1/19. Sarcoid-like pulmonary disorder in human immunodeficiency virus-infected patients receiving antiretroviral therapy.We report two cases of hiv-infected patients who presented with diffuse interstitial micronodular lesions on chest X-ray after institution of protease inhibitor-containing highly active antiretroviral therapy (HAART). Granulomatous pulmonary disorder mimicking sarcoidosis was diagnosed on histopathological studies revealing noncaseating granuloma and bronchoalveolar lavage analysis showing an intense CD4( ) lymphocyte alveolitis. Causative agents such as infectious organisms and environmental compounds were excluded. The relationship between sarcoid-like reaction and immune reconstitution under HAART is discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/19. infant pulmonary hemorrhage in a suburban home with water damage and mold (stachybotrys atra).The American Academy of pediatrics recently issued guidelines regarding the potential toxic effect of indoor molds. We now report another case of an infant with pulmonary hemorrhage whose residential environmental assessment revealed the presence of the toxigenic mold stachybotrys atra. We used a questionnaire to identify environmental factors that could predispose the home to fungal contamination. We collected air samples from multiple locations in the home that we felt would reflect areas of relevant exposure. Surface samples were collected with a piece of transparent tape for semiquantitative measurement of spores present. We classified spores into their respective genera based on shape, size, and color. We also measured mycotoxin levels. air sampling revealed significantly elevated total spore counts in the patient's bedroom and in the attic. aspergillus/penicillium species were predominant. stachybotrys spores were found in the air sampled in the patient's bedroom, as well as from surfaces sampled in the patient's closet and the attic ceiling. Additionally, a small patch of stachybotrys-contaminated area in the closet ceiling was sent for mycotoxin analysis. This material proved to be highly toxigenic. As the link between the presence of stachybotrys in the home and pulmonary hemorrhage in infants increases, further efforts should be made to educate physicians, health care providers, and new parents about the potential toxic effects of this mold.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
3/19. Pulmonary hemorrhage in an infant following 2 weeks of fungal exposure.BACKGROUND: Exposure to indoor fungus growth and tobacco smoke has been epidemiologically linked to unexplained pulmonary hemorrhage in infants. OBJECTIVE: To describe the 40-day-old male infant who had been exposed to fungi for a discrete 2-week period followed by acute exposure to environmental tobacco smoke prior to development of a life-threatening pulmonary hemorrhage. PATIENT AND methods: history and clinical evaluation of the infant immediately followed the pulmonary hemorrhage. air and surface sampling for isolation and identification of fungal growth in the dwelling where the infant resided before the acute hemorrhage was accomplished when the homeowner returned from vacation 4 months after the clinical event. RESULTS: Two fungi associated with mycotoxin production were cultured from surface samples collected in the residence: penicillium (possibly penicillium purpurogenum) and a trichoderma species. stachybotrys atra was not isolated from air or surface samples. Environmental tobacco smoke exposure occurred over a discrete several-hour period prior to onset of the acute pulmonary hemorrhage. CONCLUSIONS: Avoidance of unnecessary exposure of infants to fungus growth in water-damaged environments or exposure to tobacco smoke is prudent. Further investigation into the toxic effects of indoor fungi as causes of infantile pulmonary hemorrhage is warranted.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
4/19. hantavirus pulmonary syndrome associated with Monongahela virus, pennsylvania.The first two recognized cases of rapidly fatal hantavirus pulmonary syndrome in pennsylvania occurred within an 8-month period in 1997. Illness in the two patients was confirmed by immunohistochemical techniques on autopsy material. reverse transcription-polymerase chain reaction analysis of tissue from one patient and environmentally associated peromyscus leucopus (white-footed mouse) identified the Monongahela virus variant. physicians should be vigilant for such Monongahela virus-associated cases in the eastern united states and canada, particularly in the appalachian region.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/19. Impairment rating and disability evaluation of the pulmonary system.An increasing number of patients are being seen by physicians for impairment and disability of the pulmonary system, partially because of the increasing prevalence of chronic obstructive pulmonary disease and increased awareness of industrial and environmental hazards to the respiratory system. As legislative efforts and social expectations towards entitlement and compensation become more permissive, an increasing number of individuals with respiratory impairment are claiming disability and seeking compensation. Consequently, the physician whose practice includes pulmonary rehabilitation may be expected to evaluate and rate impairment and disability of the pulmonary system. Fortunately, for respiratory disorders, excellent objective measures of pulmonary function exist that are readily applicable to the process of disability assessment. This article highlights the diagnostic procedures and assessment criteria of choice for pulmonary disability determination.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/19. Clinical profile of 30 infants with acute pulmonary hemorrhage in Cleveland.Between 1993 and 2000, 30 infants were hospitalized with acute pulmonary hemorrhage at Rainbow Babies and Children's Hospital in Cleveland. Most infants presented with severe pulmonary symptoms requiring intensive support, but a few infants had less severe hemorrhage. Three quarters of the patients required ventilator support and blood transfusions. Eleven patients had transitory hemoglobinuria. Five patients died, but infants who survived did well. There are currently no specific treatment modalities, although we have advised moving to a different home and avoiding environmental tobacco smoke. Subsequently, rebleeding from the lower respiratory tract has decreased from 5 of 7 infants to 1 in 21. On the basis of decreased subsequent fatal hemorrhage, high dose glucocorticoids seem to be of some value. Several patients revealed continued low-grade alveolar hemorrhage for months after their initial bleed, even after removal from their original home environments.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
7/19. IS1311 and IS1245 restriction fragment length polymorphism analyses, serotypes, and drug susceptibilities of mycobacterium avium complex isolates obtained from a human immunodeficiency virus-negative patient.Six isolates of Mycobacterium avium of genotype dnaJ( ) IS901(-) IS1311( ) IS1245( ) and serotypes 6 (n = 1), 6/9, (n = 2), and 9 (n = 3) were obtained within a 5-month period from a human immunodeficiency virus-negative patient treated for tuberculosis. The isolates were identified with PvuII restriction fragment length polymorphism (RFLP) analysis as a single IS1311 RFLP type and six different IS1245 RFLP types. Six separate colonies/clones obtained by subculture from each of the six isolates were tested for MICs of a set of 10 drugs. This report documents the appearance of isolates that are resistant to antimycobacterial drugs as the duration of therapy increases. Because isolates recovered from the patient following longer duration of treatment were more likely to be resistant to more antimycobacterial drugs, we would conclude that there was selection for antimycobacterial drug-resistant isolates. Analyses of all 36 clones identified three IS1311 and 22 IS1245 types forming three clusters. Tests of 105 environmental samples collected in the home and the work place of the patient yielded 16 mycobacterial isolates, of which one M. avium from soil was of genotype dnaJ( ) IS901( ) IS1311( ) IS1245( ) and serotype 2, and the second M. avium from a vacuum cleaner was of genotype dnaJ( ) IS901(-) IS1311( ) IS1245( ) and serotype 9. overall analyses of the results did not reveal any relation between serotype, RFLP type, and drug susceptibility. Based on the course of the disease in the patient and different serotypes, IS1311 and IS1245 RFLP types of isolates of M. avium we suppose represent polyclonal infection.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/19. mycobacterium xenopi, a potential human pathogen.mycobacterium xenopi is infrequently recognized as a cause of pulmonary disease. During a 12-year survey (1978-89),. 108 strains of this Mycobacterium were isolated from 90 persons and 6 hot water samples. From 87 patients 89 occasional strains of M. xenopi were isolated, and 3 patients were diagnosed as having pulmonary mycobacteriosis caused by it. The treatment and the response in these three cases were variable, depending on clinical conditions and sensitivity to drugs. Most of the strains isolated came from patients hospitalized at the Barzilai Hospital, Ashkelon, therefore a local environmental contamination was suspected. The suspicion was confirmed by the isolation of this thermophile organism from the hot water samples of the above hospital.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/19. Unusual occupationally related disorders of the lung: case reports and a literature review.Diseases of the lung are among the work-related conditions most widely recognized among nonspecialists and the lay public. Five pulmonary conditions for which occupational or environmental exposures are not typically emphasized are reviewed here in their clinical-pathologic context. These are diffuse alveolar hemorrhage, lipoid pneumonitis, granulomatous lung disease, pulmonary alveolar proteinosis, and pulmonary vascular disease.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/19. Investigation of spa pools associated with lung disorders caused by mycobacterium avium complex in immunocompetent adults.Three cases of mycobacterium avium complex-related lung disorders were associated with two poorly maintained spa pools by genotypic investigations. Inadequate disinfection of the two spas had reduced the load of environmental bacteria to less than 1 CFU/ml but allowed levels of M. avium complex of 4.3 x 10(4) and 4.5 x 10(3) CFU/ml. Persistence of the disease-associated genotype was demonstrated in one spa pool for over 5 months until repeated treatments with greater than 10 mg of chlorine per liter for 1-h intervals eliminated M. avium complex from the spa pool. A fourth case of mycobacterium avium complex-related lung disease was associated epidemiologically but not genotypically with another spa pool that had had no maintenance undertaken. This spa pool contained low numbers of mycobacteria by smear and was culture positive for M. avium complex, and the nonmycobacterial organism count was 5.2 x 10(6) CFU/ml. Public awareness about the proper maintenance of private (residential) spa pools must be promoted by health departments in partnership with spa pool retailers.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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