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

Bacterial infection is a serious and often fatal complication of patients with liver disease and can prove fatal either directly or by precipitation of gastrointestinal bleeding, renal failure, or hepatic encephalopathy. At greatest risk are patients with alcoholic cirrhosis or decompensated chronic liver disease, or cases of acute liver disease who progress to fulminant hepatic failure or subacute hepatic necrosis. Infection appears to be unusual in patients with primary biliary cirrhosis. The site and type of infection is unrelated to the aetiology of the liver disease. Bacteraemia, pneumonia, urinary tract infection and spontaneous bacterial peritonitis are most common but infective endocarditis and meningitis, especially with pneumococci, are easily overlooked. Clinical suspicion of infection must be high as the only indication may be a general deterioration in the patients' clinical state, increasing encephalopathy or renal impairment. In the case of patients with fulminant hepatic failure, infection may precipitate the initial or recurrent encephalopathy and contributes to death in 10% of fatal cases. Spontaneous bacterial peritonitis is now recognized to occur in the absence of clinical features of peritonitis. The PMN content of the ascitic fluid may provide the only indication of infection and is the most readily available screening test. The most common types of organism responsible for all types of infection are Gram-negative enteric and streptococci, especially pneumococci, while infection with anaerobes is rare. Risk factors for infection include decompensated alcoholic liver disease, fulminant hepatic failure, gastrointestinal bleeding, invasive practical procedures and impaired host defence mechanisms against infection. Of the host defence mechanisms, impaired function of the reticuloendothelial system, complement, and PMNs represent the most common and serious defects. Defects of humoral immunity are present in ascitic fluid from patients with cirrhosis and are probably a major reason for development of spontaneous bacterial peritonitis. Diuresis improves these functions and reduces the risk of peritonitis. Treatment of infections even with the appropriate antibiotic is still associated with a high mortality but the use of adjuvant gut sterilization is promising, particularly in cases infected with Gram-negative enteric organisms. Infusions of fresh frozen plasma, blood and cryoprecipitate improve some systemic host defences and may be beneficial in the treatment and reduction of risk of infection.
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PMID:Bacterial infections complicating liver disease. 265 49

Interstitial pneumonitis is an uncommon complication of low-dose methotrexate therapy in patients with psoriasis but occurs in 3%-5% of patients with rheumatoid arthritis. We found a higher incidence of interstitial pneumonitis in patients with primary biliary cirrhosis (14%) and describe its clinical manifestations, treatment, and possible etiology. Blood tests, arterial blood gas determinations, chest radiographs, bronchoscopy, tear production, autoantibody tests, and serum immunoglobulin levels were obtained in six women who developed interstitial pneumonitis while receiving methotrexate in a double-blind prospective trial of methotrexate vs. colchicine in 87 patients with primary biliary cirrhosis. Six of 43 patients (14%) who received methotrexate compared with no patients receiving colchicine developed interstitial pneumonitis 19-61 weeks after starting treatment. The pneumonitis was characterized by dyspnea, hypoxemia, and bilateral lung infiltrates, all of which responded within 24 hours to the administration of intravenous glucocorticoids. There was no correlation between the pneumonitis and pre-existing lung disease, the severity of the primary biliary cirrhosis, the titer of antimitochondrial antibody, or other diseases associated with primary biliary cirrhosis. Patients with primary biliary cirrhosis receiving low-dose methotrexate (15 mg/wk) are more susceptible to interstitial pneumonitis than patients with psoriasis or rheumatoid arthritis. The pneumonitis appears to be a hypersensitivity reaction and responds rapidly to intravenous glucocorticoid therapy.
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PMID:Interstitial pneumonitis after low-dose methotrexate therapy in primary biliary cirrhosis. 802 Jun 70

The clinical history, radiological and histomorphological alterations of the lung parenchyma in a patient suffering from primary biliary cirrhosis are described. The 70-year-old woman had developed a primary biliary cirrhosis, verified by serological abnormalities (AMA positivity, elevated IgM levels) and by liver biopsy. The lung parenchyma displayed immature epithelioid granulomas and characteristics of a chronic organizing pneumonia. Lung function revealed moderate restrictive changes; chest radiographs revealed bilateral, diffuse, patchy infiltrates in the basal lobes. Application of immunohistology detected antigens in liver cells reactive with anti-IgD and anti-IgG, in pneumocytes those reactive with anti-IgD. Presence of macrophage migration inhibitory factor (MIF) by application of its antibody and of the ligand sarcolectin as well as expression of binding capacities to MIF could not be demonstrated in the liver and lung parenchyma. Neoglycoproteins exposing fucose, N-acetyl-D-glucosamine, lactose and mannose residues did not bind to both the liver and lung tissue. The data indicate that at least some patients with primary biliary cirrhosis may develop or suffer from immunological abnormalities, affecting the lung.
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PMID:Alteration of human lung parenchyma associated with primary biliary cirrhosis. 813 Jan 70

We report three patients with cystic fibrosis and one patient with primary biliary cirrhosis and plexogenic pulmonary hypertension who have undergone heart-lung-liver transplantation as a combined procedure. Liver transplantation was necessary in the three patients with cystic fibrosis because of portal hypertension secondary to either hepatic fibrosis or established cirrhosis in addition to their advanced lung disease. Three of the four patients were alive at 20, 50, and 100 months after transplantation (one patient with cystic fibrosis died on day 16 of pneumonia) with well-preserved pulmonary function (forced expiratory volume in 1 second 110%, 49%, and 100% predicted, respectively), normal hepatic function and New York Heart Association class 1 performance status. Heart-lung and concurrent liver transplantation is a feasible and successful procedure with a satisfactory long-term outcome in selected patients with advanced pulmonary and hepatic disease.
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PMID:Heart-lung-liver transplantation. 877 10

A 55-year-old woman with a 6-year history of primary biliary cirrhosis presented with an acute onset of fever, dyspnoea, crackles over both lower lung fields, and diffuse interstitial and bibasilar patchy pulmonary opacities. After exclusion of an infectious aetiology, an open lung biopsy was performed which revealed two histopathological features: (1) bronchiolitis obliterans organising pneumonia and (2) lympho-histiocytic interstitial pneumonitis and destructive bronchiolitis. Treatment response to corticosteroids and azathioprine followed a bimodal pattern with immediate resolution of her initial presenting symptoms and late resolution of residual gas exchange defects.
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PMID:Bronchiolitis obliterans organising pneumonia and primary biliary cirrhosis-like lung involvement in a patient with primary biliary cirrhosis. 969 63

A 62-year-old woman with primary biliary cirrhosis (PBC) and rheumatoid arthritis (RA) was examined at our hospital for a 2-week history of non-resolving fever, cough and malaise. Her chest radiograph revealed left lower lobe opacity. Various kinds of antibiotics were not effective and transbronchial biopsy revealed non-specific inflammatory alveolar lesions. Chest radiograph at 14 days after admission revealed migration of the pulmonary opacity, suggesting bronchiolitis obliterans organizing pneumonia (BOOP), which responded well clinically and radiologically to oral corticosteroid therapy. BOOP may be one of the possible non-hepatic complications of PBC especially in patients associated with other connective tissue diseases.
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PMID:Bronchiolitis obliterans organizing pneumonia in a patient with primary biliary cirrhosis and rheumatoid arthritis treated with prednisolone. 1219 78

Pretransplant renal failure is a well-known risk factor which adversely affects the prognosis after liver transplantation. We report a case with pretransplant renal failure and discuss the perioperative management of such patient. The patient was 62 year-old-woman who was diagnosed with end-stage liver disease due to primary biliary cirrhosis, for which living donor liver transplantation (LDLT) was indicated. Her pretransplant serum creatinine was 9.4 mg/dl due to combination of drug-induced (antibiotics) acute tubular necrosis and hepatorenal syndrome. The management of renal failure consisted of the avoidance of calcineurin inhibitor as an induction immunosuppression and the use of perioperative continuous hemodiafiltration (CHDF). The postoperative course of the patient was complicated with CMV pneumonia and acute rejection, however she recovered and discharged on 94 POD with well-preserved graft function and normal renal function without any adverse sequela. LDLT for patients with renal failure can be performed successfully by careful management.
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PMID:[Living donor liver transplantation for a patient with renal failure]. 1263 31

Recently, we have experienced significant number of patients diagnosed with non-specific interstitial pneumonia (NSIP) by open lung biopsy or video-assisted thoracoscopic surgery. The purpose of this study is to compare clinical and pathological features of idiopathic NSIP and NSIP associated with underlying diseases (mainly autoimmune disorders). Forty-six patients with histologically proven NSIP were retrospectively collected. Twenty-four patients had underlying diseases (12 polymyositis/dermatomyositis, 5 systemic sclerosis, 2 rheumatoid arthritis, 2 Sjogren's syndrome, 1 ulcerative colitis, 1 primary biliary cirrhosis, and 1 multiple myeloma). Twenty-two of the 46 patients had no underlying diseases. It was very difficult to distinguish idiopathic NSIP and NSIP associated with underlying diseases, clinically and radiologically. Pathologically, Lymphocytic pneumonitis was demonstrated in both groups, and it was impossible to distinguish idiopathic NSIP and NSIP associated with underlying diseases. Since generalized symptoms were not observed in patients with idiopathic NSIP, and clinical and pathological features were identical to NSIP with several autoimmune disorders, we postulate new clinical entities of "autoimmune interstitial pneumonia" in cases without underlying diseases.
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PMID:Idiopathic non-specific interstitial pneumonia: as an "autoimmune interstitial pneumonia". 1571 92

Liver transplantation has been reported to reach excellent results for selected indications. We analysed the results of liver transplantation in our centre over a period of 23 years, with a total of 2,114 consecutive liver transplants in 1,773 patients (eras I-III 5.5 years each, era IV 6.5 years). Overall 20-year survival after liver transplantation was 29.8%. The most frequent leading causes of death were infections of various origins (30%), tumour recurrence (14.2%), and pneumonia (8.4%). The most frequent leading causes for graft loss were infection of various origins (19.6%), initial nonfunction of the graft (14.6%), and tumour recurrence (9.6%). Both long-term patient and graft survival were significantly better after primary liver transplantation than after first retransplantation (P<0.001). Patient and graft long-term survival improved significantly across all four consecutive eras (P<0.001). In era IV, the most recent, 5-year patient survival reached 96% for PBC, 89.4% for PSC, 78.5% for biliary atresia, 70% for acute liver failure, 69.1% for HBV-related cirrhosis, 61.3% for hepatocellular carcinoma, and 56% for HCV-related cirrhosis.
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PMID:[Long-term results after liver transplantation]. 1820 88

A 58-year-old woman with an 18-year history of primary biliary cirrhosis was admitted because of pneumococcal pneumonia. She was treated with antibiotics and mechanical ventilation. After the pneumonia improved, she developed severe watery diarrhea. Although vancomycin was administered enterally, the diarrhea persisted. She died of multiple organ failure within 16 days of the onset of diarrhea. An autopsy showed intracapillary cryptococci in the systemic organs, especially in the intestinal tract. The cause of diarrhea was considered to be extensive intestinal mucosal necrosis due to disseminated cryptococcosis. This is a rare case of cryptococcal infection manifesting as acute diarrhea.
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PMID:An autopsy case of disseminated cryptococcosis manifesting as acute diarrhea in a patient with primary biliary cirrhosis. 2072 Mar 61


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