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 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 40-year-old woman who had recently undergone kidney transplantation was succesfully treated for diffuse influenza virus pneumonia. The illness was acute, with rapid onset, high fever, nonproductive cough, dyspnea, cyanosis, crepitations and rales over both lung bases, and associated arterial hypoxemia, leukopenia, and thrombocytopenia. Prophylactic use of antibiotics to prevent superimposed bacterial infection and reduction of immunosuppressive therapy to minimal dosage during the critical phase of the respiratory infection contributed to the patient's survival. An episode of graft rejection was reversed by resumption of immunosuppressive therapy at standard dosage levels.
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PMID:Influenza virus pneumonia after renal transplant. 32 48

Thirty-two confirmed and 24 highly probable cases of Legionnaires' disease occurred in Vermont between May 1 and Oct 15, 1977. Confirmed cases had positive results for direct fluorescent antibody testing of lung tissue or fourfold rise in antibody titer. Highly probable cases had one elevated titer (greater than or equal to 1:256) and a compatible illness. Forty-eight (86%) had underlying chronic disease, and 22 (39%) were immunocompromised. Prominent early symptoms were fever, cough, chills, and malaise. All but one patient had verified pneumonia. Courses ranged from a pneumonia not requiring hospitalization to respiratory failure necessitating support with mechanical ventilation. Seventeen patients died. Although the clinical presentation was variable, rapid development of high fever and leukocytosis together with negative cultures of lower respiratory tract secretions strongly suggested the diagnosis in an epidemic setting.
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PMID:Legionnaires' disease in Vermont, May to October 1977. 35 Dec 19

In January 1977 an unsolved outbreak of infection at St. Elizabeth's Hospital (Washington, D.C.) that occurred in 1965 was linked with Legionnaires' disease. The link was made by fluorescent antibody testing with the bacterium isolated from tissues of persons with Legionnaires' disease in the 1976 outbreak in Philadelphia. In July and August 1965, an epidemic of severe respiratory disease characterized by abrupt onset of high fever, weakness, malaise, and nonproductive cough, frequently accompanied by radiographic evidence of pneumonia, affected at least 81 patients at St. Elizabeth's Hospital, a general psychiatric hospital. Fourteen (17%) of the affected patients died. Intensive epidemiologic and laboratory investigations in 1965 did not determine the etiology. The etiologic organism may have become airborne from sites of soil excavation.
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PMID:An outbreak in 1965 of severe respiratory illness caused by the Legionnaires' disease bacterium. 36 97

Since the initial description of Legionnaires' disease 2 years ago, a clearer picture of its clinical manifestations has emerged as a result of investigations of further epidemics and studies of laboratory-confirmed sporadic cases. Although individual clinical features are not sufficiently distinctive to distinguish Legionnaires' disease from other types of acute pneumonia, a composite can provide a sufficiently characteristic clinical profile to indicate the likelihood of this diagnosis. Such a profile includes high fever (above 39.4 degrees C); recurrent chills; relative bradycardia; early gastrointestinal symptoms (particularly diarrhea); prominent myalgias; microscopic hematuria; liver function abnormalities; toxic encephalopathy; nonproductive cough; absence of bacterial pathogens on Gram stain and culture of transtracheal aspirate; progression from patchy bronchopneumonia to lobar and multilobar consolidation; and frequently prompt and sometimes dramatic response to treatment with erythromycin.
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PMID:Clinical aspects of Legionnaires' disease. 43 24

A review of the medical records of 123 persons with Legionnaires' disease hospitalized in the 1976 Philadelphia epidemic showed that the manifestations of infection ranged from mild grippe to a severe pneumonia that also involved other organ systems. Early in the illness, constitutional symptoms predominated. Fever, malaise, myalgia, rigors, confusion, headache, and diarrhea were usually followed by nonproductive cough and dyspnea. Physical examination showed few abnormalities other than rales. Moderate leukocytosis with left shift, elevated erythrocyte sedimentation rate, elevation of serum levels of liver enzymes, and hematuria and proteinuria were characteristic. Chest radiograph showed patchy, often nodular, areas of consolidation. Progression of pneumonia led to respiratory failure and the need for mechanical ventilatory assistance for 19 patients; renal failure, primarily after shock, occurred in 18 persons. Twenty-six patients died. Treatment with erythromycin or tetracycline resulted in the lowest case-fatality ratios, but the associations were not statistically significant.
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PMID:Legionnaires' disease: clinical features of the epidemic in Philadelphia. 43 27

Aspiration pneumonitis is an important cause of many anesthetic and non-surgical deaths and complication. One hundred and eight cases from 1964 to 1974 were reviewed to study the factors associated with aspiration pneumonia. Forty surgical and 68 non-surgical patients were evaluated and compared. Predisposing factors included impaired consciousness, esophageal and neurological disorders, cardiac resuscitation, debilitation, presence of a nasogastric tube or tracheostomy. The most common findings in both groups were dyspnea, cough, cyanosis, fever, tachycardia, rhonchi, rales and wheezes. Sputa of 64 patients failed to reveal the precise etiologic agent. High mortality (30%) and morbidity were found in both groups even with optimum treatment. The causes of morbidity in both groups of patients were pneumonia, lung abscess, myocardial infarction, gastrointestinal hemorrhage, and pulmonary embolus. Prevention, with particular attention to high-risk patients and to factors influencing aspiration in groups of surgical and non-surgical patients, is the solution to the problem.
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PMID:Aspiration pneumonia: a ten-year review. 45 16

A 28 year old veterinary medical student experienced spiking fever, cough, peripheral blood eosinophilia and an eosinophilic pulmonary infiltrate. Corynebacterium pseudotuberculosis was isolated from a transtracheal aspirate and bronchoscopy washings. C. pseudotuberculosis, a pathogen responsible for lymphadenitis in livestock, has never been reported to cause pneumonia in man. In the four cases of C. pseudotuberculosis previously reported, lymphadenitis was the chief clinical presentation. In our patient specific antibodies against the isolated C. pseudotuberculosis developed but not against the other corynebacteria. With erythromycin therapy, the peripheral blood eosinophilia and IgE anti-C. pseudotuberculosis titer decreased whereas the IgG titer continued to increase.
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PMID:Corynebacterium pseudotuberculosis. A new cause of infectious and eosinophilic pneumonia. 46 27

Mycoplasmal pneumonia, tularemic pneumonia, Q fever pneumonia, psittacosis, and Legionnaires' disease are the most frequently encountered treatable atypical pneumonias. Mycoplasmal pneumonia, the most common, is often accompanied by nonexudative pharyngitis, conjunctivitis, or otitis. The nonproductive cough is characteristic. Tularemic pneumonia is characterized by substernal chest pain, bloody pleural effusion, and bilateral hilar adenopathy. Although the clinical presentation is mild, roentgenographic findings are impressive. Q fever pneumonia resembles psittacosis but is less serious; it may be accompanied by subacute bacterial endocarditis, hepatitis, or both. Psittacosis is characterized by prominent headache, bloody sputum, and relative bradycardia. Tetracycline is the drug of choice for either. In Legionnaires' disease, pneumonia is accompanied by prominent extrapulmonary symptoms. The most important diagnostic clues include diarrhea and mental confusion. Relative bradycardia and laboratory abnormalities are also helpful. Erythromycin is the drug of choice unless doubt exists as to the diagnosis.
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PMID:The atypical pneumonias: a diagnostic and therapeutic approach. 47 55

In this retrospective study of 115 cases of histoplasmids, there were 66 male and 49 female patients ranging in age from 2 months to 79 years. The most common presenting symptoms were cough, chest pain, wheezing, weight loss, hemoptysis, and shortness of breath. Thirty-five patients (30%) were asymptomatic. Two patients had manifestations of obstruction of the superior vena cava. Radiologic findings simulated carcinoma, tuberculosis, pneumonia, and viral infections. Sixty-five patients had various operative proceudres, such as lung biopsy, wedge resection, lobectomy, pneumonectomy, resection of lymph node, and bypass of superior vena cava, for diagnosis and treatment. There were two deaths and two postoperative complications. A total of 15 patients received intravenous amphotericin B. Four patients with pneumonic infiltrates developed disseminated histoplasmosis.
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PMID:Histoplasmosis: clinical manifestations and surgical management. 47 35

Congenital tracheoesophageal fistula (TEF) without esophageal atresia, commonly referred to as H-type fistula, comprises only 4.2% of all TEF's. Four infants with this entity were surgically treated at Santa Rosa Children's Hospital during the period of 1974 to 1977, and their diagnosis, surgical management, and hospital course are described in detail. H-type TEF is characterized by a clinical triad consisting of paroxysms of coughing precipitated by feeding, gaseous distention of the gastrointestinal tract, and pneumonitis. Demonstration of H-type TEF can be difficult and may be accomplished only by repeated examinations. The esophagogram using cinefluoroscopy and image intensification is the primary diagnostic technique utilized. If this is nondiagnostic, then tracheobronchoscopy should be performed in conjunction with ancillary techniques which improve endoscopic yield. Surgical correction can be accomplished through a cervical approach in 80% of cases. Preoperatival treatment of H-type TEF is dependent upon a high index of suspicion, an aggressive diagnostic approach, and prompt surgical correction. Our series of patients demonstrates that early diagnosis is feasible.
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PMID:Congenital tracheoesophageal fistula without esophageal atresia. 48 Sep 68


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