Hypersensitivity pneumonitis secondary to Klebsiella oxytoca. A new cause of humidifier lung.

A 30-year-old woman developed recurrent episodes of fever, dyspnea, and nonproductive cough after repeated exposure to a home humidifier. The diagnosis of hypersensitivity pneumonitis was confirmed by detection of serum-binding antibodies at significant titer to Klebsiella oxytoca colonizing the humidifier water but not to other potential antigens. This represents a newly recognized cause of hypersensitivity pneumonitis related to exposure to K oxytoca contaminating a commercially available ultrasonic cold air home humidifier. The potential role for these frequently used home humidifier devices in unexplained pulmonary illness is emphasized.

Pulmonary changes after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has become a widely used procedure. Upper abdominal surgery and particularly open cholecystectomy are known to be associated with marked declines in lung volume and a high risk of postoperative pulmonary complications. The pulmonary effects of laparoscopic cholecystectomy have not yet been studied. We prospectively evaluated 22 patients admitted for laparoscopic cholecystectomy for lung volume changes and development of postoperative pulmonary complications. The procedure was associated with a marked decline in forced vital capacity (FVC, 41.2 +/- 20.7%) and forced expiratory volume in one second (FEV1, 41.4 +/- 20.8%) in the immediate postoperative period. There was no significant difference in loss of lung function according to age (p = 0.18), sex (p = 0.33), or smoking history (p = 0.58). Despite the marked loss in lung function in the immediate postoperative period, no major pulmonary complications occurred. We conclude that laparoscopic cholecystectomy, although associated with early loss of lung function, is a safe and effective procedure with an incidence of postoperative pulmonary complications much less than with open cholecystectomy.

Infection with Mycobacterium avium complex in patients without predisposing conditions.

Pulmonary disease caused by Mycobacterium avium complex usually occurs in patients with chronic lung disease or deficient cellular immunity, and its prevalence is increasing. We describe 21 patients (mean age, 66 years) with such infection without the usual predisposing factors, representing 18 percent of the 119 patients surveyed. Seventeen women and 4 men were given a diagnosis of M. avium complex from 1978 to 1987, with a stable incidence over the decade, on the basis of pulmonary symptoms, abnormalities on chest films, positive cultures, and in 14, biopsy evidence of invasive disease. Most of the patients (86 percent) presented with persistent cough and purulent sputum, usually without fever or weight loss. The cough was present for a mean of 25 weeks before the correct diagnosis was made. Radiographic patterns of slowly progressive nodular opacities predominated (71 percent); only five patients had cavitary disease at presentation. All patients responded initially to antimycobacterial therapy, but eight eventually relapsed when it was stopped. Four patients died of progressive pulmonary infection caused by M. avium complex. The extent of the initial pulmonary involvement was greater in patients with progressive disease than in those whose condition improved. We conclude that pulmonary disease caused by the M. avium complex can affect persons without predisposing conditions, particularly elderly women, and that recognition of this disease is often delayed because of its indolent nature.

Longitudinal changes in pulmonary function following bone marrow transplantation.

We prospectively followed a well characterized cohort of patients post-bone marrow transplantation for changes in pulmonary function. Thirty-four recipients without respiratory symptoms were available for follow up with a mean of two years. Spirometry and other measures of lung volume were well preserved following bone marrow transplantation. A progressive 11.9 percent decline in percent predicted diffusing capacity per year occurred. Age, cigarette smoking, type of cytoreductive therapy, type of GVHD prophylaxis, and the occurrence of AGVHD did not affect longitudinal changes in pulmonary function. Patients receiving transplants for CML developed a highly significant fall in diffusing capacity. Asymptomatic patients with CGVHD developed evidence of progressive obstructive ventilatory impairment. This suggests a subclinical spectrum of patients who may progress to the development of bronchiolitis obliterans and respiratory failure post-bone marrow transplantation.

Aerosol transmission of experimental rotavirus infection.

Several aspects of the epidemiology of rotavirus suggest the possibility that transmission may occur by nonenteral routes. We utilized the mouse model of rotavirus infection to investigate the experimental transmission of rotavirus infection by respiratory droplets. Following exposure to a defined dose of aerosolized rotavirus, the kinetics of viral replication within the lung and gastrointestinal tract was studied using a double antibody enzyme immunoassay and indirect immunofluorescence. These studies documented the efficient transmission of rotavirus infection by means of aerosol in all exposed animals. Rotavirus antigen was detected as early as 12 hours after infection in the pulmonary and gastrointestinal tracts of the infected animals and antigen remained detectable in both sites for at least 8 days following infection. Gastrointestinal illness was clearly demonstrable in the animals while pulmonary pathology was not evident. These studies document that rotavirus infection can be transmitted by aerosol droplets under experimental conditions.

Respiratory arrest following first dose of timolol ophthalmic solution.

Within 30 minutes of the administration of his first dose of timolol ophthalmic solution, a 67-year-old man with stable chronic obstructive pulmonary disease experienced severe dyspnea leading to respiratory arrest. He recovered after endotracheal intubation and mechanical ventilation. Patients with bronchospastic pulmonary disease who are candidates for therapy with timolol ophthalmic solution should receive their first dose under medical supervision and should have continued close medical follow-up for as long as they receive timolol.