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Pathological findings in suspected cases of e-cigarette, or vaping, product use-associated lung injury (EVALI): a case series.
Reagan-Steiner, Sarah; Gary, Joy; Matkovic, Eduard; Ritter, Jana M; Shieh, Wun-Ju; Martines, Roosecelis B; Werner, Angela K; Lynfield, Ruth; Holzbauer, Stacy; Bullock, Hannah; Denison, Amy M; Bhatnagar, Julu; Bollweg, Brigid C; Patel, Mitesh; Evans, Mary E; King, Brian A; Rose, Dale A; Baldwin, Grant T; Jones, Christopher M; Krishnasamy, Vikram; Briss, Peter A; Weissman, David N; Meaney-Delman, Dana; Zaki, Sherif R.
Afiliação
  • Reagan-Steiner S; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA. Electronic address: sor1@cdc.gov.
  • Gary J; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Matkovic E; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Ritter JM; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Shieh WJ; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Martines RB; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Werner AK; National Center for Environmental Health, Atlanta, GA, USA.
  • Lynfield R; Minnesota Department of Health, Saint Paul, MN, USA.
  • Holzbauer S; Center for Preparedness and Response, Atlanta, GA, USA; Minnesota Department of Health, Saint Paul, MN, USA.
  • Bullock H; Synergy America, Atlanta, GA, USA.
  • Denison AM; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Bhatnagar J; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Bollweg BC; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Patel M; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Evans ME; National Center for Injury Prevention and Control, Atlanta, GA, USA.
  • King BA; National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA.
  • Rose DA; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
  • Baldwin GT; National Center for Injury Prevention and Control, Atlanta, GA, USA.
  • Jones CM; National Center for Injury Prevention and Control, Atlanta, GA, USA.
  • Krishnasamy V; National Center for Injury Prevention and Control, Atlanta, GA, USA.
  • Briss PA; National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA.
  • Weissman DN; Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
  • Meaney-Delman D; National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA.
  • Zaki SR; Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Atlanta, GA, USA.
Lancet Respir Med ; 8(12): 1219-1232, 2020 12.
Article em En | MEDLINE | ID: mdl-32763198
BACKGROUND: Since August, 2019, US public health officials have been investigating a national outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). A spectrum of histological patterns consistent with acute to subacute lung injury has been seen in biopsies; however, autopsy findings have not been systematically characterised. We describe the pathological findings in autopsy and biopsy tissues submitted to the US Centers for Disease Control and Prevention (CDC) for the evaluation of suspected EVALI. METHODS: Between Aug 1, 2019, and Nov 30, 2019, we examined lung biopsy (n=10 individuals) and autopsy (n=13 individuals) tissue samples received by the CDC, submitted by 16 US states, from individuals with: a history of e-cigarette, or vaping, product use; respiratory, gastrointestinal, or constitutional symptoms; and either pulmonary infiltrates or opacities on chest imaging, or sudden death from an undetermined cause. We also reviewed medical records, evaluated histopathology, and performed infectious disease testing when indicated by histopathology and clinical history. FINDINGS: 21 cases met surveillance case definitions for EVALI, with a further two cases of clinically suspected EVALI evaluated. All ten lung biopsies showed histological evidence of acute to subacute lung injury, including diffuse alveolar damage or organising pneumonia. These patterns were also seen in nine of 13 (69%) autopsy cases, most frequently diffuse alveolar damage (eight autopsies), but also acute and organising fibrinous pneumonia (one autopsy). Additional pulmonary pathology not necessarily consistent with EVALI was seen in the remaining autopsies, including bronchopneumonia, bronchoaspiration, and chronic interstitial lung disease. Three of the five autopsy cases with no evidence of, or a plausible alternative cause for acute lung injury, had been classified as confirmed or probable EVALI according to surveillance case definitions. INTERPRETATION: Acute to subacute lung injury patterns were seen in all ten biopsies and most autopsy lung tissues from individuals with suspected EVALI. Acute to subacute lung injury can have numerous causes; however, if it is identified in an individual with a history of e-cigarette, or vaping, product use, and no alternative cause is apparent, a diagnosis of EVALI should be strongly considered. A review of autopsy tissue pathology in suspected EVALI deaths can also identify alternative diagnoses, which can enhance the specificity of public health surveillance efforts. FUNDING: US Centers for Disease Control and Prevention.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesão Pulmonar Aguda / Vaping Tipo de estudo: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Lancet Respir Med Ano de publicação: 2020 Tipo de documento: Article País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesão Pulmonar Aguda / Vaping Tipo de estudo: Diagnostic_studies / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male País/Região como assunto: America do norte Idioma: En Revista: Lancet Respir Med Ano de publicação: 2020 Tipo de documento: Article País de publicação: Reino Unido