Silicotuberculosis: Current Evidence, Clinical Challenges, and Management Strategies

Abstract

Silicotuberculosis is a severe clinical condition characterized by the coexistence of silicosis resulting from exposure to respirable crystalline silica (RCS) and infection with Mycobacterium tuberculosis. Ongoing exposure of millions of workers worldwide to silica dust across multiple industries has made silicotuberculosis an increasing global public health concern. Silica exposure disrupts alveolar macrophage function, promotes oxidative stress, inflammation, and fibrosis, and facilitates both primary tuberculosis infection and reactivation of latent disease. Current evidence indicates that individuals with silicosis have a markedly increased lifetime risk of developing both pulmonary and extrapulmonary tuberculosis. The diagnosis of silicotuberculosis remains challenging because clinical and radiological features of silicosis and tuberculosis often overlap. Chest radiography and computed tomography are frequently insufficient for differentiation, while molecular rapid diagnostic tests improve detection but may show reduced sensitivity in the presence of comorbidities such as HIV infection. Treatment outcomes in patients with silicosis and tuberculosis are generally poorer than in tuberculosis alone, with higher rates of treatment failure, relapse, and mortality, highlighting the need for optimized therapeutic strategies. Primary prevention relies on reducing occupational exposure to respirable crystalline silica through engineering controls, effective ventilation, personal protective equipment, and workplace surveillance. Secondary prevention focuses on early detection and management of latent tuberculosis infection in high-risk populations. Given the persistent and elevated tuberculosis risk associated with silicosis, regular screening and integrated occupational health policies are essential. In conclusion, silicotuberculosis is a complex occupational lung disease with significant diagnostic and therapeutic challenges. Multidisciplinary approaches that integrate tuberculosis control programs with occupational health interventions are critical to reducing disease burden, particularly in high-risk worker populations.

Keywords

• Silicotuberculosis
• silicosis
• tuberculosis
• occupational lung diseases
• respirable crystalline silica
• latent tuberculosis infection

Silikotüberkülozda Güncel Kanıtlar, Klinik Zorluklar ve Yönetim Stratejileri

Öz

Silikotüberküloz (Siliko-TB), solunabilir kristal silika (SKS) maruziyeti sonucu gelişen silikozis ile Mycobacterium tuberculosis enfeksiyonunun bir arada bulunduğu, ağır seyirli bir klinik tablodur. Dünya genelinde milyonlarca çalışanın çeşitli endüstrilerde SKS tozuna maruz kalması, Siliko-TB’yi giderek büyüyen bir halk sağlığı sorunu haline getirmektedir. Silika, alveoler makrofaj fonksiyonunu bozarak oksidatif stres, inflamasyon ve fibrozise yol açmakta; bu süreç tüberküloz basillerinin kolayca yerleşmesine ve latent enfeksiyonun reaktivasyonuna zemin hazırlamaktadır. Güncel veriler, silikozisli bireylerde pulmoner ve ekstrapulmoner TB gelişme riskinin belirgin şekilde arttığını, hatta yaşam boyu yüksek seyrettiğini göstermektedir. Siliko-TB tanısı, klinik ve radyolojik bulguların silikozis ile TB arasında benzerlikler göstermesi nedeniyle zor olabilmektedir. Akciğer grafisi ve bilgisayarlı tomografi (BT) çoğu zaman ayırt edici değildir; moleküler hızlı testler ve BT bulguları tanıda değerli olmakla birlikte, duyarlılık HIV gibi ek hastalıklarda azalabilmektedir. Silikozisli hastalarda TB tedavi sonuçları genellikle daha kötüdür; tedavi başarısızlığı ve nüks oranları belirgin biçimde yüksektir. Bu nedenle standart rejimlerin etkinliğini artıracak yeni tedavi stratejilerine ihtiyaç vardır. Birincil korunma, SKS maruziyetinin azaltılmasına dayanır. Tozu kaynakta önleme, mühendislik kontrolleri, etkin havalandırma, uygun maske dahil kişisel koruyucu donanımlar ve işyeri denetimleri temel unsurlardır. İkincil korunmada ise latent TB enfeksiyonunun tespiti ve uygun kemoprofilaksi öne çıkmaktadır. Silikozisin TB üzerindeki belirgin etkileri göz önüne alındığında, riskli gruplarda düzenli tarama programlarının uygulanması kritik öneme sahiptir. Sonuç olarak, Siliko-TB, tanısal zorlukları, yüksek mortalite riski ve sınırlı tedavi başarısı nedeniyle kapsamlı, disiplinler arası müdahaleler gerektiren önemli bir mesleki akciğer hastalığıdır. İş sağlığı politikalarının güçlendirilmesi ve riskli topluluklara yönelik hedefe yönelik stratejiler bu yükün azaltılmasında temel rol oynamaktadır.

Anahtar Kelimeler

• Silikotüberküloz
• silikozis
• tüberkülozis
• mesleki akciğer hastalıkları
• solunabilir kristal silika
• latent tüberküloz enfeksiyonu

Kaynakça

1. 1. National Institutes of Health (NIH). Silicotuberculosis. Published online December 18, 2025. https://www.ncbi.nlm.nih.gov/medgen/11426#Definition
2. 2. Watt AH. Silicosis (“Miners’ Phthisis”) on the Witwatersrand: Causation, Incidence, Pathology, Symptoms, and Radiographic Appearances. Government Print. and Stationery Office; 1916.
3. 3. Rosner D, Markowitz G. Consumption, silicosis, and the social construction of industrial disease. Yale J Biol Med. 1991;64(5):481.
4. 4. Carnevale F, Rosental PA. Silica, Silicosis, and Occupational. Silicosis: A World History. Published online 2017:206.
5. 5. Lanzafame M, Vento S. Mini-review: Silico-tuberculosis. J Clinical Tuberculosis and Other Mycobacterial Diseases. 2021;23:100218.
6. 6. Dheda K, Barry CE, Maartens G. Tuberculosis. Lancet. 2016;387(10024):1211-1226. doi:10.1016/S0140-6736(15)00151-8
7. 7. Joshi S, Tiwari M, Pasi S, Kharkwal G. Global workplace health and safety policies for silicosis elimination and way forward. Discov Public Health. 2025;22(1):465. doi:10.1186/s12982-025-00872-4
8. 8. Krefft S, Wolff J, Rose C. Silicosis: an update and guide for clinicians. Clin Chest Med. 2020;41(4):709-722.

9. 9. Kromhout H, Cherrie JW, van Tongeren M. Letter to the editor. Environ Int. 2023;179:108107. doi:10.1016/j.envint.2023.108107
10. 10. Cherrie JW, van Tongeren M, Kromhout H. Estimating occupational disease burden: a way forward. Ann Work Expo Health. 2024;68(7):673-677. doi:10.1093/annweh/wxae040
11. 11. Thomas CR, Kelley TR. A Brief Review of Silicosis in the United States. Environ Health Insights. 2010;4:EHI.S4628. doi:10.4137/EHI.S4628
12. 12. Greenberg MI, Waksman J, Curtis J. Silicosis: a review. Disease-a-Month. 2007;53(8):394-416.
13. 13. Konečný P, Ehrlich R, Gulumian M, Jacobs M. Immunity to the Dual Threat of Silica Exposure and Mycobacterium tuberculosis. Front Immunol. 2018;9:3069. doi:10.3389/fimmu.2018.03069
14. 14. Nasrullah M, Mazurek JM, Wood JM, Bang KM, Kreiss K. Silicosis mortality with respiratory tuberculosis in the United States, 1968-2006. Am J Epidemiol. 2011;174(7):839-848. doi:10.1093/aje/kwr159
15. 15. Yew WW, Leung CC, Chang KC, Zhang Y, Chan DP. Can treatment outcomes of latent TB infection and TB in silicosis be improved? J Thorac Dis. 2019;11(1):E8-E10. doi:10.21037/jtd.2018.12.113
16. 16. Commentary for JOEM Forum-Silicosis: Then and Now. J Occup Environ Med. 2017;59(2):222-233. doi:10.1097/JOM.0000000000000957
17. 17. Kurt OK, Karaketir S, Kılıçaslan Z, Akgün M. Artificial Stone Silicosis in Türkiye: The First National Case Series Follows the Footsteps of Denim Sandblasting. J Occupational Environmental Med. 2025:e768-e770.
18. 18. Kurt ÖK, Karaketir S, Kılıcaslan Z, Akgun M. Artificial stone-related interstitial lung diseases: the first case series from Türkiye. Published online 2025. Accessed January 6, 2026. https://publications.ersnet.org/content/erj/66/suppl69/pa1578
19. 19. Shen J, Wang J, Zhang B, et al. Global, regional, and national burden of Pneumoconiosis caused by different etiologies: An update from the global burden of disease study 2021. Respiratory Med. 2025:108480.
20. 20. Heidary M, Shirani M, Moradi M, et al. Tuberculosis challenges: Resistance, co-infection, diagnosis, and treatment. Eur J Microbiol Immunol (Bp). 2022;12(1):1-17. doi:10.1556/1886.2021.00021
21. 21. Rosen G. A History of Public Health. Jhu Press; 2015. Accessed December 18, 2025. https://books.google.com/books?hl=tr&lr=&id=hpyeBgAAQBAJ&oi=fnd&pg=PP1&dq=Rosen+G.:+A+History+of+Public+Health.2015.Jhu+Press&ots=bN0J684KGN&sig=-ZPkMPNInXMgH-tdbfoEbm0KQWw
22. 22. Hoy RF, Jeebhay MF, Cavalin C, et al. Current global perspectives on silicosis-Convergence of old and newly emergent hazards. Respirology. 2022;27(6):387-398. doi:10.1111/resp.14242
23. 23. Austin EK, James C, Tessier J. Early Detection Methods for Silicosis in Australia and Internationally: A Review of the Literature. Int J Environ Res Public Health. 2021;18(15):8123. doi:10.3390/ijerph18158123
24. 24. GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1084-1150. doi:10.1016/S0140-6736(17)31833-0
25. 25. Fernández Álvarez R, Martínez González C, Quero Martínez A, Blanco Pérez JJ, Carazo Fernández L, Prieto Fernández A. Guidelines for the diagnosis and monitoring of silicosis. Arch Bronconeumol. 2015;51(2):86-93. doi:10.1016/j.arbres.2014.07.010
26. 26. Cokic SM, Hoet P, Godderis L, et al. Cytotoxic effects of composite dust on human bronchial epithelial cells. Dent Mater. 2016;32(12):1482-1491. doi:10.1016/j.dental.2016.09.010
27. 27. Calvert GM, Rice FL, Boiano JM, Sheehy JW, Sanderson WT. Occupational silica exposure and risk of various diseases: an analysis using death certificates from 27 states of the United States. Occup Environ Med. 2003;60(2):122-129. doi:10.1136/oem.60.2.122
28. 28. Kirby T. Australia bans engineered stone to prevent silicosis. Lancet Respir Med. 2024;12(4):e18. doi:10.1016/S2213-2600(24)00007-9
29. 29. Liu X, Jiang Q, Wu P, Han L, Zhou P. Global incidence, prevalence and disease burden of silicosis: 30 years’ overview and forecasted trends. BMC Public Health. 2023;23(1):1366. doi:10.1186/s12889-023-16295-2
30. 30. Huang X, Liu W, Yao Y, Wang D, Sun Y, Chen W. 30-Year Trends in the Disease Burden, Incidence, and Prevention of Pneumoconiosis. China CDC Wkly. 2023;5(38):856-860. doi:10.46234/ccdcw2023.163
31. 31. International Labour Organization (ILO). Occupational health: Silicosis. Published online December 18, 2025.
32. 32. Hingley-Wilson SM, Sambandamurthy VK, Jacobs WR. Survival perspectives from the world’s most successful pathogen, Mycobacterium tuberculosis. Nat Immunol. 2003;4(10):949-955. doi:10.1038/ni981
33. 33. Rupani MP, Vyas S, Shah IA. Cohort study on association between catastrophic costs and unfavorable tuberculosis treatment outcomes among TB-HIV and TB-diabetes comorbid patients in India. BMC Public Health. 2024;24(1):2028. doi:10.1186/s12889-024-19609-0
34. 34. Ehrlich R, Akugizibwe P, Siegfried N, Rees D. The association between silica exposure, silicosis and tuberculosis: a systematic review and meta-analysis. BMC Public Health. 2021;21(1):953. doi:10.1186/s12889-021-10711-1
35. 35. Kambouchner M, Bernaudin JF. The pathologist’s view of silicosis in 1930 and in 2015. The Johannesburg Conference legacy. Am J Ind Med. 2015;58(Suppl 1):S48-58. doi:10.1002/ajim.22506
36. 36. Farazi A, Jabbariasl M. Silico-tuberculosis and associated risk factors in central province of Iran. Pan Afr Med J. 2015;20:333. doi:10.11604/pamj.2015.20.333.4993
37. 37. Shafiei M, Ghasemian A, Eslami M, Nojoomi F, Rajabi-Vardanjani H. Risk factors and control strategies for silicotuberculosis as an occupational disease. New Microbes New Infect. 2019;27:75-77. doi:10.1016/j.nmni.2018.11.002
38. 38. Sarkar B, Sarkar K. End tuberculosis strategy also requires initiation and integration of a national silicosis control program with the ongoing tuberculosis elimination activities: A review of the silicotuberculosis situation in India. J Biol Methods. 2024;11(4):e99010035. doi:10.14440/jbm.2024.0053
39. 39. Suci YD, Permatasari A, Koesomoprodjo W. Rare concurrent extrapulmonary tuberculous pericarditis and pleuritis accompanied with lung silicosis. Respir Med Case Rep. 2024;50:102030. doi:10.1016/j.rmcr.2024.102030
40. 40. Ozden K, Araz O, Ucar EY, Alper F, Akgun M. Co-existence of tuberculous meningitis and pulmonary tuberculosis in a denim sandblaster. Eurasian J Med. 2012;44(1):54.
41. 41. Rees D, Murray J. Silica, silicosis and tuberculosis. Int J Tuberc Lung Dis. 2007;11(5):474-484.
42. 42. Sarkar K, Dhatrak S, Sarkar B, Ojha UC, Raghav P, Pagdhune A. Secondary prevention of silicosis and silico‐tuberculosis by periodic screening of silica dust exposed workers using serum club cell protein 16 as a proxy marker. Health Science Reports. 2021;4(3):e373. doi:10.1002/hsr2.373
43. 43. Loddenkemper R, Lipman M, Zumla A. Clinical Aspects of Adult Tuberculosis. Cold Spring Harb Perspect Med. 2015;6(1):a017848. doi:10.1101/cshperspect.a017848
44. 44. Allison AC, Hart PD. Potentiation by silica of the growth of Mycobacterium tuberculosis in macrophage cultures. Br J Exp Pathol. 1968;49(5):465-476.
45. 45. Rosenman KD, Hall N. Occupational risk factors for developing tuberculosis. Am J Ind Med. 1996;30(2):148-154. doi:10.1002/(SICI)1097-0274(199608)30:2%3C148::AID-AJIM5%3E3.0.CO;2-X
46. 46. Orlowski GM, Colbert JD, Sharma S, Bogyo M, Robertson SA, Rock KL. Multiple cathepsins promote pro–IL-1β synthesis and NLRP3-mediated IL-1β activation. J Immunol. 2015;195(4):1685-1697.
47. 47. Kusaczuk M, Krętowski R, Naumowicz M, Stypułkowska A, Cechowska-Pasko M. Silica nanoparticle-induced oxidative stress and mitochondrial damage is followed by activation of intrinsic apoptosis pathway in glioblastoma cells. Int J Nanomedicine. 2018;13:2279-2294. doi:10.2147/IJN.S158393
48. 48. Lopes-Pacheco M, Bandeira E, Morales MM. Cell-Based Therapy for Silicosis. Stem Cells Int. 2016;2016:5091838. doi:10.1155/2016/5091838
49. 49. Chen S, Yuan J, Yao S, et al. Lipopolysaccharides may aggravate apoptosis through accumulation of autophagosomes in alveolar macrophages of human silicosis. Autophagy. 2015;11(12):2346-2357. doi:10.1080/15548627.2015.1109765
50. 50. Tan S, Chen S. Macrophage autophagy and silicosis: current perspective and latest insights. Int J Molecular Sci. 2021;22(1):453.
51. 51. Chen H, Tao X, Cao H, et al. Nicotine exposure exacerbates silica-induced pulmonary fibrosis via STAT3-BDNF-TrkB-mediated epithelial-mesenchymal transition in alveolar type II cells. Food Chemical Toxicol. 2023;175:113694.
52. 52. Chong S, Lee KS, Chung MJ, Han J, Kwon OJ, Kim TS. Pneumoconiosis: Comparison of Imaging and Pathologic Findings. RadioGraphics. 2006;26(1):59-77. doi:10.1148/rg.261055070
53. 53. Ringshausen FC, Nienhaus A, Schablon A, et al. Frequent detection of latent tuberculosis infection among aged underground hard coal miners in the absence of recent tuberculosis exposure. PLoS One. 2013;8(12):e82005.
54. 54. Caraux-Paz P, Diamantis S, de Wazières B, Gallien S. Tuberculosis in the elderly. J Clin Med. 2021;10(24):5888.
55. 55. Stead WW. Tuberculosis among elderly persons, as observed among nursing home residents. Int Union Against Tuberculosis Lung Dis. 1998;2(9 Suppl 1):S64-70.
56. 56. Orme IM. A Mouse Model of the Recrudescence of Latent Tuberculosis in the Elderly. Am Rev Respir Dis. 1988;137(3):716-718. doi:10.1164/ajrccm/137.3.716
57. 57. Moyo D, Ncube R, Kavenga F, et al. The triple burden of tuberculosis, human immunodeficiency virus and silicosis among artisanal and small-scale miners in Zimbabwe. Int J Environmental Res Public Health. 2022;19(21):13822.
58. 58. Heimann S, Johansson K, Franklin WT. Gender in industrial mine work and organizations. A review of an expanding research field. The Extractive Industries and Society. 2023;16:101371.
59. 59. Hnizdo E, Murray J. Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners. Occupational Environmental Med. 1998;55(7):496-502.
60. 60. Carneiro APS, Teixeira V d S, Silveira AM, Araújo SCB, Algranti E. Non-malignant silica-related diseases in a specialized outpatient clinic. Occupational Med. 2022;72(6):394-402.
61. 61. Corbett EL, Charalambous S, Fielding K, et al. Stable incidence rates of tuberculosis (TB) among human immunodeficiency virus (HIV)–negative South African gold miners during a decade of epidemic HIV-associated TB. J Infect Dis. 2003;188(8):1156-1163.
62. 62. Murray J, Kielkowski D, Reid P. Occupational disease trends in black South African gold miners. An autopsy-based study. Am J Respir Crit Care Med. 1996;153(2):706-710. doi:10.1164/ajrccm.153.2.8564121
63. 63. Organization WH. WHO Consolidated Guidelines on Tuberculosis. Module 2: Screening-Systematic Screening for Tuberculosis Disease. World Health Organization; 2021. Accessed December 19, 2025. https://books.google.com/books?hl=tr&lr=&id=SI5FEAAAQBAJ&oi=fnd&pg=PR5&dq=122.%09World+Health+Organization+.+Consolidated+guidelines+on+tuberculosis.+Module+2:+Screening+%E2%80%93+systematic+screening+for+tuberculosis+disease.+2021.+https://iris.who.int/bitstream/handle/10665/340255/9789240022676-eng.pdf+Date+last+accessed:+28+November+2025&ots=cllKtX6A4S&sig=8TQspVXUAq2yvJS34M_YhvwzBEY
64. 64. Khil HS, Choi SI, Kim BK, et al. Risk of tuberculosis after endoscopic resection and gastrectomy in gastric cancer: nationwide population-based matched cohort study. Surg Endosc. 2024;38(3):1358-1366. doi:10.1007/s00464-023-10610-z
65. 65. Hnizdo E, Murray J. Risk of pulmonary tuberculosis relative to silicosis and exposure to silica dust in South African gold miners. Occupational Environmental Med. 1998;55(7):496-502.
66. 66. Carneiro APS, Teixeira V d S, Silveira AM, Araújo SCB, Algranti E. Non-malignant silica-related diseases in a specialized outpatient clinic. Occupational Med. 2022;72(6):394-402.
67. 67. Ndlovu N, Musenge E, Park SK, Girdler-Brown B, Richards G, Murray J. Four decades of pulmonary tuberculosis in deceased South African miners: trends and determinants. Occupational Environmental Med. 2018;75(11):767-775.
68. 68. Cowie RL. The epidemiology of tuberculosis in gold miners with silicosis. Am J Respir Crit Care Med. 1994;150(5):1460-1462. doi:10.1164/ajrccm.150.5.7952577
69. 69. Corbett EL, Churchyard GJ, Clayton T, et al. Risk Factors for Pulmonary Mycobacterial Disease in South African Gold Miners: A Case-Control Study. Am J Respir Crit Care Med. 1999;159(1):94-99. doi:10.1164/ajrccm.159.1.9803048
70. 70. Chang KC, Leung CC, Tam CM. Tuberculosis risk factors in a silicotic cohort in Hong Kong. Int J Tuberculosis Lung Dis. 2001;5(2):177-184.
71. 71. Mizutani RF, Santos UP, Sales RKB, et al. Risk of mycobacterial infections in a cohort of silicosis patients with autoimmune rheumatic diseases. J Brasileiro de Pneumologia. 2024;50(05):e20240265.
72. 72. Lai CC, Lee MT, Lee SH, Chang SS, Lee CC. Risk of incident active tuberculosis and use of corticosteroids. Int J Tuberculosis Lung Dis. 2015;19(8):936-942.
73. 73. Bryant PA, Baddley JW. Opportunistic infections in biological therapy, risk and prevention. Rheumatic Dis Clin. 2017;43(1):27-41.
74. 74. Singh D, Sarkar B, Yadav S, Sarkar K. Silent epidemic of silicotuberculosis in India and emergence of multidrug-resistant tuberculosis? J Global Antimicrobial Resistance. 2024;38:163-166.
75. 75. Ehrlich R, Murray J, Said-Hartley Q, Rees D. Silicotuberculosis: a critical narrative review. Eur Respiratory Rev. 2024;33(174). https://publications.ersnet.org/content/errev/33/174/240168.abstract
76. 76. Lewis JJ, Charalambous S, Day JH, et al. HIV Infection Does Not Affect Active Case Finding of Tuberculosis in South African Gold Miners. Am J Respir Crit Care Med. 2009;180(12):1271-1278. doi:10.1164/rccm.200806-846OC
77. 77. Zifodya JS, Schiller I, Dendukuri N, et al. Xpert MTB/RIF and Xpert MTB/RIF Ultra for pulmonary tuberculosis and rifampicin resistance in adults. Cochrane Database of Systematic Reviews. 2019;(6). Accessed December 19, 2025. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009593.pub4/abstract
78. 78. Leung AN. Pulmonary Tuberculosis: The Essentials. Radiology. 1999;210(2):307-322. doi:10.1148/radiology.210.2.r99ja34307
79. 79. Sun J, Weng D, Jin C, et al. The value of high resolution computed tomography in the diagnostics of small opacities and complications of silicosis in mine machinery manufacturing workers, compared to radiography. J Occupational Health. 2008;50(5):400-405.
80. 80. Carneiro APS, da Silva LL, Silva F das CL, Hering KG, Algranti E. Volume-based tomography for the diagnosis of incipient silicosis in former gold miners. Occupational Environmental Med. 2022;79(6):427-432.
81. 81. Bégin R, Ostiguy G, Fillion R, Colman N. Computed Tomography Scan in the Early Detection of Silicosis. Am Rev Respir Dis. 1991;144(3_pt_1):697-705. doi:10.1164/ajrccm/144.3_Pt_1.697
82. 82. Skoura E, Zumla A, Bomanji J. Imaging in tuberculosis. Int J Infect Dis. 2015;32:87-93.
83. 83. Verschakelen JA, De Wever W. Nodular Pattern. In: Computed Tomography of the Lung. Medical Radiology. Springer Berlin Heidelberg; 2018:81-101. doi:10.1007/978-3-642-39518-5_6
84. 84. Nin CS, de Souza VVS, do Amaral RH, et al. Thoracic lymphadenopathy in benign diseases: a state of the art review. Respiratory Med. 2016;112:10-17.
85. 85. D’Sa L, Pezzuto F, Lunardi F, et al. A Complex Case of Pulmonary Silico-Tuberculosis and Review of Literature. Diagnostics. 2023;13(17):2728.
86. 86. Chung SY, Lee JH, Kim TH, Kim SJ, Kim HJ, Ryu YH. 18F-FDG PET imaging of progressive massive fibrosis. Ann Nucl Med. 2010;24(1):21-27. doi:10.1007/s12149-009-0322-9
87. 87. O’connell M, Kennedy M. Progressive massive fibrosis secondary to pulmonary silicosis appearance on F-18 fluorodeoxyglucose PET/CT. Clin Nuclear Med. 2004;29(11):754-755.
88. 88. Zhang L, Wang C, Yan Q, Zhang T, Han Z, Jiang G. Diagnostic and clinical application value of magnetic resonance imaging (MRI) for progressive massive fibrosis of coal worker pneumoconiosis. Medicine. 2017;96(20):e6890.
89. 89. Weissman DN. Progressive massive fibrosis: An overview of the recent literature. Pharmacol Ther. 2022;240:108232. doi:10.1016/j.pharmthera.2022.108232
90. 90. Zhang L, Wang C, Yan Q, Zhang T, Han Z, Jiang G. Diagnostic and clinical application value of magnetic resonance imaging (MRI) for progressive massive fibrosis of coal worker pneumoconiosis. Medicine. 2017;96(20):e6890.
91. 91. Simsek C, Uzmezoglu B, Algin O, Sari G. A comparison of MRI findings in cases with progressive massive fibrosis and lung cancer. ERS International Congress 2020 Abstracts. Published online 2020. Accessed December 19, 2025. https://publications.ersnet.org/content/erj/56/suppl64/4170.abstract
92. 92. Carnevale F, Rosental PA. Silica, Silicosis, and Occupational. Silicosis: A World History. Published online 2017:206.
93. 93. Silicosis, Committee SD. Diseases associated with exposure to silica and nonfibrous silicate minerals. Arch Pathol Lab Med. 1988;112:673-720.
94. 94. Churg A, Green FH. Pathology of occupational lung disease. (No Title). Published online 1988. Accessed December 19, 2025. https://cir.nii.ac.jp/crid/1130282272768505856
95. 95. Mukhopadhyay S, Gal AA. Granulomatous lung disease: an approach to the differential diagnosis. Arch Pathol Lab Med. 2010;134(5):667-690.
96. 96. Rosen Y. Pathology of granulomatous pulmonary diseases. Arch Pathol Lab Med. 2022;146(2):233-251.
97. 97. Ragavi E, Ashwin K, Ghanshyam V, Prasana R. Silico-Tuberculosis Mimicking Malignancy. Cureus. 2024;16(7). Accessed December 19, 2025. https://search.proquest.com/openview/a1f5019a039385b642a09257853924e5/1?pq-origsite=gscholar&cbl=2045583
98. 98. Barboza CEG, Winter DH, Seiscento M, Santos U de P, Terra Filho M. Tuberculosis and silicosis: epidemiology, diagnosis and chemoprophylaxis. J Brasileiro de Pneumologia. 2008;34:959-966.
99. 99. Ehrlich R, Barker S, te Water Naude J, et al. Accuracy of computer-aided detection of occupational lung disease: silicosis and pulmonary tuberculosis in ex-miners from the South African gold mines. Int J Environmental Res Public Health. 2022;19(19):12402.
100. 100. Organization WH. WHO Consolidated Guidelines on Tuberculosis. Module 3: Diagnosis–Rapid Diagnostics for Tuberculosis Detection. World Health Organization; 2024. Accessed December 19, 2025. https://books.google.com/books?hl=tr&lr=&id=z6YOEQAAQBAJ&oi=fnd&pg=PR7&dq=WHO+consolidated+guidelines+on+tuberculosis&ots=INxLrlCm6u&sig=aLkr-ioO48WkHq1q-QgprD3sCzs
101. 101. Hong Kong Chest Service, Tuberculosis Research Centre, Madras, British Medical Research Council. A Controlled Clinical Comparison of 6 and 8 Months of Antituberculosis Chemotherapy in the Treatment of Patients with Silicotuberculosis in Hong Kong. Am Rev Respir Dis. 1991;143(2):262-267. doi:10.1164/ajrccm/143.2.262
102. 102. Rupani MP. A mixed-methods study on impact of silicosis on tuberculosis treatment outcomes and need for TB-silicosis collaborative activities in India. Scientific Rep. 2023;13(1):2785.
103. 103. Tüberküloz Tani ve Tedavi Rehberi.; 2019. https://hsgm.saglik.gov.tr/depo/birimler/tuberkuloz-db/Dokumanlar/Rehberler/Tuberkuloz_Tani_ve_Tedavi_Rehberi.pdf
104. 104. García-Basteiro AL, Eyüboglu FÖ, Rangaka MX. The Challenge of Tuberculosis in the 21st Century: ERS Monograph 101. Vol 101. European Respiratory Society; 2023. Accessed December 22, 2025. https://books.google.com/books?hl=tr&lr=&id=KOveEAAAQBAJ&oi=fnd&pg=PP2&dq=127.%09Garc%C3%ADa-Basteiro,+Alberto+L.,+F%C3%BCsun+%C3%96ner+Ey%C3%BCboglu,+and+Molebogeng+X.+Rangaka,+eds.+The+challenge+of+tuberculosis+in+the+21st+century:+ERS+monograph+101.+Vol.+101.+European+Respiratory+Society,+2023.&ots=gfnMyfFJpE&sig=cnA4UvlaPZNjmJElL0iJu-y8N90
105. 105. Cupido G, Günther G. Post tuberculosis lung disease and tuberculosis sequelae: A narrative review. Indian J Tuberculosis. 2024;71(1):64-72.
106. 106. Irfan M. Post-tuberculosis pulmonary function and noninfectious pulmonary disorders. Int J Mycobacteriol. 2016;5(Suppl 1):S57.
107. 107. Leung CC, Yew WW, Law WS, et al. Smoking and tuberculosis among silicotic patients. Eur Respiratory J. 2007;29(4):745-750.
108. 108. Tse LA, Yu IT, Qiu H, Leung CC. Joint effects of smoking and silicosis on diseases to the lungs. PloS One. 2014;9(8):e104494.
109. 109. Monaco A. Antituberculous Chemoprophylaxis in Silicotics. Bulletin of the International Union Against Tuberculosis. 1964;35:51-56.
110. 110. Hong Kong Chest Service/Tuberculosis Research Centre, Madras/British Medical Research Council. A Double-blind Placebo-controlled Clinical Trial of Three Antituberculosis Chemoprophylaxis Regimens in Patients with Silicosis in Hong Kong. Am Rev Respir Dis. 1992;145(1):36-41. doi:10.1164/ajrccm/145.1.36
111. 111. Ruan QL, Huang XT, Yang QL, et al. Efficacy and safety of weekly rifapentine and isoniazid for tuberculosis prevention in Chinese silicosis patients: a randomized controlled trial. Clin Microbiol Infect. 2021;27(4):576-582.
112. 112. Cowie RL. Short course chemoprophylaxis with rifampicin, isoniazid and pyrazinamide for tuberculosis evaluated in gold miners with chronic silicosis: a double-blind placebo controlled trial. Tubercle Lung Dis. 1996;77(3):239-243.
113. 113. Churchyard GJ, Fielding KL, Lewis JJ, et al. A Trial of Mass Isoniazid Preventive Therapy for Tuberculosis Control. N Engl J Med. 2014;370(4):301-310. doi:10.1056/NEJMoa1214289
114. 114. Organization WH. WHO Operational Handbook on Tuberculosis. Module 1: Prevention-Tuberculosis Preventive Treatment. World Health Organization; 2024. Accessed December 22, 2025. https://books.google.com/books?hl=tr&lr=&id=JU5HEQAAQBAJ&oi=fnd&pg=PR6&dq=138.%09WHO+consolidated+guidelines+on+tuberculosis.+Module+1:+prevention+%E2%80%93+tuberculosis+preventive+treatment,+second+edition.+Geneva:+World+Health+Organization%3B+2024.+https://iris.who.int/server/api/core/bitstreams/314ddea2-6fc2-4ff0-9357-a038feca1d31/content+Date+last+accessed:+30+November+2025.&ots=x71GQFgowy&sig=xyXahqTAF6sCyjQIQna-11EjdSQ
115. 115. Sterling TR. Guidelines for the treatment of latent tuberculosis infection: recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recommendations and Reports. 2020;69. Accessed December 22, 2025. https://www.cdc.gov/mmwr/volumes/69/rr/rr6901a1.htm
116. 116. Ehrlich R, Murray J, Rees D. Subradiological silicosis. Am J Industrial Med. 2018;61(11):877-885. doi:10.1002/ajim.22909
117. 117. Deslauriers JR, Redlich CA. Silica Exposure, Silicosis, and the New Occupational Safety and Health Administration Silica Standard. What Pulmonologists Need to Know. Annals ATS. 2018;15(12):1391-1392. doi:10.1513/AnnalsATS.201809-589ED
118. 118. Yönetmeliği TM. Resmi Gazete Tarihi: 05.11. 2013. Resmi Gazete Sayısı. 2013;28812.
119. 119. JE C. Diseases associated with exposure to silica and nonfibrous silicate minerals. Arch Pathol Lab Med. 1988;112:673-720.
120. 120. Kim EA, Kang SK. Historical review of the List of Occupational Diseases recommended by the International Labour organization (ILO). Ann of Occup and Environ Med. 2013;25(1):14. doi:10.1186/2052-4374-25-14
121. 121. Saliba MF, Karam ZZ, Khayat ME, et al. Risk factors for silicotuberculosis among miners: a scoping review. BMC Public Health. 2025;25(1):287. doi:10.1186/s12889-025-21362-x
122. 122. Howlett P, Mousa H, Said B, et al. Silicosis, tuberculosis and silica exposure among artisanal and small-scale miners: a systematic review and modelling paper. PLOS Global Public Health. 2023;3(9):e0002085.
123. 123. Cobelens F, Kik S, Esmail H, Cirillo DM, Lienhardt C, Matteelli A. From latent to patent: rethinking prediction of tuberculosis. Lancet Respiratory Med. 2017;5(4):243-244.
124. 124. Gribben KC, Poole JA, Nelson AJ, et al. Relationships of serum CC16 levels with smoking status and lung function in COPD. Respir Res. 2022;23(1):247. doi:10.1186/s12931-022-02158-8
125. 125. Rupani MP, Soundararajan S. Survival analysis shows tuberculosis patients with silicosis experience earlier mortality and need employer-led care models in occupational settings in India. Scientific Reports. 2024;14(1):28891.
126. 126. Diez M, Bleda MJ, Alcaide J, et al. Determinants of health system delay among confirmed tuberculosis cases in Spain. Eur J Public Health. 2005;15(4):343-349.
127. 127. Cowie RL, Hay M, Thomas RG. Association of silicosis, lung dysfunction, and emphysema in gold miners. Thorax. 1993;48(7):746-749.
128. 128. Kumari J, Advani M, Purohit G. Prevalence of pulmonary hypertension in chronic simple silicosis patients and its correlation with smoking history, occupation type, age and duration of silica exposure. Monaldi Arch Chest Dis. 2024;94(4). Accessed December 22, 2025. https://www.monaldi-archives.org/macd/article/view/2719
129. 129. Hatman EA, Karagül DA, Oyman EK, Tüzün B, Şimşek KO, Kılıçaslan Z. Premature deaths due to silicosis in Turkey, 2006–2017: a twelve-year longitudinal study. Balkan Med J. 2021;38(6):374.