OBJECTIVE: To investigate the clinical characteristics and treatment of coal workers’ pneumoconiosis complicated by chronic tuberculous pleurisy.
METHODS: A retrospective analysis was performed on 14 cases of coal workers’ pneumoconiosis complicated by chronic tuberculous pleurisy.
RESULTS: Thirty cases of coal workers’ pneumoconiosis complicated by tuberculous pleurisy became chronic in 14 cases (47%). 7 of these 14 cases (50%) had persistently positive sputum, 3 cases (21%) had MDR-TB, 11 cases (79%) had non-occlusive pulmonary cavities, all combined with different degrees of underlying disease, and various treatments had little effect. 13 cases (93%) had no effective control of the disease and died within 2 years. 5 cases (36%).
Conclusion: Inadequate control of coal workers’ pneumoconiosis is an important factor in the transformation of tuberculous pleurisy into chronicity, and the condition of coal workers’ pneumoconiosis complicated by tuberculous pleurisy has poor efficacy and high mortality rate.
Tuberculous pleurisy (referred to as nodular pleurisy) is a common disease in respiratory medicine, and simple nodular pleurisy has a good prognosis as long as it is treated with early regular anti-tuberculosis and active fluid extraction supplemented with corticosteroids [1] [1]. However, patients with coal workers’ pneumoconiosis complicated by nodular chest are reflected clinically differently due to the complexity of the disease. Among 30 cases of coal workers’ pneumoconiosis complicated by nodular chest and 27 cases of pulmonary tuberculosis complicated by nodular chest admitted to our department from January 2003 to January 2006, 14 cases of coal workers’ pneumoconiosis complicated by nodular chest turned into chronic nodular chest; while none of the patients with pulmonary tuberculosis complicated by nodular chest showed chronic nodular chest changes. These 14 cases of coal workers’ pneumoconiosis complicated by chronic nodular chest are summarized as follows.
1. Clinical data
1.1 General data: All 14 patients were male coal miners, aged 65-86 years, with an average of 70±2.9 years; 3, 9, and 2 cases of stage I, II, and III coal workers’ pneumoconiosis complicated by chronic nodular chest, respectively, including 3 cases of combined diabetes mellitus, 2 cases of destruction of one side of the lung, 7 cases of pulmonary heart disease, and 7 cases of cerebrovascular accident.
1.2 Clinical manifestations: 14 cases had respiratory symptoms such as cough, sputum, shortness of breath, chest suffocation, etc., 2 cases had vague chest pain, 2 cases had fever for more than 2 months, 2 cases had intermittent or irregular fever, 6 cases had obvious symptoms of tuberculosis poisoning.
1.3 Laboratory examination: monthly monitoring of sputum TB bacilli (coating and peeling), ESR, TB antibodies (TB-Ab), PPD test once every six months, routine chest fluid, biochemical and bacteriological examinations were done for each chest fluid extraction, and chest fluid pathology was done at least twice in each case. There were 7 cases of persistent positive sputum TB, including 3 cases of multidrug-resistant TB (MDR-TB), ESR was increased (25~90mm/h), 14 cases of persistent positive TB-Ab, 5 cases of PPD test (+), 7 cases of (++), 2 cases of (++++), and the results of chest fluid examination were all consistent with the change of nodular chest.
1.4 Chest plain film, CT and ultrasound examination: chest plain film was examined at least once a month, chest CT at least once a half year, and chest ultrasound at least twice a month. 14 cases had different degrees of pneumoconiosis and pneumoconiosis changes, 2 cases had one lung destruction, 8 cases had one cavity in both lungs, 3 cases had two cavities, 6 cases had large mass shadows, and all 14 cases had pleural effusion suggested by X-ray and ultrasound.
1.5 Diagnostic basis.
1.5.1 The diagnosis of pneumoconiosis tuberculosis was confirmed by the expert group of occupational diseases of Beijing Coal Group Corporation
1.5.2, the diagnosis of nodular chest with reference to Li’s eight points [1].
1.5.3. If the pleural fluid persists or does not decrease significantly after more than 3 months of inpatient systemic treatment, or if the pleural fluid still needs to be pumped, and the nature of the pleural fluid is still consistent with the diagnosis of nodular chest, it is determined as “chronic tuberculous pleurisy”.
1.6 Treatment methods: 1.6.1.
1.6.1 Anti-tuberculosis chemotherapy regimen: 4~6HRZE/8~18HRE/6HR for primary treatment; 4~6HL3ZE/3~12HL3EV/3~12HL3 for re-treatment; chemotherapy regimen for drug-resistant patients is determined according to the drug sensitivity test, and individual chemotherapy drugs (H: isoniazid, R: rifampin, L: rifabendin, Z: pyrazinamide, E: ethylamine) are adjusted according to the condition during treatment. butanol, V: levofloxacin).
1.6.2. Treatment of pleural effusion: conventional conventional thoracentesis for fluid aspiration or microcatheter drainage for fluid drainage.
1.6.3. Thoracic administration: inject one or both of isoniazid, amikacin, levofloxacin, furosemide, dexamethasone (all commonly used) into the chest cavity.
1.6.4. Combination therapy for other diseases.
1.7. Treatment effect: 4 cases in which the pleural fluid existed for more than half a year and died, 1 case in which the pleural fluid existed for more than 1 year and died, 8 cases in which the pleural fluid existed for more than 2 years, 1 case in which the pleural fluid disappeared after 18 months, and none of them had pleural wrapping.
Discussion
Coal workers’ pneumoconiosis is a refractory pulmonary tuberculosis, and pleural effusion is often used as one of the important symptoms of coal workers’ pneumoconiosis. Among the 14 cases in this group, 7 cases (50%) had persistent positive sputum TB, including 3 cases (21%) with MDR-TB, 11 cases (79%) with non-occlusive pulmonary cavities, 14 cases (100%) with persistent ESR increase and persistent positive TB-Ab; clinical data directly or indirectly reflected that the control of TB in this group of patients was unsatisfactory; the nodular pleura was caused by the entry of Mycobacterium tuberculosis and its metabolites into the pleural cavity and Pneumoconiosis is an inflammatory disease caused by the entry of Mycobacterium tuberculosis and its metabolites into the pleural cavity, and the body is in a hypersensitive state.6 Pneumoconiosis complicated by chronic nodular chest reflects the intractability of coal workers’ pneumoconiosis and the activity of the lesions.
In this group, there are elderly patients with pneumoconiosis, 3 cases with diabetes mellitus, 11 cases with stage II or higher pneumoconiosis, 2 cases with lung destruction, all with different degrees of cardiovascular and cerebrovascular diseases; metabolic and immune functions are severely reduced, so the possibility of chronic nodular chest changes can be considered in patients with more underlying diseases.
Although we adopted various treatment methods for coal workers’ pneumoconiosis complicated by chronic nodular chest, the efficacy was unsatisfactory. 14 patients were hospitalized for a long time, and the DOTS strategy was fully implemented, whether the pleural effusion was pumped by traditional or modern techniques, or the diversity of the types of drugs administered in the chest cavity, the chronic effect was minimal, and only one case (7%) was controlled. Due to the limited number of cases in this group, the actual treatment of patients with coal workers’ pneumoconiosis complicated by chronic nodular chest cannot be accurately reflected yet, and there is not enough practical experience on how to effectively control pneumoconiosis TB complicated by chronic nodular chest, which needs to be further discussed.
Among the 57 cases of pneumothorax admitted, none of the 27 cases of tuberculosis with pneumothorax became chronic, while 14 cases (47%) of the 30 cases of pneumoconiosis with pneumothorax became chronic; and 5 cases (36%) of these 14 cases died within 2 years and 13 cases (93%) did not have effective control of their disease, reflecting from one side that pneumoconiosis with pneumothorax is prone to become chronic and has a poor prognosis after becoming chronic. Therefore, in the diagnosis and treatment of pneumoconiosis complicated by pneumothorax, it is necessary to actively control the development of the disease and take effective treatment to prevent its chronic transformation.