Main Article Content
Welders’ lung, pneumoconiosis, manganism, T1 hyperintesity, blood manganese levels
Background: Biomarkers of manganese (Mn) exposure and manganism are poorly understood. Blood Mn levels are often used to assess exposure, while brain Mn accumulation may be demonstrated by pallidal hyperintensity at magnetic resonance imaging (MRI). Mn-containing electrodes used in manual metal arc welding may be associated with the welder's lungs. Methods: A cross-sectional study was set up to compare T1 intensity in basal ganglia at MRI and Mn blood levels in subjects with or without pneumoconiosis. Clinical, radiological, pulmonary function and laboratory parameters were assessed among 154 welders referred to our hospital for suspected pulmonary pathology. Results: The study group included 123 male welders with pneumoconiosis (79.9%) and 31 welders without pulmonary damage (20.1%). The cases without pneumoconiosis were younger (38.5±6.6 vs 42.1±7.1, p=0.012). Cases with pneumoconiosis had blood lower Mn levels [13.5 (10-21)] as compared to those without pneumoconiosis [18.5 (7.8- 34)], p=0.035. In the same groups, the cases with high blood Mn levels were 49 (39.8%) and 18 (58.1%) p= 0.052, respectively. Brain MRI hyperintensity was found in 86 (55.8%) subjects with welder's lung 63 (51.2) but also in 23 (74.2) individuals without welder's lung. MRI hyperintensity in basal ganglia was significantly related to high blood Mn (p<0.005). Conclusion: This is the first study evaluating blood Mn levels of welders and their correlation with pulmonary and neurological effects. Poor working conditions may be associated with exposure to Mn and fibrogenic fumes leading to chronic lung diseases and hyperintensity in brain MRI suggesting Mn accumulation.
2. US Bureau of Labor Statistics. Available from: https://www.bls.gov/ooh/production/welders-cutters-solderers-and-brazers.htm. Accessed December 2020.
3. Esnaf ve Sanatkâr İstatistikleri Bülteni T.C. Gümrük ve Ticaret Bakanlığı Esnaf ve Sanatkârlar Genel Müdürlüğü 2014. Available at esnaf.gtb.gov.tr/data/53fdcc9ef29370a0e461fadf/Temmuz_2014.pdf. Ac-cessed December 2020.
4. Antonini JM, Lewis AB, Roberts JR, Whaley DA. Pulmonary effects of welding fumes: review of worker and experimental animal studies. Am J Ind Med. 2003;Apr;43(4):350-60. Doi: 10.1002/ajim.10194. PMID: 12645092
5. Howden DG, Desmeules MJA, Saracci R, Sprince NL, Herber PI. Respiratory hazards of welding: Occupa-tional exposure characterization. Am Rev Respir Dis. 1988;138:1047-1048.
6. Beckett WS. Metal industry and related jobs (including welding). In Occupational and Environmental Lung Diseases Ed Tarlo SM, Cullinan P, Nemery B. 2010, John Wiley & Sons: 350-60
7. American Welding Society (AWS) Safety and Health Committee. Effects of welding on health. XIV:2011.550 NW (US). Available from: https://www.aws.org/standards/page/effects-of-welding-on-health. Accessed December 2021.
8. Billings CG, Howard P. Occupational siderosis and welders' lung: a review. Monaldi Arch Chest Dis. 1993;48:304-314.
9. Buerke U, Schneider J, Rosler J, Woitowitz HJ. Interstitial pulmonary fibrosis after severe exposure to welding fumes. Am J Ind Med. 2002;41(4): 259-268.
10. Kalliomäki PL, Sutinen S, Kelhä V, Lakomaa E, Sortti V, Sutinen S. Amount and distribution of fume con-taminants in the lungs of an arc welder post mortem. Br J Ind Med. 1979;Aug;36(3):224-30. Doi: 10.1136/oem.36.3.224. PMID: 500782; PMCID: PMC1008569
11. Şimşek C. Kaynakçı Akciğeri Türkiye Klinikleri, Tıp Bilimleri 1992;12:212-8.
12. Taube F. Manganese in occupational arc welding fumes-aspects on physiochemical properties, with focus on solubility. Ann Occup Hyg. 2013;Jan;57(1):6-25. Doi: 10.1093/annhyg/mes053. Epub 2012 Sep 20. PMID: 22997412
13. Defazio G, Soleo L, Zefferino R, Livea P. Manganesetoxicity inserumlessdissociated mesencephalic and striatal primary cultures. Brain Res. Bull. 1996;40:257.
14. Wolff NA, Garrick MD, Zhao L, Garrick LM, Ghio AJ, Thevenod F. A role for divalent metal transporter (DMT1) in mitochondrial uptake of iron and manganese. Sci Rep. 2018;8:211. Doi: 10.1038/s41598-017-18584-4
15. Dorman DC, Struve MF, Marshall MW, Parkinson CU, James RA, Wong BA. Tissue manganese concentra-tions in young male rhesus monkeys following subchronic manganese sulfate inhalation. Toxicol Sci. 2006;92:201-210.
16. Kim Y, Kim KS, Yang JS, et al. Increase in signal intensities on T1-weighted magnetic resonance images in asymptomatic manganese-exposed workers. Neurotoxicology. 1999;20:901-907.
17. Li SJ, Jiang L, Fu X, et al. Pallidal index as biomarker of manganese brain accumulation and associated with manganese levels in blood: a meta-analysis. PLoS One. 2014;9:e93900.doi: 10.1371/journal.pone.0093900. PMID: 24718592; PMCID: PMC3981755.
18. American Thoracic Society. Standardization of Spirometry,1994 update. Am J Respir Crit Care Med. 1995;152(3):1107-36. Doi: http://dx.doi.org/10.1164/ajrccm.152.3.7663792
19. International Labour Office. Guidelines for the use of the ILO International Classification of Radiographs of Pneumoconioses. ILO Occupational Safety and Health Series No. 22. Revised edition. Geneva: ILO; 2011. pp. 1-11.
20. Morgan WKC. Arc welders’ lung complications by conglomeration. Am Rev Respir Dis. 1962;85:570-575.
21. Yu IJ, Song KS, Chang HK, et al. Lung fibrosis in Sprague-Dawley rats, induced by exposure to manual metal arc-stainless steel welding fumes. Toxicol Sci. 2001;63(1):99-106.
22. Wongwit W, Kaewkungwal J, Chantachum Y, Visesmanee V. Comparison of biological specimens for man-ganese determination among highly exposed welders. Southeast Asian J Trop Med Public Health 2004; 35(3):764-769.
23. Lu L, Zhang LL, Li GJ, Guo W, Liang W, Zheng W. Alteration of serum concentrations of manganese, iron, ferritin, and transferrin receptor following exposure to welding fumes among career welders. Neurotoxi-cology. 2005;Mar;26(2):257-65. Doi: 10.1016/j.neuro.2004.09.001. PMID: 15713346; PMCID: PMC4002285
24. Halatek T, Sinczuk-Walczak H, Szymczak M, Rydzynski K. Neurological and respiratory symptoms in shipyard welders exposed to manganese. Int J Occup Med Environ Health. 2005;18(3): 265-274.
25. Racette BA, Mcgee-Minnich L, Moerlein S, Mink J, Videen T, Perlmutter JS. Welding-related parkinsonism: Clinical features, treatment, and pathophysiology. Neurology. 2001;56(1):8-13.
26. Kim Y. High signal intensities on T1-weighted MRI as a biomarker of exposure to manganese. Ind Health. 42(2):111-115, 2004.
27. Olanow CW. Manganese-induced parkinsonism and Parkinson’s disease. Ann N Y Acad Sci. 2004; 1012:209–223.