Thread by @PulmCrit

vaping-induced lung injury cases continue to rise (now 450 cases & 5 deaths). this thread summarizes some key points from fresh articles in NEJM & MMWR to help us stay on our toes with this emerging disease (1/8).

epidemiology:
- mostly young men (likely reflects the population using modified vape products)
- most patients report vaping with tetrahydrocannabinol (but not all)
- generally previously healthy (2/8)
nejm.org/doi/full/10.10…

upon admission, most patients have symptoms in three domains:
1) respiratory (dyspnea, chest pain, cough)
2) GI (n/v, diarrhea, pain) - may be *dominant* symptom initially
3) constitutional (fever, chill, weight loss, fatigue)

Upper respiratory tract usually uninvolved (3/8)

Deterioration occurs slowly over days (median one week illness before admission). ~1/3 patients evaluated & sent home during this period (often with azithromycin). so keep this in mind for patients with mild resp and/or GI symptoms-- patients *won't* be super sick initially (4/8)

radiology at hospital admission:
- 90% CXR with bilateral infiltrates
- 100% CT with bilateral ground-glass opacities (often sparing periphery, but not always)
- May also see pleural effusion, micronodular tree-in-bud pattern, patchy consolidation, pneumomediastinum (5/8)

labs are generally nonspecific
- Usually white blood count elevation with left shift
- Acute phase markers (ESR, CRP) usually elevated
- Procalcitonin may be slightly elevated (6/8)

workup focuses on exclusion of alternative diagnoses (esp infection). bronchoscopy isn't always necessary (only ~half of patients in Layden et al. underwent bronch). when in doubt, empiric coverage with antibiotics plus steroid may be reasonable (7/8).

for suspected or confirmed cases, contact the local health department to report cases & get further advice. more info:
- CDC: bit.ly/2lWykRe
- IBCC: bit.ly/2MpatWo (8/8)