Possible Risk of Invasive Pulmonary Aspergillosis with Marijuana Use during Chemotherapy for Small Cell Lung Cancer

Sutton, Sharon E.; Lum, Bert L.; Torti, Frank M.

doi:10.1177/106002808602000416

Cited by 36 publications

(17 citation statements)

References 13 publications

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“…This possibility is supported by previous case reports of invasive Aspergillus pneumonia in immunocompromised patients with AIDS [29], chronic granulomatous disease [30], bone marrow transplantation [31], renal transplantation [32] or small cell lung cancer treated with chemotherapy [33], all of whom smoked marijuana. On the other hand, these cases of invasive pulmonary aspergillosis could be due primarily to the immune compromise from their underlying disease and/or the fact that marijuana is frequently contaminated with Aspergillus fumigatus [34], although a superimposed THC-related impairment of pulmonary host defenses could be an important additive factor predisposing to opportunistic infection.…”

Section: Clinical Implications Of Marijuana-related Impairment In Alvsupporting

confidence: 59%

Smoked Marijuana as a Cause of Lung Injury

Tashkin

2005

Monaldi Arch Chest Dis

100

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P. Tashkin. In many societies, marijuana is the second most commonly smoked substance after tobacco. While Δ9-tetrahydrocannabinol (THC) is unique to marijuana and nicotine to tobacco, the smoke of marijuana, like that of tobacco, consists of a toxic mixture of gases and particulates, many of which are known to be harmful to the lung. Although far fewer marijuana than tobacco cigarettes are generally smoked on a daily basis, the pulmonary consequences of marijuana smoking may be magnified by the greater deposition of smoke particulates in the lung due to the differing manner in which marijuana is smoked. Whereas THC causes modest short-term bronchodilation, regular marijuana smoking produces a number of long-term pulmonary consequences, including chronic cough and sputum, histopathologic evidence of widespread airway inflammation and injury and immunohistochemical evidence of dysregulated growth of respiratory epithelial cells, that may be precursors to lung cancer. The THC in marijuana could contribute to some of these injurious changes through its ability to augment oxidative stress, cause mitochondrial dysfunction, and inhibit apoptosis. On the other hand, physiologic, clinical or epidemiologic evidence that marijuana smoking may lead to chronic obstructive pulmonary disease or respiratory cancer is limited and inconsistent. Habitual use of marijuana is also associated with abnormalities in the structure and function of alveolar macrophages, including impairment in microbial phagocytosis and killing that is associated with defective production of immunostimulatory cytokines and nitric oxide, thereby potentially predisposing to pulmonary infection. In view of the growing interest in medicinal marijuana, further epidemiologic studies are needed to clarify the true risks of regular marijuana smoking on respiratory health.

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Section: Clinical Implications Of Marijuana-related Impairment In Alvsupporting

confidence: 59%

Smoked Marijuana as a Cause of Lung Injury

Tashkin

2005

Monaldi Arch Chest Dis

100

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“…HIV infection is associated with a predisposition to respiratory disease as a result of both immunologic and nonimmunologic factors in the respiratory tract (11,(40)(41)(42)(43)(44)(45)(46)(47). A number of bacteria and fungi implicated in lower respiratory infections in immunosuppressed cancer patients have been isolated from marijuana samples, raising the possibility of direct transmission among HIV-infected patients as well (48,49). In summary, it seems likely that compromised pulmonary host defenses by HIV infection and PCP episodes (40)(41)(42)(43)(44) and changes in lung function, morphology, and responsiveness either by HIV infection (~7) or by the inhalation of drugs, including cigarette smoking (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), may help to explain the increased susceptibility to respiratory infections among HIV-seropositive injection drug users.…”

Section: Discussionmentioning

confidence: 99%

Drug smoking, Pneumocystis carinii pneumonia, and immunosuppression increase risk of bacterial pneumonia in human immunodeficiency virus-seropositive injection drug users.

Caiaffa¹,

Vlahov²,

Graham

et al. 1994

Am J Respir Crit Care Med

123

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To examine the risk factors for the first episode of bacterial pneumonia among human immunodeficiency virus (HIV)-seropositive injection drug users (IDUs), medical record review was performed on IDUs participating in a cohort study from January 1988 to June 30, 1992. HIV-seropositive IDUs with a first episode of bacterial pneumonia (n = 40) were matched with up to five HIV-seropositive control subjects without bacterial pneumonia (n = 197) by date of entry (+/- 3 mo) and length of follow-up. Odds ratios (OR) were estimated using conditional logistic regression. The incidence of bacterial pneumonia was 1.93 in 100 person-years in HIV seropositive and 0.45 in 100 person-years in HIV seronegative subjects (relative incidence = 4.3; 95% CI 2.4 to 7.5). In univariate analyses, CD4 lymphocyte count < 200 cells/microliters previous episode of Pneumocystis carinii pneumonia (PCP), age between 30 and 40 yr and smoking illicit drugs (marijuana, cocaine, or crack) were associated with bacterial pneumonia. Cigarette smoking was associated with an increased odds of bacterial pneumonia (OR = 2.0), but this was not statistically significant because it was nearly universal in this cohort. In multivariate analysis, CD4 < 200 cells/microliters (OR = 6.75, 95% CI 2.13 to 21.42) and smoking illicit drugs (OR = 2.24, 95% CI 1.03 to 4.89) remained significantly associated with bacterial pneumonia. The odds ratio for cigarette smoking in the final model remained at 2.08 but was still not significant (95% CI 0.49 to 8.70). Smoking illicit drugs had the strongest effect on risk of bacterial pneumonia among HIV-seropositive IDUs with a previous history of PCP (OR = 22.94; 95% CI 2.18 to 241.10).

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“…There is currently uncertainty about any causal association between marijuana use and lung cancer as the effects of concomitant tobacco smoking amongst these users confound analyses. A small number of cases of various forms of aspergillosis have been associated with marijuana smoking, but the association appears to be uncommon 1–9…”

Section: Introductionmentioning

confidence: 99%