Abstract:

Objective: To investigate the clinical characteristics of artificial stone associated silicosis (AS-silicosis) complicated with pulmonary tuberculosis and non-tuberculous mycobacteria disease, and to provide reference for clinical diagnosis. Methods: A retrospective study was conducted, 28 patients with AS-silicosis complicated with pulmonary tuberculosis and non-tuberculous mycobacteria disease admitted to the Department of Pneumoconiosis of Shanghai Pulmonary Hospital from January 2017 to December 2020 were selected as study objects. The clinical symptoms, bacteriological test results, Mycobacterium tuberculosis (MTB) nucleic acid test results, chest CT imaging features and treatment outcomes of all subjects were collected and analyzed. Results: Among all 28 patients, AS-silicosis combined with non-tuberculous mycobacterium (NTM) lung disease and with pulmonary tuberculosis were both 14, accounting for 50.0% for each. The main clinical manifestations of all subjects were cough (92.9%, 26/28), expectoration (89.3%, 25/28), and puff (64.3%, 18/28). Smear positive rate among patients with NTM (64.3%, 9/14) was higher than those with pulmonary tuberculosis (28.6%, 4/14), while immunological test positive rate among NTM patients (25.0%, 3/12) was lower than those with pulmonary tuberculosis (40.0%, 4/10). Ground glass opacity (53.6%, 15/28), small nodule (92.9%, 26/28), patchy (25.0%, 7/28), progressive mass fibrosis (PMF)(71.4%, 20/28) and cavity (85.7%, 24/28) were the main manifestations of CT images in all subjects, and there was no significant difference between patients with NTM and patients with pulmonary tuberculosis. Cavities of patients with NTM mainly showed having thin wall (55.0%, 11/20) with smooth inner wall (70.0%, 14/20), while 0.0% (0/14) of cavities in patients with pulmonary tuberculosis got this feature. If imaging improvement such as CT lesion shrinking, cavity narrowing or close were considered as the necessary conditions for effective treatment, the effective treatment rate in patients with NTM and with pulmonary tuberculosis were 2/8 and 50.0% (6/12), respectively. Conclusion: AS-silicosis combined with pulmonary tuberculosis and non-tuberculous mycobacteria disease have low effective treatment rate. The difference of CT images could provide a basis for clinical diagnosis as thin-walled cavity with smooth inner wall may be associated with NTM lung disease.

Key words: Silicosis, Tuberculosis, Mycobacteria, atypical, Treatment outcome