Brazil
Revista Brasileira de Saúde Ocupacional
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Case Report • Rev. bras. saúde ocup. 51 • 2026 • https://doi.org/10.1590/2317-6369/01626en2026v51e30 linkcopy

Open-access Severe illness and deaths from silicosis in underground miners of rutilated quartz in the Chapada Diamantina region of Bahia, Brazil: a case series

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective  To describe the clinical, occupational, imaging, and functional data of 12 underground artisanal miners in the Chapada Diamantina region (Bahia, Brazil).

Methods  A case series study using data from medical records and a technical visit to the mining site.

Results  Three workers were diagnosed with accelerated silicosis, and nine with complicated chronic silicosis. The mean age was 44.1 years (SD 8.2). Eleven died due to severe silicosis. The median time between the first consultation and death was 12 months. Mining was carried out using artisanal methods, without a humidification system, resulting in the release of large amounts of dust.

Conclusion  The workers presented with severe forms of silicosis, which rapidly progressed to death. The results indicate that the described occupational activity is associated with severe forms of silicosis. The inadequacy of measures to prevent silica exposure was evident. The introduction of wet processes, the use of appropriate personal protective equipment, and the monitoring of workers´ health are some of the urgent actions that must be taken to eliminate the risks leading to these outcomes.

Keywords
Silicoses; Occupational Exposure; Silicon Dioxide; Quartz; Mining; Miners; Occupational Health; Case Reports

Resumo

Objetivo  Descrever dados clínicos, ocupacionais, de imagem e funcionais de 12 trabalhadores de mineração artesanal subterrânea na região da Chapada Diamantina, Bahia, Brasil.

Métodos  Estudo de série de casos com dados de prontuários e visita técnica ao local da mineração.

Resultados  Três trabalhadores tiveram diagnóstico de silicose acelerada e nove, de silicose crônica complicada. A idade média era de 44,1 anos (desvio-padrão: 8,2). Onze faleceram em decorrência de quadros graves de silicose. A mediana do tempo entre a primeira consulta e a data do óbito foi de 12 meses. O trabalho de mineração era realizado de forma artesanal, sem sistema de umidificação, com liberação de grande quantidade de poeiras.

Conclusão  Os trabalhadores apresentaram formas graves de silicose, com rápida evolução para óbito. Os resultados indicam que a atividade ocupacional descrita está associada a formas graves de silicose. Evidenciou-se a precariedade das medidas de prevenção da exposição à sílica. A introdução de processos úmidos, o uso de equipamentos de proteção individual adequados e o monitoramento de saúde dos trabalhadores são algumas das ações urgentes a serem tomadas para eliminar os riscos que levam a esses desfechos.

Palavras-chave
Silicose; Exposição Ocupacional; Dióxido de Silício; Quartzo; Mineração; Mineradores; Saúde do Trabalhador; Relatos de Casos

Introduction

Silicon dioxide, or silica, is the most abundant mineral in the Earth’s crust, occurring in various crystalline or amorphous forms. Among the crystalline forms, quartz is the most prevalent; it is present in various rocks such as granite, slate, and sandstone1. Exposure to crystalline silica can occur in a wide variety of activities and occupations, and the greatest risks are found in underground mining, rock extraction and processing, tunnel construction, and, more recently, in the production of residential countertops using high concentrations of quartz mixed with resins, known as engineered stone2.

In Brazil, exposure to silica continues to affect millions of workers3. It is estimated that, in 2022, there were more than two million formally registered workers in the mineral extraction sector4. Given the high prevalence of informal work, these figures should be viewed with caution, because of the sheer scope of the extractive industry in Brazil.

Occupational exposure to crystalline silica is associated with the risk of developing silicosis, lung cancer, chronic obstructive pulmonary disease, autoimmune diseases, pulmonary and extrapulmonary tuberculosis, as well as infections caused by nontuberculous mycobacteria5,6.

Silicosis is the most common and most impactful pneumoconiosis in Brazil and worldwide. Between 1990 and 2019, there was an absolute increase in incidence, prevalence, and morbidity and mortality – measured by disability-adjusted life years (DALYs) – of 64.6%, 91.4%, and 20.8%, respectively. However, during the same period, a slight decline was observed in these rates when standardized by age7. Although underreporting and underdiagnosis are global problems, they are likely more prevalent in low-income countries, where workplace surveillance and access to diagnosis are less effective2.

This case series describes the clinical, occupational, imaging, and functional data of 12 patients who developed severe silicosis, with a history of working in artisanal underground mining for the extraction of semiprecious stones in the Chapada Diamantina region (Bahia, Brazil).

Methods

Study design

A case report study was conducted, with the data from 12 workers treated at the Outpatient Clinic of the Unit for Occupational and Environmental Respiratory Diseases and Smoking Cessation at the Heart Institute of the Hospital das Clínicas, School of Medicine, University of São Paulo, investigating lung illness from January 2015 to May 2024.

Worker information

Data were retrospectively extracted from the medical records: clinical and occupational history, physical examination, chest X-ray, high-resolution chest computed tomography (HRCT), and pulmonary function tests. Digital subtraction chest X-ray images were acquired using the Allura DSA unit (Philips, the Netherlands) with a posteroanterior view. HRCT scans were performed using a Primer Aquilion multidetector CT scanner (Toshiba, Brazil). Pulmonary function tests were performed using the Elite DX plethysmograph (Medical Graphics Corporation, USA), and the results are presented as absolute values and as a percentage of the predicted values for the Brazilian population10.

Diagnostic assessment

All workers were diagnosed with silicosis based on an occupational history of silica exposure and compatible radiological findings, according to the International Labour Organization’s Classification of Radiographs of Pneumoconioses (ILO/2021). Cases were classified as diagnosed with acute silicosis, accelerated silicosis, and chronic silicosis using the following criteria11:

  • Acute silicosis: latency period of up to five years (60 months) and chest HRCT showing “mosaic paving” opacities and no nodules or masses;

  • Accelerated silicosis: latency period of up to 10 years (120 months) and HRCT scan showing micronodules, coalesced nodules, and/or a “mosaic paving” pattern;

  • Simple chronic silicosis: latency period of more than 10 years (120 months) and HRCT scan showing micronodules up to 10 mm in size, with no nodules or masses larger than 10 mm;

  • Complicated chronic silicosis: latency period of more than 10 years (120 months) and HRCT scan showing nodules or masses larger than 10 mm.

Information on mining activities

Information on mining activities was collected during a visit to the municipality of Novo Horizonte, in the Chapada Diamantina region (Bahia, Brazil), in 2023, followed by meetings with officials from the Directorate of Occupational Health Surveillance and Care and the Bahia State Reference Center for Occupational Health (DIVAST/CEREST), as well as public health officials from the municipal governments of Seabra (Bahia) and Novo Horizonte (Bahia), with the participation of the president of the Novo Horizonte Prospectors’ Cooperative (COOPEGANH).

Samples of rutilated quartz mined in the region were analyzed by the Institute for Technological Research (IPT) of the state of São Paulo using X-ray Fluorescence Spectrometry (XRF) and X-ray Diffraction (XRD). Prior to analysis, each sample was ground in a vibratory mill (Renard, model MPV 1) until the particles were smaller than the mesh size of a 200-mesh sieve. For XRF analyses, a Panalytical spectrometer (model PW 2404) was used with the SuperQ – Spectra Evaluation software (version 5.1B) to identify inorganic elements. XRD analyses were performed on a Panalytical Empyrean diffractometer, and the diffraction patterns were identified using the Highscore Plus software, version 4.7.To discuss the possible underreporting of silicosis in information systems, social security and health data were collected using ICD-10 codes J62, J62.8, and J64, respectively, corresponding to pneumoconiosis due to dust containing silica, , pneumoconiosis due to other dust containing silica, and unspecified pneumoconiosis, for the period from 2012 to 2022. Data on social security benefits granted and the number of Work Accident Reports (CATs) issued were obtained from the Ministry of Social Security’s Social Security Statistical Bulletin12 and the Brazilian Open Data Portal13; the number of mandatory reports of silicosis cases was obtained from the Ministry of Health’s (MS) Information System for Notifiable Diseases (SINAN)14, records of deaths and hospitalizations were extracted from the Information Technology Department of the Unified Health System (DataSUS)15 of the MS, and population data from the Brazilian Institute of Geography and Statistics (IBGE)16.

Ethical considerations

This study was approved by the Ethics Committee of the University of São Paulo School of Medicine under No. 5691/23/093 on February 8, 2024.

Results

The 12 assessed workers were diagnosed with silicosis. All had worked in artisanal underground mines for semiprecious stones (11 mining rutilated quartz and one mining dumortierite quartz) and were residents of small towns in the Chapada Diamantina region (Brotas de Macaúbas, Ibitiara, Novo Horizonte, Oliveira dos Brejinhos, and Gentio do Ouro), in the inland of the state of Bahia.

Eleven died because of severe cases of silicosis, within a timeframe ranging from weeks to months after the initial evaluation. One worker was still being treated.

Worker Assessment

The clinical and occupational characteristics are presented in Table 1.

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Table 1
Sociodemographic, occupational, and clinical data of the evaluated individuals (n=12)

Of the 12 workers followed in our outpatient clinic, 11 have died and one is still under follow-up. All were male, with a mean age at initial evaluation of 44.1 ± 8.2 years. Nine reported mMRC dyspnea grades 3-4 and 10 reported a dry cough as the most frequent symptoms. Six hypoxemic individuals used home oxygen therapy. Three reported having undergone empirical treatment for tuberculosis at healthcare facilities in their region of origin, without microbiological confirmation; two were diagnosed with latent tuberculosis during follow-up at our outpatient clinic and underwent treatment for latent infection after a negative microbiological test.

The median duration of exposure was 168 months (range: 12-240); the median latency period between the start of reported exposure and the onset of symptoms was 180 months (range: 36-348), the time between the first medical visit and the date of death was 12 months (range: 5-48), and the time between the onset of symptoms reported by the patients and death was 57 months (range: 20-73).

Figures 1A, B, and C show chest CT images of three workers, and Table 2 presents the data on the last recorded pulmonary function test for each individual.

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Table 2
Latest pulmonary function data for the evaluated individuals (n=12)

Example Clinical Case Description

Individual No. 5, a 51-year-old man, was referred for medical evaluation due to exertional dyspnea that began two years ago. He had no known medical condition and had never smoked. He had worked for 11 years in rutilated quartz mining in the city of Brotas de Macaúbas, Bahia, performing underground mining in a shaft up to 120 m deep, using dynamite and other explosives to expand the mine, which lacked a ventilation system or adequate personal protective equipment (PPE). On clinical examination, he had a peripheral oxygen saturation of 91% in room air, and pulmonary auscultation revealed overall reduced breath sounds. During the initial evaluation, he underwent a chest X-ray, HRCT scan, and pulmonary function test using plethysmography. The chest X-ray showed large type C opacities; the HRCT scan (Figure 1A) showed large bilateral pulmonary masses; the pulmonary function test (Table 2) revealed mixed ventilatory impairment, with marked reduction in carbon monoxide diffusion. He was diagnosed with complicated chronic silicosis. Treatment with formoterol, budesonide, and tiotropium was initiated. He was referred for evaluation for lung transplantation; however, the procedure was contraindicated due to the anticipated significant technical difficulties in performing a pre-transplant pneumonectomy because of masses adherent to the pleura and mediastinum, which posed a high risk of surgical complications. The dyspnea progressively worsened, requiring oxygen therapy, and he died 11 months after the diagnosis of silicosis due to respiratory failure.

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Figure 1
High-resolution chest CT images of three of the evaluated workers

Characterization of mining activities

The state of Bahia has the second-largest gemstone reserves in the country and is the leading producer of rutilated quartz17. Rutilated quartz is a type of quartz crystal that contains inclusions of golden, needle-shaped rutile filaments (titanium dioxide – TiO2); dumortierite quartz contains inclusions of dumortierite, a fibrous silicate composed of aluminum and boron (Al7BO3(SiO4)3O3), with a violet color18,19.

According to the Geological Survey of Brazil20, there are 18 active rutilated quartz mines in the region, two of which are located in the municipality of Ibipitanga, 13 in Novo Horizonte, one in the municipality of Oliveira dos Brejinhos, and two in Rio do Pires. The worker who mined dumortierite quartz, reported having worked in the municipality of Gentio do Ouro, where he stated there were between 10 and 20 different ore extraction sites.

At these mining sites, shafts between 60 and 100 meters deep are dug (Figure 2A), and from the bottom of these shafts, workers construct horizontal tunnels from which the semiprecious stones are extracted. Workers carry out the excavation using tools such as pickaxes, drills, and jackhammers, as well as explosives to blast the rock. This process releases large amounts of dust, a situation exacerbated by the fact that the equipment lacks a dust collection system at the worksite and does not have a humidification system. Workers do not use adequate personal protective equipment, but only half-face dust masks (Figure 2B), when available, although these are not replaced as frequently as necessary, and the heat and humidity at the site make them difficult to use.

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Figure 2
Images collected during a visit to the municipality of Novo Horizonte in 2023

Some of the workers in this region are affiliated with COOPEGANH, although many of the mining sites are informal and located in areas without environmental permits21,22. When the owner of the land where the mining area is located holds a license for its exploitation, both the surface and the subsoil can be mined; reportedly, the extracted material belongs to the owner, who offers workers a percentage of the proceeds from the sale of the products and, in some cases, provides housing near the mining area (Figure 2C). In general, working conditions are poor, with long workdays, strenuous physical labor, and exposure to high concentrations of dust.

Demographic indicators and disease records for the region

Table 3 presents data from the Ministry of Health information systems and social security data for the municipalities of residence of workers treated at the outpatient clinic, for the state of Bahia, and for Brazil, presented as rates per 100,000 inhabitants.

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Table 3
Rates per 100,000 inhabitants of reported deaths, hospitalizations, reported cases, and social security data by municipality of residence for the period from 2012 to 2022 for ICD-10 codes indicative of silicosis (J62, J62.8, J64)

Rock Analysis

XRD analyses of the crystalline phase of the 26 rock samples provided by the workers revealed a composition predominantly consisting of quartz (silicon dioxide), with smaller proportions of muscovite, kaolinite, and microcline. XRF analysis showed that the largest component of the chemical composition of the 26 samples is silicon, with smaller proportions of aluminum, barium, calcium, chlorine, cobalt, copper, sulfur, strontium, iron, phosphorus, yttrium, magnesium, manganese, neodymium, niobium, nickel, potassium, rubidium, sodium, titanium, zinc, and zirconium.

Discussion

The severe cases of silicosis, characterized by rapid progression and early death among the workers evaluated, highlight the need for urgent action to eliminate workplace hazards that lead to these outcomes. In response to this situation in the region, meetings were held in 2023 to assess working conditions and support environmental and occupational health surveillance efforts. It was found that many miners work under similar conditions, a fact that requires that measures be adopted promptly to prevent further deaths and illnesses.

Global data from the late 20th century estimate that artisanal and small-scale mining (ASM) employed 13 million people23, while current data suggest that this number has risen to nearly 45 million workers, who contribute a considerable portion of the global economy24. The ASM sector is broad, heterogeneous, and complex; while it represents an important source of income for millions of people, it also exerts significant pressure on the environment and presents precarious conditions for worker safety and occupational health25. In contrast to large-scale mining, it is characterized by self-employment, a predominance of labor-intensive work, and limited adoption of occupational health and safety measures26. Despite their social and economic importance, these miners remain among the most marginalized workers in the world, working under conditions that fall far short of the best international standards24. The ILO recognizes that, beyond the technical aspects of occupational safety, the underlying condition of poverty in small-scale mining – which is concentrated in low- and middle-income countries – hinders the adoption of technical improvements23. This fact does not exempt public authorities from responsibility; on the contrary, it compels them to adopt surveillance measures and health care and prevention initiatives.

A recent systematic review indicated that the prevalence of silicosis among ASM miners ranged from 11% to 37%. Regarding tuberculosis, the prevalence of microbiologically confirmed cases ranged from 1.8% to 6.1%, while cases without microbiological confirmation ranged from 3% to 17%. Between 16% and 58% of the miners were smokers. Exposure to crystalline silica ranged from 0.19 to 89.5 mg/m326, values 7.6 to 3,500 times higher than the occupational exposure limit of 0.025 mg/m3 recommended by the American Conference of Governmental Industrial Hygienists (ACGIH)27. In a cohort of workers at 10 large mining operations, the median concentration of crystalline silica ranged from 0.02 to 0.59 mg/m3, and the lifetime prevalence of silicosis ranged from 4.5% to 21%26.

Based on air sampling conducted at two underground mines, Souza et al. (2021) estimated exposure to respirable crystalline silica among 49 artisanal and small-scale amethyst mines located in Rio Grande do Sul, Brazil. Using a Bayesian model that integrated environmental monitoring data and exposure estimates, the authors determined a median exposure concentration to crystalline silica of 1.3 mg/m3 (interquartile interval: 0.42). The miners used wet drilling, an exhaust system at the tunnel entrance, and PPE, the use of which was mandatory, indicating a higher level of safety than in the mines studied here28. Two studies on ASM, tanzanite, and gold mining in Tanzania – where wet drilling was not used – identified median silica concentrations of 2.4 (interquartile range: 1.2; 3.2) mg/m3 in six samples collected over three working days at a single mine and a mean of 16.85 (standard deviation: 8.74) mg/m3 from 11 samples collected at five mines, respectively29,30.

Although the studies in Tanzania do not report the depth at which the measurements were taken, the similarity of the working conditions to those cited in the present study lends plausibility to the conclusion that workers in underground rutilated quartz mining may also be exposed to high concentrations of crystalline silica, taking into account possible differences in local geological and mineralogical conditions.

The findings among the 12 patients who traveled to São Paulo seeking medical care suggest limited access to health services in the region, a fact that may explain the low incidence of silicosis in the area. The indicators in Table 3 suggest a flawed reporting system for pneumoconioses, as there is underreporting in both the Ministry of Health’s information systems (DataSUS and SINAN) and those of Social Security. There are more reports in SINAN than in the Social Security system, especially regarding CATs; this reflects the fact that a large proportion of workers do not have formal employment status, a requirement for registering a CAT and consequently receiving workers’ compensation benefits, whereas reporting to SINAN does not depend on employment status or any social security contributions. In turn, the fact that the number of cases reported in SINAN is lower than the number of deaths suggests underreporting of pneumoconiosis cases. This situation has room for improvement, as Ministry of Health Ordinance No. 5,201, dated August 19, 2024, now classifies work-related illnesses as notifiable diseases – not only by sentinel units, but by all public and private health care providers nationwide31.

Among the workers studied, the rapid progression of the disease is striking, despite the short duration of exposure for some of them. It is important to note that many artisanal and small-scale mining workers engage in this activity seasonally, using it to supplement their income25. Thus, it is very likely that the duration of exposure to silica is shorter than what is recorded in medical records. There is no effective treatment for silicosis, other than, when possible, a lung transplant32. Of the 12 patients, eight were referred for evaluation for a lung transplant; four died before the evaluation was completed, and four were deemed ineligible for the procedure due to the high risk of intraoperative complications.

The introduction of wet processes is an essential step toward reducing silica exposure26,33. Souza et al. (2017) revealed that the lack of ventilation and the use of dry drilling in underground mines in Rio Grande do Sul were associated with a higher prevalence of silicosis34. A study conducted in underground gold mines in Minas Gerais, Brazil, analyzed free silica levels in the respirable fraction for various tasks performed underground from 1933 to 1986, finding concentration values that varied over time from 12.45 mg/m3 to 0.012 mg/m3. Over the period evaluated, a decrease in the incidence of silicosis and in the prevalence of more severe cases of the disease was also observed. The drastic change in the measured values and in the number of silicosis cases was attributed to the adoption of new technologies and changes in work processes35,36. A study of underground mining in Tanzania demonstrated that the adoption of wet processes and the use of new drill bits reduced airborne silica concentrations by 99%37. Keeping drill bits sharp is associated with lower levels of silica dust and sound pressure. Extending the waiting periods after rock blasting also allows the dust to settle. Moreover, exhaust ventilation should be used to reduce dust concentrations in the work environment. Furthermore, the use of appropriate PPE is necessary, and workers must always perform a fit test and participate in a training program on how to use and maintain PPE33,37,38.

Regarding occupational health monitoring, in addition to being informed about the risks of silica exposure and methods to reduce exposure, workers must participate in a medical follow-up program, which may require chest X-rays or chest CT scans when necessary.

Finally, measures for reporting cases of silicosis in information systems need to be revised and discussed, and workers’ access to labor and social security rights must be expanded.

To achieve the proposed objectives, representatives of employers, workers, and the public health services in the affected region must come together to provide better care for exposed and affected workers, with a greater understanding that most cases of silicosis are preventable through preventive policies26,39.

This study has some limitations. Clinical data were collected retrospectively from medical records. It was not possible to measure environmental concentrations during the visit to the mine due to a lack of equipment. In addition, only a small number of workers were evaluated, which may not reflect the condition of all those working in the region’s mines. Furthermore, since the evaluation was conducted at InCor, located in the state of São Paulo, probably workers presenting more severe conditions sought care at a tertiary hospital far from their area of residence.

The data indicate that underground mining of rutilated quartz and dumortierite quartz in Brazil is associated with severe forms of silicosis. Because it is predominantly artisanal and lacks public support to guide and implement hygiene and safety measures, this activity exposes workers to a high risk of developing the disease in its severe form. Public policies are needed to identify miners and help them implement safe mining practices, as mining is a source of income and survival for the workers’ families.

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  • Data Availability:
    The entire anonymized dataset supporting the results of this study is available in the Mendeley Data repository (DOI: https://data.mendeley.com/datasets/c72zkv57gj/1; Date of data access: June 10, 2026). Chest images (X-rays and CT scans) are available upon request to the corresponding author, as they contain sensitive information.
  • Statement on the use of Artificial Intelligence:
    No artificial intelligence tools were used in the preparation of this article.
  • Presentation at a Scientific Event:
    The authors report that the study was presented at the 2023 European Respiratory Society (ERS) Congress, which took place in Milan from September 9 to 13, 2023. The abstract was published in the Congress Proceedings, available at: https://publications.ersnet.org/content/erj/62/suppl67/pa3796.
  • Funding:
    The authors declare that the study was not subsidized.

Appendix A

(A) A sample of rutilated quartz collected by one of the patients at the mining site and analyzed by XRD. (B) Dumortierite quartz mined by one of the patients.

thumbnail of Supplementary Figure 1
Supplementary Figure 1
Semiprecious stones mined by the patients evaluated

Edited by

Data availability

The entire anonymized dataset supporting the results of this study is available in the Mendeley Data repository (DOI: https://data.mendeley.com/datasets/c72zkv57gj/1; Date of data access: June 10, 2026). Chest images (X-rays and CT scans) are available upon request to the corresponding author, as they contain sensitive information.

Publication Dates

  • Publication in this collection
    14 Sept 2026
  • Date of issue
    2026

History

  • Received
    19 Jan 2026
  • Reviewed
    04 May 2026
  • Accepted
    13 May 2026
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