Ongoing vape cart issue, the Megathread

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We're getting a lot of questions about this lately, so I figured we should just do a megathread where everyone can post info.

More than 2,409 people got sick and 52 died from vaping associated pulmonary injury in 2019

As of Thursday, Oct. 10, the CDC has reported 1,299 confirmed and probable cases in 49 states of severe acute respiratory distress syndrome possibly associated with a recently inhaled drug aerosol (commonly known as vaping). As many as 26 patients in 21 states may have died from the condition. The deaths occurred in Illinois, Oregon (2), Indiana, California (3), Minnesota, Kansas (2), Missouri, Georgia (2), Florida, Mississippi, Nebraska, New Jersey, Alabama, Virginia, Delaware, Pennsylvania, Connecticut, Massachusetts, Michigan, New York, Utah, and Texas

More updated and detailed info here:

https://www.leafly.com/news/health/vape-pen-lung-disease-advice-consumers

Also, while there was initially much speculation about additives like Vitamin E acetate and MCT oil and other viscosity-adjusters causing lipid pneumonia, recent research from the Mayo Clinic appears to potentially rule this out.

Despite the accumulating data on the clinical and imaging features of vaping-associated lung injury,1,2 its pathology is poorly understood. We reviewed lung biopsies from 17 patients (13 men; median age, 35 years [range, 19–67]), all of whom had a history of vaping (71% with marijuana or cannabis oils) and were clinically suspected to have vaping-associated lung injury. Presentation was acute or subacute in all cases, with bilateral pulmonary opacities; all but two patients presented in 2019. Eleven met the criteria for a “confirmed” diagnosis of vaping-related lung injury; the remaining six met the criteria for a “probable” designation.

In all cases, histopathological findings showed patterns of acute lung injury, including acute fibrinous pneumonitis, diffuse alveolar damage, or organizing pneumonia, usually bronchiolocentric and accompanied by bronchiolitis (Figure 1; also see the Supplementary Appendix, available with the full text of this letter at NEJM.org). No histologic findings were specific, but foamy macrophages and pneumocyte vacuolization were seen in all cases and may be useful diagnostic clues in an appropriate clinical context. Pigmented macrophages were sometimes present but were never a dominant feature. Neutrophils were often prominent, but eosinophils were rare and granulomas were not seen. In two cases, bronchioloalveolar lavage fluid was available and contained abundant foamy macrophages. Despite treatment with glucocorticoids and maximum supportive care, two patients with diffuse alveolar damage died. To date, few reports of vaping-associated lung injury have included histopathological findings. Our cases corroborate many of these descriptions and provide some preliminary insight into the pathogenesis of this injury. Much recent attention has been given to the possibility that vaping-associated lung injury may represent exogenous lipoid pneumonia.3

However, none of our cases showed histologic evidence of exogenous lipoid pneumonia and no radiologic evidence thereof has been found2; this calls into question the diagnostic utility of identifying lipid-laden macrophages or performing oil red O staining on bronchioloalveolar lavage fluid as a marker of vaping-associated lung injury, as has been proposed.3,4 The significance of this observation remains unclear, particularly in patients with a known vaping history; until more data accumulate, our observations suggest that this finding should be interpreted with caution, as it may simply be a marker of exposure and not necessarily a marker of toxicity. Although it is difficult to discount the potential role of lipid, we believe that the histologic changes instead suggest that vaping-associated lung injury represents a form of airway-centered chemical pneumonitis from one or more inhaled toxic substances rather than exogenous lipoid pneumonia as such, but the agents responsible remain unknown. www.nejm.org/doi/full/10.1056/NEJMc1913069?query=featured_home

There has also been recent speculation that the illnesses are attributed to fumigants like Eagle 20 that is commonly used on cannabis, especially in the black market, or possibly to poor quality carts themselves, but of these are only theories or hypothesis, not confirmed evidence of the cause of these deaths and illnesses.

Also, one good subreddit I have found useful is /r/fakecartridges. If anyone knows of any others let me know and I can add it in later.

Edit:

Here is the cdc link

Short video https://youtu.be/XSdIYmrr4yo

Colorado regulators planning ban on cannabis vape additives https://www.apnews.com/25b209db3c58493eb219d664d2bf612f

EDIT:

Vitamin E acetate, a compound used in supplements, cosmetics and vaping products was detected in all 29 lung tissue samples from patients that health officials tested. www.cnbc.com/2019/11/08/cdc-says-its-made-a-breakthrough-in-finding-possible-cause-of-vaping-illness.html

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