Lanzafame Massimiliano, Vento Sandro
Diagnosis and Treatment of HIV Infection Unit, "G.B. Rossi University Hospital", Verona, Italy.
Faculty of Medicine, University of Puthisastra, Phnom Penh, Cambodia.
J Clin Tuberc Other Mycobact Dis. 2021 Feb 2;23:100218. doi: 10.1016/j.jctube.2021.100218. eCollection 2021 May.
Silicosis continues to be a serious health issue in many countries and its elimination by 2030 (a target set by WHO and the International Labour Organization in 1995) is virtually impossible. The risk to develop pulmonary tuberculosis for silicosis patients is higher than for non-silicosis people, and there is also an increased risk of both pulmonary and extrapulmonary tuberculosis in individuals exposed to silica. HIV coinfection adds further to the risk, and in some countries, such as South Africa, miners living with HIV are a considerable number. The diagnosis of active tuberculosis superimposed on silicosis is often problematic, especially in initial phases, and chest X-ray and smear examination are particularly important for the diagnosis of pulmonary tuberculosis. Treatment is difficult; directly observed therapy is recommended, a duration of at least eight months is probably needed, drug reactions are frequent and the risk of relapse higher than in non-silicosis patients. TB prevention in silicosis patients is essential and include active surveillance of the workers, periodic chest X-rays, tuberculin skin test or interferon-gamma releasing assay testing, and, importantly, adoption of measures to reduce the exposure to silica dust. Chemoprophylaxis is possible with different regimens and needs to be expanded around the world, but efficacy is unfortunately limited. Silico-tuberculosis is still a challenging health problem in many countries and deserves attention worldwide.
矽肺病在许多国家仍然是一个严重的健康问题，要在2030年消除矽肺病（这是世界卫生组织和国际劳工组织在1995年设定的目标）几乎是不可能的。矽肺病患者患肺结核的风险高于非矽肺病患者，接触二氧化硅的个体患肺结核和肺外结核的风险也会增加。合并感染艾滋病毒会进一步增加风险，在一些国家，如南非，感染艾滋病毒的矿工数量相当可观。叠加在矽肺病上的活动性肺结核的诊断往往存在问题，尤其是在初期阶段，胸部X光检查和涂片检查对肺结核的诊断尤为重要。治疗困难；建议采用直接观察治疗法，可能需要至少八个月的疗程，药物反应频繁，复发风险高于非矽肺病患者。矽肺病患者的结核病预防至关重要，包括对工人进行主动监测、定期胸部X光检查、结核菌素皮肤试验或干扰素-γ释放试验检测，重要的是，采取措施减少二氧化硅粉尘的接触。采用不同方案进行化学预防是可行的，需要在全球范围内推广，但遗憾的是效果有限。矽肺结核在许多国家仍然是一个具有挑战性的健康问题，值得全世界关注。
