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1/5. inhalation anthrax in a home craftsman.

    inhalation anthrax with complicating subarachnoid hemorrhage due to simultaneous infection with two capsular biotypes of bacillus anthracis of different virulence for the mouse is reported. The patient, a home craftsman, acquired his infection from imported animal-origin yarn.
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2/5. A family outbreak of chlamydia pneumoniae infection.

    chlamydia pneumoniae, a newly described chlamydia species, has been shown to be a cause of acute respiratory tract infection in both adults and children, but its role in human infection is still under investigation. Here we present a family outbreak of C. pneumoniae infection where three members of a family presented with a 'flu-like illness' and acute upper respiratory tract infection which did not improve despite penicillin or septrin therapy. No history of exposure to birds, pets or animals was obtained. As C. pneumoniae isolation from respiratory secretions is not without difficulty, diagnosis usually relies currently on serum-based tests. In this study C. pneumoniae specific IgM determined by the micro-immunofluorescence test was detected in the three clinical cases. All three cases had an elevated complement-fixing antibody titre to psittacosis-LGV antigen, which may have suggested psittacosis, if type-specific tests had not been performed. In addition, three other members of the family had C. pneumoniae-specific IgG antibody although specific IgM was absent. These three younger members of the family had been symptomatic in the month preceding symptoms in their older sibling and their parents. All the symptomatic members of the family made a complete recovery on tetracycline therapy.
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3/5. "aspergillus fumigatus"--a pathogen and allergen.

    aspergillus fumigatus is being increasingly recognised as causing various pathological conditions in man, animals and birds. In man the use of antibiotics has increased the importance of fungi in various clinical situations as opportunistic infective agents. In man, cavities in the lung are often (20 per cent) colonised by Aspergillus species, nearly always A. fumigatus. The mycetoma so formed can be specifically diagnosed by finding precipitating antibodies to A. fumigatus in the serum. In an asthma clinic, the findings of an immediate positive prick skin test to A. fumigatus, with or without precipitating antibodies to the fungus, confirms the diagnosis of pulmonary aspergillosis. These asthmatic patients develop transient lung infiltrations and proximal bronchiectasis, so that they eventually develop some degree of irreversible airways obstruction. Except for a small number of old patients, there are usually multiple positive type I skin responses to other inhalant allergens which will include other aspergilli species. Basically the complaint is a complication of allergic asthma. When first seen the patients often have treated with repeated courses of antibiotics for presumed infective asthma. Some of the findings in 86 asthmatic patients suffering from pulmonary aspergillosis will be presented.
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4/5. A new chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections.

    During a 2 1/2-year period, we studied 386 University of washington students with acute respiratory disease, to determine whether a chlamydia psittaci strain, here designated TWAR, is an important respiratory pathogen. Serologic evidence of recent TWAR infection was found in 13 students, and the organism was isolated from 8 of these. TWAR infection occurred in 12 percent of the students who had pneumonia (9 of 76), 5 percent of those with bronchitis (3 of 63), and 1 percent of those with pharyngitis (1 of 150). The TWAR infections occurred throughout the study period. pharyngitis, often accompanied by laryngitis, was a common first symptom. Clinically, the infections resembled those with Myco-plasma pneumoniae; therefore, the patients were given courses of erythromycin used for the treatment of M. pneumoniae infections. This therapy proved to be inadequate. The limited data available suggest that the TWAR strain is a "human" C. psittaci that is spread from human to human, without a bird or animal host.
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5/5. Group C streptococcal pneumonia: report of a fatal case and review of the literature.

    A previously healthy 22-year-old man acquired tonsillitis due to streptococcus equisimilis, a group C streptococcus. He rapidly developed pneumonia, empyema, septicemia, and metastatic arthritis, and despite appropriate therapy with antibiotics and drainage of abscesses, he experienced progressive respiratory insufficiency and died. The four species of group C streptococci are described in terms of their biochemical properties, the infections they cause in animals, and their tendency to produce disease in humans. Pharyngeal carriage of these organisms is not rare, and outbreaks of pharyngitis and tonsillitis occur. Group C streptococcal pneumonia, like group A pneumonia, is often a severe disease with a prolonged febrile course and frequently is complicated by empyema. Appropriate management includes isolation of the patient, penicillin g therapy, drainage, and respiratory support.
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