Biomedical subjects
C M Kronauer
Publications and source records attributed to C M Kronauer.
[Treatment of tuberculosis: scalpel or chemistry?].
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[Therapy of refractory bronchial asthma].
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[Bothersome, posture-dependent cough. Tracheopathica osteochondroplastica].
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[Extrapulmonary infections with Mycobacterium tuberculosis complex].
In a retrospective study we reviewed all records of patients with newly diagnosed Mycobacterium tuberculosis complex infection during the years 1990-1994. Of the 45 patients identified, 27 (60%) had only pulmonary tuberculosis and 18 (40%) had extrapulmonary tuberculosis with (5 patients, 11%) or without (13 patients, 18%) concomitant pulmonary infection. The extrapulmonary manifestations were as follows: miliary 5, joint 3, meningeal 2, pleural 2, kidney 1, peritoneal 1, bone 1, psoas 1, lymphatic 1, and anal 1. In the 18 patients with extrapulmonary tuberculosis the infection was due to Mycobacterium tuberculosis 14 times, Mycobacterium bovis twice, and Mycobacterium bovis BCG once.
Images in clinical medicine. Skin findings in a patient with scurvy.
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[HIV-associated Penicillium marneffei infection].
We report on an HIV positive patient with a disseminated Penicillium marneffei infection. A 35-year-old Swiss homosexual male with HIV-associated immunodeficiency with a CD4 cell count of 90/mm3 presented with a two-month history of malaise, intermittent fever, loss of weight, unproductive cough and widespread molluscum contagiosum-like skin lesions, mainly on the face. The patient had travelled extensively and had last visited Thailand 19 months before admission. The chest X-ray showed bilateral diffuse reticulonodular markings. The diagnosis was suspected in bronchoalveolar lavage, which showed round-to-oval intracellular yeast cells but also elongated sausage-shaped extracellular forms. The diagnosis was confirmed on culture. Penicillium marneffei was further isolated from the following specimens: blood cultures, bone marrow, stool, skin and tracheal mucosa biopsy. Intravenous amphotericin B therapy led to a complete subsidence of all symptoms and the skin lesions healed without leaving a scar. The infection, with its clinical presentation, epidemiology, diagnostic problems and therapy is reviewed. We stress that since Penicillium marneffei is an increasingly important pathogen in HIV positive patients in Southeast Asia, this fungus can also be imported to Europe by travellers. If immunocompromised patients have molluscum contagiosum-like skin lesions, pneumonitis and a history of travelling in Southeast Asia, disseminated Penicillium marneffei infection should be considered in differential diagnosis.
Prognostic score for Pneumocystis carinii pneumonia.
Sixty episodes of Pneumocystis carinii pneumonia in 59 patients were evaluated for risk factors predicting fatal outcome within 14 days after bronchoscopy. We found significantly higher values for serum lactate dehydrogenase (p less than 0.001), alveolar-arterial oxygen difference (p less than 0.001) and percentage of bronchoalveolar lavage neutrophils (p less than 0.001) in patients dying within 14 days, but there was considerable overlap of these variables between the two groups. Using a score system combining the three parameters allowed however an excellent discrimination between the two groups.
[Alveolar hemorrhage].
Alveolar hemorrhage (AH) is the result of diffuse bleeding into the acinar portion of the lung. Cardinal symptoms of AH include hemoptysis, dyspnea, alveolar filling opacities on chest roentgenogram, anemia and hypoxemia. However, AH is often misdiagnosed as pneumonia or pulmonary edema at the time of initial presentation. Isolated AH may occur but is more often seen in diffuse connective tissue diseases or in rapidly progressive glomerulonephritis. - At the Medical Clinic of the University Hospital of Zurich we have diagnosed AH in 18 patients (13 males, 5 females) over the last ten years (1978-1988). In 2 patients AH occurred as an isolated symptom: once due to occupational inhalation of fumes containing trimellitic anhydride, and once as so-called idiopathic pulmonary hemosiderosis. In 16 patients AH was associated with kidney disease, including the following disorders: vasculitis and collagen vascular disorders (9), rapidly progressive glomerulonephritis (4) and Goodpasture's syndrome (3). In 5 patients the presenting symptom was AH. 9 patients presented initially with renal symptoms and in 2 patients renal and pulmonary features occurred simultaneously. 7 patients died of the underlying disease or its complications. Both patients with isolated AH have survived. In the remaining 9 patients 1 required dialysis temporarily and 4 permanently. All patients except the one with AH due to inhalation of trimellitic anhydride were treated with immunosuppressive agents. - Since the pulmonary features are similar in each of the AH syndromes, diagnosis of the underlying disorder is heavily dependent upon pathologic evaluation of diseased extrapulmonary organs. Moreover, immunologic studies are essential. Failure to diagnose or treat AH syndromes in the early stages may have lethal consequences.
[Aspecific and lymphocytic interstitial pneumonia in HIV infections].
The results of 115 bronchoscopic examinations and one autopsy in 105 adults with HIV-infection and pulmonary complications are presented. Whereas 51.7% of the events were caused by Pneumocystis carinii pneumonia (PCP), nonspecific interstitial pneumonitis (NIP) without evidence of an infectious or neoplastic condition was the second most frequent diagnosis in 14 patients (12.1%), four of whom exhibited features of lymphocytic interstitial pneumonia (LIP). The clinical, radiological and prognostic aspects of NIP/LIP, which are very similar to those of PCP, and the possible pathogenesis are discussed. The importance of an adequate diagnostic pulmonary workup is emphasized. We suggest classifying patients with NIP/LIP as stage IV E (CDC) and evaluating the efficacy of a treatment with azidothymidine (AZT) in a controlled clinical study.
Bilateral focal pulmonary densities.
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[Familial sarcoidosis. 4 cases from 2 families].
Sarcoidosis is frequently familial. We report on four cases of sarcoidosis which include a father and son and two sisters. As is well known in familial sarcoidosis, our patients show strikingly similar clinical findings within their respective families. The literature is reviewed in regard to racial, ethnic, geographical and familial prevalence, and the findings are interpreted as evidence for a genetic predisposition.