Factbox: What does vaping-related illness look like?

CHICAGO (Reuters) – U.S. health officials are investigating reports of 380 confirmed and probable cases of serious lung illnesses and at least six deaths linked to use of electronic cigarettes or vaping devices in 36 states and the U.S. Virgin Islands.

The U.S. Centers for Disease Control and Prevention (CDC) and state health officials are still trying to define the illness and determine its cause. In the meantime, many health experts recommend that people stop using e-cigarettes and other vaping devices.

The following is a look at the illness and how doctors are treating it.

PATIENT PROFILE:

Most of the cases so far have involved young men under the age of 20 who were otherwise healthy. All reported vaping within 90 days prior to developing symptoms, and many had vaped within a week of feeling sick. Patients experienced symptoms for several days to several weeks before being admitted to the hospital.

So far, in-depth interviews with 41 patients from Illinois and Wisconsin found that 61 percent reported using nicotine products, 80 percent reported using oils containing tetrahydrocannabinol, or THC, the psychoactive component of cannabis, and 3 percent used oils containing cannabidiol, or CBD, a widely-used compound found in cannabis that does not cause a high.

Of that group, 37 percent said they only used THC and 17 percent said they only used nicotine. These patients reported using 14 different brands of THC products and 13 brands of nicotine products with a wide range of flavors. The only brand mentioned in the report was “Dank Vape,” a THC product used by 24 of the 41 people interviewed, according to the report published in the New England Journal of Medicine.

The patient profile for those who have died differed than the vast majority of cases in that they tended to be older and already had an underlying lung illness.

SYMPTOMS:

Nearly all patients involved in the outbreak so far have reported respiratory issues, including a dry, or unproductive, cough that does not bring up mucus, shortness of breath and chest pain that worsened with deep breathing. About 80 percent had gastrointestinal symptoms, including nausea, vomiting or diarrhea. Those symptoms often appeared before patients started having trouble breathing.

Most also had general symptoms of illness, including fever, chills, weight loss and fatigue.

Chest X-rays and CT scans revealed shadows or abnormalities in both lungs in all of the patients, which has become a defining characteristic of the illness.

An analysis of lung cells from five patients in North Carolina turned up pockets of oily deposits within immune system cells called macrophages. Experts have not yet determined whether these are an artifact of the immune system’s attempt at removing vaping oils – a foreign substance – from the lungs, or if they are central to the disease process itself.

TREATMENT:

Many of the patients had sought treatment before going to a hospital. Nearly half were initially treated with antibiotics either before going to the hospital or after being hospitalized, but patients failed to respond.

Ultimately, nearly all of the patients were hospitalized, with more than half admitted to an intensive care unit suffering from respiratory failure. Nearly all required supplemental oxygen and about a third were ultimately intubated to receive breathing support with a mechanical ventilator.

Most patients recovered after six days of treatment. Many responded to steroids, which reduced inflammation in the lungs. Doctors also believe time in the hospital that patients spent on a ventilator and not vaping helped the lungs heal.

Because no infectious cause has been found, the CDC believes the illnesses are the result of chemical injury to the lungs. It is not yet clear whether patients will have any lasting damage.

SOURCES: The New England Journal of Medicine and the CDC’s Mortality and Morbidity Weekly Report