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

The new quinolones are rarely indicated for the treatment of community-acquired pneumonia in the normal host. For nosocomial pneumonia they may be used when a Gram-negative aerobic bacillus is the causative organism. Pneumonia in the compromised host may be an indication for a quinolone. In the hypogammaglobulinaemic patient with Haemophilus influenzae pneumonia, the quinolones may be used, especially when the organism is resistant to other drugs. For the neutropenic patient with Gram-negative pneumonia the quinolones may be a good choice. However, more clinical studies are needed. In treatment for exacerbations of chronic bronchitis, failures seem to be associated with pneumococcal infections. For patients with cystic fibrosis, the quinolones offer successful ambulatory treatment for their Pseudomonas and Haemophilus infections. The information regarding dosage schedules is still incomplete.
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PMID:The place of quinolones in the treatment of respiratory tract infections. 267 85

In the eight major clinical studies published on use of oral quinolones in therapy of contiguous osteomyelitis, clinical and microbiologic cure/improvement rates were 75% and 73%, respectively, when drug therapy was combined with appropriate surgical debridement. This included many cases of polymicrobial osteomyelitis, as well as infection caused by recalcitrant pathogens such as Pseudomonas aeruginosa. In contrast, the response of staphylococcal osteomyelitis to oral quinolones, especially in cases caused by methicillin-resistant strains, appeared suboptimal. Quinolones appear to have a limited role in the treatment of community-acquired pneumonia, since other established antibiotic regimens have been proven effective in such situations. Quinolones may play an important role in the treatment of nosocomially acquired aerobic gram-negative bacillary pneumonia, either as primary parenteral therapy or as transitional oral therapy when affected patients become outpatients. In cystic fibrosis-associated acute exacerbations of chronic pseudomonal pneumonitis, the outcome of oral ciprofloxacin therapy was very satisfactory in the six major studies reported (approximately 85% improvement rates). In three comparative studies oral quinolone treatment of such pulmonary exacerbations resulted in clinical response rates equivalent to those for aminoglycoside plus beta-lactam therapy given intravenously. Quinolone-resistant Pseudomonas aeruginosa strains were commonly isolated from sputum during treatment; however, such patients continued to respond clinically to quinolone treatment, and sputum became rapidly repopulated with quinolone-susceptible Pseudomonas aeruginosa strains after discontinuation of therapy.
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PMID:Clinical utility of new quinolones in treatment of osteomyelitis and lower respiratory tract infections. 269 31

The results of the clinical observations over 127 patients with mucoviscidosis and chronic (primary and secondary) pneumonia are presented. The children were aged from 1 to 15 years. Study of the plasma and platelet links of hemostasis permitted one to reveal considerable disorders seen during exacerbation in all the groups. The intensity of the disorders correlated well with the gravity of the patient's condition and with the bronchopulmonary process spreading as well as with the presence of complications on the part of the cardiovascular system (cor pulmonale) and the hepatobiliary system (liver cirrhosis). The chronic form of the disseminated intravascular coagulation (DIC) syndrome was diagnosed in 50 percent of the patients with mucoviscidosis, in 1/3 of the patients with secondary and in 18 percent of the patients with primary chronic pneumonia. The subacute form of the DIC syndrome was diagnosed in 15 percent of the patients with mucoviscidosis and in 4.5 percent of the patients with secondary chronic pneumonia. The multimodality treatment without heparin made it possible to correct the hemostatic disturbances in the majority of the patients under observation. In some children with mucoviscidosis and secondary chronic pneumonia, the use of heparin in the form of intravenous injections or ultrasonic inhalations permitted making such a correction more rapidly and more completely.
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PMID:[Clinical significance of disorders of hemostasis in children with chronic pneumonia and mucoviscidosis]. 272 62

The maternal death rate and rate of preterm delivery associated with pneumonia during pregnancy have not decreased since the introduction of antibiotics four decades ago. We retrospectively reviewed 25 cases of pneumonia during pregnancy; these cases occurred among 32,179 deliveries. Medical complications included: bacteremia, 16%; empyema, 8%; atrial fibrillation, 4%; respiratory failure necessitating mechanical ventilation, 20%. Obstetric complications occurring during the pneumonia episode included: preterm labor, 44%; preterm delivery, 36%. A patient with cystic fibrosis died; one stillbirth and two neonatal deaths occurred. Underlying maternal disease was significantly associated with maternal medical complications (p = 0.023) and preterm delivery (p = 0.012). Significant medical and obstetric complications continue to occur frequently despite modern antimicrobial, tocolytic, and supportive therapy. Underlying maternal disease, including acquired immunodeficiency syndrome and cystic fibrosis, was associated with preterm delivery and neonatal and maternal death.
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PMID:Pneumonia during pregnancy: has modern technology improved maternal and fetal outcome? 278 48

An 18-year-old girl was hospitalized because of a treatment-refractory broncho-pneumonia requiring artificial ventilation. She had been suffering from recurrent respiratory infection since the age of three years. Chest X-ray films demonstrated bronchiectasis: Pseudomonas, Klebsiella and Candida albicans were isolated from the respiratory tract. The correct diagnosis of the underlying disease had not previously been made. A sweat test, when aged 15 years, was borderline abnormal. Despite the application of all available therapeutic measures she died in cardiorespiratory failure from an overwhelming pulmonary infection. The typical clinical features and the findings at autopsy established the diagnosis of mucoviscidosis.
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PMID:[Mucoviscidosis: late diagnosis despite typical clinical features]. 280 86

We report our experience of heart-lung transplantation for the treatment of children with terminal respiratory disease. Between May 1987 and October 1988 we performed heart-lung transplantation in five children under the age of 16 (age range 11-15). All the patients were severely disabled by dyspnoea and hypoxia. Two had primary pulmonary hypertension, two cystic fibrosis, and one had Eisenmenger's syndrome. All five children are alive and well five to 17 months after operation and have returned to activities normal for their age. Three of the five patients had episodes of infection after operation. These were staphylococcal pneumonia, herpes simplex pneumonitis and, in one of the patients with cystic fibrosis, persistent purulent sputum. The mean number of episodes of rejection per child was 2.7 per half year. Heart-lung transplantation is a practical treatment for children in these disease groups with terminal respiratory failure.
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PMID:Early experience of heart-lung transplantation. 281 41

Pseudomonas aeruginosa elaborates a number of extracellular products which have been shown to play a role in the pathogenesis of disease caused by this organism. In this study, we showed that the host environment markedly affects the levels of exoproducts produced. We compared the phenotypes of a number of P. aeruginosa strains obtained from a variety of clinical sources, including burn wounds, skin wounds, urine, cystic fibrosis sputum, acute pneumonia sputum, and blood. The clinical isolates were examined quantitatively for levels of total protease, elastase, phospholipase C, exotoxin A, and exoenzyme S produced in vitro under defined conditions. The exoproduct levels varied significantly, depending on the site of isolation. Elevated levels of elastase were demonstrated in strains isolated from acute lung infections, phospholipase C levels were elevated in urinary tract and blood isolates, exotoxin A levels were elevated in blood isolates, and exoenzyme S levels were increased in acute pneumonia isolates. Isolates from cystic fibrosis sputum produced low amounts of virtually all of the tested exoproducts, particularly as compared with sputum isolates from acute P. aeruginosa lung infections.
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PMID:Phenotypic comparison of Pseudomonas aeruginosa strains isolated from a variety of clinical sites. 301 37

We examined the effect of nutritional rehabilitation in cystic fibrosis patients with severe disease. Thirteen malnourished patients (seven males, six females, age 7-27 yr) were studied over 7-16 mo. Oral supplementation was attempted initially in 12 patients (mean duration 6.7 mo); only 2 patients gained weight, 2 withdrew, and 1 died. The remaining 7 patients failed to achieve adequate weight gain and were commenced on nasogastric supplementation with a semisynthetic formula. An additional patient was entered without a prior period of oral supplementation because of the severity of malnutrition. Weight gain was achieved in 7 of 8 patients with nasogastric supplementation (mean duration 6.4 mo). Weight gain was associated with an increase in lean body mass, total body fat, and height velocity. While pulmonary function and biochemical parameters were unchanged, patient well-being improved and episodes of pneumonia decreased.
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PMID:Nutritional rehabilitation of malnourished patients with cystic fibrosis. 308 67

We used DNA restriction fragments, derived from the exotoxin A gene and surrounding sequences, as an epidemiological marker for Pseudomonas aeruginosa. Using these DNA fragments as probes in Southern blot hybridizations and/or total genomic digestions, we were able to distinguish greater than 100 different strains of P. aeruginosa. The stability of the marker in vitro was established by using well-characterized strains, which were stored under different conditions and subjected to chemical mutagenesis. The stability of the marker within a given strain in vivo was established during experimental infection in the chronic rat lung model of pseudomonas pneumonia. P. aeruginosa serially cultured from individual patients with cystic fibrosis were examined by using this marker. Isolates that varied in colonial morphology, serotype, and biotype were identical when analyzed by Southern blot hybridization using the fragment as a probe. Indistinguishable isolates (by serotyping, biotyping, and antibiograms) cultured from two unrelated patients were easily distinguished by using Southern blot analysis.
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PMID:Characterization and use of a DNA probe as an epidemiological marker for Pseudomonas aeruginosa. 309 62

A clinical isolate of Pseudomonas cepacia from a cystic fibrosis patient was examined for its ability to produce extracellular toxic material. The organism was grown to stationary phase in a defined medium and toxic material was isolated by ultrafiltration, ion-exchange chromatography on DEAE-Sephacel and gel-filtration chromatography on Sepharose 4B. It consisted of a surface carbohydrate antigen, lipopolysaccharide and protein, and had an LD50 (when injected intraperitoneally into mice) of 395 +/- 20 micrograms. The toxicity appeared to be associated with the lipopolysaccharide portion of the complex, because boiling for 15 min and exposure to proteolytic enzymes had no effect on toxicity. However, saponification destroyed the toxicity of the compound. Studies employing radial immunodiffusion with the sera of mice infected with this organism demonstrated production of the complex in vivo at levels approaching those sufficient to produce death. When sublethal amounts of this complex were placed in the lungs of specific-pathogen-free rats, the lung pathology observed after 12, 24, 36 and 48 h was extensive. However, antibody generated in rabbits against this material could protect mice against the complex, as well as against challenge by the homologous organism. These data indicate that extracellular toxic material produced by P. cepacia may be responsible for the lethality and lung tissue destruction normally associated with an active pneumonia caused by this organism.
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PMID:The importance of extracellular antigens in Pseudomonas cepacia infections. 313 8


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