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Chronic pulmonary histoplasmosis is best regarded as an opportunist or saprophytic infection of abnormal pulmonary spaces by a fungus of very low human pathogenicity. Tissue disease results from host immune response to dispersions of soluble antigen from these focal sources. There are two distinct types of clinical and radiological response. One is an acute or subacute illness manifested by often large segmental pneumonic lesions which tend to heal and are designated as early lesions. The other, usually developing as a complication of the first, is a chronic disease marked by persistent cavitation, low gard chronic illness, and a tendency to promote pulmonary fibrosis and often progressive pulmonary insufficiency. The early lesion is a segmental interstitial pneumonitis with central areas of infarct-like necrosis often adjacent to bullous disease and often outlining prominent emphysematous spaces which appear as radiolucencies. These radiological findings are further characterized by early clearing of the interstitial components, infarct-like contraction of the necrotic zones, obliteration of much of the contained emphysematous and bullous spaces, and healing attended by considerable loss of lung volume. Symptoms are variable but tend to be mild. Malaise, fatigability, low-grade fever, aching chest pain and mild cough lasting a few days to a few weeks are usual. Symptoms are ameliorated by rest. Rest and diminished activity are recommended as treatment. Under these circumstances, 80% of early lesions heal completely and probably most of these would heal spontaneously. Any subsequent course of the disease depends on whether or nor large air spaces, adjacent to or contained within the area of pneumonitis, become infected and persist as cavities. This occurs in 20% of early lesions. Once established, an infected cavity tends to persist and to be attended by symptoms of chronic bronchitis with chronic cough and sputum, fatigability, anorexia, and weight loss. Persisting thickwalled cavities often induce gradual development of pulmonary fibrosis, particulary in the lung bases, apparently from aspiration of antigenic material. This and the accelerated obstructive bronchopulmonary disease often lead to progressive pulmonary insufficiency. The use of amphotericin B is recommended for all persistent thick-walled cavities and in some circumstances surgical resection may be indicated.
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PMID:Chronic pulmonary histoplasmosis. 79 26

Squirrel monkeys (Saimiri sciureus) inoculated intratracheally with 10(4.2)-10(8.2) egg median infectious doses (EID50) of type A influenza virus (H3N2) responded with clinical illness including such signs as fever, sneezing or coughing, coryza, and increased respiratory rates. Necropsy studies performed six days after inoculation revealed bronchopneumonia in addition to a mild tracheitis. Squirrel monkeys given 10(5)-6 x 10(8) colony-forming units (cfu) of Streptococcus pneumoniae intratracheally died four to six days later after developing severe illness characterized by fever, bacteremia, lethargy, anorexia, coughing, labored breathing, and bronchopneumonia. Monkeys given 770 cfu of S. pneumoniae responded with less severe symptoms and survived. Four squirrel monkeys inoculated with 10(8.2) EID50 of virus and then 102 hr later with 770 cfu of S. pneumoniae developed severe disease; three of the four animals died within 40 hr. At necropsy these monkeys had more extensive and severe bronchopneumonia than was seen in monkeys infected with either organism alone.
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PMID:Influenza alone and in sequence with pneumonia due to Streptococcus pneumoniae in the squirrel monkey. 2215 62

During the winter months 1974/75 we were able to observe a number of unusual respiratory tract infections particularly in children over 6 years of age which appeared as pneumonias. Characteristic clinical findings included a dry, hacky cough, refractive to the usual antitussives, starting 1--2 weeks prior to admission, fever up to 104, malaise, headache, anorexia, shortness of breath and cyanosis. Several Pts were treated prior to admission with a number of antibiotics and failed to respond. Laboratory findings showed a peripheral polymorphonuclear leucocytosis with toxic granulations of neutrophiles. A sedimentation rate above 40 in the first hour occurred in most Pts. X Ray of the lung revealed a characteristic mottled appearance with patchy infiltrations, atelectasis and nodular densities. Frequently a shift of the mediastinum towards the infiltrate was seen. One of the hallmarks on physical examination was the discrepancy between the severity of the clinical illness and the paucity of physical findings. Decreased breath sounds over affected lung areas were often the only findings on auscultation; find rales, rhonchi or dullness on percussion were less often heard. The combination of a typical history, physical examination, laboratory tests and X Ray findings enabled us to make a presumptive clinical diagnosis of Mycoplasma pneumonia before serologic test results were available and to start with the appropriate antibiotic (Erythromycin, Tetracycline) early in the course of the disease. Complement fixation tests with a titer of 1 : 20 and a fourfold rise over the next two weeks or an initial titer of 1 : 80 and above were considered significant for acute disease.
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PMID:[Mycoplasma pneumonias in childhood (author's transl)]. 83 54

The incidence of new cases of extrapulmonary tuberculosis has remained constant, despite the decline in new cases of active pulmonary tuberculosis. This might be due to a delay in recognition, and particularly a lack of consideration of tuberculosis when the presenting symptoms are other than respiratory. Extrapulmonary tuberculosis should be considered in the differential diagnosis of bone, joint, genitourinary tract and central nervous system (CNS) diseases. To determine factors that might delay recognition and identification, 62 patients having extrapulmonary tuberculosis during 1969-1972 at the Los Angeles County-University of Southern California Medical Center were studied.Three quarters of these patients had had CNS, skeletal or genitourinary tuberculosis in equal distribution or 25 percent each. CNS involvement was seen frequently in the disseminated form. Presenting symptoms were protean and not specific, such as fever, anorexia, weight loss, cough, lymphadenopathy and neurologic abnormalities. Roentgenograms of the chest were abnormal in most. When a roentgenogram of the chest suggests pulmonary tuberculosis, signs and symptoms in other body systems should suggest extrapulmonary tuberculosis. If no abnormalities are seen on a roentgenogram of the chest, however, this does not preclude the diagnosis of extrapulmonary tuberculosis. Neither does a negative tuberculin skin test exclude the condition. Abnormal laboratory findings are common, especially in disseminated tuberculosis. These include various anemias, bone marrow disorders, hyponatremia due to inappropriate antidiuretic hormone syndrome. Analyses of pleural, peritoneal, pericardial and joint fluid usually show an exudate high in lymphocytes and occasionally low in glucose. Similar findings are seen in spinal fluid. The histological features of caseous or noncaseous granulomas are suggestive of but not specific for tuberculosis. Only culture of mycobacteria from sputum, urine, spinal fluid, pleural and other effusions and tissue biopsy specimens will yield a definitive diagnosis. Physicians must have a high index of suspicion to diagnose extrapulmonary tuberculosis, as it can resemble any disease in any organ system. Immediate therapy in the disseminated variety, sometimes even before a definite diagnosis can be made, may be lifesaving.
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PMID:The spectrum of extrapulmonary tuberculosis. 85 17

A 2 year old girl develops a fever, anorexia and a cough which last three weeks. Following this event, she presented with intention tremor and increasing difficulty with crawling. At the age of 3, a nerve biopsy was done which made the diagnosis of metachromatic leukodystrophy. EM examination of the nerve biopsy revealed large quantitites of abnormal structures in the cytoplasm of Schwann and phagocytic cells. Virus like spheroid bodies were present in a few axons and cytoplasm of Schwann cells.
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PMID:Inclusions in the sural nerve in metachromatic leukodystrophy. 124 2

We present the clinical features of Influenzavirus A2 infection in 75 young children admitted to a children's hospital. The most common presenting features were febrile convulsions. vomiting, coughing, diarrhea, and anorexia. At any age, the illness may present with respiratory tract symptoms and signs but in young babies gastroinestinal symptoms are often the presenting complaint. Children aged one to three years often present with febrile convulsions. Only in older children does the adult pattern begin to emerge. Evidence is put forward to suggest that encephalitis in association with influenza can be due to direct invasion of the central nervous system by the virus.
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PMID:Influenzavirus A2 infections presenting with febril convulsions and gastrointestinal symptoms in young children. 125 16

A 19-year-old man presented with dyspnea, cough and chest pains; he also complained of nausea, anorexia and postprandial vomiting and reported a 10-kg weight loss. Generalized lymphadenopathy and some rales over both lung bases were noted and a chest radiograph showed bilateral nodular lesions. Persistent leukocytosis, thrombocytosis, proteinuria and anergy to a series of natural antigens were found. The diagnosis of lymphoid interstitial pneumonia was made from material obtained at open lung biopsy. Rapid but incomplete clearing of the lung lesions resulted from steroid therapy; the other abnormalities were corrected gradually, except for the proteinuria, which persisted. The clinical improvement and the ability to work and play have been maintained for the past 20 months.
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PMID:Lymphoid interstitial pneumonia. 126 92

124 Rhesus monkeys (Macaca Mulatta) were caught in the Taihang Mountain region, a high incidence area of human esophageal cancer in Northern China, in January 1989. Among them, two monkeys died of esophageal carcinoma in 1990. Case 1, a male monkey about 6.5 years old and weighing 14.5 kg, had symptoms of salivation, vomiting and dysphagia in February 1990. The symptoms became gradually more serious and died in March 1990. Postmortem examination revealed a huge tumor in the distal segment of esophagus, causing severe stricture of the organ. The tumor was classified as medullary type and histopathologically diagnosed as a well differentiated squamous cell carcinoma, with metastases to mediastinum and lymph nodes of right gastric group. Case 2, a female monkey about 11-year-old and weighing 10.0 kg, showed loss of appetite, tiredness, somnolence, coughing and vomiting in September and died in December 1990. Autopsy revealed an annular tumor involving the whole circumference of lower portion of the esophagus. The tumor was of ulcerative type and diagnosed as a well differentiated squamous cell carcinoma. The symptoms and pathological changes of the two monkeys showed high similarity to esophageal cancer in humans. We believe that the present findings would provide important leads for further study to clarify the etiology and pathogenesis of human esophageal cancer in this high incidence area of esophageal cancer.
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PMID:[Esophageal cancer in rhesus monkeys from the Taihang Mountain area. A preliminary report]. 130 71

The RC/79 strain of the Aujeszky's disease virus was able to induce reproductive failure of pregnant gilts intranasally inoculated at different gestation periods. Four gilts 40-46 days pregnant (group A) and 6 gilts 70-73 days pregnant (group B) were instilled with 0.2 ml x 10(5) tissue culture infectious dose 50 (TCID50/0.2 ml) of the RC/79 strain into each nostril. Two gilts 70-73 days pregnant (group C) were used as non exposed controls. The three groups were kept in separated boxes and they were observed for clinical signs of infections and samples were collected for determination of viral shedding every day. Viral isolation was attempted in Vero cells (figure 1). From the 2nd to 7th day after inoculation, groups A and B showed fever anorexia, sneezing, coughing and depression; and viral isolation from nasal swabs was possible in 7 gilts at days 4 to 11, 9 gilts developed neutralizing antibodies. The virus caused fetal reabsorption in swine during the first period of pregnancy (group A), while infection during late pregnancy resulted in still birth or normal pigs and one mummification (group B). The entire a live litter was composed of no more than 8 suckling pigs in both groups. At necropsy virus from turbinates, ovary , placenta, spleen and lung could be isolated only from 3 gilts (group B, table 1). In 5 of 35 stillbirth and alive fetuses virus could be isolated from spleen (100%), lung (80%), liver (60%) and brain (40%) indicating that the virus has the ability to cross the placental barrier thus producing lesions in porcine fetuses and causing reproductive failure in sows (table 2). Tissue specimens from these 35 fetuses were fixed in 10% formalin, included in paraffin sectioned and stained with hematoxylin and eosin. In 13 fetuses microscopic lesions i.e. necrotic foci were found in lung (60%), liver (40%) and spleen (20%), these alterations were coincident with gross lesions in most of them. Inclusion bodies were absent. The gilts organs did not present gross lesions.
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PMID:[Experimental infection of pregnant gilts with Aujeszky's disease virus strain RC/79]. 133 79

A 77-year-old female with primary duodenal cancer had undergone pancreatoduodenectomy in May, 1989. Postoperative chemotherapy was done in combination with MMC (mitomycin C), lentinan and UFT (combined medicine of tegafur and uracil). In August, 1991, the patient complained of a cough and then was examined for multiple pulmonary metastases from duodenal cancer by chest X-ray and CT-scan. Then, she received 5'-DFUR (400-800 mg) and MMC (total 6 mg). Two months from the start of this therapy, the cough almost vanished and pulmonary lesions were diminished markedly. For about five months, this case corresponded to partial response (PR) according to the response criteria proposed by Koyama-Saitoh. The side effects of 5'-DFUR were diarrhea and anorexia. Therefore, we think that 5'-DFUR and a small dose of MMC yielded a partial response to multiple pulmonary metastases from duodenal cancer.
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PMID:[A case of multiple pulmonary metastases from duodenal cancer showing partial response using 5'-DFUR and a small dose of MMC]. 136 Nov 21


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