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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Outcome and Prognostic Factors of Community-Acquired Pneumonia (CAP) (I-V): A pre-existing illness or alcoholism was present in 60% of 53 patients with CAP requiring treatment in an intensive care unit (ICU). An etiological diagnosis was established in only half of the patients, with S. pneumoniae as the predominating agent. Immediate active treatment was required in 70% of the patients, in 58% including mechanical ventilation. Mortality in hospital was 25% and rose to 39% after an average follow-up period of 3.25 years. A significantly higher mortality was seen in elderly patients, and in those who were immunocompromised, or had a leukocyte count less than or equal to 9 x 10(9)/l. In contrast to earlier discouraging data, and despite of the considerable case fatality rate, it was evident that many patients would not have survived without the intensive care treatment. In addition, the long-term prognosis was more favorable than previously reported. During an eight-year period, case fatality rate in bacteremic pneumococcal pneumonia (Pnb) was 7% (19/285) (99% confidence interval, 3-11%), in adult patients treated at either of the two departments for infectious diseases in Stockholm. In the last year of this period (1984), the mortality for all adults hospitalized because of Pnb in Stockholm county was 11% (7/62). The incidence of Pnb was 5/100,000/year, which is in accordance with earlier data, whereas the incidence of fatal Pnb was markedly lower than that reported from the U.S: 0.5 vs. about 1.5 per 100,000 per year. The reason for this low rate of early deaths in fulminant disease is not clear. No significant differences from earlier reports were found in pre-existing conditions, bacterial serotype distribution, duration of illness before hospitalization, or in frequency or sensitivity of blood cultures. As in earlier studies, we also found that male sex, alcoholism, absence of leukocytosis and extrapulmonary complications were significantly associated with a higher mortality. However, contrary to most other studies, high age was not a negative prognostic factor, perhaps like some other recent data indicating that the general health of elderly people in Sweden is remarkably good. Outcome, and prognostic factors were prospectively studied in 277 adults (mean age 62 years) hospitalized because of CAP. Despite the high age of many patients, only half had a pre-existing chronic disease. However, 58% had been treated in hospital at least once during the last five years.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Prognosis in community-acquired pneumonia requiring treatment in hospital. Importance of predisposing and complicating factors, and of diagnostic procedures. 235 49

Hemostasis system and immune reactivity were studied in chronic alcoholics with (92 subjects) and without (65 subjects) acute pneumonia. Activation and antiplasmin activities of blood in the alcoholics were found reduced. In associated alcoholism and pneumonia the two diseases aggravate each other causing a sharp suppression of lymphocytic component of immunity and inhibition of plasminogen activator activity. The majority of patients respond with a compensatory rise in the number of monocytes with active receptors. In coupled lymphocytopenia and monocytopenia the favorable outcome is unlikely. The prognosis is more beneficial in enhanced systemic fibrinolysis observed in elevated count of mononuclears with active Fc-receptors suggesting laboratory evidence for convalescence.
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PMID:[Hemostasis system and immune reactivity in patients with acute pneumonia and chronic alcoholism]. 237 Jul 69

Between January 1985 and December 1987, seventy-five children of intravenous heroin-addicted parents (one or both) were studied. Their ages ranged from 4 days to 14 years. All patients had suffered from several pediatric diseases. Three major types of problems were found among the children studied: infectious diseases, nutritional diseases, and parental neglect and/or disinterest. The most common diagnoses at discharge were gastroenteritis (24%), pneumonia (21%), malnutrition (17%), upper airway infectious diseases (13%), septicemia (12%), child abuse (4%), acquired immunodeficiency syndrome (3%), and other infectious diseases (24%). Their parents reported hepatitis B virus infection, acquired immunodeficiency syndrome (AIDS), and alcoholism. The unemployment rate among the fathers was 37%. Sixteen percent of mothers were prostitutes. There was an imprisonment record of 19% for mothers and fathers combined. A multidisciplinary approach for this group of children would make prevention possible and care less expensive.
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PMID:Social and medical problems in children of heroin-addicted parents. A study of 75 patients. 239 28

Of 47 patients with Klebsiella pneumoniae bacteraemia admitted to the Hillbrow Hospital, Johannesburg during a period of 18 months, 31 were males and 16 were females. Features predisposing to illness were found in 89.4% patients, chronic alcoholism, neoplastic disease and diabetes mellitus being the most common. Twenty-five infections were acquired in hospital and 22 in the community. Most patients (59.6%) had pneumonia. All isolates of K. pneumoniae were resistant to ampicillin (100%); several (42.6%) were resistant to other antibiotics also. The overall mortality rate was 55.3%. A higher mean initial blood pressure and lower concentrations of serum urea and bilirubin were found in survivors. None of the 28 patients, surviving more than 48 h who received combined therapy with an aminoglycoside and a beta-lactam antibiotic (to which the organism was susceptible) died. Among the remaining patients treated with either an appropriate beta-lactam agent alone, an appropriate aminoglycoside alone or ciprofloxacin the combined mortality rate was 83.3% (P = 0.007).
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PMID:Klebsiella pneumoniae bacteraemia at an urban general hospital. 240 58

A case of Pseudomonas pseudomallei pneumonia with septicemia is described. The onset was insidious with paucity of systemic symptoms except fever. Diabetes mellitus and alcoholism were associated problems. Initially blood cultures were negative but subsequently P. pseudomallei was isolated. The outcome was fatal. Unless diagnosed early and treated appropriately, patients often succumb to septicemic shock.
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PMID:Pseudomonas pseudomallei pneumonia with septicemia--case report. 260 80

We have discussed the relationship between systemic illness, infection, and lung disease. As we have seen, patients with a wide variety of disease states, including advanced age, diabetes mellitus, alcoholism, collagen vascular disease, cancer, heart failure, and organ transplantation are potentially at increased risk for pneumonia because of disease-related impairments in host defenses. In addition, two virtually ubiquitous conditions in hospitalized patients, malnutrition and therapeutic interventions (especially with common medications), frequently add to the risk of airway invasion by bacterial pathogens. Systemic illness not only makes lung infection more common, but may adversely affect outcome and resolution, as well as determine the clinical presentation of pneumonia. In one particular population, the intubated and mechanically ventilated patient, the risk of infection is particularly high, and nosocomial pneumonia is a major cause of mortality. To the extent that the host response itself leads to the symptoms and signs of infection, systemically ill individuals may have subtle clinical features when serious bacterial invasion is present. Many components of the host defense system can become abnormal with serious illness, but a common mechanism that ties many systemic diseases to pneumonia is an alteration in airway epithelial cell receptivity for bacteria, namely, bacterial adherence, a process that mediates airway colonization, the first pathogenetic step on the road to pneumonia. The impetus for understanding how serious illness promotes lung infection is that once these mechanisms are identified, potential preventative strategies to minimize infection risk in the individual with systemic disease may be developed. The relationship among systemic illness, the lung, and infection also exists in a different direction: infection of a systemic nature (the septic syndrome) can lead to disease in the lung (ARDS). We have described the features of the septic syndrome and identified how it may lead to lung injury, usually by indirect means, through activation of inflammatory mediators that are carried to the lung via the vasculature. Although it is frequently impossible to predict which specific patient with systemic sepsis will develop acute lung injury, the current state of knowledge does permit us to identify high-risk individuals. Surprisingly, clinical assessment rather than biochemical testing is the best predictor of the development of acute lung injury. Patients with severe injury, profound shock and multiple systemic insults are most prone to acute lung injury in the presence of systemic sepsis.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Respiratory infections and acute lung injury in systemic illness. 268 63

A limited study of 18 deaths among homeless persons in Atlanta, Georgia, has shown that about two-thirds had utilized public health care facilities prior to their death, often over a period of many years. Utilization of two available, specific clinics for the homeless could not be demonstrated. The county hospital and alcoholism treatment center accounted for all documented episodes of health care. Formal, medical documentation of significant alcohol-related morbidity was shown in 50% of those who died homeless. Other common medical problems included seizure disorders, hypertension, pneumonia, chronic pulmonary disease, and non-lethal trauma. These data may be used practically during medico-legal death investigation and by public health agencies when planning policy and procedure relevant to the homeless population. Paucity of data concerning mortality in the homeless should prompt additional, region-specific studies to determine risk factors in areas where homelessness is manifest.
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PMID:Health care history and utilization for Atlantans who died homeless. 271 46

We reviewed the clinical and laboratory presentation of Haemophilus species bacteremia at our institution, with special attention to predisposing and prognostic factors. Of 36 cases, 18 presented with pneumonia, 1 with cellulitis, and another with sinusitis. No cases of meningitis or endocarditis were detected. Most episodes were caused by Haemophilus influenzae, and the overall response rate to treatment was 72%. Factors including chronic obstructive pulmonary disease, alcoholism, prior splenectomy, and neutropenia did not play an important role in these patients' infections. Most of the isolates serotyped were found to be nontypable. The occurrence of ampicillin resistance was 6% throughout the study. Ampicillin, chloramphenicol, and second-generation cephalosporins were all effective therapeutic regimens. Bacteremia due to Haemophilus species remains an uncommon infection in patients with cancer, despite the predominance of traditional predisposing factors.
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PMID:Haemophilus species bacteremia in patients with cancer. A 13-year experience. 273 Feb 52

We describe the first case report of community-acquired Acinetobacter pneumonia in Australia. Well recognised risk factors for this entity (alcoholism, diabetes mellitus and chronic lung disease) were present in our patient. His pneumonia ran a fulminant course, with death occurring within 24 hours of presentation to hospital. Whilst rare, this infection is being described with increasing frequency, particularly in developing countries including Papua New Guinea.
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PMID:Community-acquired Acinetobacter pneumonia. 277 48

We hypothesize that chronic alcohol abuse results in a loss of neurons and their associated synaptic receptors. This encephalopathy may be a precursor of brain atrophy and end-stage dementia. Autopsies were performed on normal brains of 27 alcoholics (mean age 62.5) and 30 nonalcoholic matched controls (mean age 64.4) free of other brain and liver diseases. None had recently received benzodiazepine medications. Gross brain atrophy was slight and equal in both groups. Benzodiazepine receptor densities and affinities in homogenates of frontal cortex were determined using [3H]flunitrazepam. Bmax specific binding was reduced by 20% in alcoholics compared with nonalcoholic controls of comparable age and with similar death-autopsy time intervals. The affinity was slightly less in the alcoholics. Wet tissue brain protein concentrations and their yields of 50,000-g pellet proteins were similar. Aging, death-autopsy time intervals, pneumonia and chronic obstructive pulmonary disease (diseases usually associated with hypoxia) had no significant effect on brain proteins, receptor densities, or affinities. We conclude that chronic alcoholism is associated with a loss of benzodiazepine receptor densities. Alcohol abuse may affect the results of post-mortem neurochemical investigations of other diseases.
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PMID:Decrease of benzodiazepine receptors in frontal cortex of alcoholics. 285 95


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