Histopathological Lung Changes in Children due to Biomass Fuel

Abstract

Three billion people use biomass fuel worldwide, and up to 2million deaths are attributed to its exposure each year (1). In Peru, over 9 million people use biomass fuel, and in developing countries, biomass fuel exposure is the fourth highest risk factor for disease (2). In this letter, we describe the histopathological findings in the lungs of four children who died nearly four decades ago from accidental causes and resided in homes in which biomass fuel was used. At that time in Peru, children less than 5 years old spent on average 4–5 hours a day inside the kitchen with their mothers. At the time of death, these children underwent a detailed necroscopy in our institute (4,340 m above sea level). Lung tissue sections from the preserved paraffin blocks generated during those necroscopies were stained with hematoxylin and eosin and examined by a pathologist unaware of the clinical data associated with these children. The pathologist scored lung sections from the four children according to the criteria described in Table 1. Macrophages with anthracotic pigment were found in the alveoli and in the septum of all four children (Table 1 and Figure 1). In three of the four children, we found changes compatible with bronchitis (1). We found no evidence for caliciform cell metaplasia or a positive Reid’s index (.0.4) in any of the children. Mild emphysema was noted in a girl of 1 year and 2 months. In adults, exposure to biomass fuel has been associated with the changes we observed in children as well as septal enlargement, fibrosis, bronchitis, glandular hyperplasia, and goblet cell metaplasia (3–6). We suggest that the changes we observed in these children represent the earliest changes associated with biomass fuel–induced lung disease.