Cardiac and Pulmonary Cystic Echinococcosis With Massive Obstruction of the Pulmonary Vessel System in a 16-Year-Old Girl.

We describe herein the management of a 16-year-old girl with cystic echinococcosis of the right ventricle and massive obstruction of the pulmonary vessel system by parasitic metastatic dissemination. After resection of the cardiac cyst, pulmonary thromboendarterectomy was performed to remove parts of the obstructive parasitic material. The treatment reduced the elevated pulmonary arterial pressure, improving the patient's overall condition.

Diarrea y erupción cutánea enun paciente con obstrucción crónicadel flujo aéreo corticodependiente / Diarrhoea and cutaneous rash in a patient with chronic air flow obstruction

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[Strongyloides stercoralis infection in a cortico-dependent patient with chronic airflow obstruction]. / Infección por Strongyloides stercoralis en un paciente con obstruccion crónica al flujo aéreo corticodependiente.

We report a case of Strongyloides stercoralis infection in a male agricultural worker with corticoid dependent chronic obstructive air flow disease and bronchial hyperreactivity. The clinical picture initially involved digestive symptoms and bronchospasm resistant to steroid treatment. Diagnosis was established by demonstrating the larvae of S. stercoralis in stool. We emphasize that this infection should be suspected in patients living in endemic areas such as Spain, and describe S. stercoralis-caused respiratory manifestations that can be masked by bronchial disease.

[Parasitic invasions and bronchial obstruction]. / Parazitnye invazii i bronkhoobstruktivnyi sindrom.

The course and outcomes of bronchial obstruction were reviewed for clonorchiasis, metagonimosis, lambliasis. Bronchial obstruction is shown to run more aggressive course in Trematoda infestation with further transformation into bronchial asthma despite dehelminthization. In lambliasis current antiparasitic therapy is able to abolish the obstruction. In combination of lambliasis with bronchial asthma it is feasible to achieve a persistent remission of bronchial asthma.

Exacerbation of chronic obstructive pulmonary disease due to hyperinfection with Strongyloides stercoralis.

Pulmonary infection due to the filariform larvae of Strongloides stercoralis may occur in immunocompromised patients residing in endemic areas of the United States. Such infection usually presents as dyspnea with a cough that sometimes results in bloody sputum. Although the chest roentgenogram often reveals a patchy bilateral alveolar infiltrate, acute respiratory distress is unusual. We report a patient who experienced severe exacerbation of his underlying obstructive lung disease that was associated with chest infiltrates and recovery of S stercoralis from his sputum. Although initial improvement was accomplished with Thiobendazole treatment, a re-exacerbation occurred when antiparasitic therapy was completed. The persistence of his infection is correlated to factors that are commonly employed in the treatment of COPD but may be overlooked as predisposing causes of hyperinfection with S stercoralis.

Alveolar macrophage function and inflammatory stimuli in smokers with and without obstructive lung disease.

To explore possible cofactors in the development of chronic obstructive pulmonary disease (COPD) in smokers, we performed bronchoalveolar lavage in 6 smokers with normal pulmonary function, 6 smokers with COPD (FEV1/FVC less than or equal to 65%) matched for smoking history and age, and 9 age-matched nonsmoking control subjects. Elastase release by macrophages from smokers with COPD was significantly higher (p less than 0.016) than was elastase release by macrophages from normal smokers. There were no differences between chemoattractiveness of alveolar macrophage supernatants for one person's polymorphonuclear leukocytes among the groups of smokers and there was no detectable C5/C5a in these supernatants (limit of detection of C5a greater than 1 ng/ml). There were no significant differences in numbers or species of bacteria in aerobically and anaerobically cultured bronchial brushings. There was no difference in alveolar macrophage superoxide anion release with particulate or membrane-perturbing stimuli for the smokers. Alveolar macrophages from the 3 groups of subjects had similar limited microbicidal ability for the obligate intracellular protozoan, Toxoplasma gondii, and similar numbers of elastase receptors and affinity for elastase.

Strongyloidiasis. When to suspect the wily nematode.

Strongyloidiasis is a tenacious soil-transmitted nematode infestation endemic in the south-eastern United States. Thirty-three cases were diagnosed in a series of 1,290 stool examinations in 971 patients at Veterans Administration Medical Center, Mountain Home, Tennessee. Most patients had a concurrent major illness, such as chronic lung disease, serious bacterial infection, or cancer. A minority presented with gastrointestinal symptoms alone. Skin rash was uncommon. Eosinophilia, IgE elevation, and skin anergy were common. Atypical presentations included severe proctitis, colitis, and exacerbation of inflammatory bowel disease. In a patient with the hyperinfection syndrome, the diagnosis was made only at autopsy. Since strongyloidiasis seems to present like an opportunistic illness, all physicians, not just those in endemic areas, should consider its presence in the appropriate setting.