Comparison of Long Term Follow-up Chest CT Imaging in Adult and Pediatric Patients with Humidifier Disinfectant-related Lung Injury

Abstract

Background To compare the chest computed tomography (CT) images of children and adults in families with clusters of humidifier disinfectant-related lung injury (HDLI) after cessation of exposure to humidifier disinfectant (HD). Methods We reviewed medical records of 19 families with 43 patients (21 adults, 22 children) among families, which had at least one adult and one child with HDLI. Each family was exposed to the same HD exposure environment. Results In adults, centrilobular nodules were predominant (95.2%) in chronic HDLI findings after cessation of exposure to HD, however, in children, normal pattern was most prevalent on chest CT (45.5%), followed by centrilobular nodule (36.4%), bizarre lung cysts (36.4%), and reticulation (13.6%). Conclusion Unlike the known chronic HDLI finding of adults, centrilobular nodules were only present in 36.4% of children. The frequency of bizarre lung cysts were significantly greater in children than that in adults after cessation of similar exposure to HD. Thus, bizarre lung cysts may be useful as another novel finding of chronic HDLI in children who have no history of pulmonary infection or other perinatal disorder such as hyaline membrane disease or other interstitial lung disease.

Health Effects Associated With Humidifier Disinfectant Use: A Systematic Review for Exploration

“…For group 1, studies published on humans, a total of 49 articles were selected ( Table 2 ). 1 2 3 4 5 6 7 9 10 11 12 13 14 17 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 The suspicion that humidifier disinfectant might be a cause of lung damage was suggested in 2011. Studies in international journals began to appear in 2013.…”

“…Forty-eight published studies using non-human animal subjects or in vitro toxicology studies were included in the review ( Table 3 ). 16 39 40 41 42 43 44 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 To investigate the hazardous effects of humidifier disinfectants, in vitro studies were performed using various cell lines, and toxicity tests were performed using several animal models. Cytotoxicity, lung fibrosis, and pulmonary genotoxicity due to PHMG exposure were described as a consequence of toxicity testing undertaken shortly after HDLI was reported.…”

“…The long-term follow-up of HDLI patients revealed that central lobular nodules remained in the majority of adults but disappeared in the majority of children. 44 However, even at long-term follow-up, lung function was not recovered in patients with severe HDLI. 24 Furthermore, an animal study found that long-term follow-up after repeated exposure suppressed the expression of specific genes in the lungs.…”