Thygeson(1950) reported the specific type of superficial punctate keratitis and suspected this probably come from viral origin. Braley(1953) described and illustrated well about the superficial punctate keratitis in his article. According to his paper, its diagnostic features can be summarized as follows; 1) Appearance as a chronic, bilateral punctate epithelial keratitis. 2) Long duration. 3) Eventual healing without scar. 4) Lack of response to systemic or topical antibiotics or sulfonamide, or to removal of corneal epithelium. 5) Striking symptomatic response to topical steroids. These diagnostic features form the basis for this report. 249 cases of this disease has been observed during the period of this study(October, 1960-July, 1962). 25 cases were available for detailed clinical and laboratory analysis. Following observations were made. 1) Corneal punctate opacity is strictly epithelial and located mostly in lower quadrant in chronic cases without associated conjunctivitis. 2) None of the cases gave a history of acute onset. 3) Long duration with remission and exacerbation. 4) No response to topical antibiotics or sulfonamide, or to removal of corneal epithelium. Remarkable symptomatic response to topical steriod. 5) No seasonal and professional relationship with this disease. 6) Normal conjunctival bacterial flora in simple culture. None of them showed inclusion bodies or significant cytological changes. No lesions developed in rabbit cornea inoculartion using scraping from conjunctiva and cornea. 7) Healing without scar. 8) Further detailed virological studies are needed for determinning the etiological agent.
Anti-Bacterial Agents ; Cicatrix ; Conjunctiva ; Conjunctivitis ; Cornea ; Epithelium, Corneal ; Inclusion Bodies ; Keratitis* ; Seasons ; Steroids ; Strikes, Employee

PURPOSE: In the Spring 1995, there was an outbreak of adenoviral infection, which caused four death out of ten patients with adenoviral pneumonia in our hospital. Clinical courses of ten patients with severe pneumonia were similar each other, and two were confirmed as adenoviral pneumonia by postmortem autopsy. Although not proven, we believe eight patients had adenoviral pneumonia. Therefore, we report clinical features in ten cases of severe adenoviral pneumonia. METHODS: Two cases with adenoviral pneumonia and eight cases with presumed adenoviral pneumonia were admitted in this hospital from March to June, 1995. Age and sex distribution, clinical manifestations, laboratory data, chest X-ray findings were reviewed. RESULTS: They were young children between 4 to 25 months of age(mean 12.7+/-6.1 months), and male to female ratio was 9:1. They presented with abrupt fever, cough, tachypnea, and dyspnea. Mean duration of fever were 12.7+/-6.1 days. Crackles on auscultation were heard in all patients. Studies for Mycoplasma and Tuberculosis were all negative. Cultures of bacteria and fungi were negative, and they did not respond to the antibiotics. The chest X-ray revealed the diffuse lobar consolidation with varying amount of pleural effusions. The findings of pleural fluid showed characteristics of transudate with predominant monocyte. Eight of our severe adenoviral pneumonia patients were enjoying normal health previously. Only two patients had previous medical problems, one with chronic cytomegalovirus pneumonia and the other with neutropenia induced by phenobarbital. The course of illness suggests that the infection was hospital acquired and the final outcome was fatal. Three of them developed seizure with fever, five change of consciousness, four conjunctivitis, three otitis media, and two gastro-intestinal symptoms. Autopsy was done in two of four patients. Grossly, the lungs were heavy and dark- red in color. There were bilateral pneumonic consolidation with patchy areas of hemorrhage. Microscopically, severe necrotizing bronchitis and bronchiolitis with numerous intranuclear inclusion of Cowdry type A and B were found. Alveoli were edematous and filled with fibrinous exudate, and covered with hyaline membrane. Ultrastructurally, typical adenoviral particles showing hexagonal shape in paracrystalline array symmetry were found in the nucleus of aleveolar lining cells. CONCLUSIONS: Yet, occasionally, adenoviral infection becomes most aggressive form of pneumonia. We should consider adenoviral pneumonia when clinical findings of pneumonia are very similar with baterial pneumonia except poor response to broad spectrum antibiotics. There is no specific treatment for adenoviral infection. So, for prevention of adenoviral pneumonia, we recommend isolation in suspicious adenoviral infection.
Adenoviridae ; Anti-Bacterial Agents ; Auscultation ; Autopsy ; Bacteria ; Bronchiolitis ; Bronchitis ; Child ; Conjunctivitis ; Consciousness ; Cough ; Cytomegalovirus ; Dyspnea ; Exudates and Transudates ; Female ; Fever ; Fibrin ; Fungi ; Hemorrhage ; Humans ; Hyalin ; Intranuclear Inclusion Bodies ; Lung ; Male ; Membranes ; Monocytes ; Mycoplasma ; Neutropenia ; Otitis Media ; Phenobarbital ; Pleural Effusion ; Pneumonia* ; Respiratory Sounds ; Seizures ; Sex Distribution ; Tachypnea ; Thorax ; Tuberculosis

BACKGROUND: Chlamydia trachomatis (C. trachomatis) is an obligatory intracellular parasite which causes trachoma, inclusion conjunctivitis, pneumonia in infants, nongonococcal urethritis, epididymitis, cervicitis, and salpingitis. Salpingitis frequently produces tubal damage and infertility. The micro-immunofluorecence (MIF) test is the standard method for chlamydial serology and is highly sensitive and specific. This study aimed to evaluate the prevalence of C. trachomatis antibodies in healthy individuals and patients with various diseases as well as the clinical value of chlamydial serology by MIF testing. METHODS: A total of 692 serum samples were collected. Of these, 388 samples were obtained from healthy individuals (male 209, female 179). Cord blood samples were collected from 38 healthy babies. Serum samples of 53 female patients with infertility due to PID (group 1), 107 patients with respiratory diseases (group 2; pneumonia, bronchitis, etc.), and 106 patients with cardiovascular diseases (group 3; angina pectoris, acute myocardial infarction, etc.) who were admitted to Hanyang University Hospital from March 1995 to June 1998 were enrolled in this study. Serological diagnosis of a previous infection was made when IgG antibody titers to C. trachomatis were 1:32 or higher. A single titer of antibody of > or =1:512 for IgG or > or =1:16 for IgM was considered to indicate a recent infection. RESULTS: The IgG antibody detection rate in healthy individuals was 27%, broken down by age as follows: < or =10 year old, 36%; 11 to 20 years old, 17%; 21 to 30 years old, 28%; 31 to 40 years old, 36%; 41 to 50 years old, 25%; 51 to 60 years old, 26%; > or =61 years old, 24%. For cord blood, the antibody was detected in 29% of the samples. There were 1 case (0.3%) of recent infection with C. trachomatis by IgG, and 6 cases (1.5%) for IgM. The incidence of IgG antibodies to C. trachomatis in the disease group was 70%, 28%, and 19% for group 1, group 2, and group 3, respectively. There were 3 cases of recent infection detected by IgG and 4 cases by IgM in group 1. Recent infection with C. trachomatis was detected by IgG in 1 case of group 2 and by IgM in another case of group 3. CONCLUSIONS: In healthy individuals, the prevalence of antibodies to C. trachomatis was highest in those between the ages of 21-40 years. Patients with infertility due to PID showed a significantly higher positive rate (P=0.000 by Chi-square test) and more cases of recent infection to C. trachomatis than others. The results suggest that a positive chlamydial serology indicates a higher risk for infertility due to PID.
Adult ; Angina Pectoris ; Antibodies ; Bronchitis ; Cardiovascular Diseases ; Chlamydia trachomatis* ; Chlamydia* ; Conjunctivitis, Inclusion ; Diagnosis ; Epididymitis ; Female ; Fetal Blood ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Incidence ; Infant ; Infertility ; Male ; Middle Aged ; Myocardial Infarction ; Parasites ; Pneumonia ; Prevalence ; Salpingitis ; Serologic Tests* ; Trachoma ; Urethritis ; Uterine Cervicitis ; Young Adult