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The most common form of silicosis (chronic) will often develop between 20 to 45 years after the exposure, but certain rare forms of the disease can occur after a single heavy dose or heavy exposures to a very high concentration of silica in a short period of time. Workers with Silicosis may have following symptoms: Shortness of breath following physical exertion, severe and chronic cough, fatigue, loss of appetite, chest pains and fevers.
In all forms of the disease, silica particles end up in the air sacs of the lung, causing inflammation and scarring that damages the sacs, preventing gas exchange and normal breathing. Depending on the severity, the disease will be fatal as the inflammation spreads and lung tissue becomes damaged.
There are three main types discussed in greater detail below:
Acute Silicosis: Occurs after heavy exposure to high concentrations of silica. The symptoms can develop within a few weeks or as long as 5 years after the exposure.
Occurs after long term exposure(over 10 years) of low concentrations of silica dust. This is most common form of the disease,and is often undetected for many years because a chest X-Ray often will not reveal the disease for as long as 20 years after exposure. This type of the disease severely hinders the ability of the body to fight infections because of the damage to the lungs, making the person more susceptible to other lung illnesses, including tuberculosis.
Accelerated Silicosis: Occurs after exposure to high concentrations of silica. The disease develops within 5 to 10 years after exposure.
In addition to the three types, silica dust can kill people and can cause many serious diseases besides silicosis. Or often the silicosis can lead to other dangerous lung conditions.
The Progression of the Disease
After silica particles are inhaled, the smallest particles work their way to the lower respiratory tract. Once in the lungs the particles cause acute toxicity damage to the lung cells. Scientists believe that the surface and sharp structure of the silica particle are to blame for the extreme danger and toxic nature of the dust. As support for this theory, it has been observed that freshly crushed silica particles cause more inflammation and kill more cells than silica that has aged in the air.
The silica particles are quickly attacked and ingested by the body's defense releasing enzymes and radicals. This release of these by products can result in death of the lung and white blood cells cell which causes inflammation which can result in acute silicosis. However the process usually produces a condition called alveolitis which is often the first stage of chronic silicosis.
As scar tissue is created it will form lesions in the later stages of the disease.
As the body develops chronic inflammation dark areas become visible in X-ray chest film. The silicotic nodules are dense spherical structures which collect together and become visible on chest X-rays usually in the upper lung fields.
As silicosis develops, the lungs become increasingly susceptible to infections with tuberculosis, fungi, and bacteria of many kinds, which accelerates the disease process.
What Happens to The Lungs as Silicosis Progresses
Silicosis is characterized by what doctors see on the Chest X-Rays and they have various classifications for these stages.
In cases of acute silicosis, the damage to the lung occurs quickly and early in the disease due to heavy silica exposure. Patients have a poor prognosis and the disease rarely ha s a chance to become one of the chronic forms.
Acute silicosis, is caused by a massive outpouring of protein debris and fluid into lung sacs. It happens with short term exposure to extremely high concentrations of silica dust. Acute silicosis is treated with a high dose of steroids, but the prognosis is generally poor. This is because the ongoing accumulation of debris in the lungs air spaces causes respiratory failure which is largely untreatable. Additionally, acute silicosis is complicated by opportunistic infections of fungi, and bacteria. Acute silicosis reportedly has caused many deaths among workers exposed at the same time, at a single work site. Lung Transplants for young workers with this form of silicosis provides some hope.
Chronic Silicosis: Angel of Death
In this form of silicosis, also called "chronic nodular silicosis", the silicotic nodules collect to form a mass, which can be identified on Chest X-Rays. These masses cause the upper lobes of the lungs to contract, which appears as an "angel wing pattern" on the X-Rays. Doctors and radiographers refer to this pattern as the angel of death because it is a poor prognostic sign.
Clinically, this massive formation of the nodules in the lungs leads to shortness of breath and progressive disease. Ultimately, the condition causes respiratory failure. Additionally, the silicosis causing respiratory failure can lead to cardio-pulmonary arrest if the disease continues to progress. Complications of chronic silicosis can also include tuberculosis, condition called silicotuberculosis and a number of other infections and lung diseases.
Accelerated silicosis is a very rare, form that progresses rapidly from intense short term exposure to silica particles.In this form the nodules develop at a much faster rate and is usually fatal within a few years.
Other complications include:
Infections: Fungal or mycobacterial infections are believed to result when the lung scavenger cells (macrophages) that fight these diseases are overwhelmed with silica dust and are unable to kill mycobacteria and other organisms.
Silicotuberculosis: Patients with silicosis have a greatly increased risk of developing from tuberculosis
Systemic Sclerosis (Scleroderma): Silica exposure has been associated with systemic sclerosis (scleroderma) and its many forms. Systemic sclerosis is a disorder of connective tissues and joints and small blood vessels. Scleroderma involves skin changes and injury to the joints: most obvious changes are seen on the skin, particularly over the fingers and face.
Silica-Associated Lung Cancer: Lung cancer has been associated with preexisting silicosis. However, lung cancer may also occur in persons exposed to silica in the absence of silicosis. Scientists believe that silicosis produces increased risk for lung cancer and that the association between silica exposure and lung cancer is causal. The International Agency for Research on Cancer has identified silica as a Class 1 human carcinogen and a definite animal carcinogen.
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