LUNG-DISEASES IN THE TROPICS .1. TROPICAL GRANULOMATOUS DISORDERS OF THE LUNG - DIAGNOSIS AND MANAGEMENT

International travel, student and cultural exchanges and changing immi gration patterns are insidiously transforming the face of medicine in the United States, Europe and other developed countries. It is essenti al that the practising clinician be aware of the increasing prevalence of various new and exotic tropical lung diseases. The definitive diag nosis of the pulmonary granulomas that constitute the bulk of lung dis orders in the tropics is important since the treatment varies signific antly. At the same time, recent developments in molecular biology, imm unology and biochemistry have increased the diagnostic accuracy and th erapeutic effectiveness related to tropical granulomatous disorders. C linicians in the developing countries can now supplement their clinica l acumen with rapid advances in immunology and histopathology enabling them to grasp the fundamental mechanisms of granuloma formation. Myco bacterial, fungal, parasitic, spirochetal and other infections must be differentiated from a variety of non-infectious granulomas including sarcoidosis, hypersensitivity pneumonitis, drug reaction and generaliz ed vasculitis since therapy is vastly different. The treatment, if ina ppropriate, may not only be worthless but, in many cases, extremely ha rmful and even fatal.