KEROSENE POISONING IN CHILDREN: AN OVERVIEW

Hydrocarbon pneumonitis with abscess formation following diesel siphoning

A man in his early 40s presented with a 1-month history of fever after accidental diesel aspiration. He had received treatment with intravenous antibiotics, steroids and supportive care. Contrast-enhanced CT of the thorax revealed a right middle lobe lung abscess and bronchoscopy revealed hyperaemia around the middle lobe bronchus. The abscess was initially managed by drainage using a pigtail catheter and intravenous antibiotics. However, only partial drainage of the abscess was achieved and fever persisted. The cardiothoracic surgery team performed drainage of lung abscess through a right posterolateral thoracotomy. Postprocedure, the patient's symptoms improved and the patient was discharged in good health. This case demonstrates a rare complication of hydrocarbon aspiration pneumonitis and lung abscess. Post acute management of diesel aspiration, patients should be advised to return for medical assessment immediately, should symptoms like persistent fever and chest pain recur or persist as these symptoms may herald the development of post-hydrocarbon-aspiration lung abscess.

Association Between Solid Cooking Fuels and Respiratory Disease Across Socio-Demographic Groups in India

BACKGROUND

The use of solid fuels in household cooking contributes to indoor air pollution and is the cause of more than 4 million deaths around the world annually. Solid fuel use varies with the level of development and ranges from 0% in high-income countries to more than 80% in low- and middle-income countries. Three billion people (more than 40% of the global population) are still dependent on solid fuels like firewood, dung cakes, coal, wood and agricultural residues in these countries.

OBJECTIVES

The present study aims to analyze the association of certain respiratory diseases (tuberculosis (TB), acute upper respiratory infections (AURI), chronic obstructive pulmonary diseases (COPD), and bronchial asthma) with the use of solid fuels for cooking across sociodemographic groups in India.

METHODS

The 71st round of the National Sample Survey, conducted in 2014, was used. In total, 54,985 inpatients who received medical treatment from any medical institution during the last 365 days preceding the survey and who reported various diseases, such as infections, cancers, blood diseases, cardiovascular diseases, and respiratory diseases were included in the analysis. Of these inpatients, 2513 participants who reported TB, AURI, COPD and bronchial asthma were considered the dependent variables in the study. The main variable was exposure to different types of fuels used as a primary source of energy for cooking. Multinomial logistic regression was used to explain associations.

RESULTS

The results reveal a significant association between solid fuel use and respiratory diseases in India. Overall, more than 60% of the population uses firewood and cow dung as their primary source of energy for cooking and are at a higher risk of TB, COPD and bronchial asthma. In rural areas there is a high dependence on solid fuels (80.5%) and a higher risk of respiratory diseases compared to those residing in urban areas where people are less dependent on solid fuels (22%). Among different socio-demographic groups, the dependence on solid fuels is highest among Scheduled Tribes (87.42%), followed by Scheduled Castes (74.78%) and Other Backward Classes (OBCs) (a term used by the Indian government to categorize castes that face social or educational challenges) (64.47%). Scheduled Tribes have the highest risk of TB, followed by Scheduled Castes and OBCs, respectively.

CONCLUSIONS

Exposure to solid fuels for cooking increases the potential risk of TB, COPD and bronchial asthma. Access to clean and efficient fuels for cooking is essential to reduce the burden of respiratory disease. Measures are needed to increase the availability of clean fuels for households, especially among socially disadvantaged and marginalized groups, to reduce the burden of respiratory diseases in India.

COMPETING INTERESTS

The authors declare no competing financial interests.

Lung diseases associated with hydrocarbon exposure

The human race has been exposed to the potential toxicity of hydrocarbons, whether by the inhaled or ingested route, for thousands of years and the consequent inflammatory reaction in the lungs depends on the degree of exposure, volatility and viscosity of the particular hydrocarbon in question. Heating, lighting, transportation, industry and nature all provide the potential for both inhalation and/or ingestion of hydrocarbons. Some forms, such as those related to petroleum products, e.g. diesel exhaust particles (DEP) and polycyclic aromatic hydrocarbons (PAH) have been shown to cause both malignant and non-malignant respiratory diseases. Accidental ingestion represents another significant exposure risk and we now have increasing evidence that pollutant particles may adsorb allergens to their surface and potentially enhance the allergic response. It seems unlikely that this potential will significantly decrease in the near future and depending on individual socio-economic circumstances, work environment and habitation, the risks of significant lung disease will vary. This review outlines the domestic, outdoor, occupational and natural sources of hydrocarbon exposure and considers the evidence relating to radiological and pathological lung changes in both animals and man. The acute effects of hydrocarbon toxicity are well recognised but the effects of longer term, lower exposure, and the mechanisms of their toxicity, require further research.