Dr John E. Parker worked in West Virginia hospital in 2015 when 31 year old female patients with acute respiratory problems were admitted. Doctors' staff suspected that her mysterious lipoid pneumonia case could be related to steam and we were unsure of seeing anything like it before. They were very interested in presenting a case report – a type of medical paper on unusual or stimulating patient outcomes. Such reports can be a call to the medical community to watch, although they sometimes raise more questions than they answer.
This summer, nearly four years later, federal officials began investigating a national outbreak of major lung illnesses that were involved in steam which met more than 150 patients in 16 states. In an interview, Parker, a professor of critical pulmonary care and sleep medicine at the University of West Virginia, sent down on what happened.
Q: Can you describe the patient's symptoms when she arrived?
We would expect them to be classic from which called lung-related disease of steam. She was very rough and had a cough, and we were, of course, concerned that she could have pneumonia or other acute respiratory illness. And then she was so sick that she had to be turned.
Q: What happens next in cases like this?
We look for things like [hemorrhage] or active infection. And then for macrophages containing lipid. And then we usually start on some antibiotics [and a] low-dose steroid and then supports the patient with ventilator and oxygen and nutrition. And then just wait and see if any other cultures come back to create anything else than you might be thinking.
Soon, we felt it was an unusual case and maybe not a common viral or bacterial infection.
Q: How did you find out why her lipoid pneumonia or e-cigarettes were caused?
It is a diagnosis of exclusion. We issued other people [options], and the most likely reason was.
We were satisfied that the case was presented in that year at the annual College of Physicians of the American Chest College.
Q: When you could say that the reason was e-cigarettes, did you contact the Disease Control and Prevention Centers or the Food and Drug Administration or any other regulatory agency to tell them this?
We didn't. We felt at the time that it was appropriate to place it in medical literature. And if other case reports from other parts of the country were brought forward, then we had more clusters of results that could warrant research agencies t [getting a] better understanding [about] the cause of the disease.
Q: Which federal agency would you let him know if you did?
In 2015, of course, the FDA was controlling cigarettes, but I do not think the government had yet decided who would regulate steam products. So I'm sure it wasn't clear who we should call.
Q: So did you or your team think that this was a once-off event when you saw it?
We really felt that it would not be a one-off event and that we usually had in a public health event a “mental health event”… that it is an example of respiratory illness that can result from this exposure and probably not. the first case ever seen was the last.
Q: Is the first case you saw at your institution?
We know that the first case we had was, but many clinicians understand that I might have missed some other cases we interpreted [as] viral pneumonia or bacterial pneumonia.
Q: Have you seen more cases since then?
I know we've seen a case [of alveolar hemorrhage syndrome] we published, and in some colleagues we think it is likely, we will also see [cases of] Cryptogenic pneumonia is also organized with lipoid pneumonia and acute eosinophilic pneumonia. Yes, we will certainly see at least four forms of lung disease from steam.
Q: If your team were looking at this in 2015, can it be happening in the four years ago and people don't know about it?
I have every reason I think, in fact, we were not the first one to see it, in any way.
And I don't think we are the first person to report it. I think there were some clusters in Wisconsin and some other places in the United States. I also know that the Japanese are very interested. They are likely to have received at least four or five papers in medical literature relating to steam related injury.
Q: Do you have a theory about what might cause lipoid pneumonia cases? Do you think some chemicals may be irritating?
We need a strong multidisciplinary team to understand the real biology and cause of inhalation of lung. I think it could be any number of ingredients in the mixtures. Oil lungs generally do not like, and probably the most distinctive agent recently studied is diacetyl, which was studied in a role-lung lung disease.
Q: Have these types of cases changed the way you go to patients?
Yeah, we search very carefully the history of evaporation. … I think it is important to understand whether they could be using inhalation agents or steam that may give new toxins to the lung.
Q: Will these illnesses have long-term health effects?
An acute injury could cause a severe injury to the lung that is life-threatening and that one could survive and have no long-term sequelae [condition]. But there is also the possibility that it will be long-term [e-cigarette] use that cannot be fully recovered may result in chronic or chronic diseases.
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