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Marangu D, Gray D, Vanker A, Zampoli M. Exogenous lipoid pneumonia in children: A systematic review. Paediatr Respir Rev 2020; 33:45-51. [PMID: 30962152 PMCID: PMC7106224 DOI: 10.1016/j.prrv.2019.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/08/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To describe the clinical-radiological-pathological characteristics and treatment outcomes of children with suspected exogenous lipoid pneumonia (ELP). DESIGN Systematic review. We searched electronic databases and reference lists published between 1967 and 2018, restricted to non-accidental cases. RESULTS Forty-four studies including 489 participants aged 1 day to 17 years from 13 countries were included. Cultural, medical, and behavioural rationale for oil-use was described. The clinical-radiological presentation varied widely. Diagnostic certainty was deemed highest if ELP was confirmed on bronchoalveolar lavage/frozen section lung biopsy with documented extracellular lipid on cytological staining and/or fat analysis. Non-tuberculous mycobacteria infection was identified in six studies: Mycobacterium fortuitum/chelonei, Mycobacterium smegmatis and Mycobacterium abscessus. Treatment comprised supportive therapy, corticosteroids, stopping oil, therapeutic lung-lavage and surgical resection. Outcomes were reported inconsistently. CONCLUSION Paediatric ELP resulting from cultural and medical practices continues to be described globally. Preventive interventions, standardized reporting, and treatment efficacy studies for cases not averted, are lacking. Protocol registration: PROSPERO CRD42017068313.
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Affiliation(s)
- Diana Marangu
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya; Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - Diane Gray
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Aneesa Vanker
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Marco Zampoli
- Division of Paediatric Pulmonology, Department of Paediatrics and Child Health and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
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Alharbi NS, Alenizi AS, Al-Olayan AM, Alobaidi NA, Algrainy AM, Bahadhailah AO, Alhunayni AA, Alqurashi HD, Alrohaimi YA. Herbs use in Saudi children with acute respiratory illnesses. Sudan J Paediatr 2018; 18:20-24. [PMID: 30799894 DOI: 10.24911/sjp.106-1538457624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The current study aims to evaluate the prevalence of the utilization of various herbal remedies in children hospitalized with lower respiratory illnesses and assess the different herbal products which are most commonly used. Moreover, the indications of usage and the route and frequency of administration are also highlighted. All children who were hospitalized in three centers, through the period of 18 months, due to acute bronchiolitis, pneumonia, or bronchial asthma were included in this study. Any caregivers who were present during the hospitalization of such children were asked if they could respond to a questionnaire that included the names of any herbal products that they used, the indications which warranted their usage, and the frequency and route of administration. A total of 155 patients with acute lower respiratory illnesses were included. The overall prevalence of herbal medicine use was found to be 59.3%. The highest percentage of use was amongst children with bronchiolitis. Around 24 herbal products were used; the most common ones being sesame oil, fenugreek, olive oil, and dates. The most common indications of use were in order to relieve cough and abnormal breathing. The oral route was the main route of administration (95.7%) followed by nasal administration (4.3%). The median number of frequency of administration was two times. In conclusion, the use of herbal medicine in Saudi children with acute lower respiratory illnesses is very common. Further studies to assess the safety profile and possible benefits of these products are needed.
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Affiliation(s)
- Nasser S Alharbi
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S Alenizi
- King Saud Medical City, Children Hospital, Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, Saudi Arabia
| | - Abudllah M Al-Olayan
- Department of Pediatrics, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
| | - Nadhar A Alobaidi
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alanood M Algrainy
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani O Bahadhailah
- King Saud Medical City, Children Hospital, Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, Saudi Arabia
| | - Abdulaziz A Alhunayni
- King Saud Medical City, Children Hospital, Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, Saudi Arabia
| | - Hashim D Alqurashi
- King Saud Medical City, Children Hospital, Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, Saudi Arabia
| | - Yousef A Alrohaimi
- Department of Pediatrics, College of Medicine, Majmaah University, Al Majmaah, Saudi Arabia
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Abstract
OBJECTIVE To analyze the clinical and imagenological characteristics of acute Exogenous lipoid pneumonia (ELP), explore its risk factors, and assess the potential role of multiple bronchoalveolar lavages (BALs) and steroid therapy in the treatment of children with acute ELP. METHODS Between May 2011 and July 2014, 33 pediatric patients with pneumonia caused by aspiration of oil-based substances were admitted to the Guangzhou Women and Children's Medical Center, Guangdong, China. Data on the demographics of these patients, as well as that on clinical presentations, imagenological characteristics, history of ingestion, laboratory observations, treatment protocol, response to therapy, BAL findings, and treatment outcomes were collected. RESULTS The study group consisted of 23 boys (69.7 %) and 10 girls (30.3 %), with ages ranging from 4 mo to 4 y. They were admitted to the hospital 2 h to 13 d after ingesting the oil-based substance. By the time of admission, most patients presented with respiratory distress and other symptoms, including tachypnea (n = 21), cough (n = 25), mild fever (n = 18), progressive dyspnea (n = 12), and pneumorrhagia (n = 5); six patients received mechanical ventilation because of complicated respiratory distress syndrome. The most common laboratory observations were leukocytosis (25 of 33, 75.8 %), neutrophilia (23 of 33, 69.7 %), and anemia (8 of 33, 24.2 %). Serum biochemical examination showed elevated sedimentation rates (24 of 33, 72.7 %), lactate dehydrogenase levels (18 of 33, 54.5 %), and C-reactive protein levels (17 of 33, 51.5 %). The most common finding on computed tomography (CT) scans was areas of consolidation. Within the follow-up duration of 2 wk to 6 mo, all patients with clinical symptoms of ELP experienced remission, and none died. The CT scans of most of the cases were normal by 1 to 3 mo, except for two patients who showed complete improvement 6 mo after treatment. CONCLUSIONS It was found that multiple BALs combined with steroid therapy result in significant improvement of clinical, radiologic, and laboratory parameters in children with acute ELP. Further, some traditional practices may predispose children to ELP, even in the absence of underlying risk factors. Finally, pneumorrhagia and acute respiratory distress syndrome may be the main complications of acute ELP in children.
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Stathis G, Priftis KN, Moustaki M, Alexopoulou E. Non-resolving Findings in a Long-term Radiographic Follow-up of an Infant with Acute Paraffin Oil Aspiration. J Clin Imaging Sci 2014; 4:2. [PMID: 24678434 PMCID: PMC3952376 DOI: 10.4103/2156-7514.126028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/17/2013] [Indexed: 12/17/2022] Open
Abstract
Acute lipoid pneumonia (LP) in children is a rare disorder caused by the aspiration of oil-based substances and is difficult to diagnose due to non-specific clinical symptoms and radiological findings. We report the case of a 5-month-old male infant with acute LP caused by accidental aspiration of a large amount of mineral oil. We present the imaging findings in the computed tomography scans performed during his hospitalization and focus on the residual abnormalities seen on a scan performed 7-years after the incident. This, to the best of our knowledge, is the longest follow-up report of an acute exogenous LP patient and the only case that demonstrates non-resolving abnormalities in a pediatric patient after a single acute episode of mineral oil aspiration.
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Affiliation(s)
- George Stathis
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
| | - Konstantinos N Priftis
- Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
| | - Maria Moustaki
- Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
| | - Efthymia Alexopoulou
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, General University Hospital "ATTIKON", Chaidari, GR 124 62, Athens, Greece
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Rabahi MF, Ferreira AA, Madeira JGP, Galvao PM, Pinto SA. Lipoid pneumonia secondary to long-term use of evening primrose oil. J Bras Pneumol 2011; 36:657-61. [PMID: 21085832 DOI: 10.1590/s1806-37132010000500018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 05/24/2010] [Indexed: 11/22/2022] Open
Abstract
Lipoid pneumonia is an underdiagnosed disease that is caused by the aspiration of lipid particles into the lungs. Although most of the reported cases have been associated with the use of mineral oil as a laxative, other lipid substances can also cause the disease. We report the case of a 50-year-old female patient with a complaint of productive cough who was initially diagnosed with bronchial hyperresponsiveness and gastroesophageal reflux disease (GERD). The patient was treated for GERD. Because the productive cough persisted, the patient underwent chest CT, fiberoptic bronchoscopy, and open lung biopsy. She was diagnosed with lipoid pneumonia. The patient was questioned regarding the use of lipid substances, and she reported the chronic use of evening primrose oil. After the discontinuation of the substance and the maintenance of GERD treatment, her condition improved.
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Affiliation(s)
- Marcelo Fouad Rabahi
- Department of Clinical Medicine, Federal University of Goiás School of Medicine, Goiânia, Brazil.
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Affiliation(s)
- Dolly Sharma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
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Kim ES, Kim KW, Song TW, Cho SH, Kim MJ, Kim KE, Sohn MH. Squalene-induced exogenous lipoid pneumonia in an infant. Pediatr Int 2009; 51:751-3. [PMID: 19799746 DOI: 10.1111/j.1442-200x.2009.02902.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Eun Soo Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Sias SMDA, Ferreira AS, Daltro PA, Caetano RL, Moreira JDS, Quirico-Santos T. Evolução da pneumonia lipoide exógena em crianças: aspectos clínicos e radiológicos e o papel da lavagem broncoalveolar. J Bras Pneumol 2009; 35:839-45. [DOI: 10.1590/s1806-37132009000900004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 05/05/2009] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever os aspectos da evolução da pneumonia lipoide em crianças, com base em aspectos clínicos, radiológicos e de achados no lavado broncoalveolar, enfatizando a importância diagnóstica e terapêutica da lavagem broncoalveolar. MÉTODOS: Foram incluídas 28 crianças, com idade média de 20 meses (1-108 meses) e diagnóstico de pneumonia crônica refratária a antimicrobianos e/ou TB. A maioria apresentava um fator de risco para aspiração, e todas apresentavam história de ingestão de óleo mineral para o tratamento de constipação intestinal (23/28) ou de ascaridíase complicada (5/28). A avaliação clínica e tomográfica e análises do lavado broncoalveolar foram realizadas no início do tratamento e em até 24 meses. RESULTADOS: Os sintomas mais frequentes foram taquipneia e tosse. As principais alterações radiológicas foram consolidações (23/28), infiltrado peri-hilar (13/28) e hiperinsuflação (11/28). A TC de tórax mostrou consolidações com broncograma aéreo (24/28), diminuição de atenuação nas áreas de consolidação (16/28), opacidade em vidro fosco (3/28) e padrão em mosaico (1/28). O estudo do lavado broncoalveolar apresentava macrófagos espumosos corados por Sudan, confirmando o diagnóstico da pneumonia lipoide. Após tratamento com múltiplas lavagens broncoalveolares (média = 9,6), 20 crianças tornaram-se assintomáticas, havendo normalização tomográfica em 18. CONCLUSÕES: O diagnóstico de pneumonia lipoide deve ser considerado na pneumonia crônica ou TB refratárias ao tratamento, especialmente se houver história de ingestão de óleo mineral. A broncoscopia com múltiplas lavagens broncoalveolares mostrou-se eficiente para a depuração do óleo aspirado do parênquima pulmonar e a prevenção da fibrose, contribuindo para a redução da morbidade dessa doença, que ainda é pouco diagnosticada.
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Armangil D, Canpolat FE, Erdal N, Korkmaz A, Tekinalp G. Lipoid pneumonia caused by intranasal butter application in a newborn infant. J Paediatr Child Health 2009; 45:475-6. [PMID: 19712187 DOI: 10.1111/j.1440-1754.2009.01542.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sias SMA, Daltro PA, Marchiori E, Ferreira AS, Caetano RL, Silva CS, Müller NL, Moreira J, Quirico-Santos T. Clinic and radiological improvement of lipoid pneumonia with multiple bronchoalveolar lavages. Pediatr Pulmonol 2009; 44:309-15. [PMID: 19283836 DOI: 10.1002/ppul.20918] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To assess the potential role of multiple bronchoalveolar lavages (BALs) in the treatment of children with lipoid pneumonia (LP). MATERIALS AND METHODS This prospective study included 10 children (7 female, 3 male) with LP secondary to mineral oil aspiration. The age ranged from 3 months to 7 years and 1-60 days history of mineral oil intake, with a 6 months clinic follow-up. High-resolution computer tomography (CT) was performed 1-7 days prior to treatment and 2-20 days after the last therapeutic BAL, and reviewed by two experienced chest radiologists. Oxygen saturation was measured with digital oximetry. Therapeutic BAL was performed weekly until BAL fluid was nearly transparent and the cell count returned to normal range values. RESULTS In all children, the initial CT scans showed multifocal bilateral consolidation involving mainly the dorsal and central regions. The areas of consolidation had foci of decreased attenuation in eight patients. Following a total of 4-10 therapeutic BALs, the CT scans returned to normal in 3 patients, improved considerably in 5, and showed only slight improvement in 2. Oxygen saturation increased from 88.8 +/- 3.4% at presentation to 96.2 +/- 0.8% after treatment (P < 0.0001). Multiple lavages reduced (P < 0.003) numbers of lipid-laden macrophages and restored BAL cellularity to normal range values. CONCLUSION Multiple therapeutic BAL of children with LP results in significant improvement of CT findings, oxygen saturation, restoration of BAL fluid cellularity and clinical recover without any evidence of respiratory distress at the end of treatment and 6 months after the last BAL.
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Affiliation(s)
- Selma M A Sias
- Department of Pediatrics, Hospital Universitario Antonio Pedro, Fluminense Federal University, Rio de Janeiro, Brazil.
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Adhisivam B, Mahadevan S. Oil that spoils the child. Indian J Pediatr 2006; 73:544. [PMID: 16816526 DOI: 10.1007/bf02759908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Baron SE, Haramati LB, Rivera VT. Radiological and Clinical Findings in Acute and Chronic Exogenous Lipoid Pneumonia. J Thorac Imaging 2003; 18:217-24. [PMID: 14561906 DOI: 10.1097/00005382-200310000-00002] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the radiologic and clinical findings in a group of patients with exogenous lipoid pneumonia focusing on features that differentiate the acute and chronic presentations. MATERIALS AND METHODS We retrospectively identified 15 patients from a single institution with exogenous lipoid pneumonia 1992-2001. Inclusion criteria were: imaging with chest CT and either CT features diagnostic of lipoid pneumonia or intrapulmonary lipids on pathologic examination. Each chart was reviewed for the clinical presentation, history of ingestion/exposure, predisposing factors, treatment and response to therapy. Initial (n = 13) and follow-up (n = 11) chest radiographs were reviewed for the patterns and distribution of lung parenchymal abnormalities and pleural effusion. Initial (n = 15) and follow-up (n = 7) CT scans were reviewed for lung parenchymal abnormalities (consolidation, ground glass opacities, linear/nodular opacities, masses, and crazy paving), presence or absence of fat attenuation, and pleural effusion. The groups were compared using the Fischer exact test. RESULTS Nine patients had acute lipoid pneumonia, 7 males and 2 females with a mean age of 45 (range 4.5-81) years. Six patients had chronic lipoid pneumonia, 4 men and 2 women with a mean age of 63 (range 37-83) years. 78% (7/9) of patients with acute and all of the patients with chronic presentations had a known ingestion and/or a predisposing condition associated with lipoid pneumonia. On chest radiographs, consolidation and lower lobe involvement were present in the majority of patients with acute and none of the patients with chronic presentations. On CT, consolidation and fat attenuation were present in the majority of patients with each presentation. However, masses were present in 67% (4/6) of patients with chronic and none of the patients with acute presentation (P < 0.05). 86% (6/7) of patients with acute presentation had improvement on follow-up chest radiograph in contrast to none of the patients with chronic presentation (P < 0.05). 75% (3/4) of patients with acute lipoid pneumonia had improvement on follow-up CT in contrast with 67% (2/3) of patients with chronic lipoid pneumonia who had progression on follow-up CT. CONCLUSIONS The imaging features of acute and chronic lipoid pneumonia overlap with consolidation and lower lobe involvement present in both groups. However, only the patients with acute lipoid pneumonia had pleural effusions and improvement on follow-up. Only the patients with chronic lipoid pneumonia had pulmonary masses.
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Affiliation(s)
- Shira E Baron
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA
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Pérez Payá A, Martínez Serrano C, López Andreu JA, Cortell Aznar I, Roqués Serradilla JM. [Rapid development of pneumonia]. An Pediatr (Barc) 2003; 58:619-20. [PMID: 12781126 DOI: 10.1016/s1695-4033(03)78136-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- A Pérez Payá
- Sección de Neumología Pediátrica. Hospital Universitario La Fe. Valencia. España
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Abstract
This review summarizes important pathological lesions of the lung that typically present radiographically with an 'alveolar pattern'. For each entity, the latest findings as to its pathogenesis, aetiology and pathology are reviewed in the introductory remarks. We then present the typical radiological appearances alongside macroscopic and microscopic pathological photographs. It is hoped that the parallel presentation of radiological image with the pathology will enhance the understanding of the diverse range of diseases the aevolar pattern comprises.
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Affiliation(s)
- J Stahl
- Department of Anatomical Pathology and Division of Medical, Imaging, Flinders Medical Centre, Bedford Park, South Australia, Australia.
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