Restaging Pulmonary Schistosomiasis.

Schistosomiasis is traditionally classified into an acute and a chronic phase, although a precise temporal distinction between the two phases has not been established. Lung involvement can be observed in both phases. We previously reported seven cases of pulmonary lesions due to chronic schistosomiasis in African immigrants. All cases were documented with CT scans and demonstrated complete resolution after treatment with praziquantel. Moreover, another case showed spontaneous disappearance of the nodule before treatment with praziquantel. These findings are similar to those observed in the acute phase of schistosomiasis, with well-defined or ground glass nodules that resolve spontaneously. According to these findings, we postulate the presence of an "intermediate" phase of schistosomiasis involving the lungs that can be defined as an "early chronic phase," and presents analogies to the acute phase. We also hypothesize that in the "early chronic phase," the female worms transit through the lungs where they may lay eggs. These passages not only cause transient, but also radiologically visible alterations. The pathophysiology of lung lesions in the late chronic phase is probably different: the adult worms settled in the mesenteric plexuses produce eggs for years. The eggs repeatedly migrate to the perialveolar capillary beds via portal-caval shunting. Thus, in this case it is the eggs and not the adult worms that reach the lungs in a scattered way. Based on our findings, we suggest the alternative hypothesis that the pulmonary involvement is a phase of the natural evolution of the infection, both from Schistosoma mansoni and Schistosoma haematobium.

[Infectious pulmonary diseases]. / Infektiöse Lungenerkrankungen.

Infectious pulmonary diseases and pneumonias are important causes of death within the group of infectious diseases in Germany. Most cases are triggered by bacteria. The morphology of the inflammation is often determined by the agent involved but several histopathological types of reaction are possible. Histology alone is only rarely able to identify the causal agent; therefore additional microbiological diagnostics are necessary in most cases. Clinically cases are classified as community acquired and nosocomial pneumonia, pneumonia under immunosuppression and mycobacterial infections. Histologically, alveolar and interstitial as well as lobar and focal pneumonia can be differentiated.

Sindrome de Loeffler: presentación de un caso / Loeffler syndrome: a case report

Presentamos el caso de un niño pre escolar procedente de Los Yungas Paceños, que ingresó al Hospital del Niño de la ciudad de La Paz, por disentería, desnutrición y antecedentes de eliminación de Ascaris por boca, nariz y recto. Recibió mebendazol para su enteroparasitosis, con franca mejoría de su cuadro enteral, permaneciendo hospitalizado para otros agentes de disentería y rehabilitación nutricional. A los siete días de internación presenta en forma súbita dificultad respiratoria, datos clínicos de pulmón sibilante (sibilancias, roncus y crépitos finos en ambos pulmones), marcada eosinofília periférica de 24% (recuento absoluto de eosinófilos 3.360) e imágenes radiográficas de tórax con infiltrado intersticial difuso, bilateral compatible con una neumonía difusa intersticial. Por proceder de una región con elevada incidencia de enteroparasitosis masiva, eliminación de nematodos, eosinofilia simultánea, compromiso pulmonar sibilante, intersticial y transitorio antes descrito; se considera el cuadro como síndrome de Loeffler, recibiendo tratamiento como tal, con mejoría clínica.

We present the case of a preschool child coming from the Yungas of La Paz which was admitted to the Hospital del Niño in La Paz with dysentery , malnutrition and a history of elimination of Ascaris through mouth, nose and rectum. The child received mebendazol against the enteroparasites, resulting in a clear improvement of the dysentery, while remaining hospitalized for treatment of other dysentery agents and nutritional rehabilitation. At seven days of his stay, the child suddenly presented breathing difficulty, clinical signs of a "sibilant lung" (crepitating, sibilant and roncus sounds in both lungs), marked peripheral eosinophilia of 24% ( eosinophil count 3,360 cells) and radiografíc images of the torax with diffuse bilateral interstitial infiltrations compatible with diffuse interstitial pneumonía . Since the child comes from a region with a high incidence of massive enteroparasitism, elimination of nematodes, simultaneous eosinophilia, sibilant lung, interstitial and temporal previously described, the disease is considered as Loeffler's Syndrome and treated accordingly with clinical improvement.

Radiology of pneumonia.

Infection of the lower respiratory tract, acquired by way of the airways and confined to the lung parenchyma and airways, typically presents radiologically as one of three patterns: (1) focal nonsegmental or lobar pneumonia, (2) multifocal bronchopneumonia or lobular pneumonia, and (3) focal or diffuse "interstitial" pneumonia. These patterns can be useful in identifying the etiological organism in the appropriate clinical setting. To serve the purpose of this article, these patterns are used as the primary method of classification of pulmonary infections caused by different organisms. Mycobacterial and fungal pulmonary infections are reviewed separately because of their wide range of radiographic appearance that depend on the stage of the disease at presentation. This article discusses the clinical and radiographic features of the most common causes of pneumonia, primarily in the adult population of the United States.

Epidemiological aspects of lungworm infections of goats in Morocco.

The results of a survey of lungworm infections in goats in the Middle Atlas and Rabat areas in Morocco during 1990-1992 are reported. Five species were recorded: Dictyocaulus filaria, Protostrongylus rufescens, Cystocaulus ocreatus, Muellerius capillaris and Neostrongylus linearis. The parasitological profile of protostrongylid species was represented by Muellerius (69-78%), Protostrongylus (16-25%) and Cystocaulus (5-6%) in the Rabat and Middle Atlas areas. Neostrongylus was virtually non-existent (under 1%) in both regions. Multigeneric infection involving several species of lungworms reached 54% in Rabat and 88% in Middle Atlas. Dictyocaulus infection of goats does not appear to be a serious problem. Infection rates of 40% and 50%, and average worm burdens of three and five worms per kid and adult goat were recorded in autumn in the Rabat area. A similar pattern was noted in Middle Atlas. In contrast, the incidence of small lungworm infections in goats is widespread at levels likely to be of economic significance. The level of infection was considerably higher than the Dictyocaulus infection and the infection rate was virtually 100% in both age groups in the two areas. The overall worm burdens averaged 77.03 +/- 22.6 parasites per adult goat and 44.16 +/- 16.3 per kid in the Rabat area, whereas the corresponding figures in Middle Atlas were 51.48 +/- 16.65 and 34.06 +/- 2.69 worms. The periods of high risk of infection by small lungworms were autumn, early winter and late spring-early summer. However, the heaviest infection by adult worms and the highest larval excretion were observed in late autumn and winter when molluscs were heavily infected. The periparturient period seemed to exert a positive influence on protostrongylid larval production. The output of first stage larvae (L1) of lungworms was significantly higher in goats than in sheep. Thus, goats may play a greater role in pasture contamination. The epidemiological factors influencing the seasonal fluctuations of lungworms are discussed and a timetable of recommended treatments is suggested.