pulmonary disorders
Beryllium Disease
Pathophysiology of Beryllium Disease
Acute beryllium diseaseis a chemical pneumonitis causing diffuse parenchymal inflammatory infiltrates and nonspecific intra-alveolar edema. Acute beryllium disease is now rare because most industries have reduced exposure levels. Chronic beryllium diseasecontinues to occur in industries that use beryllium and beryllium alloy. It differs from most pneumoconioses in that it is a cell-mediated hypersensitivity disease. T cells become sensitized to beryllium and then proliferate on re-exposure. This leads to the release of proinflammatory cytokines (such as tumor necrosis factor-alpha, interleukin-2, andinterferon-gamma) and granulomatous inflammation. The proliferation of T cells from the lungs or blood when exposed to beryllium in vitro forms the basis of the beryllium lymphocyte proliferation test [BeLPT] test, which is used clinically to identify immune sensitization to beryllium. is a diffuse pulmonary, hilar, and/or mediastinal lymph node granulomatous reaction that is histologically indistinguishable from Sarcoidosis . The risk of progression from beryllium exposure to beryllium sensitization is multifactorial, including the dose of exposures, duration of exposures, and genetic factors. Studies have shown that about 1% to 18% of beryllium-exposed workers develop beryllium sensitization (defined by positive blood lymphocyte proliferation to beryllium salts in vitro), with 6% to 8% of the workers progressing to chronic beryllium disease ( Pathophysiology reference ). Workers with bystander exposures, such as administrative assistants and security guards, can also develop sensitization and disease at lower rates. 