Adult respiratory distress syndrome due to Chlamydia pneumoniae in a young adult.

A case of life-threatening Chlamydia TWAR pneumonia complicated by encephalitis in a young, previously healthy adult is described. The patient presented with full blown adult respiratory distress syndrome and required prolonged ventilatory support and rigorous antibiotic and supportive care. He recovered fully without any neurologic sequelae. Chlamydia pneumoniae pneumonia should be included in the differential diagnosis of the severe community acquired pneumonia, because if properly sought and adequately treated, may have an excellent outcome.

Prevalence of asthma and asthma-like symptoms in Athens, Greece.

Asthma is a common chronic condition and there is evidence that its prevalence may be rising. The European Respiratory Health Survey (ECRHS) was planned to produce comparable data on asthma epidemiology in Europe. In Greece, in particular, a similar study has not been conducted previously and no epidemiological data are available on adult asthma prevalence. Furthermore, the role of air pollution in the pathogenesis of asthma is currently an issue of debate. Athens is a city with high air pollution, and a study of asthma epidemiology in this city may confirm or refute a possible link with the expression of asthma. A questionnaire developed by the ECRHS was sent to a random sample of 3533 households in Peristeri, an industrialized borough of Athens. Responses were received from 2774 households (response rate 78%). Of all the data on individual subjects, only those from 3325 adults aged 20-44 years were considered, according to the study protocol. The self-reported current prevalence of asthmatic attacks and asthma-like symptoms were as follows: asthma attack 2.4%, use of asthma medication 2.1%, awakening by shortness of breath 5.6%, awakening by cough 17.8%, wheezing 15.8% and nasal allergies 18.4%. It is concluded that the prevalence of asthma and related symptoms in this region of Athens is rather low, despite the high air-pollution levels in the city.

Evaluation of nasal patency: comparison of patient and clinician assessments with rhinomanometry.

The correlation between the objective measurement of nasal resistance and nasal airflow sensation is usually regarded as poor. The aim of the study was to assess the relation between objective indices of nasal patency, as assessed by the occlusion method (RN) and the Youlten peak nasal inspiratory flow meter (PNIF), with subjective sensations of nasal blockade by either the patient or the clinician in groups of patients with rhinitis, asthma, rhinitis and asthma, nasal septal deformity and ill normal controls. We studied nasal airway patency in 254 subjects (37 women, 217 men), mean age 21 years (range 14-78) by RN and PNIF. Nasal resistance was also measured by the application of Ohm's law for parallel resistors (NRO) by estimating the unilateral resistance separately. Subjective sensation of nasal blockade was assessed either by the patient on a 10-point Borg scale (SUB), or the clinician (CLN) on a 6-point scale (3 for each side of the nose). The latter was done in a controlled fashion with the aid of reference sensations. Adjusting for age, height, smoking status and airway calibre, we found good correlation between RN and CLN (r=0.57, p=10(-4)), whereas the association between RN and SUB was moderate and of borderline significance (r=0.42. p=0.05). By logistic regression analysis, we found that the only independent predictors of abnormal nasal resistance at a cut-off value of 0.30 kPa/l/s were the nasal scores as assessed by the clinician (r-=0.26, odds=2.45). We conclude that PNIF measurement and SUB scores are of limited use as indices of nasal patency, although the latter showed an improved association in comparison to older studies. As there is a necessity for some sort of objective measurement to assess nasal patency, the described clinician evaluation may be clinically useful in place of PNIF, but due to its somewhat subjective nature and its inability to detect milder levels of nasal obstruction it cannot be recommended as an alternative to rhinomanometry.

Suppressive BALF lymphocyte phenotype in a patient with prolonged stable alveolar proteinosis.

The case history of a 25-year-old man suffering from idiopathic alveolar proteinosis is described. The patient showed a prolonged stable mild disease and a distinct suppressive phenotypic profile of BALF lymphocytes. Specifically, a low T4/T8 ratio and a high percentage of CD11b+ T8 lymphocytes was found. Correlations with disease expression are made.