Clinical characteristics, pulmonary function abnormalities and outcome of prednisolone treatment in 106 patients with sarcoidosis.

The clinical profile of one hundred and six biopsy proved patients with sarcoidosis is reported from New Delhi. The disease occurred more frequently in males (68 of the 106; 64%) in their fifth decade. Dry cough (83%), exertional dyspnoea (61%), fever (56%) and joint pains (44%) were frequent symptoms. Hepatomegaly (45%), peripheral lymphadenopathy (45%), cutaneous involvement (42%), presence of crepitations (36%) were frequent signs. In addition, ocular symptoms (18%), parotid gland enlargement (12%), facial nerve palsy (8%) were observed. Audible wheeze was present in nine patients. Radiologically, 25 (24%), 67 (63%) and 14 (13%) of patients belonged to stage I, II and III respectively at presentation. More than one sibling was involved in six families. Pulmonary functions revealed mixed obstructive and restrictive ventilatory defect. However, obstructive ventilatory defect was predominant. Systemic steroids were used in 81 patients who regularly followed up. Frequent relapses occurred on tapering off or stopping the corticosteroids in 21 patients. History of malaise (p < 0.05), presence of crepitations (p < 0.05), wheezing (p < 0.05), peripheral blood eosinophilia (p < 0.05) and FEV1/FVC (%) < 65% of the predicted value (p < 0.05), were independent predictors of relapse. Hyperuricaemia, hitherto unreported in patients with sarcoidosis was observed in 41% of patients for whom values were available. Two patients died; one from cardiomyopathy and another from stroke. In summary, constitutional symptoms such as fever, weight loss and pulmonary infiltrates, were more frequently encountered in Indian patients with sarcoidosis as compared to western studies. A high index of clinical suspicion and histopathological confirmation early in the illness are required to ascertain the diagnosis lest these patients will get treated as tuberculosis with potentially hepatotoxic drugs.

The problem of emerging chloramphenicol resistance in typhoid fever--a preliminary report.

Drug sensitivity of Salmonella typhi isolated from 25 blood culture positive cases of typhoid fever who presented between May and July 1990 was tested to determine their in vitro susceptibility to various antimicrobials. Twenty-one of them (84%) showed resistance to chloramphenicol and 24 (96%) to cotrimoxazole. All the 25 cases were sensitive to norfloxacin, gentamicin and cephalexin. Sixteen of 21 chloramphenicol resistant typhoid cases in whom chloramphenicol was initially started failed to respond to this drug even after 5 to 7 days, thereby indicating that in vivo response matched with the in vitro sensitivity. Clinical response to norfloxacin, whether given initially or following chloramphenicol failure, was prompt and satisfactory. Norfloxacin thus appears to be a good choice in such cases.

Clinical and bacteriological profile of hospitalized community acquired pneumonias--a preliminary study.

The spectrum of clinical and bacteriological features of 46 cases of pneumonias presenting to U.C.M.S. and Guru Tegh Bahadur Hospital complex in East Delhi over a period of three months are presented and their etiopathogenesis discussed. The high incidence of pneumonias in admitted patients belonging to the population adjacent to the hospital is highlighted. Etiological diagnosis based on sputum culture and sensitivity tests was possible only in 37% cases, and there is need for the use of newer even though invasive methods for arriving at the bacteriological diagnosis.

Bronchoalveolar lavage fluid (BALF) analysis in interstitial lung diseases--a 7-year experience.

Bronchoalveolar lavage (BAL) was performed in 89 patients with diffuse interstitial lung disorders of varied aetiology and 19 normal control subjects over a period of 7 years. Alveolar macrophage was the predominant cell in BALF in normal control subjects. Increased neutrophils were found in BALF in patients with cryptogenic fibrosing alveolitis (CFA) and fibrosing alveolitis associated with collagen vascular diseases. BALF lymphocytosis was seen in patients with chronic hypersensitivity pneumonitis, sarcoidosis, miliary tuberculosis, silicosis and carcinomatosis. Diagnosis of alveolar microlithiasis was made in one patient with the help of BALF examination. One patient developed anaphylactic reaction to the topical xylocaine solution and there was no mortality with the procedure.

Interrelationship between bronchoalveolar lavage cellular constituents and pulmonary functions in sarcoidosis.

Bronchoalveolar lavage (BAL) using a fiberoptic bronchoscope was done in 36 patients with sarcoidosis on 45 occasions and in 19 control subjects over a period of seven years. Total cell, polymorphonuclear cell and eosinophil cell counts of bronchoalveolar lavage fluid (BALF) in patients with sarcoidosis were not significantly different from control subjects. However, lymphocyte count (% total cells) in BALF was significantly higher (P less than 0.001) in patients with sarcoidosis as compared to control subjects. Alveolar macrophage was the predominant cell type in BALF in control subjects. A significant positive correlation (r = 0.46; P less than 0.01) between vital capacity (VC) and pulmonary diffusing capacity (DLCO) and a negative correlation (r = -0.52; P less than 0.001) between BAL fluid lymphocytes (%) and DLCO (per cent predicted) was found in patients with sarcoidosis. An increase in lymphocytes in BALF is considered to be one of the parameters indicating activity of sarcoidosis. In view of the relationship between this parameter and the reduction in DLCO, the latter may also be an indicator of disease activity.