1/20. Recurrent flu-like illness with migrating pulmonary infiltrates of unknown aetiology.Migrating pulmonary infiltrates present a difficult diagnostic and therapeutic challenge. We report on eight patients (mean age 51 years, range 32-78 years, with a prolonged history of migrating pulmonary infiltrates of unknown aetiology despite a very elaborate search for infectious causes, hypersensitivity pneumonitis or inhalation fever due to occupational or domestic exposure to fungi, or to other environmental causes, and for humoral or cellular immunological incompetence. These patients (one male, seven females) presented with recurrent episodes (mean 6, range 2-13) of a flu-like illness, often with cough, wheezing and pleuritic chest pain, but without systemic involvement. Previous medical histories were unremarkable. There was no relation with smoking habits, occupation, drug use or other possible exposures. Biochemical data were non-specific. There was no peripheral nor pulmonary eosinophilia; total IgE was normal, with negative RASTs and precipitins to a variety of antigens. Cultures and serological tests for bacteria, viruses, fungi, etc were non-contributory. Chest X-ray and computed tomography (CT) scan showed bilateral migratory pulmonary infiltrates, with a predilection for the middle and lower lung zones, often with a minor-to-moderate pleural effusion. lung function tests were usually normal; at the most a slight decrease in diffusing capacity was noted in some patients. There was no or only a slight response to antimicrobials; systemic corticosteroids were not given. Further evolution was benign with patients being asymptomatic between the episodes. Despite elaborate investigations, the cause of these 'pneumonias' remains frustratingly unknown.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/20. Bioaerosol lung damage in a worker with repeated exposure to fungi in a water-damaged building.There has been increased concern over health effects related to potential exposure of building occupants to bioaerosols. We report the case of a worker with a respiratory illness related to bioaerosol exposure in a water-damaged building with extensive fungal contamination. We performed environmental tests to evaluate potential exposure to fungi, and we used mycotoxin-specific IgG antibody in serologic studies in the attempt to evaluate exposure to mycotoxins. Extensive fungal contamination was documented in many areas of the building. penicillium, aspergillus, and stachybotrys species were the most predominant fungi found in air sampling. Our serologic test was not useful in differentiating workers who were probably occupationally exposed to mycotoxins from those who were not; however, it did yield evidence that individuals may make specific IgG antibodies to macrocyclic tricothecene mycotoxins. Further research is needed concerning health effects related to bioaerosol exposures, particularly regarding markers of exposure to specific fungi that may produce mycotoxins. In the absence of clinical tools specific for evaluation of mycotoxin-related illness, a systematic clinical approach for evaluating persons with suspected building-related respiratory illness is warranted.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/20. Fatal inhalational anthrax with unknown source of exposure in a 61-year-old woman in new york city.A 61-year-old woman who was a new york city hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. blood cultures, as well as dna amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/20. Fulminant primary pseudomonas aeruginosa pneumonia and septicaemia in previously well adults.We report two cases of primary, community acquired, pseudomonas aeruginosa pneumonia, occurring in previously well adults without any recognisable environmental risk factors. Both patients died within 36 h of the onset of symptoms, despite broad spectrum antibiotics and aggressive supportive care. In neither case was the diagnosis considered in life and neither patient received adequate anti-pseudomonas therapy. Heightened awareness of this rare, fulminant, variant of primary Pseudomonas pneumonia is required if specific anti-pseudomonas therapy is to have any impact on outcome.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/20. Exposure to extremely high concentrations of carbon dioxide: a clinical description of a mass casualty incident.Clinical reports on unintentional mass exposure to extreme concentrations of carbon dioxide are rare. We describe an industrial incident caused by a container of liquid carbon dioxide that was unintentionally opened in an enclosed working environment. Twenty-five casualties reached our emergency department. Symptoms included dyspnea, cough, dizziness, chest pain, and headache. ECGs (n=15) revealed ST-segment changes in 2 (13.3%) patients, atrial fibrillation in 2 patients, and non-Q wave myocardial infarction in 1 patient. Chest radiographs (n=22) revealed diffuse or patchy alveolar patterns, consistent with pneumonitis, in 6 (27%) patients and pulmonary edema in 2 (9%) patients. Eleven (44%) patients were admitted to the hospital: 8 were discharged 24 hours later and the others within 8 days. No patient died. Exposure to high concentrations of carbon dioxide resulted in significant but transient cardiopulmonary morbidity with no mortality when victims were promptly evacuated and given supportive therapy. Cardiac complications were frequently observed and should be actively sought.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/20. Community-acquired pseudomonas pneumonia in a normal host complicated by metastatic panophthalmitis and cutaneous pustules.pseudomonas aeruginosa is a frequent pathogen of patients with chronic underlying disease in the hospital environment. This organism is, however, an extremely rare cause of either community-acquired pneumonia in a normal host, metastatic bacterial endophthalmitis or metastatic cutaneous pustules. We report here a case combining these three rare manifestations in a previously well young woman, to highlight the serious disease that may result from this pathogen and the difficulties of treatment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/20. Characterization of a Legionella anisa strain isolated from a patient with pneumonia.Legionella anisa, previously found only in environmental specimens, was isolated from a bronchial lavage specimen of an immunocompromised patient with pneumonia. growth, physiologic, gas-liquid chromatographic, serologic, and dna characteristics were consistent with those of the type strain of L. anisa, WA-316-C3 (ATCC 35292).- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/20. legionella pneumophila serogroup 12 pneumonia in a renal transplant recipient: case report and environmental observations.We describe the first reported case of pneumonia due to legionella pneumophila serogroup 12 in the UK. This hospital-associated infection occurred in an immuno-incompetent patient and coincided with a change in character of the local environmental strains of legionellas. The patient produced a serological response both to her own isolate and to L. pneumophila serogroups 1-6. Thus serodiagnosis was attainable using the usual screening antigens.- - - - - - - - - - ranking = 5keywords = environment (Clic here for more details about this article) |
9/20. legionella longbeachae pneumonia: report of two cases.legionella longbeachae serogroup 1 was isolated from the respiratory secretions of two patients with community-acquired pneumonia. One patient had a mild infection without evidence of the involvement of other organs and recovered, in spite of inappropriate antibiotic therapy. The other patient was severely-ill on presentation with multisystem failure and died soon after admission to hospital. The organisms were identified by the immunofluorescence technique and by quantitative dna-hybridization studies. The sources of the infection in these patients are unknown as the organism has never been isolated from the SA environment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/20. aspergillus pneumonia--a cluster of four cases in an intensive care unit.Four cases of aspergillus pneumonia occurred in an intensive care unit within a short period. Clusters of cases of invasive aspergillosis are rare and have usually been attributed to excessive contamination of the environment. Extensive environmental studies were, however, negative. Three of the cases were diagnosed ante mortem. One patient survived after early initiation of treatment with amphotericin b.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
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