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

Viral pneumonias are both a diagnostic and a therapeutic challenge for primary care physicians. The illness should be suspected when an upper respiratory tract infection progresses to include dyspnea and cyanosis. Rapid diagnostic tests are now available to detect most of the viruses that cause pneumonias. Fortunately, viral pneumonias usually resolve without specific antiviral therapy; however, ribavirin is indicated for respiratory syncytial virus pneumonia in children and ganciclovir sodium (Cytovene) for cytomegalovirus pneumonia in immunocompromised patients. Acyclovir (Zovirax) is indicated for pneumonias due to herpes simplex virus and varicella-zoster virus infections. A high index of suspicion for bacterial superinfections is essential to reduce the risk of death from this complication.
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PMID:Viral pneumonias. A diagnostic and therapeutic challenge. 223 93

A 64-year-old man with chronic obstructive pulmonary disease presented with pneumococcal pneumonia that progressed to respiratory failure within one week, requiring mechanical ventilation. Despite a low minute ventilation and clear chest roentgenogram, multiple weaning attempts failed. Bronchoscopy revealed significant narrowing of the distal trachea with erythema, edema, and ulceration of the mucosa. Cytology of tracheal washings was consistent with herpes simplex virus, and the patient was successfully extubated following treatment with intravenous acyclovir. Bronchoscopy following acyclovir therapy demonstrated resolution of the inflammation and narrowing. Herpetic tracheitis is a rarely recognized reversible cause of tracheal stenosis, especially in a nonimmunocompromised patient. It should be suspected in patients without an obvious cause of failure to wean from mechanical ventilation, and can be successfully treated with acyclovir.
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PMID:Tracheal stenosis and failure to wean from mechanical ventilation due to herpetic tracheitis. 224 99

A 59 years old woman, born in Fukuoka Prefecture, was admitted to our hospital in Aug, 1988 because of diarrhea, fever and skin eruption. Physical examination revealed systemic lymphadenopathy and hepatosplenomegaly. The white blood cell count was 11,200/microliters with 28% atypical lymphocytes with convoluted nuclei. Mild anemia, thrombocytopenia and hypercalcemia were also observed. Antibody against the adult T-cell leukemia (ATL) associated antigen in serum was positive. OKT 4/8 ratio was high. A diagnosis of ATL was made. Because of the complications of pneumonia and herpes simplex, systemic chemotherapy was not given, and interferon (IFN)-alpha-2b was intramuscularly injected daily from Oct, 1988, resulting in the disappearance of atypical lymphocytes and improvement of skin lesions. The effect of IFN therapy lasted for three months, followed by increase of atypical lymphocytes. Although the patient became refractory to systemic IFN therapy, local injection of IFN into a buccal tumor infiltrated with atypical lymphocytes resulted in its regression of size. In spite of continued administration of IFN, the patient died of pneumonia in Jan, 1989.
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PMID:[Successful treatment of adult T-cell leukemia with interferon-alpha-2b by systemic and local administration]. 224 35

We report our experience of herpes simplex virus infection in a series of 51 recipients of heart lung transplantation (HLT). Nine patients, all of whom were seropositive for the virus preoperatively, developed HSV infection. Seven episodes of culture-proved mucocutaneous HSV infection without evidence of pulmonary involvement occurred in four patients. Six episodes of HSV pneumonia were seen in a further five patients, one of whom died. Diagnosis of HSV pneumonia was by histological appearances on transbronchial biopsy, together with culture of lung tissue or bronchoalveolar lavage. Concomitant cytomegalovirus infection occurred in four patients. All patients who developed HSV pneumonia did so within the first two postoperative months; in four patients following augmented immunosuppression. We now suggest that HLT recipients who are HSV antibody-positive should receive prophylactic acyclovir for the first two months after surgery and at times of augmented immunosuppression.
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PMID:Herpes simplex virus infection in heart-lung transplant recipients. 232 68

Herpes type infections in AIDS patients tend to be more severe, generalized and have a torpid evolution. We present here two cases of intravenous drug addicts with a clinical picture of ulcerative lesions with a scar in the perioral and ungual regions with an evolution of several months an which were diagnosed of Herpes Simplex by a histopathological study. They were treated with intravenous Acyclovir achieving a complete remission; one patient developed a pneumocystis carinii pneumonia a month later. We want to highlight the importance of this case as a clinical sign of profound cellular immunity depression as well as the risk of developing more severe conditions.
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PMID:[Herpes simplex infections in patients with AIDS]. 237 75

In regard to AIDS, attention has focused on Africa for the following reasons: 1) Solid evidence indicates that antibodies against HIV were present in African sera collected in the early 1960s. 2) Up to 1986, AIDS epidemiology was hampered by inconsistent demographic data, inadequate public health services, and scanty laboratory evidence. 3) Prevalent infection routes in Africa are not entirely overlapping with Western countries. 4) Clinical aspects of AIDS progression in Africa appear linked to the different opportunistic agents and to the prevailing hygienic and social conditions. In 1983, in Rwanda and Zaire, the annual incidence of HIV infection ranged from 17 to 800/million and 170/ million, respectively. In the first five months of 1985, the range of annual incidence in Africa was 50-1000/million. In Zaire, the male-female infection ratio was 1:1.2 and the average age of infected people was 33.6 years. Seropositivity ranged from 1% to 15%. The distribution of African AIDS is characterized by heterosexual transmission, transmission via contaminated syringes, blood transfusion, and maternal-fetal transmission. Lack of condom use among prostitutes and multiple partners are the main routes of heterosexual transmission. Other routes are high risk sexual practices as well as traditional and tribal rituals (clitoridectomy/female genital mutilation). Perinatal infection results from maternal-fetal transmission but also from blood transfusion and the use of unsterilized syringes. In 1986, in Zaire, among 2384 hospital workers, significantly more seropositivity occurred in a group who had had injections in the previous three years. A 1986 study also hinted at the possible role of insects in HIV infection. The major symptoms of AIDS in an African context, in addition to the usual depletion of CD4 lymphocytes, include diarrhea and weight loss, candida, cryptococcus, cytomegalovirus, cryptosporidium, and herpes simplex. Only 14% of AIDS patients in Africa have pneumonia carinii as compared with 63% of AIDS patients in Europe. The concomitant infection with both HIV and tuberculosis is particularly high in Africa.
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PMID:[AIDS in Africa]. 248 91

Thirty-two patients underwent combined heart and lung transplantation at Papworth Hospital between 1984 and 1987. The clinical and physiologic observations made at the time of episodes of infection and rejection together with the histopathology of lung tissue obtained by transbronchial lung biopsy were compared with pre- and postepisode chest radiographs. There were 45 episodes of rejection in 20 patients: 23 episodes during the first month after transplantation, and 22 after 1 month. Twenty-six episodes of infection occurred in 15 patients. The causative organisms included Aspergillus fumigatus, cytomegalovirus (CMV), herpes simplex, Pneumocystis carinii, and Staphylococcus aureus. When an abnormal chest radiograph is common during the first month after transplantation during acute rejection (74%), it may alternatively be due to lung infection (most commonly CMV pneumonitis). The chest radiograph during this period provides a useful indication for transbronchial biopsy and bronchial lavage. The chest radiograph is abnormal in the minority (23%) of episodes of rejection occurring later than 1 month after transplantation. Pulmonary function tests (FEV1 and VC) offered a more useful indication for transbronchial biopsy during this period.
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PMID:The radiographic appearances of infection and acute rejection of the lung after heart-lung transplantation. 250 57

We report a patient with pathologic evidence of anterograde spread of varicella zoster virus (VZV) through the visual system. A 29-year-old homosexual man developed the acquired immunodeficiency syndrome (AIDS) 2 months before the onset of left herpes zoster ophthalmicus. During the next 11 months, the zoster infection progressed to involve the left eye, with resultant keratitis, iritis, retinitis, and eventual blindness. Later, the patient developed bilateral blindness, left hemiparesis, and fatal pneumonia. At autopsy, the brain revealed destruction of the visual system and adjacent structures, with sparing of the remainder of the brain. Glial cells near the areas of necrosis showed Cowdry type A intranuclear inclusions. In situ hybridization with probes to VZV nucleic acid sequences were positive in the necrotic brain and retinal areas. Hybridization with probes to cytomegalovirus, herpes simplex virus type II, human immunodeficiency virus, and Epstein-Barr virus were negative. Electron microscopy revealed characteristic herpes group nucleocapsids. This case provides insight into the mechanisms of virus dissemination and the production of encephalitis.
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PMID:Transsynaptic spread of varicella zoster virus through the visual system: a mechanism of viral dissemination in the central nervous system. 253 32

Viral pneumonitides are among the known pulmonary complications of human immunodeficiency virus (HIV) infection. Cytomegalovirus (CMV) pneumonitis is the most frequently recognized viral infection involving the lung. Although CMV may occasionally be the sole pathogen found to be responsible for severe pneumonitis in patients with the acquired immunodeficiency syndrome (AIDS), in most cases, its role in causing pulmonary disease is less clear, primarily because of the propensity to infect with a variety of other copathogens. CMV pneumonitis has been difficult to diagnose during life, although techniques utilizing in situ DNA hybridization or monoclonal antibodies for detection of the virus may improve the diagnostic yield of less invasive procedures such as bronchoalveolar lavage. Pneumonitis due to herpes simplex virus, varicella-zoster, and respiratory syncytial virus have occasionally been reported in AIDS patients, and are of practical importance because of the availability of effective treatment. The role of influenza and adenoviruses in causing HIV-related pulmonary complications is unknown, but could be of importance during outbreaks of these infections. Finally, data from several studies now suggest that Epstein-Barr virus or HIV itself or both have a role in the pneumonitis. Further study in this area could provide information leading to more effective management of this common complication of childhood AIDS.
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PMID:Pulmonary infection in human immunodeficiency disease: viral pulmonary infections. 254 36

Because immunosuppression is required to control rejection, liver allograft recipients are susceptible to a variety of opportunistic pathogens. A total of 191 bronchoalveolar lavage (BAL) specimens from 89 patients (53 adults and 36 children) who underwent orthotopic liver transplantation was reviewed. One case each of cytomegalovirus (CMV), staphylococcal and Enterobacter pneumonia was diagnosed with the aid of pretransplant BAL. The pretransplant BAL in 62 patients showed rare yeasts in 24.2%; these probably represent oropharyngeal contaminants since the patients involved had no symptoms of Candida pneumonia. Among 54 patients who developed respiratory symptoms and underwent posttransplant BAL, 23 (42.6%) were infected with opportunistic pathogens, including Pneumocystis carinii (22.2%), CMV (22.2%) and herpes simplex virus (HSV) (7.4%). Frequently, infection with multiple organisms was present. Adults constituted 100% of the HSV-infected group, 69.2% of the CMV-infected group and 16.6% of the group infected with P carinii. The diagnosis of these infections was aided by a combination of cytology, microbial culture and in situ hybridization techniques. Although BAL permitted the diagnosis and treatment of opportunistic infections, high mortality (62.5%) occurred with CMV and HSV pneumonia. Further studies into methods that permit earlier diagnoses of these infections are necessary.
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PMID:Bronchoalveolar lavage in liver transplant patients. 254 52


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