Pulmonary schistosomiasis

Schistosoma infection is one of the most common infectious diseases, limited in the past only to the endemic countries. With the enormous increase in migration and travel, we encounter more and more cases in developed, nonendemic countries. Although the disease has been known for many years from studies in the endemic countries, the new patient population of nonimmune travelers presents with a different clinical pattern that requires further investigation. One of the features of the disease in the nonendemic population is pulmonary involvement that seems to be much more common than previously suspected. The differences between the nonimmune population with the early pulmonary involvement and the population of endemic areas with late pulmonary involvement are summarized in Table 1. Clinicians in the Western countries have a higher chance of encountering the early (acute) form of the disease, although immigrants from endemic countries may present with late (chronic) schistosomiasis. In the differential diagnosis of pulmonary pathology, especially when accompanied by eosinophilia, schistosomal infection should be considered. The travel history of the patient is mandatory for an evaluation.     

Pulmonary manifestations of leptospirosis

Pulmonary involvement in leptospiral infection is common, usually mild, and often overlooked. When pulmonary manifestations are prominent in a patient with leptospirosis, there is the potential for diagnostic confusion. We present the case of a patient with adult respiratory distress syndrome secondary to leptospirosis and review the pulmonary manifestations of leptospiral infection.     

埃及血吸虫病的临床表现与治疗

埃及血吸虫病是人体主要血吸虫病之一, 流行于非洲及地中海地区, 可导致泌尿生殖系疾病。虽中国大陆仅流 行日本血吸虫病, 但随着我国经济发展和对外交流的不断深入, 援非项目和赴非务工人员中感染埃及血吸虫的病例报道 逐渐增多, 而相关的临床资料乏见。本文就其临床表现、 治疗进展以及今后的防治建议等作一介绍。     

Pulmonary manifestations of bioterrorism

Along with smallpox, inhalation anthrax and pneumonic plague are among the diseases most likely to be spread by biowarfare, either from a rogue nation or terrorist group. Neither anthrax nor plague has been seen by many pulmonary (or any other) physicians in the United States. This article summarizes these two diseases as pulmonary manifestations of bioterrorism and discusses the possibility of avian influenza as a potential respiratory pathogen in biowarfare. It is hoped that phyisicians will need to know this information only as an academic exercise and not because of a clinical circumstance.     

Pulmonary manifestations of Kaposi's sarcoma

Pulmonary Kaposi's sarcoma is an unusual pre-mortem diagnosis in AIDS patients. During a four-year period, 318 patients with AIDS-associated Kaposi's sarcoma presented to New York University Medical Center; 19 patients were found to have pulmonary involvement. All 19 patients were homosexual men; 18 of these patients presented with cutaneous and/or visceral Kaposi's sarcoma. Seventy-nine percent of patients had previous or concurrent pulmonary opportunistic infections. Clinical presentation of pulmonary Kaposi's sarcoma was indistinguishable from opportunistic pneumonia with respect to symptoms, physical examination results, and laboratory findings. Chest roentgenograms revealed a typical nodular pattern in only five patients. In contrast to AIDS-associated opportunistic pneumonia, the yield from fiberoptic bronchoscopy (24 percent) and open lung biopsy (56 percent) was low. Pathologically, Kaposi's sarcoma of the lung is less cellular than the cutaneous lesion. It is focal and scattered throughout the pulmonary interstitium, which may explain the difficulty in pre-mortem diagnosis.     

Pulmonary manifestations of scleroderma.

Scleroderma is a severe systemic collagen vascular disease of unknown cause characterized by marked vascular and connective tissue abnormalities. The lungs are commonly involved in scleroderma, ranking only behind the skin, the peripheral vasculature, and the esophagus in frequency of organ involvement. Respiratory symptoms are, in a very few cases, the presenting manifestation of the disease. Abnormalities of pulmonary function in affected patients include a restrictive ventilatory defect, air flow obstruction, and a depressed diffusing capacity for carbon monoxide, which may be an isolated early finding. Interstitial lung disease and honeycombed lung are the most common pulmonary parenchymal abnormalities seen on chest radiographs. Enlargement of the cardiac silhouette and pulmonary artery due to scleroderma-induced pulmonary vascular disease is also noted. High-resolution computed tomography (HRCT) apparently is a sensitive, potentially useful technique for detecting occult interstitial lung disease in patients with scleroderma. Bronchoalveolar lavage usually shows an increase in total cell count and in the percentage of granulocytes; occasionally, there is a predominantly mononuclear (lymphocytic) cell alveolitis. Premortem and postmortem studies reveal two predominant lung lesions: (1) interstitial lung disease and (2) pulmonary vascular disease. Pulmonary vascular disease may occur in the absence of interstitial lung disease, particularly in patients with limited, as opposed to diffuse, scleroderma. The overall mortality rate in scleroderma is 50% at 7 years, and pulmonary complications are the major cause of death. No prospective, well-controlled studies have established that treatment alters the natural course of pulmonary disease in patients with scleroderma. Both D-penicillamine and cyclophosphamide have shown promise for treating patients with interstitial lung disease, and nifedipine may be useful for treating patients with early pulmonary vascular disease.     

Pulmonary manifestations of gastrointestinal disease

The respiratory and gastrointestinal systems share several functional similarities. In health, the two systems remain structurally distinct and functionally integrated, so as to maintain physiologic homeostasis. However, in the setting of disease, pathophysiologic alterations in one system may be reflected in the other. This article focuses upon the nonmalignant gastrointestinal causes of respiratory illness. Using an anatomic approach, the pulmonary manifestations of selected gastrointestinal diseases are outlined. Emphasis is placed on the distinguishing features, pathophysiology, and therapy of the pulmonary sequelae of digestive diseases.     

Pulmonary manifestations of rheumatoid arthritis

Rheumatoid arthritis (RA) is a systemic disease, characterized by symmetric joint involvement, but it can also affect other organ systems, including the lungs. The better-known pulmonary manifestations of RA are interstitial lung disease, rheumatoid nodules, and pleural effusions. Less common manifestations include bronchiolitis obliterans and crycoarytenoid arthritis. Management of these conditions involves, by and large, supportive pulmonary care and control of the underlying articular process. Other pulmonary manifestations in RA patients can ensue as a result of the treatments used for it, mainly methotrexate. This article discusses the most common pulmonary manifestations of RA and their treatment. A discussion about the increasing impact that cigarette smoking is having on RA is also provided.     

Pulmonary manifestations of waldenstrom macroglobulinemia

Waldenstrom macroglobulinemia (WMG), a proliferation of malignant monoclonal IgM secreting plasmacytoid lymphocytes in lymph nodes, spleen, and marrow, usually pursues a chronic clinical course. A patient with WMG for five years who developed pulmonary tumors consisting of plasmacytoid lymphocytes prompted a review of the literature for pulmonary manifestations of WMG. Twenty-six males and 18 females, ranging in age from 33 to 84 years, have been reported with histologically proven pulmonary involvement by WMG. The x-ray findings, evident in most patients when first seen, consisted of masses (22 patients), infiltrates (31 patients), and pleural effusions (19 patients). Most patients (24) had two or more of these manifestations but only five, in addition to our patient, had isolated pulmonary nodules. Isolated pulmonary infiltrates were found in ten patients and isolated pleural effusions in only four. Symptoms at the onset of pulmonary involvement included dyspnea (54%), nonproductive cough (33%), and chest pain (7%); 15% were asymptomatic. Pulmonary manifestations, like other features of WMG, respond to alkylating agents or irradiation and do not appear to affect prognosis adversely. Pulmonary involvement should be suspected in any patient with WMG who develops an abnormal chest x-ray.     

胃十二指肠血吸虫病内镜随访结果报告

目的 探讨胃、十二指肠血吸虫病的内镜表现及预后情况。方法 对内镜及病理确诊的26例胃、十二指肠血吸虫病患者进行内镜定期随访，并做预后分析。结果 胃、十二指肠血吸虫病内镜表现缺乏特异性，26例中表现为肿瘤样6例，溃疡11例，慢性胃炎9例，病理检查中均在粘膜层，粘膜下层或坏死组织中发现有多量血吸虫卵沉积，26例中7例合并胃癌，另在最长7年的随访中发现癌变6例，癌变者达50%，结论 胃、十二指肠血吸虫病诊断要依靠流行病学调查，内镜和病理学检查，预后分析表明该病属癌前状态，应及早诊断并治疗。     

系统性血管炎肺受累

系统性血管炎是风湿性疾病乃至内科领域最具有挑战性、最复杂,也是最常见的一类疑难性疾病,可累及全身 多系统。肺脏作为人体最重要的器官之一,有丰富的血管床,是系统性血管炎最常累及的部位,可表现为间质性肺疾 病、弥漫性肺泡出血、肺部结节、肺动脉高压、肺动脉瘤、肺动静脉血栓形成等,易与感染、肿瘤等疾病相混淆。由于其 发生率高,临床表现复杂,诊断鉴别困难,预后差,因此正确认识系统性血管炎肺受累的表现,早期诊断,积极治疗,将 有助于显著改善患者的预后。     

Pulmonary manifestations associated with malaria

Pulmonary manifestations are frequently observed in children, pregnant women and travellers with malaria. The pathophysiology of these pulmonary manifestations is poorly understood but would appear to be secondary to an interaction between the parasitized red cells and the pulmonary capillary endothelium. Bronchitis and pneumonia do not directly compromise outcome but, left unrecognized, the delay in diagnosis and treatment may be fatal. Acute respiratory distress in children is the first cause of overmortality, coming before neurological involvement. The acute respiratory distress caused by severe malaria has no specific characteristics. Iatrogenic complications and pulmonary superinfections must be differentiated. The prevention of pulmonary manifestations associated with malaria can easily be accomplished by limiting water intake and carefully monitoring urinary output and weight. Treatment is the same as for acute flare-ups in combination with symptomatic respiratory treatment when required.