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[Occupational allergy due to inhalation of pollen from Euphorbia fulgens Karw (author's transl)].

The increased cultivation and sales of Euphorbia fulgens Karw., originating in Mexico, has in the last few years led to occupational allergy, type I, in three growers manifesting itself as nasal disease, tracheobronchitis or bronchial asthma. Intracutaneous tests with pollen extracts were positive in all cases, even at high dilution. A specific hyposensitisation regimen, conducted over five months, gave highly promising results in one patient who had no symptoms in the following season, despite similar exposure. Such sensitisation by pollens of Euphorbia fulgens Karw. is probably widespread among growers and florists. The allergen is found only in the pollen, not in other parts of the plant. There is no relation to the toxic substances in the milk-sap of this plant family (Euphorbiaceae).

Adult↗

The descriptive epidemiology of severe lower respiratory tract infections in children in Kiel, Germany.

BACKGROUND: Lower respiratory tract infections (LRI) inflict a high burden of disease in children worldwide. Longitudinal, descriptive epidemiological data on different forms of LRI are urgently needed to differentiate this burden, compare population-based incidence rates between countries and to recognize trends. PATIENTS AND METHODS: From July 1996 to June 2000, all children hospitalized with LRI, i. e. laryngo-tracheo-bronchitis (LTB), bronchitis, wheezing bronchitis-bronchiolitis (WBB), bronchopneumonia and pneumonia, in the municipal area of Kiel, Schleswig-Holstein, Germany, were analyzed by cross-sectional studies. Naso-pharyngeal aspirates (NPA) were analyzed by an in-house 9-valent multiplex-RT-PCR. RESULTS: In the 4-year observational period, 1 072 children aged 0 to 16 years (median 23 months) were hospitalized with LRI: 12 % (median 28 months) with LTB, 11 % (median 17 months) with bronchitis, 28 % (median 13 months) with WBB, 26 % (median 26 months) with bronchopneumonia and 22 % (median 47 months) with pneumonia. The prevalence of chronic underlying conditions (20 %) and low gestational age (13 %) varied in the different forms of LRI. The cumulative incidence rate of LRI rose steadily over the 4 years. The highest fraction was contributed by WBB, while pneumonia declined. The highest incidence rate ratio was attributable to respiratory syncytial virus (RSV, 0.46) and to children under 2 years of age. CONCLUSIONS: LRI, especially obstructive forms of LRI, are increasing in Germany as described earlier for the USA, UK and Sweden. The major burden is carried by children under 2 years. RSV is the single pathogen with the highest impact.

Adolescent↗

[Tracheotomy or intubation? Problems with long-term intensive care patients].

Three groups of probands were established among 77 long-term intensive care patients. Group I comprised cases intubated for more than 7 days, group II underwent tracheotomy after a variable time of intubation, and group III were tracheotomised immediately. All complications were severalfold more frequent in patients with hypercatabolic underlying disease than in those with less severe underlying disease. Long-term intubation led generally to laryngeal damage after one week and increased frequency of pneumonia after two weeks. Patients with tracheotomy after an interval showed frequent pneumonias only after one month. Inflammatory changes of trachea, bronchi, and tracheostoma with the appropriate consequences were frequent. Lower tracheal stenoses occurred in approximately 10% of cases in group II. The lowest complication rate was observed in patients tracheotomised immediately. Patients with hypercatabolic disease without prospects for improvement in the near future should be tracheotomised as early as possible. Tracheotomy can be postponed for up to three weeks if regression is to be expected in that time. In diseases without rapid physical deterioration the indication for tracheotomy can be postponed for six weeks.

Adolescent↗

Croup. A common cause of airway obstruction in children.

Although viral croup is usually a self-limiting disease, its signs and symptoms are distressing enough to make parents seek immediate medical advice. This is fortunate because a much more serious disorder may be present. Indeed, morbidity requiring hospitalization may occur, as may a true emergency. Drs Thomsen and Edmonds discuss the epidemiology and current management of croup and related conditions.

Airway Obstruction↗

Pseudomembranous tracheobronchitis caused by methicillin-resistant Staphylococcus aureus.

We report a case of severe tracheobronchitis caused by methicillin-resistant Staphylococcus aureus in a man exhibiting symptoms of upper airway obstruction after infection with influenza. Bronchoscopy revealed diffuse pseudomembrane formation throughout the trachea and bilateral bronchi, which were nearly obstructed. In this case, it was helpful to perform bronchoscopy, protected brushing and tracheotomy immediately in order to avoid choking.

Aged↗

Pseudomembranous tracheobronchitis caused by Aspergillus in immunocompromised patients.

We report 2 cases of Aspergillus pseudomembranous tracheobronchitis in patients with diabetes. The first patient succumbed to progressive obstructive respiratory failure despite mechanical ventilation and antifungal therapy. However, the second patient survived. Aspergillus tracheobronchitis should be considered in immuno-compromised patients presenting with cough, chest pain, fever, dyspnea and upper airway obstruction. Early bronchoscopy and histologic examination should be performed. Early, appropriate treatment may be life saving.

Aspergillosis↗