NEW YORK (Reuters Health) - A cluster of cases of acute idiopathic pulmonary hemorrhage (AIPH) in four infants in the Boston area may be associated with von Willebrand disease (vWD), in conjunction with environmental or infectious factors, according to an article in the Morbidity and Mortality Weekly Report for September 10th.
This potential tie-in has led the Centers for Disease Control to advise physicians, “when they see cases of pulmonary hemorrhage, to think of some underlying bleeding disorder -- and rule that out first,” co-author Dr. Clive M Brown, at the CDC in Atlanta, told Reuters Health.
The Massachusetts Department of Public Health and the CDC conducted complete investigations after four infants, ages 28 to 77 days, presented to two hospitals with AIPH between December 2002 and June 2003. The investigators interviewed family members regarding medical history and environmental exposures and conducted environmental sampling for fungi and mold spores in the patients’ homes.
Blood samples obtained from the infants revealed that two patients had vWD and one had borderline test results suggesting vWD. All had symptoms of upper respiratory illnesses less than 2 weeks before their pulmonary hemorrhage.
“It seems that AIPH is caused by a multiplicity of exposures,” Dr. Brown commented. For example, fungal spore counts were elevated in two of the homes, and renovations in three of the homes could have increased their exposure to airborne particulate matter. One patient had been found face down on a couch when the pulmonary bleeding was first observed suggesting acute unintentional asphyxia.
However, there was no viral or fungal organism or other environmental exposure common to all four subjects.
“The CDC will continue to investigate when clusters of AIPH are seen, because this disease is still a mystery,” Dr. Brown said.
Source: MMWR 2004;53:817-820. [ Google search on this article ]
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