1/6. Normal diluting capacity in hyponatremic patients. Reset osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion.Four patients with chronic illnesses and stable hyponatremia and plasma hypotonicity had normal urinary diluting capacity, with excretion of greater than 80% of a standard water load (20 ml/kg) within 4 hours and maintenance of a urine osmolality less than 100 mosmol/kg, during sustained water diuresis. Administration of a chronic salt load did not correct the hyponatremia. However, it was stabilized after treatment of the underlying medical condition. These subjects may represent a true resetting of the osmostat or a variant of the syndrome of inappropriate antidiuretic hormone secretion.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/6. A cluster of tuberculosis associated with use of a marijuana water pipe.SETTING: New cases of pulmonary tuberculosis (TB) were noted in a cluster of young Caucasian males, an unusual ethnic group for this disease in queensland, australia. It was noted that marijuana water pipe ('bong') smoking was common amongst cases and contacts. OBJECTIVE: To report this cluster of TB and to investigate whether shared use of a marijuana water pipe was associated with transmission of TB. DESIGN: All contacts were identified and screened according to standard protocols. Cases were asked to list contacts with whom they had shared a marijuana water pipe. RESULTS: Five cases of open pulmonary TB were identified clinically and on sputum culture, and all isolates of mycobacterium tuberculosis were identical on typing. Of 149 contacts identified, 114 (77%) completed screening, and 57 (50%) had significant tuberculin skin test (TST) reactions on follow-up. Of 45 contacts who had shared a marijuana water pipe with a case, 29 (64%) had a significant TST reaction. CONCLUSION: Sharing a marijuana water pipe with a case of pulmonary TB was associated with transmission of TB (OR 2.22, 95 % CI 0.96-5.17), although the most important risk factor for acquiring TB infection in this cluster was close household contact with a case (OR 4.91, 95% CI 1.13-20.70).- - - - - - - - - - ranking = 4.5keywords = water (Clic here for more details about this article) |
3/6. Mycobacterium gordonae: a new pathogen?Mycobacterium gordonae is a slow growing scotochromogenic acid fast bacillus (Runyon group II) with specific cultural and biochemical characteristics. It is a contaminant of water, soil, and raw milk and is usually considered to be saprophytic and non-pathogenic in man. We have recently seen two cases of pulmonary disease that may have been due to M gordonae, and we now report these and review our recent experience of this organism.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
4/6. Transmission of tuberculosis by flexible fiberbronchoscopes.The development of flexible fiberoptic bronchoscopy was an important technologic advance in the diagnosis and management of patients with pulmonary disease. However, reliable decontamination and sterilization of these delicate instruments have been difficult. Many physicians routinely use a solution of povidone-iodine diluted in 70% ethyl alcohol and water to decontaminate fiberbronchoscopes, despite the fact that these iodophor compounds were developed as skin antiseptics and not as germicidal disinfectants for decontaminating instruments. We isolated a strain of mycobacterium tuberculosis on a surveillance culture from a bronchoscope after it had been cleaned and disinfected with an iodophor solution. In another hospital, we documented the transmission of M. tuberculosis from one patient to another by a bronchoscope that had been disinfected with a commonly recommended iodophor solution. We then studied the tuberculocidal efficacy of various iodophor preparations used with exposure times from 10 to 30 min. In several experiments these iodophors failed to kill M. tuberculosis. Because iodophors do not reliably kill M. tuberculosis, they should not be used to disinfect fiberoptic bronchoscopes.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
5/6. Fatal pulmonary infection due to mycobacterium fortuitum.Environmental (atypical, opportunist, other) mycobacteria were first isolated nearly a century ago. The classification of these "other than mycobacterium tuberculosis" organisms was initially chaotic until Runyon proposed a scheme of four groups in 1959. mycobacterium fortuitum is a member of group IV: Rapid growers. These ubiquitous terrestrial and aquatic forms contaminate water supplies, reagents, and clinical samples. They may colonise the respiratory systems of patients whose local defence mechanisms have been impaired or those with congenital and acquired immune defects. They can also cause disease in immunocompetent individuals. There have been fewer than 20 published cases of pulmonary infection caused by M fortuitum. A further case is reported of fatal pulmonary infection in an elderly patient with long standing chronic obstructive airways disease (COAD). He had left upper zone shadowing on chest radiography and lung abscesses at post mortem examination yielded only M fortuitum.- - - - - - - - - - ranking = 0.5keywords = water (Clic here for more details about this article) |
6/6. Pulmonary illness associated with exposure to Mycobacterium-avium complex in hot tub water. hypersensitivity pneumonitis or infection?BACKGROUND: mycobacterium avium complex is common in water. When aerosolized, it is frequently inhaled but rarely causes illness in healthy people. hypersensitivity pneumonitis to inhaled aerosols has been described; these aerosols are from several sources of water. The pneumonitis forms are collectively known as humidifier lung; the responsible agent in the water remains uncertain. PURPOSE: To report five cases of respiratory illness in healthy subjects using hot tubs contaminated with M avium complex. DESIGN: Descriptive case reports. SETTING: Consultations in two teaching hospitals. patients: Five healthy people developed respiratory illnesses characterized by bronchitis, fever, and "flu-like" symptoms after using a hot tub. Acute exacerbations of their illness developed within hours of heavy use of the hot tubs. INVESTIGATIONS: A chest radiograph and sputum culture in all, BAL in one, CT scan and lung biopsy in another were performed. culture of the water of the two hot tubs also was done. RESULTS: Chest radiographs showed interstitial infiltrates or a miliary nodular pattern. Cultures of all sputum samples, the lung biopsy specimens, lung lavage and water samples were positive for M avium complex. The lung biopsy specimen revealed noncaseating granulomas. All patients recovered with no treatment for M avium complex. CONCLUSION: We conclude that the M avium complex in the water was responsible for the pulmonary illnesses. The symptoms and the results of investigations are more suggestive of a hypersensitivity pneumonitis than of an infection, but no serologic proof of an immunologic reaction to the M avium complex or water was obtained.- - - - - - - - - - ranking = 5.5keywords = water (Clic here for more details about this article) |