Beryllium Poisoning
Introduction
Introduction to cockroach poisoning Sputum poisoning is a systemic disease in which sputum and its compounds mainly erode the lungs and can affect other organs. Workers in the production and processing of bismuth and its compounds (such as smelting of bismuth, bismuth alloy manufacturing, etc.) can be exposed to sputum dust or smoke, causing cockroach poisoning. Clinically divided into acute sputum poisoning and chronic sputum poisoning. Acute sputum poisoning (berylliucmpoisoning) is caused by short-term inhalation of high concentrations of soluble strontium salts, clinical manifestations of chemical bronchitis and pneumonia. Chronic sputum poisoning is caused by long-term inhalation of low-concentration insoluble sputum compounds. The incubation period is several months or years or even decades, and it is generally progressive. A systemic disease that causes pulmonary granulomatous lesions, also known as berylliosis. basic knowledge The proportion of illness: the incidence rate is about 0.0001%-0.0003% Susceptible people: more common in laboratory personnel and industrial workers Mode of infection: non-infectious Complications: bronchitis pneumonia contact dermatitis pulmonary edema
Cause
Cause of poisoning
(1) Causes of the disease
Due to its light weight, hardness, high strength, high temperature resistance, corrosion resistance, oxidation resistance, magnetic reversal and no sparking during processing, it is widely used in nuclear energy, aerospace, defense instrumentation, atomic energy, electronics industry, etc. Processed bismuth and its compounds (such as smelting of bismuth, bismuth alloy manufacturing, etc.) can be exposed to sputum dust or smoke, causing cockroach poisoning.
Chronic sputum poisoning is currently considered to be a delayed type allergic disease. The minimum exposure and individual susceptibility play a major role in the etiology. The simple sputum is stable, the smelting of bismuth ore, and the manufacture of bismuth alloy can produce hinges and their Dust or soot, the compounds are bismuth oxide, barium hydroxide, barium fluoride, barium chloride, etc., mainly in the form of smoke or dust from the respiratory tract inhalation.
(two) pathogenesis
Acute sputum poisoning is a direct chemical toxic stimulus to the respiratory system caused by high concentrations of strontium and poisoning of organs such as liver and kidney. It is characterized by histomorphology characterized by respiratory inflammation and chemical pneumonia, and the central zone of toxic hepatic lobules is also visible. Hepatocyte necrosis and necrosis of renal tubular epithelial cells, there is a dose-response relationship between acute sputum poisoning.
Although the pathogenesis of chronic sputum poisoning is still not fully understood, most scholars believe that it is a delayed-type cellular immune disease. The insoluble sputum sputum combines with the protein in the body to form a specific sputum antigen, and induces anti-spasm-specific antibodies. When exposed to sputum (even if the exposure concentration is very low), it causes sputum antigen-antibody reaction, producing inflammatory lesions, which are systemic diseases characterized by pulmonary interstitial fibrosis and granuloma formation. The incubation period can be several months or several. Ten years, the serum levels of -globulin and IgG increased, skin patch test, white blood cell movement inhibition test and original lymphocyte transformation test often appear positive, glucocorticoid has obvious therapeutic effect on chronic sputum poisoning, also It shows that sputum poisoning is a cellular immune disease.
Acute sputum poisoning: mainly pathological changes of acute chemical pneumonia, manifested as increased lung volume, increased weight, grayish red, toughness such as liver, microscopic examination of alveolar cavity filled with edema fluid and a large number of macrophages, cellulose and a small amount Neutrophils, red blood cells and exfoliated alveolar epithelium, lymphocytes in the interstitial lung, plasma cell infiltration, pulmonary fibrosis may occur in prolonged cases, and hepatic parenchymal cells and renal tubular epithelium may occur in severe cases Denaturation and necrosis of cells.
Chronic sputum poisoning: The pathological features of chronic sputum poisoning are non-caseal granuloma and interstitial cell infiltration in the lung. Eyes, lung volume increases, lung surface and cut surface are widely spread in different sizes (2 ~ 15mm), grayish white For nodular lesions, diffuse interstitial fibrosis can be seen. Under the microscope, the center of granuloma is cellulose and epithelioid cells. The periphery is surrounded by fibrous tissue and some lymphocytes, plasma cells and monocytes infiltrate. Mixed with more Langerhans giant cells, there are various inclusion bodies in the Langerhans giant cells, which are star-shaped and shell-like, and are called stellate bodies or shell-like bodies. The medium is blue-black, about 6-60m. It is thought that this is the deposition of protein and calcium salt by the dust particles. The tissue morphology of chronic sputum poisoning is similar to that of sarcosis, and should be identified.
In addition, sputum granuloma can also occur in the upper respiratory tract, liver, kidney, spleen, heart muscle, striated muscle, pleura and skin and other extrapulmonary organs, is a manifestation of systemic sputum poisoning.
Prevention
poisoning prevention
Prevention is the same as other pneumoconiosis, but it is the lightest metal, so it should strengthen the sealing and smoke elimination measures.
Complication
Sputum poisoning complications Complications bronchitis pneumonia contact dermatitis pulmonary edema
Inhalation can be complicated by chemical bronchitis, pneumonia, contact with dermatitis, and severe cases can be complicated by pulmonary edema.
Symptom
Symptoms of poisoning of cockroaches Common symptoms Kidney damage granuloma, itching, shortness of breath, dizziness, difficulty breathing, herpes, herpes, wetness, chest tightness
1. Acute sputum poisoning, caused by short-term inhalation of high-concentration soluble strontium salt (barium sulphate, barium fluoride, etc.), usually respiratory tract and skin symptoms appear in hours or days, manifested as respiratory irritative inflammation, pneumonia, lung Edema, etc., patients have headache, dizziness, chills, fever, general weakness, cough, chest tightness, progressive dyspnea, tachycardia, cyanosis, extensive wet voice at the bottom of the lungs, severe cases can be complicated by pulmonary edema and death, X The chest radiograph showed flocculation or dot-like shadows on both lungs. Similar to early pneumoconiosis or miliary tuberculosis, the mortality rate of acute pneumonia was reported to be 7.2%. The skin lesions of acute sputum poisoning were contact dermatitis, mainly exposed. There are erythema, papules or acupuncture rash in the area. It can disappear after several days of contact, and then contact can occur. Soluble strontium salt can also enter the damaged skin to produce sputum skin ulcers. Similar to "chrome sores", it is bird-eye. Deep skin forms a granuloma, which often takes longer to heal.
2. Chronic sputum poisoning is caused by long-term inhalation of low-concentration insoluble bismuth compounds (mainly bismuth oxide). The incubation period is several months or years or even decades, and it is generally progressive, mainly causing chronic lung and other organs. Sexual granulomatous lesions, the patient manifests as weakness, fatigue, loss of appetite, weight loss, dry cough, chest tightness, shortness of breath, dry, wet sputum, decreased lung diffusion, causing decreased blood oxygenation and congestive heart failure, X The chest radiograph showed diffuse granules in both lungs, which were "hairy glass"-like, with nodular shadows appearing as "storms" and reticular shadows on the background of fine grain shadows. Generally, they can be seen before clinical symptoms appear. X-ray changes to the lungs.
3. Skin damage:
1 contact dermatitis, the skin is directly exposed to strontium fluoride, strontium chloride dust or barium sulfate solution, local skin redness, itching, burning pain, papules or herpes, recovered after 3 to 7 days.
2 ulcers, from shallow to deep development, mostly single, sharply raised edges, hard, usually yellow-white, generally several millimeters in diameter, must be healed after 1 to 6 months, leaving scars, ulcers more common in the hands, A part of the skin such as the forearm that is susceptible to abrasion or rupture.
Examine
poisoning check
Laboratory tests may have increased erythrocyte sedimentation rate, increased blood calcium, decreased blood phosphorus, elevated blood IgG levels, increased urinary calcium, and increased urinary fistula. Domestic reports have used the leukocyte migration inhibition test (Be-MIT) with sputum as antigen. Positive, blood lymphocyte transformation test (Be-LT) is positive, which is helpful for the diagnosis of chronic sputum poisoning. The active rose test (Be-RF) is positive, which is helpful for the diagnosis of chronic sputum poisoning.
X-ray films of acute sputum poisoning showed flocculation or punctate shadows on both lungs. Similar to early pneumoconiosis or miliary tuberculosis, chronic sputum poisoning X-ray films showed diffuse granules in both lungs. The nodular shadow is a "blizzard" and a reticulated shadow on the background of fine grain shadows. X-ray changes in the lungs are generally seen before the onset of clinical symptoms.
Diagnosis
Diagnosis and identification of sputum poisoning
The diagnosis of acute sputum poisoning mainly depends on the short-term inhalation of high-concentration sputum exposure history and the typical symptoms of chemical bronchitis and chemical pneumonia, physical signs, combined with X-ray chest film flakes or dot shadows and systemic poisoning and liver and kidney damage, etc. Make a diagnosis.
The diagnosis of chronic sputum poisoning can refer to the diagnostic criteria for sputum poisoning in China (GB4868-1996), mainly based on affirmative sputum contact history; progressive onset, duration of more than 1 year; chronic respiratory symptoms and systemic consumption symptoms; chest X-ray findings Diffuse granule shadow, nodular shadow and dense mesh tinge, pulmonary diffuse dysfunction, arterial oxygen partial pressure and oxygen saturation; immunological test (MIT, LT, RF) positive or lung biopsy with granulomatous Pathological changes, it should be noted that some cases without any symptoms, signs, and abnormalities found in regular X-ray chest radiography, need to combine occupational history, further observation and make a diagnosis.
Pulmonary lesions of chronic sputum poisoning should be differentiated from tuberculosis, alveolar carcinoma, sarcoidosis, pulmonary fungal infection, pulmonary hemosiderosis, pneumoconiosis, and specific diffuse pulmonary interstitial fibrosis.
