Table 1.

CDC Surveillance Case Definitions^a for Severe Pulmonary Disease Associated with Cigarette Use – August 30th 2019 [34]

Case Classification	CDC Criteria	Additional investigations to consider:
Confirmed	Using an e-cigarette (“vaping”) or dabbingb during the 90 days before symptom onset (and)	Consider toxicology to assess for THC or other inhalational agents
	Pulmonary infiltrate, such as opacities on plain film chest radiograph or ground-glass opacities on chest computed tomography (and)	Consider CT scan for increased sensitivity
	Absence of pulmonary infection on initial work-up: Minimum criteria include negative respiratory viral panel, influenza polymerase chain reaction or rapid test if local epidemiology supports testing. All other clinically indicated respiratory infectious disease testing (e.g., urine antigen for Streptococcus pneumoniae and Legionella, sputum culture if productive cough, bronchoalveolar lavage culture if done, blood culture, human immunodeficiency virus–related opportunistic respiratory infections if appropriate) must be negative (and)	HIV testing SARS-CoV-2 testing Procalcitonin CBC with differential
	No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process).	Echocardiography Differential on CBC ANA RF ANCA ESR CRP
Probable	Using an e-cigarette (“vaping”) or dabbingb in 90 days before symptom onset (and)	Consider toxicology to assess for THC or other inhalational agents
	Pulmonary infiltrate, such as opacities on plain film chest radiograph or ground-glass opacities on chest computed tomography (and)	Consider CT scan for increased sensitivity
	Infection identified via culture or polymerase chain reaction, but clinical teamc believes this is not the sole cause of the underlying respiratory disease process OR minimum criteria to rule out pulmonary infection not met (testing not performed) and clinical teamc believes this is not the sole cause of the underlying respiratory disease process (and)	HIV testing SARS-CoV-2 testing Procalcitonin CBC with differential
	No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process).	Echocardiography Differential on CBC ANA RF ANCA ESR CRP

^aThese surveillance case definitions are meant for surveillance and not clinical diagnosis; they are subject to change and will be updated as additional information becomes available if needed

^bUsing an electronic device (e.g., electronic nicotine delivery system (ENDS), electronic cigarette (e-cigarette), vaporizer, vape(s), vape pen, dab pen, or other device) or dabbing to inhale substances (e.g., nicotine, marijuana, tetrahydrocannabinol, tetrahydrocannabinol concentrates, cannabinoids, synthetic cannabinoids, flavorings, or other substances)

^cClinical team caring for the patient