title: Artificial stone silicosis [corrected]: disease resurgence among artificial stone workers.
abstract: BACKGROUND
  Silicosis is a progressive, fibrotic, occupational lung disease resulting from inhalation of respirable crystalline silica. This disease is preventable through appropriate workplace practices. We systematically assessed an outbreak of silicosis among patients referred to our center for lung transplant.
  
  
  METHODS
  This retrospective cohort analysis included all patients with a diagnosis of silicosis who were referred for evaluation to the National Lung Transplantation Program in Israel from January 1997 through December 2010. We also compared the incidence of lung transplantation (LTX) due to silicosis in Israel with that of the International Society for Heart and Lung Transplantation (ISHLT) registry.
  
  
  RESULTS
  During the 14-year study period, 25 patients with silicosis were referred for evaluation, including 10 patients who went on to undergo LTX. All patients were exposed by dry cutting a relatively new, artificial, decorative stone product with high crystalline silica content used primarily for kitchen countertops and bathroom fixtures. The patients had moderate-to-severe restrictive lung disease. Two patients developed progressive massive fibrosis; none manifested acute silicosis (silicoproteinosis). Three patients died during follow-up, without LTX. Based on the ISHLT registry incidence, 0.68 silicosis cases would have been expected instead of the 10 observed (incidence ratio, 14.6; 95% CI, 7.02-26.8).
  
  
  CONCLUSIONS
  This silicosis outbreak is important because of the worldwide use of this and similar high-silica-content, artificial stone products. Further cases are likely to occur unless effective preventive measures are undertaken and existing safety practices are enforced.
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva.
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: Division of Occupational and Environmental Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blanc
authors.affiliation: Institute of Pulmonary and Allergic Diseases, National Service for Interstitial Lung Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Fireman
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva.
authors.forename: Anat
authors.initials: A
authors.lastname: Amital
authors.affiliation: Pulmonary Department, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Guber
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva.
authors.forename: Nader Abdul
authors.initials: NA
authors.lastname: Rhahman
authors.affiliation: Pulmonary Department, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: davids3@clalit.org.il.
authors.forename: David
authors.initials: D
authors.lastname: Shitrit
mesh_terms: D060389:Construction Industry; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007557:Israel; D016040:Lung Transplantation; D008297:Male; D008420:Manufactured Materials / Q000009:adverse effects*; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D012829:Silicosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy