Talcosis is pneumofibrosis caused by inhalation of talc dust into the respiratory tract, less often by intravenous administration of talc. Clinically manifested by persistent dry cough, increasing shortness of breath, stabbing pains in the chest. Talcosis is diagnosed using radiography and CT of the lungs, spirometry, and a trans-bronchial biopsy. Bronchodilators, steroids, vitamins, cardiac glycosides are used in the treatment. Oxygen therapy, physical therapy, physiotherapy are indicated. In the terminal stage, lung transplantation is required.
J63.8 Pneumoconiosis caused by other refined inorganic dust
Talcosis (talc pneumoconiosis) ‒ silicatosis caused by aerosol or hematogenic intake of talc into the body. The first report on industrial pneumothalcosis was made by the French doctor K. Thorel in 1896 . In modern pulmonology, cases of talc pneumoconiosis are not uncommon, which is associated with the widespread use of talc in everyday life, industry, medicine, cosmetology. The insidiousness of talcosis lies in the fact that it can manifest itself after a decade, even after a single intense contact with the mineral.
Causes of talcosis
Talc pneumoconiosis is most often registered as an occupational disease, but other variants of its development are also possible. There are three main ways talc enters the body: inhalation, intravenous and iatrogenic:
- Inhalation of talc-containing dust. Occupational pathology develops mainly in miners, workers of rubber, pulp and paper, textile, perfumery and cosmetics, paint and varnish, pharmaceutical industries exposed to prolonged inhalation of talc-containing aerosols. Usually talcosis develops 10 or more years after contact with a harmful production factor.
- Inhalation of cosmetic talc. Women who use talc for daily skin care (in the form of powder, antiperspirant), as well as professional cosmetologists are at risk of developing talcosis. Deliberate inhalation of cosmetic talc is less commonly practiced. An episode of talc pneumoconiosis associated with the systematic inflating of latex balloons is described.
- Intravenous injections of talc-containing substances. People who abuse intravenous drugs often grind and dissolve oral preparations containing talc and use them parenterally, which leads to the hematogenic spread of particles into the lungs.
- Intraoperative ingestion of talc into the wound. Talc is commonly used as a sclerosing agent for pleurodesis in recurrent pneumothorax or pleurisy. However, cases of talcosis with intrapleural administration of talc are not frequent. Another rare cause of pathology may be the ingress of talc from rubber medical gloves into an operating wound during abdominal surgical operations.
The factors that increase the likelihood of developing talcosis are age, work experience in hazardous production, and working conditions. Concomitant anamnesis is also important, including:
- chronic bronchitis: obstructive, allergic;
- smoking cigarettes, hookah;
- regular hypothermia.
Talc (hydrated magnesium silicate) is a white crystalline powder. Fine talcum powder has a moderate fibrogenic effect.
Talc particles that have penetrated into the lungs by inhalation or injection are phagocytized by macrophages, causing the death of the latter. At the same time, proteolytic enzymes (elastase, metalloproteinases) are released from damaged macrophages, causing the destruction of lung tissue. In addition, the dust particles themselves activate pro-inflammatory cytokines. Granulomatous interstitial inflammation in the lungs is replaced by a phase of repair, however, uncontrolled neovascularization and proliferation contribute to the development of progressive pneumofibrosis.
Thickening of the interalveolar septa, bronchiectasis, emphysema of the lungs, pleural adhesions are found in the lungs. Talcum dust deposits (talcous corpuscles) are present in the overgrown connective tissue, lymph nodes in the lung root area and tracheal bifurcation.
Microscopic examination of a lung biopsy reveals granulomas consisting of macrophages and multinucleated giant cells containing numerous inclusions in the form of needle-shaped crystals, visualized in polarized light. With inhalation penetration of talc particles, granulomas are located peribronchially or perialveolar, with intravenous – perivascular or intravascular.
Taking into account the composition of the inhaled silicate dust, pure talcosis, talcosilicosis (talc and silica particles), talcoasbestosis (talc and asbestos particles) are isolated. Depending on the way the mineral enters the body, the following types of diseases are distinguished:
- pulmonary talcosis – caused by inhalation of talc dust particles;
- intravascular talcosis is associated with an intravenous method of administration of talc–containing substances;
- surgical talcosis is caused by the ingress of talc from medical gloves into an open surgical wound.
Symptoms of talcosis
Clinical manifestations of talc pneumoconiosis are identical in various etiological forms of the disease. Talcosis, as a rule, is characterized by slow progression, relatively benign course, more often limited to stage I-II.
At the first stage, complaints are usually fickle and do not bother patients much. There is a periodic dry cough, tingling in the chest and shoulder blades, slight shortness of breath with physical effort.
With the progression of talcosis to the second stage, patients feel a lack of air with little physical activity, rapid fatigue. The nasal cough intensifies, chest pain becomes constant, patients begin to lose weight. Less often, the course of talcosis is accompanied by fever, night sweating, spontaneous pneumothorax.
The third stage of talcosis develops extremely rarely, usually when inhaling dust of mixed composition containing, in addition to talc, kaolin, silicon dioxide. It is characterized by pronounced signs of cardiopulmonary insufficiency: shortness of breath at rest, cyanosis, persistent cough, intense pain syndrome.
Talcosis is usually complicated by chronic dust bronchitis and emphysema of the lungs, which, as a rule, are less pronounced than with asbestos. The progression of pneumofibrosis causes the formation of chronic respiratory failure. In the late stages of talcosis, persistent pulmonary hypertension occurs, against which the pulmonary heart disease develops. In the case of joining a tuberculosis infection to talcosis, fibrotic focal talcotuberculosis occurs.
Diagnostics of talcosis
Patients with suspected talc pneumoconiosis or other inhaled or hematogenic talcosis should be consulted by a pulmonologist and thoroughly interviewed for a previous medical history (occupational hazard, use of cosmetic talc, drug use). During auscultation, hard breathing and dry inspiratory wheezing, percussion ‒ box sound over the lungs are determined.
- X-ray and CT of the lung. Radiologically, deformity of the pulmonary pattern, diffuse pneumofibrosis, numerous nodular formations are detected. On CT scans, small nodules with a diameter of 1-2 mm and areas of “frosted glass” in all parts of the lungs are clearly visible.
- Spirometry. The study of external respiration demonstrates a decrease in the vent and maximum ventilation of the lungs, a decrease in the diffusion capacity of the lungs. When measuring blood saturation, hypoxemia is recorded.
- Bronchoscopy with biopsy. There are no specific endobronchial changes. The value of diagnostic endoscopy lies in the possibility of obtaining bronchoalveolar lavage and conducting a transbronchial biopsy. It is the morphological examination of the biopsy of lung tissue that makes it possible to detect talc crystals against the background of granulomatous inflammation.
During the instrumental examination, it is necessary to exclude other pathologies accompanied by an unproductive cough, progressive shortness of breath and similar radiological changes:
- community-acquired pneumonia;
- tuberculosis of the lungs;
- other silicatoses: asbestos, coalinosis, cementosis, mica pneumoconiosis;
- hypersensitive pneumonitis;
- Caplan syndrome;
- pulmonary embolism, etc.
Treatment for talcosis
The primary point in the treatment of pneumoconiosis is the cessation of contact with talc-containing substances. In the absence of complaints, therapy is not carried out, dynamic monitoring is carried out. Treatment of talcosis depends on the clinical and radiological stage and may include:
- Pharmacotherapy. Mucolytics, bronchodilators, NSAIDs are used to relieve disturbing symptoms. The intake of ascorbic acid, niacin, and rutin is indicated. In case of rapid progression of interstitial fibrosis, corticosteroids are prescribed. With the development of the pulmonary heart, cardiac glycosides, diuretics are connected.
- Physical rehabilitation. An important role in the complex treatment of talcosis is given to respiratory gymnastics, oxygen therapy. Physiotherapy (UFO, sollux), oil and alkaline inhalations, halotherapy, sanatorium rehabilitation are recommended.
- Lung transplantation. The terminal stage of chronic talcosis, accompanied by critical respiratory failure, is an indication for lung transplantation.
Prognosis and prevention
The natural course of talcosis progresses slowly even after the cessation of the harmful factor. Therefore, it is often not easy to associate pulmonary changes with talc exposure, which took place 15-20 years ago. At the same time, the severity of pneumofibrosis rarely reaches clinically significant degrees.
Preventive sanitary and technical measures in the workshops include mechanization of production, ensuring effective ventilation, regular monitoring of the MPC of harmful substances in the air, wearing respiratory protective equipment. All workers employed in hazardous industries must undergo medical examination and be monitored by a professional pathologist. Measures of household prevention of talcosis are based on the careful use of talc-containing cosmetic formulations. Deliberate inhalation or intravenous administration of talc is also categorically unacceptable.