Der Internist
-
The incidence of pulmonary tuberculosis (TB) is decreasing in Western Europe. However, TB should not be considered to be a rare disease, particularly in immigrants and in immunocompromised persons (i.e. HIV infection). ⋯ X-ray and a sequential investigation of three samples of sputum including microscopy, culture and susceptibility testing for the first-line drugs should be obtained. Tuberculin testing is useful in the diagnosis of latent TB and in screening persons with close contact to patients with active disease. New blood tests based on the detection of interferon-g released by antigen specific T-cells have some advantages compared to tuberculin testing.
-
Pneumonia can lead to the critical impairment of gas exchange in the lung. Due to the great variability of pneumonia causing pathogens, a large variety of diverse virulence factors act on the lung. Besides stimulation of unspecific defense mechanisms, activation of receptor-dependent cell-mediated innate immune defense mechanisms are critical for the pulmonary immune defense. ⋯ This interaction stimulates the expression of immunomodulatory molecules via signal cascades. Of particular importance, in addition to direct pathogen-caused lung damage, is the overwhelming activation of the inflammatory response which can result in lung barrier failure and impairment of pulmonary gas exchange. In addition to the design of new antibiotics, innovative therapeutic strategies should therefore concentrate on the enhancement of antimicrobial mechanisms by concurrent limitation of inflammation.