Silicotuberculosis: Current Evidence, Clinical Challenges, and Management Strategies

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.