Background and objective:
To describe the clinical-radiological-pathological characteristics and treatment outcomes of childhood exogenous lipoid pneumonia (ELP) and elucidate oil administration practices.
Methods:
A retrospective study of children with histologically-confirmed ELP at Red Cross Children’s Hospital, South Africa. Caregivers were interviewed to understand oil administration practices.
Results:
Twelve children of Zimbabwean heritage aged 2.1-10.8 months were identified between 2012 and 2017. Repeated oral administration of plant-based oil for cultural reasons was reported by 10/11 caregivers. Cough (12/12), tachypnea (11/12), hypoxia (9/12) and diffuse alveolar infiltrates on chest radiography (12/12) were common at presentation. Chest computed tomography revealed ground glass opacification with lower zone predominance (9/9) and interlobular septal thickening (8/9). All bronchoalveolar lavage specimens appeared cloudy/milky, with abundant lipid laden macrophages and extracellular lipid on Oil-Red-O staining and documented polymicrobial (6/12) and Mycobacterium abscessus (2/12) co-infection. Antibiotics, systemic corticosteroids and therapeutic partial lung lavage were interventions in all, 8 and 5 patients respectively. Median time to clinical resolution was 1.1 months IQR (0.5-8.0) with radiological resolution only in 2/12 cases.
Conclusions:
Paediatric ELP resembles pulmonary alveolar proteinosis. Health workers should explicitly probe for a history of oil administration in children with non-resolving pneumonia and consider the diagnosis of ELP in settings where this is a common practice.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uct/oai:localhost:11427/29819 |
| Date | 25 February 2019 |
| Creators | Marangu, Diana Mwendwa |
| Contributors | Zampoli, Marco, Gray, Diane, Vanker, Aneesa |
| Publisher | University of Cape Town, Faculty of Health Sciences, Department of Paediatrics and Child Health |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Masters Thesis, Masters, MPhil |
| Format | application/pdf |
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