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硅结核:最新综述。

Silico-tuberculosis: An updated review.

机构信息

Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India; Viral Research and Diagnostic Laboratory, Department of Virology, Rajendra Memorial Research Institute of Medical Sciences (RMRIMS), Patna, Bihar, India.

Indian Institute of Science Education and Research, Tirupati, Andhra Pradesh, India.

出版信息

Indian J Tuberc. 2024 Oct;71(4):471-475. doi: 10.1016/j.ijtb.2024.01.005. Epub 2024 Jan 5.

Abstract

Silico-Tuberculosis (silico-TB) is a severe combination of tuberculosis and silicosis, caused by occupational exposure to fine crystalline silica dust, which has become a global health concern. This comprehensive review compiles the updated knowledge regarding pathophysiology, clinical manifestations, important diagnostic techniques, treatment aspects, and challenges in understanding silico-TB. The review compiles the disease's history and epidemiology, highlighting a lack of data owing to poor monitoring and healthcare particularly in low- and middle-income countries like India. Further weak safety regulations, lack of preventative measures, and inadequate education increase the rates of silico-TB. The pathophysiology shows how silica particles impair the immune system and stimulate Th2 cells and M2 macrophages, which exacerbate TB, while inhibiting Th1 cells and M1 macrophages, which fight against the disease. Subsequently, it can be difficult to distinguish current TB from pre-existing silicosis. In cases where sputum and X-ray results are negative, chest CT scans may be helpful since radiographic screening identifies TB earlier than sputum assessment. Isoniazid, rifampicin, or both minimize the risk of active tuberculosis in people with silicosis. Consistent anti-tuberculosis drug therapy is recommended for 8-9 months to stop recurrence. The assessment recommends integrating silicosis and TB control initiatives to fight this combined health issue.

摘要

矽肺合并结核病(silico-TB)是一种由职业性暴露于细微结晶二氧化硅粉尘引起的严重结核病和矽肺合并症,已成为全球关注的健康问题。这篇综合综述汇集了有关矽肺合并结核病的病理生理学、临床表现、重要诊断技术、治疗方法以及理解该疾病的挑战的最新知识。综述了该疾病的历史和流行病学,强调了由于监测和医疗保健不佳,特别是在印度等低收入和中等收入国家,数据缺乏。进一步的安全法规薄弱、缺乏预防措施以及教育不足,增加了矽肺合并结核病的发病率。病理生理学显示了二氧化硅颗粒如何损害免疫系统并刺激 Th2 细胞和 M2 巨噬细胞,从而加剧结核病,同时抑制 Th1 细胞和 M1 巨噬细胞,从而对抗疾病。因此,区分当前的结核病和已有的矽肺可能具有挑战性。在痰和 X 光结果均为阴性的情况下,胸部 CT 扫描可能会有所帮助,因为放射学筛查比痰评估更早地发现结核病。异烟肼、利福平或两者联合使用可降低矽肺患者发生活动性结核病的风险。建议对矽肺合并结核病患者进行 8-9 个月的抗结核药物治疗以防止复发。评估建议整合矽肺和结核病控制倡议,以应对这一综合健康问题。

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