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In the period of 1989-1995 seven patients with amebic liver abscess were observed in Clinic of Infectious Diseases of Pomeranian Medical School in Szczecin. The diagnosis has been made on the base of epidemiological data, presence of intrahepatic defect by a scanning procedure of liver (ultrasonography, CT, scintigraphy) and positive serologic test for amebiasis. All patients were male of Polish nationality, 29-57 years old, who became ill after travel to Africa or India. Intestinal amebiasis was present only in two cases. Five patients had acute onset of disease and two chronic. The most common complaints included fever, abdominal pain, anorexia. A cough, chest pain, diarrhea or weight lose were less common. At physical examination paleness of skin, subjaundice, abdominal tenderness, hepatomegaly and sometimes pleural effusion have been observed. Laboratory tests revealed high RBS, leucocytosis and mild anemia. Slightly higher serum level of bilirubin, alkaline phosphatase were transient. Trophozoits of Entamoeba histolytica have been found in stool specimens of one only patient. Amebic antibodies tested with indirect hemagglutination (IHA) were present in all cases. Visual technics have shown abscess of 3 to 9 cm in diameter located at right liver lobe. Six patients have been treated with both chemotherapy (metronidazole or/and dehydroemetine) and "skin needle" aspiration. In two cases recrudescence of abscess has been observed after one and three years respectively. These two patients have been undergone second course of treatment with using not only needle aspiration and metronidazole/dehydroemetine but luminal agents as well.
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PMID:[Amebic liver abscess--personal observations]. 892 39

Hepatic actinomycosis is a rare infectious disease caused by an anaerobic gram-positive bacterium of the genus Actinomyces. Herein, we describe an unusual case of hepatic actinomycosis involving the diaphragm and right lung. A 41-yr-old man was admitted to Wakayama Medical School Hospital presenting with right back pain and cough. Computed tomography and magnetic resonance image revealed a 5 x 10 cm tumor in the anterior superior segment of the liver, which extended to the diaphragm and right lung. Angiography demonstrated a hypervascular tumor and the enlarged right inferior phrenic artery feeding around the tumor. The patient underwent a hepatectomy with partial resections of the diaphragm and the right middle pulmonary lobe. Microscopically, the specimen showed sulfur granules and was positive for Gram stain and Grocott stain and negative for Ziehl-Neelsen stain. These findings were consistent with actinomycosis of the liver. His postoperative course was uneventful and no recurrence was observed 1 yr postoperatively. Although there are at least 36 well-documented cases until 1993, no other report has been found infiltrating the diaphragm and lung.
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PMID:Hepatic actinomycosis infiltrating the diaphragm and right lung. 893 29

A 22-year-old woman was admitted to the hospital with complaints of fever, loss of appetite, coughing, sputum production, and right-sided chest pain. The chest X-ray film and computed tomogram showed infiltrates in both lower lung fields. Meningococcal pneumonia was diagnosed when a sputum culture was found to be positive for Neisseria meningitidis. Infection with this organism is uncommon in Japan. The patient had never gone abroad, and the route of infection was unknown. N. meningitidis is a rare cause of respiratory infections. When this organism does cause respiratory disease, it is usually acute bronchitis rather than meningococcal pneumonia. The patient in this case was not immunodeficient. She was also not deficient in a terminal lytic component sequence (deficiency in that sequence promotes meningococcal infection). The patient was emaciated and malnourished, which was thought to have made her more susceptible to infection. Orally administered DU-6859a, one of a new generation of quinolones, was very effective and had no side effects.
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PMID:[Bilateral meningococcal pneumonia in a young Japanese woman]. 895 7

The majority of bacterial infections begin with the adherence of pathogenic bacteria to the surfaces of epithelial cells. Microorganisms adhere to cells in a highly selective manner so that sneezing, coughing, peristalsis, and fluid flow cannot remove them. Even though the study of bacterial adherence gives a new insight: to the pathogenesis of infectious diseases, the question that always arises is whether infection can be prevented or treated by interfering with this first step in the pathogenesis of infectious diseases. Adherence may be inhibited by substances that block the interaction between the bacterial adhesin and the target cell receptor. These include the soluble form of receptor, antibodies against the receptor or against the adhesin, and antibiotics which impair bacterial adherence. In this review all three possibilities are considered.
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PMID:[Inhibition of bacterial adherence--possibilities of prevention and therapy]. 896 35

This study is based on a retrospective logistic regression analysis of all human immunodeficiency virus (HIV)-infected patients with Staphylococcus aureus pneumonia (SAP) admitted to the Department of Infectious Diseases, Catholic University, Rome, Italy between January 1986 and December 1994. Nineteen patients with 24 episodes of SAP were enrolled in the study. A control group of 38 HIV-infected patients without pneumonia was included. The attack rate of SAP was 8.31/1000 HIV-related hospital admissions and the frequency, out of the total number of bacterial pneumonia observed in the study period, was 16% (24 of 154 patients). The large majority of SAP was community acquired. On the univariate analysis, intravenous drug abuse (IVDA) (P = 0.02), history of previous Pneumocystis carinii pneumonia (PCP) (P = 0.03) and cirrhosis (P = 0.03) were significant risk factors for SAP. In addition, IVDA and previous PCP were independent risk factors on multivariate analysis. All patients presented with fever associated with cough (74%), chest pain (26%) or shortness of breath (37%). Chest X-ray documented lobar pneumonia (78%), predominantly in the lower lobes, consolidation with cavitation (11%), and interstitial-nodular infiltrates (11%). Pleural effusion was present in 31% of patients. The response to therapy was favourable in 79% of patients. Recurrence occurred in 26% and death occurred in 21% of patients. Death was significantly associated with the low level (< 50 mm-3) of circulating T CD4+ cells (P = 0.03) and the recurrence of pneumonia (P = 0.03). In conclusion, the present study indicates that S. aureus is an important aetiologic agent of bacterial pneumonia in HIV-infected patients, especially if they are drug abusers with previous PCP.
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PMID:Predictors of Staphylococcus aureus pneumonia associated with human immunodeficiency virus infection. 898 27

Different vehicles of transmission of the same pathogen may induce different clinical manifestations of the disease. The hypothesis was tested that the clinical manifestation of food-borne streptococcal pharyngitis is different from air-borne streptococcal pharyngitis. The symptoms and signs of 77 patients with endemic air-borne streptococcal pharyngitis compared to 103 patients with epidemic food-borne streptococcal pharyngitis (T type 8/25/imp19, M protein negative) and 11 patients with secondary air-borne epidemic streptococcal pharyngitis (T type 8/25/imp19, M protein negative) were prospectively evaluated. The patients with food-borne streptococcal pharyngitis had a significantly higher frequency of sore throat, fever, pharyngeal erythema, tonsillar enlargement and submandibular lymphadenopathy and a lower frequency of coryza and cough compared to the patients with endemic air-borne streptococcal pharyngitis. Although both food-borne and air-borne streptococcal infection caused upper respiratory tract infection, the clinical manifestation of food-borne streptococcal pharyngitis was more severe and more confined to the pharynx compared to the endemic air-borne disease. Involvement of the nasal mucosa and bronchial tree was more common in air-borne streptococcal pharyngitis than in the food-borne disease.
Infection
PMID:Food-borne and air-borne streptococcal pharyngitis--a clinical comparison. 903 31

In a recently published German multicenter study, 25% of the patients with witnessed cardiac arrest outside the hospital were resuscitated successfully and discharged from the hospital. Approximately 100,000 people suffer a fatal cardiac arrest in Germany annually, which is approximately tenfold the number of deaths from motor vehicle accidents. Cardiopulmonary resuscitation (CPR) performed by bystanders is an important part of the chain of survival to minimize the time interval without artificial circulation and ventilation in a cardiac arrest victim. This is especially important in areas with long response times of the emergency medical service (EMS). Early examples of ventilation have been described throughout history. References to mouth-to-mouth ventilation (MTMV) are found in the Bible, in a description of the resuscitation of a coal miner in 1744, and in an experiment in 1796 demonstrating that exhaled gas was safe for breathing. In 1954, Elam and colleagues described artificial respiration with the exhaled gas of a rescuer using a mouth-to-mask ventilation method. The modern CPR era started with the combination of MTMV and chest compressions 35 years ago. However, the value of MTMV is currently under discussion because of a widespread fear of transmission of infectious diseases. Healthcare professionals have stated in several studies that they may withhold MTMV when confronted with a cardiac arrest in a stranger. Although an infection with Mycobacterium tuberculosis is more likely than one with HIV via MTMV, the fear of the public is understandable. An expert committee of the American Heart Association stated that MTMV may be omitted in the initial phase of cardiac arrest, and considered recommending chest compressions only if the EMS will arrive rapidly. In paralyzed volunteers, however, ventilation induced by chest compressions was not able to provide sufficient gas exchange, especially when the airway was not protected. Laboratory investigations studying ventilation during CPR showed controversial results; in one animal model of cardiac arrest with muscle paralysis, chest compressions were not sufficient for adequate gas exchange, but active compression-decompression CPR achieved reasonable ventilation. Animal models that prevented gasping during cardiac arrest required ventilation during CPR, whereas gasping animals seemed to be satisfactorily ventilated with chest compressions alone. The question whether spontaneous gasping after cardiac arrest in humans may be sufficient for oxygenation and carbon dioxide elimination is debatable and remains unanswered at this time. When cardiac arrest is monitored, frequent coughing by the patient may maintain artificial ventilation and circulation for 30 s. The strategy to compress the thorax first and then maintain the airway and perform ventilation may only have an advantage for the first 30 s of CPR. Therefore, MTMV remains the therapy of choice to ventilate the victim of cardiac arrest. If a rescuer chooses to not perform MTMV, at least chest compressions should be administered. During ventilation with an unprotected airway, tidal volumes of 0.5 l instead 0.8-1.2 l may have an advantage. This strategy would decrease the inspiratory flow rate and, therefore, peak airway inflation pressure, which is associated with stomach inflation. Animal models indicate that lower esophageal sphincter pressure may decrease rapidly to 5 cm H2O during cardiac arrest, which may further increase the importance of a low peak airway pressure during ventilation with an unprotected airway. Gastric inflation may cause, besides regurgitation, aspiration, and pneumonia, an increased intragastric pressure, which may push up the diaphragm, decrease lung compliance, and induce a vicious circle of hypoventilation and stomach inflation.(ABSTRACT TRUNCATED)
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PMID:[Ventilation during cardiopulmonary resuscitation (CPR). A literature study and analysis of ventilation strategies]. 913 75

A set of five missense mutations previously identified by nucleotide sequence analysis of subgroup A cold-passaged (cp) respiratory syncytial virus (RSV) has been introduced into a recombinant wild-type strain of RSV. This recombinant virus, designated rA2cp, appears to replicate less efficiently in the upper and lower respiratory tracts of seronegative chimpanzees than either biologically derived or recombinant wild-type RSV. Infection with rA2cp also resulted in significantly less rhinorrhea and cough than infection with wild-type RSV. These findings confirm the role of the cp mutations in attenuation of RSV and identify their usefulness for inclusion in future live attenuated recombinant RSV vaccine candidates.
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PMID:Recombinant respiratory syncytial virus (RSV) bearing a set of mutations from cold-passaged RSV is attenuated in chimpanzees. 955 43

Pulmonary mycotoxicosis (PM), also termed organic dust toxic syndrome or silo unloader's syndrome, is an acute illness resulting from massive inhalation of microbial toxins in organic dusts. It has not been well described histologically. Three cases of PM are presented in this report. Open lung biopsies were examined in each case. All of the patients were farmers with no prior lung disease. One had burning in his eyes, throat, and chest after exposure to moldy silage; chills, fever, dry cough, malaise, and weakness developed within 24 hours. Two patients presented with fever, progressive dyspnea, cough, and fatigue within 24 hours of emptying a corncrib, cleaning a chicken coop, and baling hay. Bilateral alveolar and interstitial infiltrates on chest roentgenograms and leukocytosis with neutrophilia were observed in all of the three patients. Two patients became hypoxemic and required mechanical ventilation. Histologic examination showed acute and organizing diffuse alveolar damage in two biopsy specimens and an acute bronchopneumonia in the third. One specimen had 1- to 10-microm ovoid organisms demonstrable with methenamine silver stains; cultures grew Fusarium and Penicillium species. The other two biopsy specimens had negative tissue cultures and special stains for organisms, although Penicillium species were grown from a preoperative bronchoalveolar lavage in one case. The two patients on mechanical ventilation recovered completely with high-dose steroids. The third patient recovered without steroids. No patient had residual functional deficits or chest radiographic abnormalities. PM can be distinguished from allergic and infectious diseases common in individuals exposed to large amounts of organic dust by its clinicopathologic features.
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PMID:Pulmonary mycotoxicosis: a clinicopathologic study of three cases. 961 95

A rapid assessment of drug abuse in Nepal was conducted at different sites, including eight municipalities in the five development regions of the country. To interview various groups of key informants, such methods as semi-structured interviews, in-depth interviews and focus group discussions were used. A snowball sampling strategy for respondents who were drug abusers and a judgemental sampling strategy for the non-drug-using key informants were applied. About one fifth of the sample was recruited from the treatment centres and the rest from the community. Drug abusers in prison were interviewed, and secondary data from treatment centres and prisons analysed. The study revealed that the sample of drug abusers had a mean age of 23.8 years and was overwhelmingly male. Most respondents lived with their families and were either unemployed or students. About 30 per cent of the sample was married. A large majority of the sample had a family member or a close relative outside the immediate family who smoked or drank alcohol and a friend who smoked, drank or used illicit drugs. Apart from tobacco and alcohol, the major drugs of abuse were cannabis, codeine-containing cough syrup, nitrazepam tablets, buprenor-phine injections and heroin (usually smoked, rarely injected). The commonest sources of drugs were other drug-using friends, cross-border supplies from India or medicine shops. The commonest source of drug money was the family. There has been a clear trend towards the injection of buprenorphine by abusers who smoke heroin or drink codeine cough syrup. The reasons cited for switching to injections were the unavailability and rising cost of non-injectable drugs and the easy availability and relative cheapness of injectables. About a half of the injecting drug users (IDUs) commonly reported sharing injecting equipment inadequately cleaned with water. Over a half of IDUs reported visiting needle-exchange programmes at two of the study sites where such programmes were available. Infection by the human immunodeficiency virus (HIV) appears to be low among IDUs, although systematic surveillance is absent. Two thirds of the sample had experienced sexual intercourse. The last sex partners reported by respondents were commercial sex workers, wives or girl friends. Condom use was low with primary partners and relatively high with sex workers. Treatment facilities, mostly located in the central urban areas of the country, are meagre. An overwhelming majority of drug abusers felt the need to stop abusing drugs. Cost-effective drug treatment and HIV prevention programmes for IDUs are urgently needed in all areas of the country.
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PMID:Drug abuse in Nepal: a rapid assessment study. 983 33


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