Olive oil aspiration pneumonia (lipoid) in children

Lipoid Pneumonia Secondary to Diesel Aspiration: An Occupational Hazard

Lipoid pneumonia is defined as a type of pneumonia that occurs as a result of inhalation of either endogenous or exogenous lipid-containing products in the lungs. We present the case of a 55-year-old male patient who presented with chief complaints of cough with blood-tinged sputum, right-sided chest pain, dyspnea, and fever for two days. The patient gave a history of working as a mechanic in an automobile garage and reported an episode of accidental aspiration of diesel during diesel siphoning at the workplace. A chest X-ray and computed tomography (CT) scan of the chest were done, which revealed right-sided lower lobe consolidation. The patient was admitted and started on intravenous antibiotics, corticosteroids, and inhaled bronchodilators, along with oxygen support. A bronchoscopy was done, which revealed the presence of thick mucoid secretions in the right lower lobe bronchus. The patient was discharged after 10 days with stable vitals and was advised to have regular follow-ups to monitor for any long-term pulmonary complications.

A case of infantile exogenous lipoid pneumonia with an unusual complication managed by modified whole lung lavage

Exogenous lipoid pneumonia (ELP) is a known complication of lipid administration through either the nasal or oral route. ELP in paediatric patients is usually managed by discontinuing lipid administration and supportive care, including respiratory support and the use of antibiotics for secondary bacterial infection. The other modalities that remain controversial include the use of corticosteroids and clearing lipids by whole lung lavage. We report a 2-month-old infant who presented with pneumonia and whose further history revealed exposure to ghee over a month period while visiting her grandparents in the south region of Saudi Arabia. The patient was later diagnosed as having ELP and was successfully managed with modified whole lung lavage till weaned off from oxygen. Unfortunately, the case was complicated by nontuberculous Mycobacterium chelonae, and the patient died despite maximum intervention.

Exogenous lipoid pneumonia in children: A systematic review

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.

Acute exogenous lipoid pneumonia presenting as spontaneous air leak following accidental baby oil aspiration

Exogenous lipoid pneumonia (ELP) is an uncommon cause of respiratory distress. The practice of oil massage and oil instillation into the nostrils is common in the Indian subcontinent. Accidental aspiration of baby oil may lead to significant chemical pneumonitis. This presentation may vary from subtle to severe respiratory distress requiring intensive care management. Spontaneous air leaks are rare in acute ELP. We successfully managed a six-month-old girl presenting with mineral oil-induced ELP and air leaks. However, these children require long-term follow-up, as a small proportion may evolve into chronic lung disease.

Herbs use in Saudi children with acute respiratory illnesses

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.

The Combined Use of Inhaled and Intravenous Steroids for Children With Chemical Pneumonitis After Ingestion of Paint Thinner

Background

Some studies in the literature support the use of either inhaled or systemic steroids for the treatment of chemical pneumonitis; however, no data have been published on the combined use of inhaled and intravenous (IV) steroids.

Objectives

This brief report describes the effective use of inhaled plus systemic steroids in managing six critical pediatric patients.

Patients and Methods

Medical records of patients were analyzed retrospectively.

Results

Of the six patients, 83.3% (n = 5) were male and 16.7% (n = 1) were female, with a mean age of 2.1 ± 0.49 years. The most common clinical signs were dyspnea (83.3%), fever (66.6%), and vomiting (66.6%). Owing to supportive treatments and the combined steroid treatment, respiratory distress diminished and there was no need for oxygen in any of the patients after 5 days. All patients were discharged without any sequelae.

Conclusions

The use of steroids in treating hydrocarbon pneumonias is still controversial. However, we suggest that the combined use of inhaled and intravenous steroids had positive effects on the clinical and radiological recovery of our patients.

"Diesel siphoner's lung": Exogenous lipoid pneumonia following hydrocarbon aspiration

Lipoid pneumonia is an unusual and uncommon form of pneumonia caused by aspiration of fatty substances. Hydrocarbon pneumonitis following aspiration of diesel is a form of exogenous lipoid pneumonia wherein, aspirated diesel reaches the alveoli rapidly without evoking any significant cough, but initiates an intense inflammatory reaction in the pulmonary parenchyma. This is a rarely described clinical scenario, although the practice of diesel siphonage from automobiles is a common practice in developing countries. We herein describe a 40-year-old male patient, in whom the diagnosis of lipoid pneumonia was delayed for a long duration and highlight the importance of taking a detailed occupational exposure history in patients with non-resolving pneumonia to rule out the underlying possibility of this rare clinical entity.

Analysis of Fatty Acids in Ghee and Olive Oil and Their Probable Causal Effect in Lipoid Pneumonia

Lipoid pneumonia develops when lipids enter the bronchial tree. This form of pneumonia is common in some developing countries where it is a traditional practice to give infants oily products (ghee and olive oil) for various reasons. We have analyzed and identified the fatty acids found in homemade ghee and in olive oil and compared them to fatty acids found in bronchoalveolar lavage of children with lipoid pneumonia. The three fatty acids common to homemade ghee, olive oil and bronchoalveolar lavage are linoleic, oleic, and stearic. The rest of the fatty acids, namely, lauric, myristoleic, myristic, pentadecenoic, pentadecanoic, heptadecenoic and heptadecanoic are found either in homemade ghee and/or olive oil but not in bronchoalveolar lavage. Therefore the deleterious effects to the lung parenchyma found in lipoid pneumonia are probably caused by these three fatty acids. Further investigations are required to ascertain the effects of the individual fatty acids found in homemade ghee and olive oil.

Evolução da pneumonia lipoide exógena em crianças: aspectos clínicos e radiológicos e o papel da lavagem broncoalveolar

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.

Exogenous lipoid pneumonia caused by facial application of petrolatum

Exogenous lipoid pneumonia is a well-described entity in the literature. To our knowledge, this is the first reported case that occurred secondary to external application of petrolatum to the face for erythrodermic psoriasis.

Prevention of murine influenza A virus pneumonitis by surfactant nano-emulsions

Non-ionic surfactant nano-emulsions have extensive anti-microbial activity and are biocompatible with skin and mucous membranes at effective concentrations. Two nano-emulsion formulations (8N8 and 20N10) made from soybean oil, tributyl phosphate and Triton X-100, were tested for their ability to prevent murine influenza virus pneumonia in vivo. In the initial study, CD-1 mice were administered various dilutions of the nano-emulsions intranasally, and safe dosages and concentrations were determined. Non-toxic concentrations of the nano-emulsions were then mixed with influenza virus and applied to the nares of mice. Animals receiving mixtures of two different emulsions (8N8 or 20N10) and a LD50 of virus survived the challenge without evidence of viral infection. To determine if the nano-emulsions could prevent influenza virus infection in vivo when used as a prophylactic treatment, the nano-emulsions (8N8 at 1.0% and 20N10 at 1.0% or 0.2%) were applied to mouse nares 90 min before exposure to 5x10(5) p.f.u./ml virus by nebulized aerosol. Animals pretreated with the nano-emulsions had significantly decreased clinical signs of infection. Only 26.0% (8N8 at 1.0%), 31.25% (20N10 at 1.0%) and 37.0% (20N10 at 0.2%) of animals pretreated with nano-emulsion died from pneumonitis, whereas >80.0% of mock pretreated animals succumbed to infection (P<0.005). These findings suggest that non-ionic surfactant nano-emulsions have therapeutic potential for the prevention of influenza virus infection in vivo.