Pulmonary Tuberculosis among Stone Miners of India vis-à-vis Silica Exposure

BACKGROUND: Tuberculosis is one of the biggest public health concerns in India with a prevalence of 195 cases per 100000. Silica is cytotoxic to macrophage which is primary defense mechanism to tubercular bacilli and, hence, exposure to silica dust increases risk for TB. Silica exposed persons are at 2.8 to 39 times greater risk of affected by pulmonary tuberculosis in comparison to healthy subjects. METHODOLOGY: A cross-sectional epidemiological study was conducted among 935 workers in sandstone mining. Full-size posteroanterior view (PA) chest X-ray in full inspiration was evaluated and evidence of tuberculosis was noted. Fourier transform infrared spectrophotometer was used for determining the free silica in 23 dust samples. RESULTS: 6.4% X-rays showed evidence of TB and silica dust concentration was 0.11 to 0.16 mg/m(3). The TB cases significantly increased from 2% to 6% to 12.7% as the work exposure increased from <10 years to 11–20 years to >20 years respectively. 8.5% of the TB cases were seen among the workers having more than 10 years of work exposure. The odds ratio (95% CI) for work exposure more than 10 years to less than 10 years was 4.53 (1.92–10.65). CONCLUSION: Reduction of silica particles from work environment can significantly reduce the number of TB cases and hence wet drilling should be practiced and personal protective equipment should be regularly used.