title: Successful treatment of lipoid pneumonia associated with bowel obstruction by Ascaris lumbricoides.
abstract: Partial bowel obstruction is a serious complication of ascariasis infestation generally treated with mineral oil. This prospective study aimed to evaluate the efficacy of multiple bronchoalveolar lavages (BAL) as a therapeutic strategy for reducing lung inflammation of lipoid pneumonia associated with ascariasis. The study included five children (mean age 25 months) with partial small-bowel obstruction by Ascaris lumbricoides, who underwent diagnostic bronchoalveolar lavage for assessment of refractory pneumonia. Routine biochemical, microbiological and cytological analysis were carried out in the BAL. Protein, lactate dehydrogenase and tumor necrosis factor-alpha (TNF-α) cytokine levels were determined in the serum before and after treatment. At admission, children consistently had respiratory symptoms, altered hematological function, increased immunoglobulin E serum level and peripheral blood eosinophilia. Chest tomography showed consolidation with air bronchogram (4/4), ground-glass infiltration (3/4) and decreased attenuation in the consolidation areas (2/4). Presence of marked pleocytosis with Sudan positive foamy alveolar macrophages, high protein and lactate dehydrogenase levels in the BAL indicated presence of mixed alveolitis. One child with extensive consolidation and air bronchogram in both lungs died before treatment. Multiple bronchoalveolar lavages efficiently removed alveolar oil deposits, restored BAL cellularity, improved clinical symptoms, radiological parameters and further reduced inflammatory reaction evidenced by marked decrease of the inflammatory cytokine, TNF-α. This study presents a therapeutic strategy for management of lung complications caused by mineral oil administration to treat intestinal bowel obstruction associated with ascariasis.
authors.affiliation: Department of Pediatrics, Hospital Universitario Antonio Pedro, Fluminense Federal University, Rio de Janeiro, Brazil. selma_sias@vm.uff.br
authors.forename: Selma
authors.initials: S
authors.lastname: Azevedo Sias
authors.forename: Regina
authors.initials: R
authors.lastname: Oliveira Caetano
authors.forename: Júlia
authors.initials: J
authors.lastname: Dutra Comarella
authors.forename: Elen
authors.initials: E
authors.lastname: de Oliveira
authors.forename: Angela
authors.initials: A
authors.lastname: Santos Ferreira
authors.forename: Thereza
authors.initials: T
authors.lastname: Quirico-Santos
mesh_terms: D001196:Ascariasis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D018893:Bronchoalveolar Lavage / Q000379:methods; D002675:Child, Preschool; D004643:Emollients / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000188:drug therapy / Q000469:parasitology*; D007421:Intestine, Small / Q000000981:diagnostic imaging; D008899:Mineral Oil / Q000008:administration & dosage / Q000009:adverse effects*; D011017:Pneumonia, Lipid / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome
chemical_list: D004643:Emollients; D008899:Mineral Oil