237
From 1985
1989 mortality of paediatric inpatients fell steadily due to the decrease in measles; mortality in adult overall, mainly inpatients steadily increased because of AIDS. Immunisation programmes continue to be of major benefit to child health in Uganda, but the AIDS epidemic is placing a huge burden on hospital services, and on medical departments, especially in to
Kampala. League of
Red Cross and Red Crescent Societies, Geneva, Switzerland
OLAF MÜLLER*
Rubaga Hospital, Kampala, Uganda
RITA MOSER
*Present address: German Red Cross
1.
Society,
1000 Berlin 61, West
Germany.
Berkley S, Okware S, Naamara W. Surveillance for AIDS in Uganda. AIDS 1989; 3: 79-85.
Berkley S, Widy-Wirski R, Okware Sl, et al. Risk factors associated with HIV infection in Uganda. J Infect Dis 1989; 160: 22-30. 3. World Health Organisation. Acquired immunodeficiency syndrome (AIDS). Wkly Epidemiol Rec 1986; 61: 69. 2.
Lung disease following allogeneic marrow transplantation SiR,—Your Dec 9 editorial implies that radiological changes are an important feature of pneumonitis. However, radiological evidence of interstitial infiltrates is not necessary for a diagnosis and is a late feature.’ Patients presenting with breathlessness who show a fall in carbon monoxide gas transfer should be investigated whether or not they have an abnormal chest radiograph. You state that over a third of cases of interstitial pneumonitis are idiopathic, but with bronchoalveolar lavage (BAL) and laboratory techniques such as the detection of early antigen fluorescent foci (DEAFF) test for cytomegalovirus (CMV) a pathogen can be isolated from the lungs of 80 % of patients. 1,2 Open lung biopsy does not add much to results obtained by BAL and carries a considerably higher morbidity and
mortality. You refer to low serum immunoglobulin concentration as a risk factor for bronchiolitis obliterans and interstitial pneumonitis. In the studies cited, pulmonary abnormalities occurred only in patients with chronic graft-versus-host disease (GVHD) in addition to low serum immunoglobulin values. These values remain low for several months after transplantation and recovery is delayed in patients with chronic GVHD.3 It should also be remembered that the measurement of serum immunoglobulins is not a good indicator of immunoglobulin levels in the lungs. Patients with interstitial pneumonitis who have low or normal serum immunoglobulin concentrations have greatly increased levels in the lungs, implying either local production of antibody or a method for concentration of the protein’ In addition, patients with CMV-associated pneumonitis have greatly increased levels of CMV-specific IgG in the lungs.** Although such a reaction is non-specific, pneumonitis cannot therefore be attributable to some failure of the humoral immune response at the site of infection. Department of Thoracic Medicine, Guy’s Hospital, London SE1 9RT, UK
Total mortality in Rubaga Hospital and mortality caused by AIDS in adults and children 1985-89. 1 =total number of deaths; 2 = number of deaths caused by AIDS; 3= number of deaths caused by measles in children.
in adult HIV-1 infected inpatients; 23% presented with meningitis or encephalitis. Mortality was high in advanced HIV-1 disease, and in adults non-specific encephalitis, cryptococcal meningitis, and severe enteritis were the major presentations before death. Fullblown disease (WHO clinical case definition fulfilled) had been present for 2 months (median) before death in HIV-1infected adult inpatients (n=206) and for 5 months in HIV-1 infected adult
outpatients (n = 47).
HEATHER MILBURN
HJ, Prentice HG, du Bois RM. Role of bronchoalveolar lavage in the evaluation of interstitial pneumonitis in recipients of bone marrow transplants. Thorax 1987; 42: 766-72. 2. Griffiths PD, Panjwani DD, Stirk PR, et al. Rapid diagnosis of cytomegalovirus infection in immunocompromised patients by detection of early antigen fluorescent foci. Lancet 1984; ii: 1242-45. 3. Witherspoon RP, Storb R, Ochs HD, et al. Recovery of antibody production in human allogeneic marrow graft recipients. influence of time post-transplantation, the presence or absence of chronic graft versus host disease, and antithymocyte globulin treatment. Blood 1982; 58: 360-66. 4. Milburn HJ, Grundy JE, du Bois RM, Prentice HG, Griffiths PD. Humoral immune responses within the lung of bone marrow transplant recipients studied by bronchoalveolar lavage. Clin Exp Immunol 1988; 72: 309-14. 5. Milburn HJ, Grundy JE, du Bois RM, Prentice HG, Griffiths PD Is the measurement of virus-specific antibody in the lungs of transplant recipients with cytomegalovirus pneumonitis of diagnostic or prognostic value? J Med Virol 1988; 26: 197-206 1. Milburn
From 1985
1989 mortality of paediatric inpatients fell steadily due to the decrease in measles; mortality in adult overall, mainly inpatients steadily increased because of AIDS. Immunisation programmes continue to be of major benefit to child health in Uganda, but the AIDS epidemic is placing a huge burden on hospital services, and on medical departments, especially in to
Kampala. League of
Red Cross and Red Crescent Societies, Geneva, Switzerland
OLAF MÜLLER*
Rubaga Hospital, Kampala, Uganda
RITA MOSER
*Present address: German Red Cross
1.
Society,
1000 Berlin 61, West
Germany.
Berkley S, Okware S, Naamara W. Surveillance for AIDS in Uganda. AIDS 1989; 3: 79-85.
Berkley S, Widy-Wirski R, Okware Sl, et al. Risk factors associated with HIV infection in Uganda. J Infect Dis 1989; 160: 22-30. 3. World Health Organisation. Acquired immunodeficiency syndrome (AIDS). Wkly Epidemiol Rec 1986; 61: 69. 2.
Lung disease following allogeneic marrow transplantation SiR,—Your Dec 9 editorial implies that radiological changes are an important feature of pneumonitis. However, radiological evidence of interstitial infiltrates is not necessary for a diagnosis and is a late feature.’ Patients presenting with breathlessness who show a fall in carbon monoxide gas transfer should be investigated whether or not they have an abnormal chest radiograph. You state that over a third of cases of interstitial pneumonitis are idiopathic, but with bronchoalveolar lavage (BAL) and laboratory techniques such as the detection of early antigen fluorescent foci (DEAFF) test for cytomegalovirus (CMV) a pathogen can be isolated from the lungs of 80 % of patients. 1,2 Open lung biopsy does not add much to results obtained by BAL and carries a considerably higher morbidity and
mortality. You refer to low serum immunoglobulin concentration as a risk factor for bronchiolitis obliterans and interstitial pneumonitis. In the studies cited, pulmonary abnormalities occurred only in patients with chronic graft-versus-host disease (GVHD) in addition to low serum immunoglobulin values. These values remain low for several months after transplantation and recovery is delayed in patients with chronic GVHD.3 It should also be remembered that the measurement of serum immunoglobulins is not a good indicator of immunoglobulin levels in the lungs. Patients with interstitial pneumonitis who have low or normal serum immunoglobulin concentrations have greatly increased levels in the lungs, implying either local production of antibody or a method for concentration of the protein’ In addition, patients with CMV-associated pneumonitis have greatly increased levels of CMV-specific IgG in the lungs.** Although such a reaction is non-specific, pneumonitis cannot therefore be attributable to some failure of the humoral immune response at the site of infection. Department of Thoracic Medicine, Guy’s Hospital, London SE1 9RT, UK
Total mortality in Rubaga Hospital and mortality caused by AIDS in adults and children 1985-89. 1 =total number of deaths; 2 = number of deaths caused by AIDS; 3= number of deaths caused by measles in children.
in adult HIV-1 infected inpatients; 23% presented with meningitis or encephalitis. Mortality was high in advanced HIV-1 disease, and in adults non-specific encephalitis, cryptococcal meningitis, and severe enteritis were the major presentations before death. Fullblown disease (WHO clinical case definition fulfilled) had been present for 2 months (median) before death in HIV-1infected adult inpatients (n=206) and for 5 months in HIV-1 infected adult
outpatients (n = 47).
HEATHER MILBURN
HJ, Prentice HG, du Bois RM. Role of bronchoalveolar lavage in the evaluation of interstitial pneumonitis in recipients of bone marrow transplants. Thorax 1987; 42: 766-72. 2. Griffiths PD, Panjwani DD, Stirk PR, et al. Rapid diagnosis of cytomegalovirus infection in immunocompromised patients by detection of early antigen fluorescent foci. Lancet 1984; ii: 1242-45. 3. Witherspoon RP, Storb R, Ochs HD, et al. Recovery of antibody production in human allogeneic marrow graft recipients. influence of time post-transplantation, the presence or absence of chronic graft versus host disease, and antithymocyte globulin treatment. Blood 1982; 58: 360-66. 4. Milburn HJ, Grundy JE, du Bois RM, Prentice HG, Griffiths PD. Humoral immune responses within the lung of bone marrow transplant recipients studied by bronchoalveolar lavage. Clin Exp Immunol 1988; 72: 309-14. 5. Milburn HJ, Grundy JE, du Bois RM, Prentice HG, Griffiths PD Is the measurement of virus-specific antibody in the lungs of transplant recipients with cytomegalovirus pneumonitis of diagnostic or prognostic value? J Med Virol 1988; 26: 197-206 1. Milburn
