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

Survival in systemic lupus erythamatosus (SLE) continues to improve because of better ancillary care, earlier diagnosis, and earlier treatment. However, infection remains a leading cause of morbidity and mortality in this disease. Although corticosteroids and immunosuppresives increase the risk of opportunistic infection, the SLE patient is still most at risk from common bacterial pathogens. As the prototypic immune-complex disease, patients with active SLE have low circulating complement as well as a reticuloendothelial system (RES) saturated with immune complexes. It seems intuitive that SLE patients should be most at risk for organisms dependent for their removal on the RES or complement for opsonization or bacteriolysis. The current series presents four patients with SLE and disseminated neisseria infection and brings to 14 the number of patients in the literature with disseminated neisserial infection. They are typically young, female, with renal disease, and either congenital or acquired hypocomplementemia, and may present with all features of a lupus flare. Surprisingly, they are not all on corticosteroids or immunosuppressives and have some features that are unusual for non-SLE patients with these infections. There seems to be an over-representation of Nisseria meningitidis (despite potential reporting bias), and there ironically may be better tolerance with fewer fulminant complications in patients who have complement deficiencies. The best approach for the physician treating SLE is to immunize all SLE patients with available bacterial vaccines to N meningitidis and Streptococcus pneumonia, have a low threshold of suspicion for the diagnosis of disseminated neisserial or other encapsulated bacterial infection in the SLE patient who is sick, and to treat empirically with third generation cephalosporins after appropriate cultures.
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PMID:Increased risk of neisserial infections in systemic lupus erythematosus. 228 42

In 18 renal transplant patients with pneumonia under ciclosporin therapy the diagnostic value of BAL and of covered micro brush smears were compared. In 10 out of 18 cases partly atypical bacterial pathogens were cultivated and cytomegaly was diagnosed 4 times, mycosis twice, whereas 2 cases could not be clarified. A granulocytosis in the differential cell pattern correlated with a bacterial infection.
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PMID:[The diagnostic value of bronchoalveolar lavage in opportunistic pneumonia following kidney transplantation]. 236 3

The pattern of illness in 60 consecutive children with homozygous sickle cell disease who attended the Paediatric Emergency Room of a busy Lagos hospital with acute illness was studied prospectively. Their ages ranged from 3 months to 13 years with a peak in the 2nd year. There were twice as many boys as girls. The commonest symptoms were fever, limb or abdominal pain and cough, and the commonest signs were pallor and hepatomegaly. Painful crises occurred in 27, anaemic crises in 11, and a combination of these in 12 children. Infection was detected in 76% of subjects in crises. Infection was found in 82% of all the children and was mainly bacterial. The commonest infections were pneumonia (35%), bacteraemia (32%), tonsillitis/pharyngitis (17%) and osteomyelitis (8%). The predominant bacteria isolated were Klebsiella spp (38%), E. coli (23%), Staph. aureus (23%), Staph. albus (23%) and Pseudomonas spp (23%). Some children had multiple isolates. Bacterial infection was a major cause of morbidity in very young children and merits appropriate control and preventive measures in this age group. The spectrum of bacteria isolated makes it unlikely that the specific anti-pneumococcal measures widely advocated in Europe and America for young children with SCA would be appropriate in Nigeria.
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PMID:Acute illness in Nigerian children with sickle cell anaemia. 244 66

Twenty-two preterm infants with systemic candidiasis are reported, of which seven cases were presumed to be antenatally acquired and 15 postnatally acquired. All except one were of very low birthweight. Fifteen infants had positive cultures of blood, cerebrospinal fluid or urine and seven had candida pneumonia only. Clinical features included general instability, respiratory deterioration and a necrotizing enterocolitis-like presentation. The incidence of leukocytosis, shift to the left, eosinophilia and thrombocytopenia were not different from those with bacterial infection. The diagnosis was made after death in two infants. In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken. Complications of amphotericin and 5-flucytosine therapy which developed in five infants resolved on cessation of treatment. The mortality rate was 18% and impairment rate among the 17 very low birthweight survivors was 18%. A high index of suspicion is required for systemic candidiasis, especially in infants of less than 1000 g birthweight. If recognized early, effective and safe antifungal therapy is possible with favourable short- and long-term outcome.
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PMID:Systemic candidiasis and pneumonia in preterm infants. 245 57

The hospital records of 49 children with adenovirus infection were reviewed. Diagnosis was made by virus isolation from the airways in 73%, the stools in 44%, the conjunctiva in 2% and by serology in 14% of the patients. Most children were less than 3 years of age. The peak incidence of virus isolation occurred during the month of April. Pharyngotonsillitis was the most frequent main diagnosis (49%), followed by pneumonia (14%), gastroenteritis (10%) and bronchitis (8%). Fever was the most frequent main symptom (43%), and 96% of the patients had fever at some time during the illness. The average fever temperature was 39.6 degrees C with a mean duration of 5.9 days. An obvious bacterial superinfection could be demonstrated in three patients: two had otitis media and one had pneumonia with pleural effusion. All three had more than 3 band forms per 100 peripheral white blood cells, whereas only 1 out of 46 children without demonstrable superinfection had an elevated band count. Other laboratory tests were not useful in detecting bacterial superinfection. That 71% of all children received antibiotics at some time during their illness, reflects the difficulty of excluding bacterial disease.
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PMID:Clinical and laboratory findings in children with adenovirus infections. 253 28

We evaluated the clinical characteristics of patients with Francisella philomiragia (formerly Yersinia philomiragia) isolated from normally sterile sites. Isolates from 14 patients were received by the Centers for Disease Control between 1975 and 1987: 9 were from blood; 2 from lung biopsies; and 1 each from pleural, peritoneal, and cerebrospinal fluid. Underlying problems included chronic granulomatous disease in 5 patients, near-drowning in 5, and a myeloproliferative disease in 2. All 13 patients for whom records were available had a febrile syndrome compatible with bacterial infection. Pneumonia and fever-bacteremia were the commonest clinical syndromes reported. In 7 cases, F. philomiragia was the only sterile-site isolate, and the clinical syndrome did not resolve without appropriate antibiotics. Familiarity with this organism is important because of its ability to cause serious disease in chronic granulomatous disease and near-drowning patients. Further study may yield new insights into pathogenic and host defense mechanisms.
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PMID:Infection caused by Francisella philomiragia (formerly Yersinia philomiragia). A newly recognized human pathogen. 254 46

The temporal relation between a lung infection with bovine herpesvirus-1, suppression of some immune functions, and susceptibility to secondary bacterial infection resulting in fibrinous pneumonia prompted a study to determine the mechanism(s) involved in the apparent immunosuppression. In six independent experiments employing from five to 40 calves, we studied the immunologic parameters of migration of and superoxide anion production by polymorphonuclear neutrophils, lectin-induced lymphocyte proliferation, interleukin-2 production, natural cytotoxicity, interferon and antibody formation, as well as complement activation and hematologic parameters. Chemotaxis of polymorphonuclear neutrophils, natural cytotoxicity, and mitogen response of peripheral blood leukocytes were depressed, whereas superoxide anion generation by polymorphonuclear neutrophils was transiently increased and interleukin-2 production was only marginally affected. The assumption that virus-induced interferon might be a common cause for the various changes could not be substantiated. However, the results did suggest that mechanisms other than lack of T helper cell activity, accessory cell activity of macrophages, or development of suppressor T cells were the cause of suppressed mitogen responses. None of the immunologic parameters appeared to have consistent prognostic value with respect to outcome of the infection.
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PMID:Viral-bacterial pneumonia in calves: effect of bovine herpesvirus-1 on immunologic functions. 258 Sep 16

Intrahepatic cholestasis associated with severe extrahepatic bacterial infection is well recognized in humans. A similar syndrome is not well characterized in veterinary medicine. Five dogs with severe extrahepatic bacterial infection that developed histologically confirmed intrahepatic cholestasis were selected from the authors' case files. The types of infections included pneumonia, peritonitis secondary to a rectal tear, urinary tract infection, bite wounds, and vegetative endocarditis. Escherichia coli was involved in two of the dogs, mixed infection in one dog, and a gram-positive cocci in the other two dogs. Total bilirubin concentrations ranged from 3.5 to 33.5 mg/dl. Serum liver enzyme activities showed only mild to moderate increases: alkaline phosphatase (ALP, 41-750 IU/l), alanine aminotransferase (ALT, 25-235 IU/l), and aspartate aminotransferase (AST, 99-255 IU/l). Fasting serum bile acids concentration was markedly elevated in the one dog in which it was measured (259 mumol/l). Histologically, the cholestasis was characterized by bile pigment accumulation in hepatocytes, canaliculi, and/or Kupffer's cells. Inflammatory parenchymal changes, when present, were minimal. The findings of hyperbilirubinemia, only a slight increase in the liver enzyme activities, and minimal inflammatory changes in liver tissue specimens in the five dogs with extrahepatic bacterial infections are similar to the findings in intrahepatic cholestasis associated with extrahepatic bacterial infection in humans.
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PMID:Cholestasis associated with extrahepatic bacterial infection in five dogs. 258 68

Sixty-two episodes of bacterial infection were studied in 51 cirrhotic patients. 2 g of ceftriaxone (active ingredient of Rocephin) were given intravenously once daily for 7-10 days. The infections were pneumonia, bacteremia, spontaneous bacterial peritonitis, urinary infection and others. Good responses were seen in 90% of the cases.
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PMID:Use of ceftriaxone in the treatment of bacterial infections in cirrhotic patients. 261 36

The author presented a patient aged 30 affected by varicella who developed a specific varicella pneumonia as a complication of the basic disease. Clinically, when establishing the diagnosis, difficulties arose when it should be differentiated from bronchopneumonia induced by secondary bacterial infection. The accurate diagnosis depended on radiological finding. In specific varicella pneumonia radiological picture was not specific but was characteristic: diffusely disseminated nodular shadows were seen in both pulmonary wings in the reticularly strengthened bronchovascular drawing. This picture in addition to changes on the skin and mucosa typical for varicella and epidemiological picture was usually sufficient for making the diagnosis. Bacterial form usually showed the shadowness of segmental or lobar infiltration. Since specific varicella pneumonia as a complication of varicella in adults is a serious and exhausting disease and the treatment and prognosis depend on the establishment of accurate diagnosis on the basis of radiological finding, a good knowledge of these radiological changes has its diagnostic value and removes difficulties occurring in clinical differentiation of specific varicella pneumonia from nonspecific pneumonia induced by secondary bacterial infection.
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PMID:[Varicella pneumonia]. 263 89


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