44 patients with atopic dermatitis who had had active generalized skin lesions, especially of the face, following transient remission after eczema in infancy were examined ophthalmologically. Their ocular findings have been correlated with the clinical features of atopic dermatitis. 25% of the patients with this clinical course had cataracts. However, the clinical features of the patients without cataracts were almost the same as those of the patients with. Thus, cataracts in patients with atopic dermatitis may not be due to the clinical symptoms and course but to other factors such as genetic, as in the case of asthma. Lenticular opacities were present in the posterior subcapsule in 50%, in the anterior subcapsule in 25% and throughout the lens in 12.5%. 2 patients with total lens opacities had shown rapid progression at the time of exacerbation of the skin lesions. Chronic conjunctivitis was found in 31.8%, superficial keratitis in 6.8% and retinal detachment in 2%.
An outbreak of Legionnaires' pneumonia occurred at a nursing home in December 1990. A 79-year-old female and a 73-year-old male clerk who were staying at the nursing home developed pneumonia with only a 5-day interval. Legionella pneumophila serogroup I was isolated from transtracheal aspirate of the former and sputum of the latter. After treatment with a combination of erythromycin and rifampicin both patients improved. Serological surveillance of inpatients and staff of the nursing home was performed in February 1991. Seven out of 51 samples (14.0%) showed a titer higher than 1:128 of anti-Legionella pneumophila serogroup I antibody determined by indirect immunofluorecence; two of these seven complained of respiratory symptoms. Molecular epidemiology analyzed by restriction endonuclease digestion of isolated L. pneumophila showed an identical pattern which suggested a common origin. (Internal Medicine 31: 508-512, 1992)
Two different kits for the detection of serum cryptococcal antigen in patients with pulmonary cryptococcosis were evaluated. The Eiken test (the Eiken Co., Tokyo), which uses pronase for pretreatment of serum, was compared with the Crypto-LA test (International Biological Laboratories, Cranbury, NJ), which did not use pronase prior to testing. Cryptococcal antigen was detected in 21 of 23 patients (91%) with the Eiken test and in only 10 of 23 patients (43%) with the Crypto-LA test (p < 0.01 by McNemar test). However, the sensitivity of two tests was identical without use of pronase, as both tests could detect as little as 10(4) cells/ml of Cryptococcus neoformans and 10 ng/ml of capsular polysaccharide of C. neoformans. In those serum specimens for which both tests were positive, titers were much higher for the Eiken test, but there was a statistically significant correlation between the two tests (coefficient correlation 0.79, p < 0.01). Cryptococcal antigen titer levels measured by the Eiken test correlated well with clinical courses. There was one false-positive reaction among 82 sera of non-cryptococcal patients. Pronase enhanced the sensitivity of the Eiken test, which appeared to be useful in patients with pulmonary cryptococcal disease, and its use may prevent unneeded lung biopsies.
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