Beryllium Disease among Workers in a Spacecraft- Manufacturing Plant -- California

From 1977 to 1981, three cases of beryllium disease (berylliosis) among workers in a large spacecraft-manufacturing plant in California, were reported to the Beryllium Case Registry (BCR) of the National Institute for Occupational Safety and Health (NIOSH). All three patients were machinists who had worked with beryllium metal from the late 1950s to the mid-1970s, fabricating special parts for missile guidance systems.

A case history: Beginning in the mid-1970s, a machinist (born in 1936) noted progressive shortness of breath, cough, and slight sputum production; by 1978, he was unable to work. Despite previous athletic ability, by 1980, he could not perform routine household chores without shortness of breath. He had never smoked. Physical examination revealed a well-developed, well-nourished male with rapid pulse rate; his diaphragm moved poorly, and breath sounds were decreased at the bases of both lungs. Occasional rhonchi were heard at the base of the right lung. He experienced shortness of breath on minimal exertion and had "clubbing" of the fingers and toes. Chest x-rays taken in 1966, 1967, and 1976 were reported to have been negative. However, films taken in June 1978 showed extensive confluent basilar infiltrates in both lung fields. The junctional areas in the mid-zones showed some granularity. The heart and costophrenic angles were normal. A chest x-ray taken in January 1980 showed irregular opacities involving the lower halves of both lungs, with bilateral areas of subsegmental atelectasis.

Laboratory tests in January 1980 showed a hemoglobin level of 16.1 g. White blood cell count was 6,100, with a normal differential. Sputum tests were negative for fungi and acid-fast bacilli. Measurements of arterial blood gases showed a pH of 7.42, PCO((2)) of 36 mm Hg, PO((2)) of 69, and oxygen saturation of 93%. Pulmonary function tests showed moderate reduction of vital capacity and total lung capacity and marked reduction of forced expiratory volume and diffusing capacity. Pathologic examination of biopsied mediastinal lymph nodes revealed non-caseating granuloma and chronic interstitial pneumonitis. A lymphoblast transformation test (LTT) conducted in 1981 was positive.

The patient was first employed in 1956 as a milling machinist. He worked with beryllium metal and alloys from 1960 through the mid-1970s at three different plants of this company, two of which have been closed. According to the industrial protocol, such machining was to be done wet or under high-efficiency, local-exhaust ventilation. However, the patient stated that at times there was sufficient spillage of dusts to require vacuuming. He did not use a respirator.

Other cases: The two other patients had similar case histories. The second patient (born in 1914) was employed in 1958, had worked in all three facilities, and became symptomatic in 1976. His LTT was negative while he was on steroid therapy. The third patient (born in 1936) was employed in 1956, had worked at two of the three facilities, and became symptomatic in 1980. His LTT was positive in 1981.

In 1981, NIOSH personnel evaluated both employee health records and present and past levels of employee exposure to beryllium. Records of the company's air sampling for beryllium indicated that, from 1963 to 1973, 14%-44% of samples* taken at the machine shops exceeded the present standard for exposure to beryllium.** From 1973 through 1981, the standard was exceeded only once; a sample in 1977 was 4.6 ug/m((3)). Review of the company's medical records showed no additional cases among current employees in the same job category. Reported by NR Johnson, MD, Barlow Hospital, Los Angeles, Div of Occupational Safety and Health Administration (Cal-OSHA), Region III-Santa Ana, California; Surveillance Br, Industrywide Studies Br, Div of Surveillance, Hazard Evaluation, and Field Studies, NIOSH, CDC.

Editorial Note

Editorial Note: Chronic berylliosis is a pulmonary and systemic granulomatous disease caused by exposure to beryllium. Acute beryllium disease in the form of chemical pneumonitis was first reported in Europe in 1933 (1) and in the United States in 1943 (2). Cases of chronic berylliosis were first described in 1946 among workers in plants manufacturing fluorescent lamps in Massachusetts (3). The BCR, established at the Massachusetts Institute of Technology in 1952 to collect data and to study the clinical course, treatment, and complications of beryllium disease (4), was maintained by the Pulmonary Unit of the Massachusetts General Hospital through 1977. A total of 887 cases were registered during those 25 years (5). Since 1978, the BCR has been maintained by NIOSH, and 10 additional cases have been identified.

Chronic berylliosis resembles sarcoidosis in many respects, and the differential diagnosis is often difficult (6). Recently, four cases of berylliosis, initially considered to be sarcoidosis, were reported among workers who smelted scraps of beryllium-copper alloy in a plant in Connecticut (7). Some investigators advocate the use of the LTT as a diagnostic tool based on the theory that berylliosis is a manifestation of immunologic reaction (8,9).

Although the use of beryllium compounds in fluorescent lighting tubes was discontinued in 1949, potential for exposure to beryllium exists in the nuclear and aerospace industries and in the refining of beryllium metal and melting of beryllium-containing alloys, the manufacturing of electronic devices, and the handling of other beryllium-containing material. The present cases indicate that an exposure hazard exists, even in industries with modern technology. By the time a case is diagnosed and reported to the BCR, many years may have passed, and the patient may already suffer considerable pulmonary disability.

It is important that management recognize the health hazards of beryllium, properly inform workers of these hazards, and establish programs to control exposure. When a physician sees a patient with suspected sarcoidosis, the occupational history should be thoroughly elicited to rule out possible berylliosis. Suspected cases of berylliosis should be reported to local and state health departments and to the Surveillance Branch, Division of Surveillance, Hazard Evaluations, and Field Studies, NIOSH, Robert A. Taft Laboratories, 4676 Columbia Parkway, Cincinnati, Ohio 45226, telephone (513) 684-3268. An evaluation for admission into the BCR will be made by NIOSH consultants at no cost to the patient or referring physician.

References

1. Weber HH, Engelhardt WE. Anwendung bei der Untersuchung von Stauben aus der Berylliumgewinnung. Zentralbl Gewerbehyg Unfallverhut 1933;10:41-7.

2. Van Ordstrand HS, Hughes R, Carmody MG. Chemical pneumonia in workers extracting beryllium oxide: report of 3 cases. Cleveland Clin Quart 1943;10:10-8.

3. Hardy HL, Tabershaw IR. Delayed chemical pneumonitis occurring in workers exposed to beryllium compounds. J Indust Hyg & Toxicol 1946;28:197-211.

4. Hardy H. Beryllium Case Registry progress report: 1962. Arch Environ Health 1962;5:265-8.

5. Sprince NL, Kazemi H. U.S. beryllium case registry through 1977. Environ Res 1980;21:44-7.

6. Sprince NL, Kazemi H, Hardy HL. Current (1975) problem of differentiating between beryllium disease and sarcoidosis. Ann NY Acad Sci 1976;278:654-64.

7. Balmes JR, Cullen MR, Robins JM. Epidemic chronic beryllium disease among scrap metal refiners. Proceedings of the 2nd International Conference on Occupational Lung Disease. March 24-27, 1982. New York: Raven Press (In press).

8. Deodhar SD, Barna B, Van Ordstrand HS. A study of the immunologic aspects of chronic berylliosis. Chest 1973; 63:309-13.

9. Epstein PE, Dauber JH, Rossman MD, Daniele RP. Bronchoalveolar lavage in a patient with chronic berylliosis: evidence for hypersensitivity pneumonitis. Ann Intern Med 1982; 97:213-6.

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