Respiratory infections unique to Asia

Abstract

Asia is a highly heterogeneous region with vastly different cultures, social constitutions and populations affected by a wide spectrum of respiratory diseases caused by tropical pathogens. Asian patients with community-acquired pneumonia differ from their Western counterparts in microbiological aetiology, in particular the prominence of Gram-negative organisms, Mycobacterium tuberculosis, Burkholderia pseudomallei and Staphylococcus aureus. In addition, the differences in socioeconomic and health-care infrastructures limit the usefulness of Western management guidelines for pneumonia in Asia. The importance of emerging infectious diseases such as severe acute respiratory syndrome and avian influenza infection remain as close concerns for practising respirologists in Asia. Specific infections such as melioidosis, dengue haemorrhagic fever, scrub typhus, leptospirosis, salmonellosis, penicilliosis marneffei, malaria, amoebiasis, paragonimiasis, strongyloidiasis, gnathostomiasis, trinchinellosis, schistosomiasis and echinococcosis occur commonly in Asia and manifest with a prominent respiratory component. Pulmonary eosinophilia, endemic in parts of Asia, could occur with a wide range of tropical infections. Tropical eosinophilia is believed to be a hyper-sensitivity reaction to degenerating microfilariae trapped in the lungs. This article attempts to address the key respiratory issues in these respiratory infections unique to Asia and highlight the important diagnostic and management issues faced by practising respirologists.

Figures

Figure 1

CXR of a 42‐year‐old woman who had contact with a SARS patient and then developed fever 3 days later (a) showing bilateral lower lobe mild ground glass consolidation, which rapidly progressed to bilateral ground glass consolidation after 24 h (b). SARS, severe acute respiratory syndrome.

Figure 2

High‐resolution CT thoracic scan of a 32‐year‐old man who contracted H5N1 infection, who developed bilateral ground glass pneumonitis and ARDS showing bilateral ground glass consolidation in the lower lobes. The patient also developed multi‐organ failure requiring intensive care therapy.

Figure 3

CXR of a 52‐year‐old man who had haemoptysis, fever and malaise showing right upper lobe lung abscess and mild surrounding consolidation. Serology confirmed the presence of a fourfold rise in IgG against Burkholderia pseudomallei, which was also detected on culture of BAL fluid obtained from the right upper lobe anterior segment.

Figure 4

High‐resolution CT thoracic scan of a 62‐year‐old lady, a frequent visitor of Cambodia, who developed high fever, headache, respiratory failure, generalized petechiae and non‐productive cough showing bilateral ground glass consolidation. There was serological confirmation of dengue fever.

Figure 5

CXR of a 27‐year‐old man, a frequent hill walker in Hong Kong, who developed a right groin painless ulcer (eschar), fever, headache, myalgia and multi‐organ failure showing bilateral lower lobe ground glass consolidation. The presence of specific IgG against scrub typhus was detected by ELISA.

Figure 6

A high‐resolution CT thoracic scan of a 22‐year‐old man who underwent drowning in a heavily contaminated river who developed high fever, liver failure, anuria and haemoptysis, and a fourfold rise in anti‐leptospiral and IgG on ELISA showing bilateral ground glass consolidation.

Figure 7

CXR (posterior‐anterior and lateral views) of a 42‐year‐old Chinese man, a frequent consumer of raw fresh water crabs, who developed daily haemoptysis, chronic cough, low‐grade fever, showing right middle lobe consolidation. BAL fluid from the affected lung segment showed the presence of brown oval eggs and serology showed the presence of specific anti‐IgG against Paragonimiasis westermani.