Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust

Our plain-English summary of Acute eosinophilic pneumonia in a New York City firefighter exposed to World Trade Center dust, by W.N. Rom, M. Weiden, R. Garcia, et al (American Journal of Respiratory and Critical Care Medicine, 2002).

The study

• Authors: W.N. Rom, M. Weiden, R. Garcia, T.A. Yie, P. Vathesatogkit, D.B. Tse, G. McGuinness, V. Roggli, D. Prezant
• Journal: American Journal of Respiratory and Critical Care Medicine
• Published: 2002;166(6):797-800
• Type of article: Case report
• Cited by: 134 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We report a sentinel case of acute eosinophilic pneumonia in a firefighter exposed to high concentrations of World Trade Center dust during the rescue effort from September 11 to 24. The firefighter presented with a Pa(O2) of 53 mm Hg and responded to oxygen and corticosteroids. Computed tomography scan showed patchy ground glass density, thickened bronchial walls, and bilateral pleural effusions. Bronchoalveolar lavage recovered 70% eosinophils, with only 1% eosinophils in peripheral blood. Eosinophils were not degranulated and increased levels of interleukin-5 were measured in bronchoalveolar lavage and serum. Mineralogic analysis counted 305 commercial asbestos fibers/10(6) macrophages including those with high aspect ratios, and significant quantities of fly ash and degraded fibrous glass. Acute eosinophilic pneumonia is a rare consequence of acute high dust exposure. World Trade Center dust consists of large particle-size silicates, but fly ash and asbestos fibers may be found in bronchoalveolar lavage cells.

In plain English

This was a case report of one 38-year-old New York City firefighter. He arrived at the World Trade Center 20 minutes after its collapse, worked 16 hours a day for 13 days, and did not use respiratory protection for the first 7 to 10 days. He was admitted to intensive care on September 24, 2001, with low blood oxygen (PaO2 53 mm Hg). His CT scan showed patchy ground glass areas, thickened airways and fluid around both lungs. Fluid washed from his lungs (bronchoalveolar lavage) contained 70% eosinophils, compared with 1% in his blood, and the authors reported acute eosinophilic pneumonia. He improved after corticosteroid treatment. Mineral analysis of the lavage cells found 305 asbestos fibers per million alveolar macrophages, including chrysotile and amosite, plus fly ash and degraded fibrous glass. No coated asbestos bodies were found, which the authors considered consistent with recent exposure. The authors called acute eosinophilic pneumonia a rare consequence of acute high dust exposure and said the findings emphasize the need for site workers to wear particulate respirators.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 38-year-old New York City firefighter (15 years on the job; former smoker, 1 pack/day for 5 years, quit 20 years earlier), admitted to the Bellevue Hospital Medical Intensive Care Unit, New York, on September 24, 2001
• Exposure: Heavy inhalation of World Trade Center smoke and dust during rescue work after the September 11, 2001 collapse: 16 hours a day for 13 days, with no respiratory protection for the first 7 to 10 days and only occasional use afterwards
• Main results:
  • On admission his arterial PaO2 was 53 mm Hg.
  • Chest radiograph and CT showed patchy ground glass opacifications, thickening of respiratory airways and bilateral pleural effusions.
  • Bronchoalveolar lavage showed 70% eosinophils, while his blood white cell count showed 1% eosinophils.
  • IL-5 was detectable in serum (24 pg/ml) and BAL fluid (16 pg/ml). No other cytokines were detectable above background. The eosinophils had not degranulated.
  • After 9 days of corticosteroids, lung function improved, the repeat CT showed near complete resolution, and repeat lavage showed 39% eosinophils.
  • Lavage cells contained 305 fibers per million alveolar macrophages, including chrysotile and amosite. One chrysotile fiber measured 70 by 0.2 (units damaged in text, apparently micrometres).
  • Non-asbestos material included chromium and silicon-containing fibers (probably degraded fibrous glass), fly ash, silica, metal particles and various silicates.
  • No coated asbestos bodies were identified. The authors considered the uncoated fiber count consistent with recent exposure.
• The authors' conclusion: The authors concluded that acute eosinophilic pneumonia is a rare consequence of acute high dust exposure, and that asbestos fibers with high aspect ratios were recovered from the lower respiratory tract. They said such findings emphasize the need for WTC workers to wear particulate respirators, and that firefighters and rescue workers exposed to WTC dust may be at risk for WTC cough and asbestos exposure.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Amosite.

Medical terms in this study, explained in our Lexicon: Eosinophilic, Bilateral, Pleural Effusion, Bronchoalveolar Lavage (BAL), Macrophage, Aspect Ratio (Length-to-diameter ratio), Silicate.

Related studies

• Characterization of the dust/smoke aerosol that settled east of the World Trade Center (WTC) in lower Manhattan after the collapse of the WTC 11 September 2001 — P.J. Lioy, C.P. Weisel, et al. (2002)
• Occupational exposures during the World Trade Center disaster response — K.M. Wallingford, E.M. Snyder (2001)
• Mind and matter: OEM and the World Trade Center — H.M. Kipen, M. Gochfeld (2002)
• The legacy of World Trade Center dust — J.M. Samet, A.S. Geyh, et al. (2007)
• Health and environmental consequences of the world trade center disaster — P.J. Landrigan, P.J. Lioy, et al. (2004)
• Development of an exposure assessment method for epidemiological studies of New York State personnel who responded to the World Trade Center disaster — M.L. Herdt-Losavio, M.P. Mauer, et al. (2008)

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