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Query: UMLS:C0032285 (pneumonia)
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In Switzerland, tropical pulmonary eosinophilia occurs in subjects who have stayed in endemic areas of lymphatic filariasis (mainly India and South East Asia) and in adopted children from these countries. Clinically, the disease manifests itself as asthmatic bronchitis or pneumonia. Blood eosinophilia is regularly present and chest X-ray shows various types of infiltrate. Tropical pulmonary eosinophilia is distinguished from Loeffler's syndrome by (a) the severe and protracted course, (b) measurable antibodies against filarial antigens, and (c) the therapeutic response to diethylcarbamazine. The pathogenesis of both syndromes may be explicable by the fact that soluble parasitic allergens bind to cellules of the respiratory tract and induce hypersensitivity reactions under the influence of reagins. Both syndromes must be differentiated from parasitoses of the lung tissue, from side effects of drugs, and from allergic, non-parasitic bronchial asthma. The clinical aspects of both syndromes are illustrated by three cases.
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PMID:[Clinical aspects, diagnosis and therapy of tropical pulmonary eosinophilia]. 70 99

Sixty-six permanent residents of Punjab, presenting with chest complaints and absolute eosinophil counts (AEC) over 2000 per cumm were investigated to find out the cause of high eosinophilia. Tropical pulmonary eosinophilia (TE) was responsible for high eosinophilia in 27 cases (40.9%), even in this region where filariasis is not endemic. Severe asthma (23 cases), allergic bronchopulmonary aspergillosis (ABPA-5 cases), drug reaction (2 cases) and chronic eosinophilic pneumonia (2 cases) in adults and ascariasis (6 cases) in children were other main causes of high eosinophilia. It is emphasized that all cases with high blood eosinophilia should not be labelled as cases of TE simply on the basis of AEC over 2000 per cumm. This is all the more important for non-filarial regions. Only a systematically conducted work up can clinch the correct diagnosis in such cases.
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PMID:Aetiological diagnosis in permanent residents of Punjab presenting with chest complaints and high peripheral blood eosinophilia. 130 20

To evaluate experimentally the usefulness of the jejunum in the correction of extensive tracheal defect, circumferential tracheal defect was surgically created in 31 mongrel dogs and primarily reconstructed with microsurgical free tissue transfer of autogenous jejunal segment. A silicone T tube was inserted to maintain the lumen of the grafted jejunal segment. First, defect of 7 cervical tracheal rings was repaired with untreated 5 cm free jejunal segment in 12 dogs (group 1). Next, a pilot experiment to examine the quantity of intestinal juices from jejunal segments revealed that abrasion and cauterization of the mucosal surface decreased the secretion of intestinal juices, so defect of 7 cervical tracheal rings was repaired with 5 cm free jejunal segment the surface of whose mucosa was abraded and cauterized in 11 dogs (group 2). In all the dogs except two, primary healing was accomplished without air leakage or infection, and gross pathological examination of the trachea and graft revealed no evidence of disruption, infection or granulation. In group 1, 6 of the 12 dogs died of pneumonia or air way obstruction caused by intestinal juices from free jejunal segment within 20 days after the operation. On the other hand, only one of the 11 dogs died of pneumonia at 9 days in group 2. One of the dogs died of air way obstruction caused by mucus at 3 months. Three dogs died of filariasis at 4 weeks, 3 and 7 months, and 5 dogs were sacrificed at 2, 4, 8 weeks and 3 months. Microscopic examination of the graft demonstrated thin jejunal mucosa. The anastomosis was already covered with epithelium by the end of 2 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Experimental reconstruction of the trachea with free jejunal graft]. 224 25

The availability of new biotechnologies has led to the prediction that new or improved vaccines can be developed for 27 diseases within the next decade. The reasons why such optimism cannot be extended to the availability of vaccines for many other infectious diseases are considered by reviewing the steps in vaccine development, from identification of the etiologic agent to construction of attenuated or inactivated vaccines. Impediments to development may exist or arise at any point in this pathway (e.g., multiplicity of serotypes, inability to cultivate the pathogen, multistage life cycles with multiple antigens, unpredictability of epidemics, inadequate knowledge of pathogenesis and immunity, fear of gene splicing, need for an adjuvant, and lack of profitability). Diseases for which vaccines are not likely to be available in the next decade include trachoma, onchocerciasis, pneumonia due to Legionella and to mycoplasmas, amebiasis and giardiasis, schistosomiasis, syphilis, chlamydial urethritis, trypanosomiasis, leishmaniasis, and filariasis, and non-A, non-B hepatitis.
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PMID:Impediments to the development of additional vaccines: vaccines against important diseases that will not be available in the next decade. 266 4

Diarrhea, pneumonia, and malnutrition account for most of mortality and morbidity in children in developing countries. The Expanded Program of Immunization (EPI) is making progress with more than 50% of children under the age of 1 year receiving vaccination against the 6 EPI-listed diseases. The eradication of poliomyelitis by 2000 is realistic, so that the world could be smallpox- and polio-free by the 21st century. In July-August 1988 a cholera epidemic erupted in Delhi, India in which several hundreds died. The combined whole cell and toxin-B subunit oral vaccine against cholera has shown a decrease in protection from around 75-80% at the end of 6 months to around 60% at the end of 2 years. Typhoid fever affecting close to 8 million people in Asia has been treated with the improved formulation of TY21A vaccine and with the Vi polysaccharide capsular surface antigen in encouraging trials in Nepal. Co-trimoxazole has reduced child mortality caused by acute lower respiratory tract infections at the community level. 3 oral antirabies vaccines have been found safe, and oral baits have been effective. Chloroquine-resistant Plasmodium falciparum malaria is a major problem in may Asian countries involving sulfadoxine-pyrimethamine combinations as well. Lymphatic filariasis is expressed clinically as elephantiasis. More than 90 million people are believed to be infected. Ivermectin in a single dose as low as 25 mcg/kg of body weight was shown to be microfilaricidal in lymphatic filariasis. Allopurinol riboside is effective against visceral leishmaniasis or kala-azar. Leprosy and tuberculosis continue to be major health problems in Asia. There have been encouraging advances in immunization against cancers of the tropics, such as hepatitis B and primary carcinoma of the liver, the human papilloma virus and cancer of the uterine cervix, the Epstein-Barr virus and Burkitt's lymphoma, and nasopharyngeal carcinoma.
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PMID:Perspectives on research and diseases of the Tropics: an Asian view. 269 93

The authors presented a rare case study of a patient with chronic elephantiasis involving the lower extremities. The patient had contracted lymphatic filariasis while serving in the armed forces during World War II. The patient was followed regularly for local wound care by the Veterans Affairs podiatry department. However, he died from congestive heart failure and pneumonia in May of 1993.
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PMID:Chronic elephantiasis. A case report. 777 17

We investigated prospectively the cause of fever in patients requiring hospitalization after returning from the tropics. All consecutive admissions (n = 195) with oral temperature > 37.0 degrees C at the time of admission were enrolled. Final diagnosis as recorded on the discharge summary by the attending physician and results of any relevant laboratory or radiological investigations were recorded on standard proforma. Malaria accounted for 42% of admissions; two patients had returned to Britain more than 6 months before presentation. The second largest group was assumed to have a non-specific viral infection (25%). Cosmopolitan infections (urinary tract infection, community-acquired pneumonia, streptococcal sore throat, etc.) accounted for 9%. Coincidental infections (schistosomiasis, filariasis, intestinal helminths) were found in 16%. Serology was positive for HIV infection in 3%. The most useful investigation was a malaria film, which was positive in 45% of cases in which it was performed. The combination of thrombocytopaenia (platelet count < 100 x 10(9)) and hyperbilirubinaemia (bilirubin > 18 IU/ml) were useful predictive markers of malaria: all 23 patients with both abnormalities had positive malaria films. Malaria must be excluded in any febrile patient returning from the tropics. In the absence of a positive malaria film, the combination of a low platelet count and raised bilirubin may suggest the need for an empirical course of therapy.
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PMID:Fever as the presenting complaint of travellers returning from the tropics. 779 78

This document presents an interview with Dr. Anthony Fauci on the development of a new generation of vaccines to prevent and possibly eradicate a legion of deadly diseases ranging from tuberculosis to AIDS. Infections that have caused major devastations in the world today include tuberculosis, malaria, schistosomiasis, filariasis, pneumococcal pneumonia, influenza, AIDS, and Ebola. Agencies should be making sure that the basic research base in microbiology, immunology, antimicrobials, and vaccinology is at the very highest level. The integration of research efforts between countries depends on collaboration between the investigators of home countries with foreign investigators. Among new developments in vaccinology are an acellular pertussis vaccine for pertussis/whooping cough (an extremely contagious disease that causes death), DNA immunization (a new technique applicable to all types of diseases), and transgenic plants for immunization against hepatitis, pertussis, and polio. As of now, AIDS in Western countries has declined, while in Africa and Asia its spread has accelerated. Combination therapy for AIDS has had a profound impact on the level of the virus in the body; however, the treatment is still vague. The good news with regard to AIDS is that education is having an impact; this is exemplified by the situation in Thailand, where the government together with nongovernmental organizations and the military has begun a crash education campaign regarding prostitutes and the use of condoms. Progress is being made in the search for better vaccine candidates. AIDS-like epidemics involving new diseases are bound to emerge at some future point, though, given the long-term historical trend.
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PMID:New drugs, new vaccines, new diseases. An interview with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID). 1234 52

This review starts with discussions of several infectious causes of eosinophilic pneumonia, which are almost exclusively parasitic in nature. Pulmonary infections due specifically to Ascaris, hookworms, Strongyloides, Paragonimus, filariasis, and Toxocara are considered in detail. The discussion then moves to noninfectious causes of eosinophilic pulmonary infiltration, including allergic sensitization to Aspergillus, acute and chronic eosinophilic pneumonias, Churg-Strauss syndrome, hypereosinophilic syndromes, and pulmonary eosinophilia due to exposure to specific medications or toxins.
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PMID:Eosinophilic pneumonias. 2303 24

Lymphatic filariasis continues to be the major cause of clinical morbidity in India and other developing tropical countries. One of the major lacunae in the effective management of clinical filarial cases is the non-availability of a suitable diagnostic test for confirming filaria aetiology in acute, chronic and occult clinical cases where microfilariae (mf) are not usually seen in peripheral circulation. Studies in our laboratory have shown the usefulness of filarial antibody and antigen assays using microfilarial excretory-secretory (mf ES) antigen in detecting microfilaraemic, acute and chronic filarial cases and in confirming filarial aetiology in occult infections. Diethylcarbamazine citrate (DEC) is the drug of choice for lymphatic filariasis. Different regimens of DEC have been explored in the treatment of microfilaraemic cases. Immunomonitoring has shown that the seroconversion of antigen and antibody positivity was found to be very helpful in determining appropriate period of DEC treatment for clinical relief and cure in clinical filarial patients and further they did not have recurrence in most of the cases. Optimal DEC (6mg/kg body wt/day for 21 days each month for 3-12 months) therapy was found to be very effective in acute and atypical clinical manifestations such as asthmatic bronchitis, pulmonary eosinophilia, monoarthritis, recurrent upper respiratory tract infections (URI), pneumonia (super imposed infections) in children and minimal hydrocele, epididymoorchitis, lymphangitis, lymphadenitis, acute abdomen, central serous retinopathy, tenosynovitis, pain and swelling in limbs and joints in adults living in filaria endemic areas.
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PMID:Immunomonitoring followed by optimal dec therapy for successful management of clinical filariasis in an endemic area. 2310 7


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