Lipid pneumonia

Proudfit JP, Van Ordstrand HS, Miller CW Chronic lipid pneumonia following occupational exposure. AMA Arch Ind Hyg Occup Med 1 105-111, 1950... 

Other Chronic abuse of laxatives is accompanied by concerns of lipid pneumonia, lymphoid hyperplasia, and foreign-body reactions... 

It has been recommended for many years that the use of liquid paraffin should be discontinued because of its propensity to cause malabsorption of fat-soluble vitamins, to leak and soil the perineal skin, and to cause lipid pneumonia if aspirated at the very least it should be avoided in young children (35). 

Vethanayagam D, Pugsley S, Dunn EJ, Russell D, Kay JM, AUen C (2000) Exogenous lipid pneumonia related to smoking weed oil following cadaveric renal transplantation. Can Respir J 7 338-342... 

Lubricants such as mineral oil increase water retention in the stool. Mineral oil absorbs essential fat-soluble vitamins A, D, E, and K. Some of the minerals can be absorbed into the lymphatic system. Side effects include nausea, vomiting, diarrhea, and abdominal cramping. They are not indicated for children, the elderly, or patients with debilitating conditions because they can aspirate the mineral oil, resulting in lipid pneumonia. 

Oil formulations are not recommended for paediatric use because they are unpleasant to ingest and their use has been associated with diminished nutrient and vitamin absorption, with anal leakage and pruritus. They are especially unsuitable for nasal drop formulation as inadvertent aspiration has caused inflammatory and fibrotic changes in the lungs due to the inhalation of various fatty substances (lipid pneumonia). 

In Scheme 1, lipid II is shown with a glutamine residue replacing the glutamate residue shown in the lipid I precursor. In some bacterial strains, for example, Streptococcus pneumoniae, a glutamine residue is present in lipid II. Experiments... 

Administration and metabolism Trimethoprim is more lipid-soluble than sulfamethoxazole and has a greater volume of distribution. Administration of 1 part of trimethoprim to 5 parts of the sulfa drug produces a ratio of the drugs in the plasma of 20 parts of sulfamethoxazole to 1 part trimethoprim. This ratio is optimal for the antibiotic effect. Co-trimoxazole is generally administered orally. An exception involves intravenous administration to patients with severe pneumonia caused by Pneumocystis carinii. or to patients who cannot take the drug by mouth. 

M. pneumoniae infection was specifically inhibited by adding M. pneumoniae reagent (Kusunoki et al., 2001). One study has reported the AMAN form of GBS in association with anti-GMl antibodies and preceding M. pneumoniae infections (Susuki et al., 2004). These investigators report that anti-GMl antibodies bind to lipids extracted fromM pneumoniae, suggesting that GMl-like structures are also expressed by this microbe. 

The Lipid I and II building blocks may be further elaborated by many other enzymes that modify the sugars or amino acid chains. Branched peptides are added to the Lipid I and II peptide chains either by enzymes that act in an ATP-dependent fashion similar to the MurC-F ligases [39], or by enzymes that add amino acid residues from aminoacyl tRNA intermediates, such as the S. aureus enzymes FemA, FemB and FemX, which form the pentaglycine bridge (O Fig. 3) [36], and the S. pneumoniae enzymes FemM and FemN, which form an L-Ser-L-Ala or L-Ala-L-Ala dipeptide bridge [34,35]. Lipid II is also the substrate for the sortase enzymes that catalyze the attachment of surface proteins for incorporation into peptidoglycan [40]. 

Petrolatum has also been tentatively implicated in the formation of spherulosis of the upper respiratory tract following use of a petrolatum-based ointment packing after surgery, and lipoid pneumonia following excessive use in the perinasal area. Other adverse reactions to petrolatum include granulomas (paraffinomas) following injection into soft tissue. Also, when taken orally, petrolatum acts as a mild laxative and may inhibit the absorption of lipids and lipid-soluble nutrients. 

Another important adverse effect with VOCs is potential for membrane and tissue irritation. Because membranes are composed principally of a protein-lipid matrix, VOCs at sufficient concentrations may act to dissolve that matrix or extract the fat or lipid components of the membrane. This defatting process, when applied to the skin, may cause irritation and cell damage and by similar processes, may seriously injure the lungs or eyes. Upon accidental or intentional ingestion, irritation in lungs caused by aspiration predisposes lungs from microbial infection to life threatening clinical pneumonias. 

New folate antagonists have been identified that are better substrates for the reduced folate carrier and appear to have significant advantages in clinical chemotherapy (see pemetrexed below). In efforts to bypass the obligatory membrane transport system and to facilitate penetration of the blood—brain barrier, lipid-soluble folate antagonists also have been synthesized. Trime-trexate (NEVTREXIN) has modest antitumor activity, primarily in combination with leucovorin rescue. However, it is beneficial in the treatment Pneumocystis jiroveci pneumonia, where leucovorin provides differential rescue of the host but not the parasite. 

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