What are the other Names for this Condition? (Also known as/Synonyms)

• Acute Berylliosis
• Beryllium Poisoning
• Chronic Beryllium Disease (CBD)

What is Berylliosis? (Definition/Background Information)

• Beryllium (Be) is a metallic element that is known to damage the lungs and other organs, when inhaled or absorbed through the skin in sufficient quantities, leading to Berylliosis
• Acute Berylliosis (or Acute Beryllium Disease - ABD), which is due to direct irritation of the lungs by beryllium, is rarely seen these days, due to better industrial safety measures and practices
• Chronic Berylliosis (or Chronic Beryllium Disease - CBD), commonly referred to as Berylliosis, continues to be a problem for workers, who manufacture or process beryllium
• Formation of inflammatory masses (granulomas) within the lungs and other organs; and the scarring of deep lung tissues (interstitial pulmonary fibrosis) characterize CBD. Difficulty breathing and cough, are the main symptoms
• The prognosis depends on the extent of the disease. The use of adequate safety measures at workplace can dramatically decrease the incidence of Berylliosis
• If Acute Berylliosis is treated promptly, a complete recovery is possible. Corticosteroids are generally used in the treatment of both conditions. However, prevention is more important, as no cure has yet been developed for Chronic Berylliosis

Who gets Berylliosis? (Age and Sex Distribution)

• Adults, who are constantly exposed to beryllium dust or particles during their work (occupational hazard) are at highest risk for CBD. Rarely affected are people, who live near beryllium refineries, and the family members of beryllium workers, who come in contact with beryllium dust from the worker’s clothing
• All age groups may be affected by Berylliosis, but it is more common in adults
• Members of both sexes are equally affected
• No racial or ethnic predilection is observed

What are the Risk Factors for Berylliosis? (Predisposing Factors)

The risk factors of Berylliosis include:

• Occupational exposure to beryllium in industries, such as aerospace, electronics, nuclear component, high-technology ceramics, dental alloy preparation, and metals extraction
• Presence of a genetic variation in a gene called HLA gene (variant major histocompatibility complex HLA-DPb1 [Glu 69]), is a strong risk factor for the development of CBD

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your health care provider.

What are the Causes of Berylliosis? (Etiology)

• Berylliosis is a form of metal poisoning caused by the airborne entry of beryllium and its compounds in the form of dust and fumes, into the lungs or via the skin
• Acute Berylliosis develops when beryllium dust and metal fumes are inhaled, in concentrations >100 µg/m3
• The specific amount or duration of exposure required to cause Chronic Berylliosis is not known. It may develop after a brief exposure (weeks or months) to levels of beryllium that are below Occupational Safety and Health Administration (OSHA, US), Permissible Exposure Limits of 2μg/m3, averaged over an 8-hour day
• In CBD, individuals who have become allergic (sensitized) to beryllium after repeated exposure, develop an exaggerated immune response (delayed-type hypersensitivity reaction) on further exposure to beryllium
• As a part of the immune response, certain white blood cells begin to increase in number. The multiplying lymphocytes form inflammatory masses or nodules (granulomas)
• Granulomas in the lung are characteristic of CBD. The granulomas can form small fibrous nodules, which lead to worsening lung function over time

What are the Signs and Symptoms of Berylliosis?

The signs and symptoms of Berylliosis are:

Acute Berylliosis (short-term inhalational exposure) presentations:

• Rapid onset of difficulty breathing (dyspnea) and coughing due to severe inflammation of the lungs (acute chemical pneumonitis)
• Inflammation of the mucous membranes of the nose (rhinitis), windpipe and air passages of the lungs (tracheobronchitis)
• Sore throat (pharyngitis) may also be seen

Chronic Berylliosis (long-term inhalational exposure) may develop many years after initial exposure to beryllium. The presentations include:

• Dyspnea, dry cough, chest pain
• Joint pain (arthralgia)
• Fatigue
• Weight loss, lack of appetite
• Fever
• Night sweats
• Enlarged lymph nodes
• Skin rashes
• Enlarged liver and spleen may be detected

How is Berylliosis Diagnosed?

A diagnosis of Berylliosis would involve:

• Physical examination and evaluation of medical history. Abnormal sounds may be heard over the lungs with a stethoscope, during inspiration (crackles)
• Determining occupational exposure to beryllium is essential to make the diagnosis
• Lung function tests, chest x-rays, and high resolution CT scans, are performed
• Microscopic examination of lung tissue after surgical removal (biopsy) may detect granulomas
• To determine sensitization to beryllium, to diagnose CBD and distinguish Berylliosis from other lung disorders ‘beryllium lymphocyte proliferation test’ (BeLPT) may be done on blood or fluid obtained from lung washings (bronchoalveolar lavage)

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Berylliosis?

Worsening lung function that may progress to respiratory failure, interstitial pulmonary fibrosis (scarring of deep lung tissues), and liver damage, are some of the possible complications.

How is Berylliosis Treated?

Treatment is not required for individuals, who are sensitized to beryllium, yet have not developed Chronic Berylliosis.

• Acute Berylliosis is treated with corticosteroids and may require breathing support (ventilators)
• Chronic Berylliosis is treated with corticosteroids, such as prednisone. If there is no response to corticosteroids, or its use is associated with significant adverse effects, then methrotrexate (cytotoxic drug) may be tried
• Lung transplantation may be performed in end-stage of the disease
• The role of infliximab, an anti-inflammatory agent, is under investigation

How can Berylliosis be Prevented?

Only those individuals, who are exposed to beryllium dust, fumes, or vapors, are at risk; not those who use end-products containing beryllium. Some of the preventive measures for Berylliosis include:

• At the workplace, protective measures to minimize exposure should be instituted. Examples include; the use of  local exhaust ventilation (hoods), high-efficiency particulate air (HEPA) vacuums, use of protective equipment by employees, and regular washing of face, hands, forearms, and other exposed body parts
• Current OSHA Permissible Exposure Limits for beryllium allow exposure to 2 μg/m3 (micrograms per cubic meter) of air as an 8-hour time-weighted average; between 5-25 μg/m3 exposure for up to 30 minutes at a time; and 25 μg/m3 as a maximum peak limit that can never be exceeded
• To reduce the risk of carrying residual beryllium back home, employees must change into ‘street clothing’ and shoes after taking a shower. Acute Berylliosis is now a very rare condition, due to the introduction of appropriate stringent protective measures in industries and factories
• To identify employees with beryllium sensitivity, voluntary screening using BeLPT blood tests may be used. Sensitized employees should be reassigned to low-exposure areas and regularly monitored by physicians
• Genetic screening for “variant major histocompatibility complex HLA-DPb1 [Glu 69]” is not useful, as it is commonly seen in the general population

What is the Prognosis of Berylliosis? (Outcomes/Resolutions)

• A complete recovery following Acute Berylliosis is possible with prompt and appropriate treatment
• If untreated, repeated attacks or continuous exposure to beryllium may lead to Chronic Berylliosis
• Presence of the genetic variation ‘variant major histocompatibility complex HLA-DPb1 [Glu 69], is a strong risk factor for the development of CBD
• No cure has been developed for CBD yet. Prevention and screening of individuals at risk is important. Without treatment, lung function will worsen and will eventually lead to respiratory failure

Additional and Relevant Useful Information for Berylliosis:

• The ‘Energy Employees Occupational Illness Compensation Program’ (US Department of Labor) provides benefits and compensation for certain individuals with beryllium sensitization (or CBD)
• Sarcoidosis, exposure to other hard metals, such as chromium, titanium dioxide, or cobalt, may present symptoms like Berylliosis