Seminars in respiratory infections
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Semin Respir Infect · Sep 1998
ReviewInvolvement of T cells and alterations in T cell receptors in sarcoidosis.
Sarcoidosis is recognized to be a multisystem granulomatous disease characterized by activated, cytokine-producing T cells and macrophages at sites of inflammation. The purpose of this article is to review new evidence concerning the role of T cells in sarcoidosis. ⋯ In addition, data on cytokine production in sarcoidosis indicate that tissue inflammation is dominated by expression of type 1 (T helper 1) cytokines such as interferon-gamma and interleukin-12 that, in keeping with experimental models of granulomatous diseases, likely orchestrate the granulomatous response. These studies offer new insight into the molecular mechanisms of granuloma formation in sarcoidosis and provide a framework for developing new therapeutic strategies for the treatment of this disease.
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Legionnaires' disease is a systemic infectious disease primarily involving the lungs, with multisystemic extrapulmonary manifestations. Any species of Legionella may cause legionnaires' disease in normal and compromised hosts. ⋯ The syndromic approach based on a weighted point evaluation system described in the article gives physicians a system to arrive at a rapid presumptive clinical diagnosis of legionnaires' disease. Definitive diagnosis of legionnaires' disease is by direct fluorescent antibody testing of respiratory specimens, serological methods, Legionella urinary antigenuria, or culture.
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Clinicians define mild pneumonia as patients who are "not too sick," have normal respiratory and mental status, and are able to maintain oral intake. As yet there is no uniform definition of mild pneumonia. By inference, mild pneumonia occurs in younger patients with less comorbidity and has a better outcome than pneumonia that is moderate to severe. "Atypical" pathogens such as Mycoplasma pneumoniae, Chlamydia pneumoniae and respiratory tract viruses are common causes of mild pneumonia.
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Strongyloides stercoralis (SS) is endemic in tropical and subtropical areas worldwide and in the southeastern United States. The lifecycle of SS is both unique and complex. Human infection begins with the penetration of skin by filariform larvae that migrate hematogenously to the lungs. ⋯ A presumptive diagnosis of SS infection can be achieved by serology. Thiabendazole is the mainstay of treatment, but repeat doses may be necessary if the parasite is not initially eradicated. The low incidence of disseminated SS in areas endemic for both SS and AIDS is surprising and unexplained.
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Tularemia pneumonia may complicate the various clinical presentations of tularemia, or present as an uncommon zoonosis. Approximately 200 cases of tularemia are reported in the United States per year, and 10% to 20% present with pneumonia either as a primary event or as a complication of ulceroglandular or typhoidal tularemia. Tularemia pneumonia also occurs with the other tularemic forms, glandular, oculoglandular, and oropharyngeal tularemia as a result of secondary bacteremic spread to the lungs. ⋯ Serum agglutination tests and ELISA are the basis of serological diagnosis. Francisella tularensis can be cultured from the sputum, skin ulcer, pleural fluid, and the lymph nodes, but cultures should not be obtained because of the danger to laboratory personnel. The drug preferred for treatment of tularemic pneumonia is streptomycin for 1 to 2 weeks.