Respiratory syncytial virus infection: a cause of respiratory distress syndrome and pneumonia in adults.

Respiratory syncytial virus (RSV) infection, an important and sometimes lethal disease of infants and children, generally causes a milder and self-limited syndrome of cough, nasal congestion and fever in adults. While some evidence suggests that RSV may be responsible for more serious respiratory illness in the elderly and chronically ill, it has not been shown to cause life-threatening respiratory tract disease in previously healthy adults. This report describes a previously healthy woman who experienced the acute onset of right lower lobe pneumonia which rapidly progressed to the adult respiratory distress syndrome (ARDS). Acute and convalescent serology showed RSV was the cause of the respiratory tract illness. Michigan Department of Public Health records revealed six additional cases of adult bilateral pneumonia with diagnostic antibody titers to RSV, with or without coinfection with a second organism. These data suggest that RSV may be an under-recognized cause of lower respiratory tract disease in adults.

Cephalic tetanus: demonstration of a dual lesion.

A clinical and electrophysiological study of 15 cases of cephalic tetanus is reported. This condition is a form of local tetanus which commonly follows an injury to the face or head. It is characterised by muscle paralysis which is maximal close to the site of injury, while spasm is evident at mroe distant sites. As muscle paralysis improves with time it is succeeded by spasm. It is argued that paralysis is due to high local concentrations of toxin in the brainstem while lesser concentrations cause spasm by abolishing inhibition. Electrophysiological studies indicate that paralysis is of lower motor neurone type with denervation potentials, hyperirritability, loss of motor units, and marginally increased distal latencies being the features recorded.