Rupani Mihir P, Nimavat Pankaj, Patel Yogesh, Shah Harsh D, Sau Arkaprabha
Clinical Epidemiology (Division of Health Sciences), ICMR - National Institute of Occupational Health (NIOH), Indian Council of Medical Research (ICMR), Meghaninagar, Ahmedabad City, Gujarat, 380016, India.
State Tuberculosis Training and Demonstration Center (STDC), Civil Hospital, Asarwa, Ahmedabad City, Gujarat, 380016, India.
Arch Public Health. 2024 Jun 18;82(1):91. doi: 10.1186/s13690-024-01325-1.
Tuberculosis (TB) treatment is more challenging for patients with silicosis, as it complicates the diagnosis of both diseases and increases mortality risk. Silicosis, an incurable occupational disease, confounds the diagnosis of TB and vice versa, making it more difficult to accurately identify and treat either condition. Moreover, TB appears to accelerate the progression of silicosis. Exposure to silica dust, a common cause of silicosis, can also trigger latent TB to become active TB. This correspondence outlines a proposed framework for implementing collaborative TB-silicosis activities in India, aimed at improving early diagnosis and management for both diseases. An expert panel of medical professionals developed this framework through online consultations in October and November 2022. The panel's goal was to establish a consensus on integrating TB-silicosis activities, with a focus on early detection and proper management. The framework suggests testing all patients with silicosis for active TB and screening workers exposed to silica dust for latent TB infection. It also recommends that patients with TB who have a history of occupational exposure to silica dust should be tested for silicosis. Reliable diagnostic tools, such as chest X-rays, are emphasized, providing guidance on their use for both diseases. The proposed collaborative TB-silicosis framework offers a structured approach to identifying and managing these two diseases, contributing to the global goal of eliminating silicosis by 2030 and aligning with the World Health Organization's targets for reducing TB incidence and mortality. It recommends specific strategies for implementation, including testing, referral systems, and workplace-based interventions. The framework also underscores the need for coordinated efforts among stakeholders, including the ministries of health, labor, industry, and environment. This correspondence provides valuable insights into how India can successfully implement collaborative TB-silicosis activities, serving as a model for other regions with similar challenges.
对于矽肺病患者而言，结核病（TB）治疗更具挑战性，因为这会使两种疾病的诊断变得复杂，并增加死亡风险。矽肺病是一种无法治愈的职业病，会干扰结核病的诊断，反之亦然，使得准确识别和治疗任何一种病症都更加困难。此外，结核病似乎会加速矽肺病的进展。接触二氧化硅粉尘（矽肺病的常见病因）也可能促使潜伏性结核病转变为活动性结核病。本信函概述了一个在印度实施结核病 - 矽肺病协作活动的拟议框架，旨在改善这两种疾病的早期诊断和管理。一个医学专家小组于2022年10月和11月通过在线磋商制定了该框架。该小组的目标是就整合结核病 - 矽肺病活动达成共识，重点是早期检测和妥善管理。该框架建议对所有矽肺病患者进行活动性结核病检测，并对接触二氧化硅粉尘的工人进行潜伏性结核感染筛查。它还建议对有职业性接触二氧化硅粉尘病史的结核病患者进行矽肺病检测。强调了可靠的诊断工具，如胸部X光，并就其在两种疾病中的使用提供了指导。拟议的结核病 - 矽肺病协作框架提供了一种识别和管理这两种疾病的结构化方法，有助于实现到2030年消除矽肺病的全球目标，并符合世界卫生组织降低结核病发病率和死亡率的目标。它推荐了具体的实施策略，包括检测、转诊系统和基于工作场所的干预措施。该框架还强调了包括卫生、劳动、工业和环境等部委在内的利益相关者之间进行协调努力的必要性。本信函为印度如何成功实施结核病 - 矽肺病协作活动提供了宝贵见解，可作为其他面临类似挑战地区的典范。
