Table 1: Comparison between EVALI and COVID-19.

 

EVALI

COVID-19

Demographics

Usually young patients

Any age

Exposure

Use of E-CIGs or ENDS

Mainly human to human transmission of the virus; through respiratory droplets or aerosols.

Clinical presentation

More common: Respiratory symptoms;

Less common: Gastrointestinal symptoms.

Usually respiratory symptoms.

Labs finding

Nonspecific elevation of white counts, liver enzymes, inflammatory markers.

Lymphopenia is observed in COVID-19 elevated procalcitonin.

Imaging

X-ray: Bilateral pulmonary infiltrates CT scan Bilateral ground-glass opacities with areas of lobular or subpleural sparing.

CT scan: Bilateral ground-glass opacities and peribronchovascular and subpleural reticular markings.

Bronchoscopy

Vitamin E and nicotine metabolite detection in lavage

positive for SARS-CoV-2 by RT-PCR

Histopathology

Variable:

Acute fibrinous pneumonitis.

Diffuse alveolar injury.

Foamy macrophages.

Organizing pneumonia.

Inflammatory changes with some organization.

Management

Stop further exposure;

Symptomatic treatment with steroids or inhaled medications.

Supportive care;

Suggested treatments: Lopinavir/ ritonavir, chloroquine, hydroxychloroquine;

Steroids are not recommended.

Prevention

Public awareness about health concerns of EVALI.

Social distancing, isolation.