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

Eight patients with severe strongyloidiasis complicating renal transplantation are reported. Twenty-one additional cases from the English-language literature are reviewed. In this setting, systemic strongyloidiasis is an often baffling illness involving multiple organ systems that is frequently complicated by serious bacterial infection. Bacteremia, meningitis, urinary tract infection, and pneumonia resulting from enteric organisms are common. In order to make the diagnosis, larvae must be sought by direct microscopy of stool, upper intestinal fluid, sputum, urine, or biopsy specimens. Treatment with oral thiabendazole in prolonged or repeated courses is recommended. Effective parenteral therapy is not available. Following treatment, previously parasitized patients must be tested at regular intervals to detect therapeutic failure or reinfection. Screening of patients awaiting renal transplantation for chronic intestinal strongyloidiasis is suggested. Improvement of the observed 52% mortality will depend upon heightened awareness by physicians caring for renal transplant candidates, and upon improved therapeutic regimens.
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PMID:Opportunistic strongyloidiasis in renal transplant recipients. 309 91

Pneumonia due to Pneumocystis carinii (PCP) is regularly encountered in organ allograft recipients who are immunosuppressed to prevent rejection. Recipients of lung/heart allografts may be particularly prone to pulmonary infection due to systemic immunosuppression and the fact that defense mechanisms in the transplanted lung may be further impaired through tissue incompatibility and the effects of surgery. In this study, we monitored 16 lung transplant recipients for infection with Pneumocystis carinii using serial bronchoalveolar lavage (BAL) and found the prevalence of Pneumocystis infection of the lung to be 88%. Six episodes were associated with the usual symptoms of pneumonia, whereas 10 episodes were associated with minimal or no symptoms. In 3 of the 6 symptomatic episodes, a concurrent bacterial infection was also found. The total number of cells recovered from the lung by BAL, the proportion of T-lymphocytes, and the number of cytotoxic/suppressor and helper/inducer cells were elevated during infection with Pneumocystis compared to before and after. Spontaneous and interleukin-2-induced proliferation of BAL cells in vitro was also higher during infection, suggesting that there was an increased number of activated T-lymphocytes in the airspaces of the infected allograft. BAL cells cultured with irradiated spleen cells from the donor proliferated at higher levels when obtained after Pneumocystis infection than when obtained before or during infection even for subclinical infections. These results indicate that in the absence of prophylaxis, the prevalence of Pneumocystis infestation is very high after lung/heart transplantation. Impaired defense of the transplanted lung does not seem to stem from the inability of activated T-lymphocytes to accumulate in the allograft.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Unexpectedly high incidence of Pneumocystis carinii infection after lung-heart transplantation. Implications for lung defense and allograft survival. 314 96

Ceftizoxime (CZX) was evaluated for absorption and excretion as well as for therapeutic effectiveness in neonates and premature infants. The following results were obtained. 1. Serum CZX concentrations were determined in 8 neonates or premature infants who were not more than 6 days old. Serum concentrations of the drug were examined in 6 neonates and/or premature infants after intravenous administration of about 20 mg/kg body weight. Average concentration at 1/2, 2, 4 and 6 hours after administration were 52.3, 36.4, 26.7 and 16.7 micrograms/ml, respectively. Serum concentrations in the other 2 infants who were given 29.7 and 25.1 mg/kg, were as high as 71 and 94 micrograms/ml at 1/2 hour and 22.1 and 39 micrograms/ml at 6 hours, respectively. Serum half-lives in 5 of the 6 mature neonates ranged from 2.36 to 3.34 hours, with averaged 2.75 hours, but was exceptionally long, 7.92 hours, in the other one. Half-lives in the 2 premature infants were 4.14 and 4.90 hours. 2. The therapeutic effectiveness on bacterial infection was evaluated for 10 newborn infants. Intravenous doses of 16.9 to 24.6 mg/kg were given in b.i.d. or t.i.d. regimen to 4 cases with pneumonia and 2 with septicemia, urinary tract infection and fetal infection each. To 1 infant with septicemia complicated with cephalohematoma, higher doses ranged from 21.8 to 49.8 mg/kg were given t.i.d. or q.i.d. Therapeutic efficacies were assessed as "Excellent" in 3, "Good" in 6, and "Poor" in 1, with an efficacy rate of 90.0%. Eradication of bacteria was complete in 2 infants each with Escherichia coli-induced septicemia or urinary tract infection. 3. For prophylactic use, the drug was given to 8 newborn infants in intravenous doses of 17.5 to 29.1 mg/kg b.i.d. or t.i.d. and no infection occurred in 7 cases. 4. No adverse reactions were obtained. Slight and transient increases in platelet count, GOT and GPT in 1 case and eosinophilia in another were observed. 5. These results suggested that CZX in an intravenous dose of 20 mg/kg b.i.d. or t.i.d. regimen in newborn infants up to 7 days of age would be effective and safe for the treatment of neonatal bacterial infections.
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PMID:[Clinical evaluation of ceftizoxime in neonates and premature infants]. 317 67

During a period of 16 months 26 fluid specimens obtained by broncho-alveolar lavage (BAL) in 24 immunocompromised patients were examined. This material included 13 HIV positive patients and 11 patients presenting malignant hemopathies (MH), of whom 7 had had a blood marrow transplantation. The BAL fluid was divided into two equal parts, one of which was sent to the Institute of Pathology and the other to the Laboratory of Bacteriology of Geneva University Hospital. In some cases a transbronchial biopsy was also studied. Eight out of 13 HIV positive patients presented a Pneumocystis carinii infection and one a cytomegalovirus (CMV) infection (associated with atypical mycobacteria infection). In another case streptococcal pneumonia was observed. In 3 patients, analysis of the BAL fluid failed to yield a diagnosis. In the 11 patients with MH, 2 cases of CMV, 2 infections with Candida albicans and one with Aspergillus fumigatus were found. In 2 patients the pneumopathy was due to bacterial infection. Four BAL fluids failed to yield a diagnosis; however, in one of these transbronchial biopsy revealed interstitial pneumonia of unknown origin. On the basis of our material and comparison with clinica, radiological and serological data, it appears that BAL fluid analysis is a helpful and rapid diagnostic aid in infectious pneumopathies of immunocompromised patients. This is especially true of AIDS patients in whom the most common pulmonary complication is Pneumocystis carinii pneumonia. However, success of the analysis requires close cooperation between clinician, bacteriologist and pathologist.
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PMID:[Infectious pneumopathies in immunodepressed patients. Value of the study of bronchoalveolar lavage fluid]. 317 70

A retrospective clinico-microbiological study of 83 patients with corneal ulcers due to bacterial infection was performed. Positive cultures of corneal ulcer samples were obtained from 57% of all patients. A high incidence of Staphylococcus epidermidis was isolated from ulcer patients; Pseudomonas, Streptococcus and Streptococcus pneumonia were the next most frequent pathogens. Of some help in identifying the causative organism were the locations of the ulcers, the presence or absence of hypopyon and the frequency of perforation. Gentamycin, cephaloridine and polymyxin were found to be the most effective therapies. Gram stains of ulcer samples were positive for organisms in only 11% of patients and accordingly were not considered useful in determining the appropriate initial therapy of ulcers. It was concluded that treatment should be started with a broad combination of antibiotics while awaiting the culture results.
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PMID:The nature of ulcerative keratitis in Kuwait (clinical and microbiological study). 317 72

58 paediatric patients with pneumonia, in whom an etiological agent had been isolated, were reviewed. The patients were designated to have either viral or bacterial pneumonia on the basis of proposed clinical and radiological criteria. These presumed diagnoses were then compared to the microbiologically proven diagnosis. When clinical features suggested a bacterial infection the chance of isolating a bacteria as opposed to a virus was 18%. Was radiological features suggested a bacterial infection the chance of isolating a bacteria as opposed to a virus was 30%. Thus the commonest cause of "bacterial" clinical and radiological features is a viral infection and the proposed criteria do not allow differentiation of bacterial from viral pneumonia.
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PMID:Differentiating bacterial from viral pneumonias in children. 318 20

During a one-year epidemiologic survey of acute community-acquired pneumonia, we prospectively investigated in 116 adult nonimmunocompromised patients (a) the importance of initial noninvasive investigations (ie, blood culture and quantitative sputum culture) and the value of the initial radiologic type of pneumonia in diagnosing of the etiologic agent, and (b) the management of pneumonia. Quantitative sputum culture or blood culture (or both) permitted bacteriologic diagnosis in 44 percent of the cases. The radiologic types found were segmental or alveolar densities in 75 patients (65 percent), patchy alveolar densities in 11 (9 percent), mixed opacities in 26 (22 percent), and interstitial infiltrates in four (3 percent). We observed that (a) the prognosis was identical whether a bacteriologic diagnosis was made or not, (b) the Gram stain, an inexpensive procedure, was as contributive for bacteriologic diagnosis as quantitative sputum culture, diagnosis as (c) blood cultures were poorly contributive in patients without severe infections, and (d) alveolar densities were associated with a bacterial infection in 90 percent of the cases of known etiology. On the basis of these results, a pragmatic strategy of initial management of community-acquired pneumonia is proposed.
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PMID:Community-acquired pneumonia. Importance of initial noninvasive bacteriologic and radiographic investigations. 327 31

Plasma concentrations of beta 2 microglobulin (B2M), the light chain of the class I major histocompatibility complex, were measured serially in 26 patients undergoing allogeneic bone marrow transplantation (BMT). The concentrations fell after conditioning treatment, and recovered when the marrow was transplanted. Bacterial infection did not influence B2M concentration, but nine of 22 episodes of acute graft versus host disease were associated with raised concentrations. Increased plasma B2M concentrations were also a feature of eight episodes of chronic graft versus host disease, and these fell after treatment. Reactivation of herpes simplex, varicella zoster, or cytomegalovirus infections were also accompanied by raised B2M concentrations. Three patients with cytomegalovirus pneumonitis had high concentrations of plasma B2M, the rise starting between five and 22 days before onset of symptoms. Although it is non-specific, serial measurement of plasma B2M in patients undergoing BMT may be clinically useful in monitoring chronic graft versus host disease.
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PMID:Changes in plasma beta 2 microglobulin concentrations after allogeneic bone marrow transplantation. 330 8

In a group of 74 hospitalized patients with the diagnosis of acute infectious pneumonia, the etiological contribution of viral and bacterial agents is analyzed in cases of clarified etiology and an assessment is made of the relationship between the explained etiology and the overall epidemiological situation. Etiology was clarified in 36 patients (48.6%). Viral and bacterial etiology was confirmed in 13.3% and 39.8% of the entire group respectively. In three cases, mixed viral and bacterial infection was reported. Most prominent among the viral agents were herpes simplex, parainfluenza, respiratory syncytial and influenza type B viruses. As far as the bacterial agents were concerned, the species most frequently isolated were Staphylococcus aureus, Streptococcus pneumoniae and a variety of Enterobacteriaceae. The relationship between the overall epidemiological situation and pneumonia etiology is discussed as well as the relevance of the diagnostic methods employed.
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PMID:On the epidemiology and etiology of pneumonia in adults. 339 28

Disseminated aspergillosis is rare in patients not suffering from haematological disorders and myelo-suppression. We report a case of pulmonary cardiac and renal aspergillosis diagnosed at autopsy in a patient with chronic respiratory failure dying in the intensive care unit during an acute exacerbation. The role of risk factors associated with invasive aspergillosis in patients not suffering from myelosuppression is discussed (steroid therapy, chronic respiratory disease, concomitant viral or bacterial infection). The discovery in this patient of a pulmonary infection associated with mycoplasma pneumonia (the micro-organisms were found in necropsy specimens of pulmonary tissue) does not seem to have been reported before in the literature.
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PMID:[Disseminated invasive aspergillosis associated with Mycoplasma pneumoniae infection]. 343 18


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