Chlamydia pneumoniae in community-acquired pneumonia.

Chlamydia pneumoniae has been established recently as an important human respiratory pathogen. The aim of this study was to define the prevalence of C. pneumoniae in community-acquired pneumonia. We prospectively investigated adult patients who were treated as inpatients and outpatients. Acute and convalescent serum samples were obtained from each patient. Serological diagnosis of C. pneumoniae infection was determined by enzyme-linked immunosorbent assay (ELISA). Eighty paired sera were tested for C. pneumoniae-specific IgM, IgG and IgA. Twenty-one patients (26.2%) had serological results compatible with acute C. pneumoniae infection. Eighteen (85.7%) of these infected patients were C. pneumoniae-specific IgM positive, three had a seroconversion of IgA and two had a four-fold or greater increase in C. pneumoniae-specific IgG antibody titer. The most common clinical manifestations of community-acquired pneumonia due to C. pneumoniae were fever (100%), cough (100%), chest pain (47.6%) and shortness of breath (42.9%). Physical examination revealed crackle in 85.7 per cent of the cases. These findings suggest that C. pneumoniae is a common cause of community-acquired pneumonia in Thailand.

Clinical and laboratory findings in patients with pulmonary embolism in Phramongkutklao Hospital.

Pulmonary embolism (PE) was believed to be a rare disease and often misdiagnosed in Thailand. Only a few cases of PE in Thai patients have been reported. The purpose of this study was to describe the characteristics of history, physical examination and laboratory investigations in Thai patients with PE. Forty-nine patients diagnosed as PE in Phramongkutklao Hospital between 1994 and 1998 were included in the study. All patients underwent complete history, physical examination and appropriate laboratory studies. The mean age of this patient group was 53 years. Thirty-four per cent of these patients were first suspected of lung embolism while the others were misdiagnosed as congestive heart failure, myocardial infarction, pneumonia or septic shock. The most common syndrome was isolated dyspnea. Interestingly, chronic thromboembolic pulmonary hypertension which is uncommonly found in western countries was diagnosed in 12 per cent of our patients. Dyspnea, pleuritic pain, leg swelling, cough, tachypnea, tachycardia and increased pulmonary component of second heart sound were common symptoms and signs. A high-probability ventilation/perfusion lung scan and deep vein thrombosis were demonstrated in 93 per cent and 55 per cent of our patients, respectively. The mortality rate was 10 per cent.

Idiopathic pulmonary fibrosis, clinical features in Thai patients.

Idiopathic pulmonary fibrosis (IPF) or cryptogenic fibrosing alveolitis (CFA) is the most common type of chronic diffuse parenchymal lung disease. We identified twenty patients who were diagnosed with this disease in Phramongkutklao Hospital. Clinical features of these patients were reported. All presented with dyspnea and the severity of dyspnea was grade 3-4 in 14 patients (70%). Every patient had bilateral basilar crackles on auscultation. The median survival time of newly diagnosed IPF in this study was only 16 months. Comparison of Thai patients with those of other reports from Western countries showed differences in severity of dyspnea and the median survival time.

Transbronchial needle aspiration in the diagnosis of bronchogenic carcinoma.

Transbronchial needle aspiration (TBNA) via a fiberoptic bronchoscope has been used for diagnosis of lung cancer by Wang since 1981. The technique uses a fiberoptic bronchoscope with a flexible needle that can penetrate the wall of the trachea and major bronchi. It is still underutilized and markedly depends on the physician's skill. We present our experience of TBNA for diagnosis of bronchogenic carcinoma. TBNA was performed on 47 consecutive patients with suspected lung cancer at the time of diagnosis bronchoscopy. Thirty six patients were diagnosed with bronchogenic carcinoma. TBNA demonstrated bronchogenic carcinoma in 61.1 per cent of the cases (22 of 36) and TBNA alone confirmed a malignant diagnosis in 33.3 per cent (12 of 36). The overall diagnostic yield of bronchoscope utilizing the conventional techniques of bronchial washing, brushings and biopsy was 50 per cent. With the addition of TBNA, bronchoscopy was diagnostic in 83.3 per cent of the patients. There were no serious complications. We concluded that TBNA is a safe technique that can significantly increase the diagnostic yield of conventional fiberoptic bronchoscopy in the diagnosis of bronchogenic carcinoma.

Diffuse panbronchiolitis, the first case reports in Thailand.

Diffuse panbronchiolitis (DPB) is an important cause of progressive obstructive lung or chronic suppurative lung disease in the Far East (Japan, China and Korea). It is a distinctive sinobronchial syndrome with typical radiological and histologic features. We have identified three patients who have typical clinical manifestation and pathological confirmation. DPB should be suspected in patients who have clinical manifestations of chronic cough, productive sputum and shortness of breath. The chest radiograph often shows diffuse nodular shadows on a background of hyperinflated lungs. High resolution computed tomographic (HRCT) can guide the diagnosis and differentiate from other diseases. Finally, the most important issue of DPB is the treatment. Chronic treatment with low-dose erythromycin can improve the survival of patients.