“…Sarcoidosis in not a rare condition in Africa—[ 232 , 233 ], the apparent infrequency of reporting being probably a result of misdiagnosis (as, e.g., tuberculosis)—[ 234 , 235 ]. Further research is therefore necessary in Africa to unravel the various clinical aspects of this mysterious and complex disease Exposure to toxic metals and rare earth elements (REEs) in the environment—[ 236 – 238 ]; Metal dusts—[ 239 ]; Crystalline silica—[ 231 ]; Industrial exposure to Be—[ 240 ] Since low dose metal particles can induce monocyte / macrophage survival (See e.g., Lacey et al—[ 241 ]), as recently as 2021, Lepzien et al—[ 242 ] went on to show that monocytes could be a vital marker in understanding the inflammatory process of sarcoidosis | Geographic clustering of disease in many parts of the world has long been noted, [e.g., in the US (Sartwell and Edwards—[ 243 ]); this (clustering) has ignited further speculations concerning weather, soil, and foliage in the pathogenesis of sarcoidosis. More recently (2019), Ramos-Casals et al—[ 244 ] asserted that local weather is a key environmental factor influencing the incidence of sarcoidosis in a specific geographical area, with the peak of diagnosed cases following a specific seasonal distribution pattern | The causes of sarcoidosis are still unknown and epidemiological data are often discordant—[ 245 , 246 ] Although the aetiology of this condition remains uncertain, Ganeshan et al [ 247 ] consider that the role of environmental and genetic factors may be considerable in any proposed causative mechanism According to Ahmadzai et al—[ 248 ], in sarcoidosis, conventional sampling techniques or cultures of non-caseating granulomas cannot detect tissue micro-organisms; although as Newman earlier (1998)—[ 236 ] proposed, clinicians should use a systematic approach to investigating the occupational and environmental history and immunologic responses of patients with sarcoidosis, for discriminating metal-induced granulomatosis from sarcoidosis | 19. |
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