

6. • What the are investigations need to done?

7. Investigations
• Complete blood count, renal function and liver function tests showed
no abnormality. Sputum for acid-fast bacilli (AFB) was negative.
• Chest X-ray showed snow-storm appearance with bilateral
pneumothorax and bilateral nodular type r/q opacities and profusions
of 3+ in both lung fields, consistent with the diagnosis of acute
silicosis as per revised edition of International Labour Office (ILO)
classification, 2011

8. • The patient was also subjected to bronchoscopy and collected
bronchoalveolar lavage (BAL) revealed macrophage laden silicotic
particles, therefore the patient was diagnosed as a case of acute
silicosis based on history, clinical and radiographic findings and
confirmed by laboratory reports of BAL findings.

9. • Enumerate the Differential Diagnosis

10. Differential Diagnosis
• The differential diagnosis includes
Pulmonary tuberculosis,
Pneumoconiosis,
Ssarcoidosis and other occupational diseases.
• The absence of AFB in the sputum, characteristic chest X-ray and the
presence of macrophage laden silicotic particle in BAL favour the
diagnosis of acute silicosis.

11. • How would you Manage this case?

12. Management
• No effective treatment
• Fibrotic changes that have already taken place, cannot be reversed.
• Rigorous dust control measures
• Regular physical examination of workers
For the case being discussed, bilateral intercostal chest tube to be
inserted under water seal drainage

13. Follow-up after 1 week and after 1 month of discharge

14. • List the various measures for the prevention of occupational diseases.

15. 1- Medical Measures
• Pre-Placement Examination
• Periodical Examination
• Medical and Health Care Services
• Notification
• Supervision of working environment
• Health Education and Counselling

16. 2- Engineering Measures
• Design of the building
• Good House-Keeping
• General Ventilation
• Mechanisation
• Substitution
• Dusts & Enclosure
• Isolation

17. - Local exhaust ventilation
- Protective devices
- Environmental monitoring
- Statistical monitoring
- Research

18. 3. Legislation
- The Factories Act, 1948
- The Employees State Insurance Act, 1948

19. Thank You