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 1â¯day to 17â¯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.
Subject(s)
Culture , Oils/adverse effects , Pneumonia, Lipid/etiology , Adrenal Cortex Hormones/therapeutic use , Anti-Bacterial Agents/therapeutic use , Biopsy , Bronchoalveolar Lavage , Chest Pain , Child , Constipation/therapy , Cough , Dietary Supplements , Humans , Hypoxia , Laxatives/therapeutic use , Mouthwashes/therapeutic use , Mycobacterium Infections, Nontuberculous/complications , Nasal Lavage , Oils/therapeutic use , Osteoarthropathy, Primary Hypertrophic , Oxygen Inhalation Therapy , Palliative Care , Pneumonia, Bacterial/complications , Pneumonia, Lipid/diagnostic imaging , Pneumonia, Lipid/microbiology , Pneumonia, Lipid/therapy , Pneumonia, Viral/complications , Respiration, Artificial , Risk Factors , Tachypnea , Tuberculosis, Pulmonary/complicationsABSTRACT
A 1-year old female spayed German Shepherd dog was evaluated for acute onset of dyspnea. Pyogranulomatous inflammation and green globoid structures were present on aspirates of the affected lung. Impression smears and histopathology confirmed pyogranulomatous pneumonia, with large amounts of lipid corresponding to the green structures noted cytologically, and identified poorly staining bacterial rods within lipid vacuoles. Special stains confirmed the presence of acid-fast bacterial rods, and polymerase chain reaction and DNA sequencing identified the organism as Mycobacterium fortuitum. M. fortuitum pneumonia is well described in humans and has previously been reported in 4 dogs and 1 cat. Lipid was a prominent cytologic and histologic feature, as is often described in humans and in the single feline case report. Additionally, this case highlights the variable cytologic appearance of lipid, as well as Mycobacterium spp, which are classically nonstaining with Wright-Giemsa.
Subject(s)
Dog Diseases/microbiology , Mycobacterium Infections, Nontuberculous/veterinary , Mycobacterium fortuitum/isolation & purification , Pneumonia, Lipid/veterinary , Animals , Base Sequence , Dog Diseases/pathology , Dogs , Fatal Outcome , Female , Molecular Sequence Data , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium Infections, Nontuberculous/pathology , Mycobacterium fortuitum/genetics , Pneumonia, Lipid/microbiology , Pneumonia, Lipid/pathology , Polymerase Chain Reaction/veterinary , Sequence Analysis, DNA/veterinaryABSTRACT
Endogenous lipoid pneumonia is an uncommon condition. This is a report of a 29-year-old woman diagnosed with endogenous lipoid pneumonia associated with Legionella pneumophila serogroup 1 infection. The patient's endogenous lipoid pneumonia resolved completely after treatment for Legionella pneumophila infection. This suggests that early diagnosis and aggressive treatment of the underlying infection may prevent any long-term sequelae of lipoid pneumonia.
Subject(s)
Legionella pneumophila/classification , Legionnaires' Disease/diagnosis , Pneumonia, Lipid/diagnosis , Pneumonia, Lipid/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Aza Compounds/therapeutic use , Azithromycin/therapeutic use , Female , Fluoroquinolones , Humans , Legionnaires' Disease/drug therapy , Legionnaires' Disease/microbiology , Moxifloxacin , Pneumonia, Lipid/drug therapy , Quinolines/therapeutic use , Treatment OutcomeABSTRACT
Postprimary tuberculosis occurs in immunocompetent people infected with Mycobacterium tuberculosis. It is restricted to the lung and accounts for 80% of cases and nearly 100% of transmission. Little is known about the immunopathology of postprimary tuberculosis due to limited availability of specimens. Tissues from 30 autopsy cases of pulmonary tuberculosis were located. Sections of characteristic lesions of caseating granulomas, lipid pneumonia, and cavitary stages of postprimary disease were selected for immunohistochemical studies of macrophages, lymphocytes, endothelial cells, and mycobacterial antigens. A higher percentage of cells in lipid pneumonia (36.1%) and cavitary lesions (27.8%) were positive for the dendritic cell marker DEC-205, compared to granulomas (9.0%, P < .05). Cavities contained significantly more T-regulatory cells (14.8%) than found in lipid pneumonia (5.2%) or granulomas (4.8%). Distribution of the immune cell types may contribute to the inability of the immune system to eradicate tuberculosis.
Subject(s)
Antigens, CD , Lectins, C-Type , Receptors, Cell Surface , T-Lymphocytes, Regulatory , Tuberculosis, Pulmonary , Antigens, Bacterial/analysis , Antigens, Bacterial/immunology , Antigens, CD/analysis , Antigens, CD/immunology , Autopsy , Biomarkers/analysis , Dendritic Cells/immunology , Dendritic Cells/pathology , Foam Cells/immunology , Foam Cells/pathology , Granuloma/immunology , Granuloma/microbiology , Granuloma/pathology , Humans , Immunohistochemistry , Lectins, C-Type/analysis , Lectins, C-Type/immunology , Lung/immunology , Lung/microbiology , Lung/pathology , Minor Histocompatibility Antigens , Mycobacterium tuberculosis/immunology , Organ Specificity , Pneumonia, Lipid/immunology , Pneumonia, Lipid/microbiology , Pneumonia, Lipid/pathology , Receptors, Cell Surface/analysis , Receptors, Cell Surface/immunology , T-Lymphocytes, Regulatory/immunology , T-Lymphocytes, Regulatory/pathology , Tuberculosis, Pulmonary/immunology , Tuberculosis, Pulmonary/microbiology , Tuberculosis, Pulmonary/pathologyABSTRACT
Endogenous lipoid pneumonia (ELP) is a rare clinical entity associated with malignant neoplasms, connective tissue disease, benign bronchial tumors and rarely infections. We present to you the first case report of ELP associated with tuberculosis.
Subject(s)
Pneumonia, Lipid/microbiology , Tuberculosis, Pulmonary/complications , Female , Humans , Middle Aged , Pneumonia, Lipid/diagnostic imaging , Pneumonia, Lipid/pathology , Radiography , Tuberculosis, Pulmonary/diagnostic imaging , Tuberculosis, Pulmonary/pathologyABSTRACT
Super-infection of an exogenous lipoid pneumonia by nontuberculous mycobacteria has been described in the literature. It produces a distinctive histologic picture with suppurative, noncaseating granulomas surrounding lipid vacuoles containing acid-fast bacilli. Mainly isolated cases have been found, but seldom in children. We describe a series of 9 children with similar histological findings. All our patients were under 1 year of age, malnourished, and with chronic respiratory symptoms. The diagnosis, based on the characteristic histology with acid-fast rods, was established at autopsy in 4 cases, on lobectomy specimens in 4 and by open lung biopsy in 1. Mycobacterium fortuitum-chelonei was cultured in 1 case. Gastro-esophageal reflux was documented in all 4 cases in which it was explored. Aspiration of lipid gastric contents or of oil given as medication can result in exogenous lipoid pneumonia, which in turn becomes super-infected with mycobacteria. Recognition of the distinctive histology permits the diagnosis of this complication.