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 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During an 8 year prospective study of community-acquired pneumonia (CAP) requiring hospitalisation we found that 47 of 1118 (4.2%) patients had Streptococcus pneumoniae bacteraemia. Females outnumbered males 27:20. The mean age was 63.4 years and 25% of our patients were admitted from a nursing home. A comparison with the 1071 other patients with CAP showed that patients with bacteraemic pneumococcal pneumonia (BPP) were more likely to be female and to have alcoholism, diabetes mellitus, and chronic obstructive pulmonary disease as co-morbidities. The mortality rate of 19% in BPP was not significantly lower than the 22% rate for the remaining patients with CAP. Four of the nine (44%) patients with BPP who died, did so within 24 h of admission, compared with 29 of 236 (12.3%) (P less than 0.02) who died of CAP. A notable clinical feature was the absence of cough in 19% while overall in only 66% was the cough productive. Most of the patients had a non-specific clinical presentation. Fifty-three per cent had an uncomplicated stay in hospital. We conclude that bacteraemic pneumococcal pneumonia is a continuously evolving disease and for the first time may now be more common in women.
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PMID:Bacteraemic pneumococcal pneumonia: a continuously evolving disease. 160 45

Bacterial mediastinal abscess or mediastinitis developed in nine (2.5%) of 361 consecutive patients who underwent isolated heart transplantation at the Texas Heart Institute. All nine patients had at least one predisposing factor that may have contributed to the development of mediastinitis. These included insulin-dependent diabetes mellitus, repeat operation for postoperative mediastinal hemorrhage, Staphylococcus aureus pneumonitis, and cardiac allograft rejection in the early postoperative period (less than 30 days), necessitating steroid pulse therapy alone or in combination with murine-derived monoclonal antibody (OKT3). In six of the nine patients, the diagnosis of mediastinitis was made on the basis of clinical findings (unstable sternum and incisional erythema, with or without gross purulence), and in the other three patients, diagnosis was confirmed by computed tomography of the chest. Culture data were unequivocal in all patients; S. aureus was the most frequent (five patients), followed by S. epidermidis (two patients), and Enterobacter cloacae (two patients). Computed tomography-directed percutaneous drainage and systemic antibiotics were successful in treating two of three patients who had stable sternums with mediastinal abscess. In the remaining seven patients, sternal and mediastinal debridement with rewiring of the sternum was successfully applied. No patient required muscle or omental flap coverage, and no patient experienced a recurrence of mediastinitis during an average follow-up period of 35 months (range, 12 to 46 months).
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PMID:Bacterial mediastinitis after heart transplantation. 1506 16

Paecilomyces is a saprophytic soil fungus that is an uncommon human pathogen. We report a diabetic patient who developed an upper lobe pulmonary infection due to Paecilomyces varioti. This pneumonia responded poorly to oral imidazole therapy with ketoconazole. Eventual treatment of the chronic infiltrating process required administration of intravenous amphotericin B. This experience emphasizes the potential pathologic nature of this fungus when immunity is compromised by poorly controlled diabetes.
J Diabetes Complications
PMID:Paecilomyces varioti pneumonia in a patient with diabetes mellitus. 161 Nov 40

The expression "immunocompromised host" refers to an individual who has one or more defects in the body's natural defense, which leads to severe, often life-threatening, infections. Alcoholism, diabetes mellitus, advanced age, the use of antacids, and viral infections have immune-modulating effects. The human immunodeficiency virus, cytomegalovirus, Epstein-Barr virus, and Non A, Non B hepatitis virus also contribute to immunosuppression. The lung has a special vulnerability to infection, and pneumonia accounts for more than 40% of deaths in the immunosuppressed population. Diagnostic methods include detection of microbial antigens by monoclonal antibodies, DNA sequences by the polymerase chain-reactions or DNA probes, and unique metabolites of pathogens by gas chromatography. Transtracheal aspiration was used to obtain uncontaminated respiratory secretions, but fiberoptic bronchoscopy with shielded brush and bronchoalveolar lavage (BAL) is a better means of diagnosis because of a 90% sensitivity in diagnosing pneumocystis infection. Percutaneous aspiration and open lung biopsy are reserved for more complicated cases. Empiric treatment is justified in far advanced AIDS or relapsed myelogenous leukemia with limited life expectancy, or when there is uncontrollable bleeding diathesis or impaired pulmonary function as invasion diagnostic procedures will not be tolerated. The most important antiinfective measure is careful hand washing, while prophylactic antibiotics, selective decontamination, and antifungal, antiviral, and antiparasitic agents can be used. Active and passive immunization against specific pathogens, immunological reconstitution with granulocyte-macrophage colony-stimulating factor (GM-CSF) and reducing the dosage of immunosuppression are the other strategies for prevention. In the last several decades there has been substantial progress in the management of chronic diseases which used to be fatal.
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PMID:Pulmonary infections in the immunocompromised host. 166 54

Thirty-six hypertensive patients with impaired renal function entered a long-term study to assess the safety of perindopril. There were 28 men and 8 women of mean age 57.1 +/- 2.0 years (mean +/- SEM). The duration of documented hypertension was 7.3 +/- 1.2 years. Perindopril was given orally in single daily doses. The initial dosage was chosen according to the degree of renal function impairment: 29 patients received 4 mg o.d. [creatinine clearance (Clcr), 42.2 +/- 3.2 ml.min-1] and 7 patients received 2 mg o.d. (Clcr, 22.3 +/- 3.1 ml.min-1). Patients in whom blood pressure was not controlled had their dose doubled and then, if necessary, an additional diuretic therapy was added at subsequent visits. Six patients were withdrawn for adverse events (myocardial infarction, pneumonia, leucopenia in a patient who had lupus, diabetes mellitus, skin rash, epigastric pain), two patients were withdrawn for poor compliance, and three for personal convenience. The mean duration of treatment was 10.2 months with a range of 3-12 months (excluding one patient who died from myocardial infarction in the first days of the study and was not included in the analysis). Systolic and diastolic blood pressure decreased significantly (from 170.5/100.6 +/- 3.4/1.8 mm Hg to 151.8/88.8 +/- 3.0/1.7 mm Hg, n = 35, p less than 0.001). Baseline and final values of plasma creatinine (from 223.7 +/- 22.7 to 234.7 +/- 28.5 mumols/l), Clcr (42.5 +/- 3.2 to 45.7 +/- 4.6 ml.min-1), and kalemia (from 4.4 +/- 0.1 to 4.7 +/- 0.1 mmol/L) were not statistically different.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term tolerance of perindopril in hypertensive patients with impaired renal function. 172 1

Choosing appropriate antimicrobial therapy for patients with pneumonia requires knowledge of the etiologic agents seen in specific kinds of patients at specific times and places. For community-acquired pneumonia, there is an important difference in the agents seen in the normal and the compromised host. The normal host most often presents with viral, mycoplasmal, or pneumococcal pneumonia. The exact place of Chlamydia pneumoniae is still under study. A normal host who aspirates is at risk of anaerobic pneumonia. Normal hosts with influenza may acquire superinfection with Streptococcus pneumoniae, Haemophilus influenzae, or Staphylococcus aureus. Under specific epidemiologic conditions, community-acquired pneumonia may be due to Legionella species, Yersinia pestis, Francisella tularensis, Coxiella burnetii, Chlamydia psittaci, a mycotic agent, or tuberculosis. Patients with chronic bronchitis and emphysema are predisposed to H. influenzae, Moraxella catarrhalis, and S. pneumoniae infections. HIV-infected patients are likely to have Pneumocystis carinii pneumonia and pneumonia due to cytomegalovirus, S. pneumoniae, and H. influenzae. Patients with diabetes, nursing-home patients, hospitalized patients, immuno-compromised patients, and patients with recent antibiotic therapy are predisposed to pneumonia due to Gram-negative aerobic bacilli of enteric and environmental origin. Initial therapy should be directed at the likely organism or organisms based on hospital susceptibility surveillance. In the normal host with community-acquired pneumonia, the therapy will often be penicillin G or erythromycin. In the patient predisposed to Gram-negative pneumonia, a third-generation cephalosporin with or without an aminoglycoside is the usual choice.
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PMID:Pneumonia. Patient profiles, choice of empiric therapy, and the place of third-generation cephalosporins. 173 Jan 86

We report a multicentric, open trial of intravenous followed by oral ofloxacin, 400 mg every 12 h, as therapy for 100 cases of nosocomial pneumonia and community-acquired pneumonia requiring hospitalization. The typical subject was 57 yr old, and underlying diseases, such as chronic obstructive pulmonary diseases (COPD), diabetes mellitus, and congestive heart failure, were common. For 10 subjects previous therapy had failed. There were 118 pathogens isolated in blood or sputum; S. pneumoniae was the most common (42), followed by H. influenzae (13), Klebsiella spp. (11), and S. aureus (10). Ofloxacin was administered for an average of 5.7 days intravenously followed by 6.9 days orally. Response to therapy was judged to be cure in 71 subjects, improvement in 24, and failure in 5. Among the more seriously ill subjects, ofloxacin therapy was successful for four of five immunocompromised subjects, for 12 of 12 subjects with nosocomial pneumonia, three of whom were on the ventilator, and for nine of 10 subjects with community-acquired pneumonia and bacteremia, including seven of eight cases due to S. pneumoniae. Univariate risk factor analysis revealed underlying COPD and/or tachypnea upon admission to be associated with failure of ofloxacin therapy, with bacteremia suggestive of failure. Conversely, ofloxacin was equally effective in cases in whom previous therapy failed and in cases of nosocomial pneumonia, multilobar pneumonia, and/or pneumonia due to S. pneumoniae. Results for P. aeruginosa were inconclusive. Intravenous followed by oral ofloxacin was highly effective in many difficult cases of pneumonia.
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PMID:Parenteral followed by oral ofloxacin for nosocomial pneumonia and community-acquired pneumonia requiring hospitalization. 173 95

When cardiac or pulmonary arrest occurs in hospitalized patients, cardiopulmonary resuscitation (CPR) is often futile. Although "do-not-resuscitate" orders are widely used and presumably screen out many patients who are poor candidates for CPR, recent studies have shown that an average of only 13 percent of patients receiving CPR in the hospital survive to discharge. An average of 4 percent of patients receiving CPR in general ward settings survive. Of those who do survive after CPR, many are in a persistent vegetative state or a chronic dependent condition. Patients with malignancy, sepsis, pneumonia, renal failure, diabetes or advanced age have a low chance of surviving after CPR. It is important for both patients and physicians to make a realistic appraisal of the likely outcome of CPR.
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PMID:CPR in hospitalized patients: when is it futile? 163 86

Melioidosis is endemic in Singapore, with diagnosis dependent upon both bacteriological culture and serodiagnosis. Using the polysaccharide (melioidin)-sensitized turkey red cells in the indirect haemagglutination test (IHAT), 20 (100%) of the Pseudomonas pseudomallei culture-positive cases were detectable by the IHAT with titles ranging from 1:16 to 1:32, 768. Eight of these patients who died within a few days after the IHAT was performed had titres ranging from 1:16 to 1:1028. Five culture-negative patients, with clinical symptoms suggestive of melioidosis infection and who responded to treatment with ceftazidime, showed IHA titres between 1:64 and 1:8,192. One hundred and twenty one sera from patients with pneumonia, abscesses, or diabetes mellitus were IHAT negative. The IHAT showed good specificity since negative titres were seen in tests using sera from 2 patients with culture-positive Pseudomonas aeruginosa and 4 patients positive for Legionella. IHAT negative results were obtained from tests of 50 normal blood donors and 50 sewerage workers. Of 683 national servicemen tested, 5 (0.73%) had IHAT titres ranging from 1:16 to 1:128. Unlike hyperendemic areas such as Thailand where interpretation of IHAT is seriously hampered by IHA titres found in one-third to half of the population, serodiagnosis of melioidosis by the sensitive IHAT may be employed in Singapore as a routine procedure since background IHA titres are low.
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PMID:Serodiagnosis of melioidosis in Singapore by the indirect haemagglutination test. 163 99

The mortality pattern among Swedish pulp and paper mill workers was evaluated in a case-referent study encompassing 4,070 men decreased during the period 1950-1987. The subjects were identified from the register of deaths and burials in six parishes. A significantly increased mortality was seen for diabetes mellitus and for secondary tumors of the lung and liver among the pulp and paper mill workers. Indications of excess risks were also found for obstructive lung disorders, pulmonary emboli, accidents, and pneumonia, as well as for malignant lymphomas, leukemias, and cancer of the pancreas and stomach. In the only parish where a sulfite process was exclusively used, cancer of the digestive tract and especially of the rectum was found to be in excess. Except for this parish, the sulfate process predominated in the plants included. The mortality pattern found in this study is in reasonable agreement with findings in various studies from this type of industry.
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PMID:Mortality pattern among pulp and paper mill workers in Sweden: a case-referent study. 180 14


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