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

Two cases of destroyed lung after repeated pneumonia are reported; one in a patient suffering from cystic fibrosis in the age of 8 years, the other in a 15 year old girl with a phrenic nerve paralysis. In both children physiotherapy as well as retreatments with appropriate antibiotics did not achieve any long-term curative effect. Therefore a pneumonectomy was indicated. In the patient with cystic fibrosis a small air leak was observed on the first postoperative day at the bronchial suture line, which was treated with an immediate rethoracotomy and correction. In the other child a pericardial effusion 4 weeks after surgery occurred. Regression was seen within two weeks under antibiotic therapy. In diseases such as cystic fibrosis and paralysis of the diaphragm a resection of the lung is justified in cases even if they are complicated by recurrent infections due to atelectasis or bronchiectasia. The preoperative investigation includes the proof of a total lung failure by scintiscan and/or measurement of a mucociliary clearance. A non altered function of the remaining lung is a prerequisite.
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PMID:[Lung resection in the principle disease of mucoviscidosis and status following poliomyelitis--2 case reports]. 317 75

It is estimated that more than 110 million dollars' worth of oral antibiotics will have been sold in Canada in 1987. In the next few years several new oral antimicrobial agents will reach the market, including beta-lactamase inhibitors, cephalosporins, monobactams, erythromycins and quinolones. Most of these new agents have a broader spectrum of antibacterial activity than the presently available oral antibiotics. A few have a longer half-life and can be administered once a day. The new oral drugs, especially the quinolones and possibly beta-lactams, will now be used to treat infections that in the past could be treated only parenterally. Exacerbations of pulmonary infections due to Pseudomonas aeruginosa in cystic fibrosis can now be successfully treated at home with the new quinolones. Osteomyelitis, arthritis, pneumonia and pyelonephritis will most likely be treated at home in the future. In severe infections patients will be admitted to hospital for short courses of parenteral therapy, followed by oral treatment. If used appropriately the new oral agents may lead to new approaches to the treatment of infectious diseases.
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PMID:The future of new oral antibiotics including the quinolones. 327 79

The role of the new fluoroquinolones in the treatment of lower respiratory tract infections is still difficult to assess. These compounds can be successfully used in the treatment of acute exacerbations of chronic bronchitis but do not seem superior to older drugs; moreover, bacteriologic persistence and even treatment failures in infections due to Streptococcus pneumoniae can be a problem. Because of the poor activity of fluoroquinolones against S. pneumoniae, these compounds do not appear to be the first choice in the empiric treatment of community-acquired pneumonia. Ciprofloxacin is apparently valuable for the treatment of pseudomonas infections in patients with cystic fibrosis: clinical results seem comparable to those obtained with conventional intravenous treatments. More clinical experience is needed to compare the role of fluoroquinolones with that of beta-lactam and aminoglycoside antibiotics in the treatment of nosocomial gram-negative pneumonia.
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PMID:Quinolones in the treatment of bronchopulmonary infections. 327 95

Infections of the respiratory tract are among the most common causes for antibiotic prescribing. Their diagnosis within the community is generally limited to clinical criteria, and microbiological information is frequently lacking. Hospitalised patients with respiratory tract infections are more likely to undergo diagnostic sampling, but difficulties remain in reliably defining a microbial aetiology, thereby providing a confident basis for antibiotic selection. In considering the role of the cephalosporins in the treatment of respiratory tract infections, over 500 published articles have been reviewed. The pharmacokinetic considerations are discussed and the limitations of existing methodology are emphasised. Individual agents are reviewed by site of sepsis and conclusions are drawn from both comparative and non-comparative studies and in relation to currently recommended regimens. Although oral cephalosporins are widely used to treat upper respiratory tract infections, none is considered ideal, especially where Haemophilus influenzae is pathogenic. In the case of lower respiratory tract infections the beta-lactamase stable parenteral cephalosporins have become widely used to treat pneumonia in hospitalised patients, especially where Gram-negative enteric bacilli are of aetiological importance. However, the lack of activity of these drugs against Legionella spp., Mycoplasma pneumoniae and Coxiella burnetii must be emphasised. Another area of increasing use is in the treatment of infective exacerbations in patients suffering from cystic fibrosis of the lungs where Pseudomonas aeruginosa is pathogenic; ceftazidime in particular has proved a useful alternative to earlier antipseudomonal penicillin antibiotics.
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PMID:Treatment of respiratory tract infections with cephalosporin antibiotics. 331 1

We studied lungs at autopsy from 40 patients with cystic fibrosis (CF) to determine the structural and clinicopathologic features of pneumonia associated with Pseudomonas cepacia respiratory tract colonization. Three clinical groups were identified: group A included 11 patients exhibiting a fulminant course following P cepacia colonization; group B included 20 patients who declined slowly following colonization; and group C included nine patients without P cepacia colonization. Acute pneumonia occurred in all groups but was most extensive and necrotizing in group A. Chronic lobular pneumonia involved all groups equally, whereas interstitial pneumonia predominated in group B. Diffuse alveolar damage occurred infrequently in all groups. Combinations of structural patterns were frequently seen. We conclude that, although there is great overlap in the structural appearance of pneumonia among patients with CF with different bacterial colonization histories, the evidence suggests that P cepacia is a cause of necrotizing pneumonia in some patients. Factors that predispose to this fulminant lung infection are poorly understood.
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PMID:Pseudomonas cepacia-associated pneumonia in cystic fibrosis. Relation of clinical features to histopathologic patterns of pneumonia. 333 28

Pneumonia is one of the most common causes of death from infectious disease in the United States. To examine the possible role of carbohydrates as adhesion receptors for infection, several pulmonary pathogenic bacteria were studied for binding to glycosphingolipids. Radiolabeled bacteria were layered on thin-layer chromatograms of separated glycosphingolipids, and bound bacteria were detected by autoradiography. The classic triad of infectious bacteria found in cystic fibrosis, Pseudomonas aeruginosa, Haemophilus influenzae, and Staphylococcus aureus, along with other bacteria commonly implicated in typical pneumonia, such as Streptococcus pneumoniae, Klebsiella pneumoniae, and certain Escherichia coli, bind specifically to fucosylasialo-GM1 (Fuc alpha 1-2Gal beta 1-3GalNAc beta 1-4Gal beta 1-4Cer), asialo-GM1 (Gal beta 1-3GalNAc beta 1-4Gal beta-1-4Galc beta 1-1Cer), and asialo-GM2 (GalNAc beta 1-4Gal beta 1-4Glc beta 1-1Cer). Bacteria maintained in nutrient medium bind better than the same cells suspended in buffer. They do not bind to galactosylceramide, glucosylceramide, lactosylceramide, trihexosylceramide, globoside, paragloboside, Forssman glycosphingolipid, or several other glycosphingolipids tested, including the gangliosides GM1, GM2, GM3, GD1a, GD1b, GT1b, and Cad. The finding that these pathogens do not bind to lactosylceramide suggests that beta 1-4-linked GalNAc, which is positioned internally in fucosylasialo-GM1 and asialo-GM1 and terminally in asialo-GM2, is required for binding. beta-N-Acetylgalactosamine itself, however, is not sufficient for binding, as the bacteria did not bind to globoside, which contains the terminal sequence GalNAc beta 1-3Gal. These data suggest that these bacteria require at least terminal or internal GalNAc beta 1-4Gal sequences unsubstituted with sialyl residues for binding. Other bacteria, including Mycoplasma pneumoniae, Streptococcus pyogenes, Salmonella species, and some E. coli, do not bind to the GalNAc beta 1-4Gal sequence. The biological relevance of these data is suggested by our finding that substantial amounts of asialo-GM1 occur in human lung tissue.
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PMID:Many pulmonary pathogenic bacteria bind specifically to the carbohydrate sequence GalNAc beta 1-4Gal found in some glycolipids. 341 84

A mouse model of chronic pulmonary infection with either Pseudomonas aeruginosa or Pseudomonas cepacia was developed to compare bacteriologic and pathologic features of these infections. Experimental pneumonia was established in Swiss mice by transoral intratracheal inoculation of 10(3)-10(4) colony-forming units of mucoid P. aeruginosa or P. cepacia enmeshed in agarose beads. Unilateral infection with either strain was tolerated without morbidity. By 10 days postinoculation, the mean colony-forming units per infected lung was 3.8 X 10(5) for P. aeruginosa and 1.0 X 10(5) for P. cepacia. Bacterial counts remained stable through 21 days with no significant difference between organisms. Acute and chronic inflammatory histopathologic changes similar to many found in the lungs of cystic fibrosis patients were present in 95% of lung specimens. The changes occurred with both organisms but were more extensive with mucoid P. aeruginosa. This model represents an important tool for study of the contribution of complement, antibody, and adoptive transfer of T cell-mediated immunity to the pathogenesis of chronic pneumonia with Pseudomonas species, and represents the first successful model of chronic pulmonary infection with P. cepacia.
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PMID:A mouse model of chronic pulmonary infection with Pseudomonas aeruginosa and Pseudomonas cepacia. 343 54

Interleukin-2 (IL-2) production by cells from children with various forms of arthritis, systemic lupus erythematosus, and cystic fibrosis was compared. In all cases more IL-2 was detectable at 24 than at 48 h and production was increased by addition of indomethacin. Cultures from children with either active lupus or the pneumonia of cystic fibrosis produced very little IL-2, but cultures from children with arthritis produced apparently normal amounts. We conclude that depressed production of IL-2 in juvenile arthritis may be a secondary epiphenomenon and not a primary immunologic deficit.
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PMID:Interleukin-2 production by lymphocytes from blood of children with arthritis is less suppressed than in systemic lupus or cystic fibrosis. 349 11

Pseudomonas cepacia, originally described as a plant pathogen, has emerged as an important cause of infection in altered hosts, particularly in the hospital setting. This organism's ability to survive and proliferate in a variety of solutions, medications, and even disinfectants and antiseptics has resulted in numerous clusters of common-source nosocomial infections. Many patients exposed to P. cepacia are merely colonized, but serious infections, including surgical and burn wound infections, bacteremia, meningitis, pneumonia, peritonitis, and urinary tract infections, are not rare. The virulence properties of this pathogen remain poorly characterized. Recently, P. cepacia has been reported in some cystic fibrosis centers as an increasingly frequent pulmonary pathogen. This trend has caused considerable concern because of reports of occasional cases of fulminant necrotizing pneumonia and bacteremia. Conversely, many patients with CF who become colonized with this organism have no ill effects. The epidemiology of P. cepacia in the CF population is unclear, but some patients probably acquire the organism from colonized siblings with CF. Circumstantial evidence suggests that the organism may also be acquired in the hospital. Treatment of infections is exceedingly difficult, particularly in patients with CF, because P. cepacia is resistant to a broad range of antibiotics.
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PMID:Pseudomonas cepacia: biology, mechanisms of virulence, epidemiology. 351 71

Cystic fibrosis is the most common lethal genetic disease of Caucasians. The disease affects the exocrine gland secretions throughout the body, and as a result, major pathologic changes develop in the pancreas and in the bronchi. Obstruction of the respiratory airways results in chronic infection, and in time, this leads to progressive deterioration of lung function. In the initial stages of the disease, usually during infancy, infection with Staphylococcus aureus plays an important role. Hemophilus influenzae infections are also common. As the disease progresses, infection with Pseudomonas aeruginosa develops. Exacerbation of bronchopulmonary infection is often initiated by respiratory viral or mycoplasmal infection, with superimposed S. aureus and P. aeruginosa infections contributing to the severity of the infection. Frequent courses of antibiotic therapy are usually required, and some patients may have to receive antibiotics continuously. Oral cephalosporins, ampicillin, and the combination of trimethoprim/sulfamethoxazole are commonly used for relatively mild infections. In the treatment of exacerbation of infection, intravenous penicillinase-resistant penicillins and anti-Pseudomonas antibiotics are the drugs of choice. For Pseudomonas infections, ticarcillin, carbenicillin, the ureidopenicillins, and the aminoglycosides are indicated. The combination of an anti-Pseudomonas penicillin and an aminoglycoside are most commonly used. Of the third-generation cephalosporins, ceftazidime appears to be the most efficacious. The quinolones (such as ciprofloxacin) are also active against P. aeruginosa, and preliminary studies of these drugs in patients with cystic fibrosis appear to indicate that they are as efficacious as the already available antibiotics. In many centers, Pseudomonas cepacia has emerged as a serious problem in patients with cystic fibrosis. This organism tends to develop resistance to multiple antibiotics. In some centers, infection with P. cepacia has been associated with a severe, frequently fatal, pneumonia.
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PMID:Infection in patients with cystic fibrosis. 352 81


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