Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A review of 58 patients with malignancies (age range, 14-73 years), who required surgical consultation for acute abdominal pain in the setting of neutropenia (granulocyte count less than 1000/mm3) after chemotherapy was conducted. Ninety percent had fevers greater than 37.8 degrees C, 30% had diarrhea or melena, and 25% had diminished bowel sounds. Five of the 29 patients (17%) with localized pain had surgical intervention; 3 of 29 patients (10%) with generalized pain underwent operations (2 for x-ray findings). All eight of these surgically treated patients survived to leave the hospital. Eighteen of the 29 patients with generalized pain were believed to have a similar syndrome of diarrhea (occasionally heme positive) and diffuse abdominal tenderness (some with peritoneal signs and distension), which was termed "neutropenic enteropathy." Eleven of these 18 patients had their symptoms resolve with antibiotic therapy, aggressive fluid replacement, and a return of their granulocyte count to normal. The other seven died of pneumonia (two), unknown causes (one), and diffuse enterocolitis throughout the intestinal tract (four documented at autopsy). The overall 30-day mortality rate in this series was 34%. Several factors correlated significantly with mortality: hypotension at the onset of pain (80% mortality), bacteremia (63% mortality), and fungemia (100% mortality). Absolute leukocyte count and absolute platelet count did not correlate with mortality. This study reaffirms that patients with neutropenic enteropathy are best treated conservatively. Patients with surgically correctable disease were identified by specific focal findings on examination or x-ray.
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PMID:Abdominal pain in neutropenic cancer patients. 394 98

The study involved 112 children with 169 confirmed vesicoureteric reflux grades I, II, III. During anti-bacterial treatment which lasted at last two years, spontaneous regression occurred in 82% of the vesicoureteral reflux. Renal scars were observed in 8% of the cases. Initially urinary tract infection was diagnosed in 84% of the children. This figure was reduced to 8% after anti-bacterial treatment. 54% of the observed children had associated diseases (anaemia, chronic enteropathy, bronchitis and pneumonia). The results confirmed the efficiency of anti-bacterial treatment in children with vesicoureteral reflux grades I, II, III.
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PMID:[Results of conservative treatment for regressive vesicoureteral reflux in childhood]. 865 25

Risk factors for proliferative enteropathy were investigated by means of a postal questionnaire survey of randomly selected British pig farms. Replies were received from 319 (56 per cent) of the 569 questionnaires posted, representing 1.5 per cent of the total number of pig farms in Britain. Thirty-one per cent of the farms had experienced at least one episode of proliferative enteropathy within the previous three years, usually confirmed by their veterinary surgeon. There was a strong association for the occurrence of proliferative enteropathy in herds of over 500 sows (P < 0.005) and in herds with enzootic pneumonia (P < 0.01). Outbreaks had occurred in five of the six nucleus herds surveyed, the other had only 80 sows. Outbreaks occurred in 32 of 69 herds that had obtained their replacement boars from nucleus herds (P < 0.05), suggesting that infected boars may carry the disease into distant herds. The use of either fully slatted (P < 0.05) or fully meshed floors (P < 0.01) above sunken pits in buildings used to house pigs immediately after weaning, and the use of partially (P < 0.05) or fully slatted floors (P < 0.05) in buildings used to house pigs two to six months old, were risk factors for outbreaks of proliferative enteropathy, compared with the use of straw bedding or solid floors. The destocking of entire buildings containing pigs two to four months old before the introduction of fresh pigs, was associated with a reduced risk (P < 0.05), but the destocking of selected pens rather than the whole building had no such association. The type of diet, or feeding or watering system and the types of buildings used were not identified as risk factors.
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PMID:Questionnaire survey of proliferative enteropathy on British pig farms. 967 Apr 57

Nuclear medicine is an important tool in the diagnostic evaluation of patients with a variety of nonosseous infections. In the immunocompetent population labeled leukocyte imaging is the radionuclide procedure of choice, with Gallium imaging reserved for those situations in which the leukocyte study is nondiagnostic or cannot be performed. Fever of unknown origin is caused by infection in less than one-third of cases, and therefore the number of positive leukocyte studies will be relatively low. The negative leukocyte study is also useful, however, as it has been demonstrated that a negative study excludes, with a high degree of certainty, focal infection as the cause of an FUO. In the cardiovascular system, labeled leukocyte scintigraphy is very useful for diagnosing mycotic aneurysms and infected prosthetic vascular grafts, with a sensitivity of about 90%. The specificity of the study is somewhat more variable--false positive results have been described in perigraft hematomas, graft thrombosis, bleeding, and pseudoaneurysms. In the central nervous system, labeled leukocyte imaging can provide important information about the etiology of contrast enhancing brain lesions identified on computed tomography, i.e., distinguishing between neoplasm and infection. In the immunocompromised population, typified by the AIDS patient, Gallium scintigraphy is the radionuclide procedure of choice for diagnosing opportunistic diseases. In the thorax, a normal Gallium scan, in the setting of a negative chest X-ray, virtually excludes pulmonary disease. A negative Gallium scan in a patient with an abnormal chest X-ray and Kaposi's sarcoma study suggests that the patient's respiratory problems are related to Kaposi's sarcoma. Focal pulmonary parenchymal uptake is most often associated with bacterial pneumonia, although Pneumocystis carinii pneumonia can occasionally present in this fashion. Diffuse pulmonary parenchymal uptake of Gallium can be due to numerous causes, but in general, the more intense the uptake, the greater the likelihood that the patient has P. carinii pneumonia. Lymph node uptake is most often due to lymphoma or mycobacterial disease. In the abdomen, Gallium is also useful for detecting nodal disease. but is not reliable for detecting large bowel disease. Labeled leukocyte imaging should be performed when colitis is a concern. Both 18FDG PET and 201Tl SPECT imaging of the brain are useful for distinguishing between central nervous system lymphoma and toxoplasmosis in the HIV (+) patient. On both studies, lymphoma manifests as a focus of increased tracer uptake, whereas toxoplasmosis shows little or no uptake of either tracer.
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PMID:Radionuclide imaging of nonosseous infection. 1023 Feb 81

The use of clarithromycin in preventing Mycobacterium avium complex (MAC) may also prevent a number of other opportunistic infections in AIDS patients. A large multinational study showed a reduction in Pneumocystis carinii pneumonia (PCP), community-acquired pneumonia (CAP), and giardiasis, an intestinal disorder. The study involved participants with CD4 counts below 100.
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PMID:Clarithromycin for MAC prevention offers additional benefits. 1136 31

Intestinal permeability was assessed (within 24-48h of admission to hospital) in 7 patients suffering from acute infections, mainly pneumonia. The permeability test involved administering an oral solution containing a mixture of lactulose (10 g) mannitol (5 g and 0.5 microCi) and (51)Cr-EDTA (30 microCi), and collecting urine samples before, and between 0-6, 6-12 and 12-24 h after dosing. The excretion of the markers was compared with the results obtained from 24 normal or control subjects and 15 patients with coeliac disease. None of the markers were excreted in significantly different amounts in the infected patients compared to the control subjects. In contrast, the coeliac patients excreted (0-6 h) four-fold more lactulose, three-fold more (51)Cr-EDTA and two-fold less mannitol than the normal subjects. The ratio of lactulose: mannitol and (51)Cr-EDTA: mannitol were therefore six- to eight-fold greater in the coeliac patients than in the normal subjects. The results confirm the sensitivity of the test for detecting the presence of an enteropathy but provide no evidence of a change in intestinal permeability in systemic infections studied under the stated conditions.
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PMID:Intestinal permeability in man: effects of acute systemic infections. 1683 99

A 5-years multicenter prospective study on 201 patients with common variable immunodeficiencies and 101 patients with X-linked agammaglobulinemia over a cumulative follow-up period of 1,365 patient-years was conducted to identify prognostic markers and risk factors for associated clinical co-morbidities, the effects of long-term immunoglobulin treatment and the IgG trough level to be maintained over time required to minimise infection risk. Overall, 21% of the patients with common variable immunodeficiencies and 24% of patients with X-linked agammaglobulinemia remained infection free during the study. A reduction of pneumonia episodes has been observed after initiation of Ig replacement. During the observation time, pneumonia incidence remained low and constant over time. Patients with pneumonia did not have significant lower IgG trough levels than patients without pneumonia, with the exception of patients whose IgG trough levels were persistently <400 mg/dL. In X-linked agammaglobulinemia, the only co-morbidity risk factor identified for pneumonia by the final multivariable model was the presence of bronchiectasis. In common variable immunodeficiencies, our data allowed us to identify a clinical phenotype characterised by a high pneumonia risk: patients with low IgG and IgA levels at diagnosis; patients who had IgA level <7 mg/dL and who had bronchiectasis. The effect of therapy with immunoglobulins at replacement dosage for non-infectious co-morbidities (autoimmunity, lymphocytic hyperplasia and enteropathy) remains to be established. A unique general protective trough IgG level in antibody deficiency patients will remain undefined because of the major role played by the progression of lung disease in X-linked agammaglobulinemia and in a subset of patients with common variable immunodeficiencies.
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PMID:Effectiveness of immunoglobulin replacement therapy on clinical outcome in patients with primary antibody deficiencies: results from a multicenter prospective cohort study. 2164 92

Patients with hypogammaglobulinemia who do not fulfill all the classical diagnostic criteria for common variable immunodeficiency (reduction of two immunoglobulin isotypes and a reduced response to vaccination) constitute a diagnostic and therapeutic dilemma, because information concerning the clinical and immunological characteristics of these patients with idiopathic primary hypogammaglobulinemia is not available. In 44 common variable immunodeficiency and 21 idiopathic primary hypogammaglobulinemia patients we determined the clinical phenotypes and performed flow cytometric immunophenotyping to assess the pathophysiological B-cell patterns and memory B-cell subset counts. Age-matched B-cell subset reference values of 130 healthy donors were generated. Severe pneumonia and bronchiectasis occurred at similar frequencies in idiopathic primary hypogammaglobulinemia and common variable immunodeficiency. Although IgG levels were only moderately reduced compared to common variable immunodeficiency, 12 of 21 idiopathic primary hypogammaglobulinemia patients required immunoglobulin replacement. Non-infectious disease-related clinical phenotypes (autoimmune cytopenia, polyclonal lymphocytic proliferation and persistent unexplained enteropathy) were exclusively observed in common variable immunodeficiency and were associated with early peripheral B-cell maturation defects or B-cell survival defects. T-cell dependent memory B-cell formation was more severely affected in common variable immunodeficiency. Furthermore, 14 of 21 idiopathic primary hypogammaglobulinemia patients showed normal peripheral B-cell subset counts, suggestive for a plasma cell defect. In conclusion, idiopathic primary hypogammaglobulinemia patients who do not fulfill all diagnostic criteria of common variable immunodeficiency have moderately decreased immunoglobulin levels and often a normal peripheral B-cell subset distribution, but still suffer from serious infectious complications.
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PMID:Common variable immunodeficiency and idiopathic primary hypogammaglobulinemia: two different conditions within the same disease spectrum. 2375 20

Common variable immunodeficiency (CVID) is the most frequent clinically relevant primary immunodeficiency and shows enormous heterogeneity in clinical presentation. Despite clinical immunodeficiency, opportunistic infections are not a typical manifestation of CVID. A retrospective study of 32 patients followed up for 335 patient-years was performed to determine the frequency of cytomegalovirus (CMV) disease. Symptomatic CMV infection was documented in 3 CVID patients. Patients No. 1 and 2 suffered from CMV pneumonia, with complications due to atypical mycobacteriosis in patient No. 1. Patient No. 3 suffered from CMV enteritis. A history of cancer and chronic hepatitis C infection (patient No. 1), immunosuppressive therapy for interstitial lung disease (patient No. 2) and serious enteropathy complicated with malnutrition (patient No. 3) may have contributed to the complications despite only mild abnormalities in T-cell subpopulations. The direct detection of CMV in bronchoalveolar lavage, stool or tissue samples was the most beneficial diagnostic laboratory method, whereas the detection of CMV DNA in blood did not produce positive results. Adequate treatment of CMV disease led to significant clinical improvement in all 3 patients. The frequency of CMV disease appears to be higher than previously described. In our experience, the probability of opportunistic infections in CVID patients increases with secondary comorbidities and their management.
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PMID:Cytomegalovirus disease in patients with common variable immunodeficiency: three case reports. 2485 73

Pleuromutilins (tiamulin and valnemulin) are antimicrobial agents that are used mainly in veterinary medicine, especially for swine and to a lesser extent for poultry and rabbits. In pigs, tiamulin and valnemulin are used to treat swine dysentery, spirochaete-associated diarrhoea, porcine proliferative enteropathy, enzootic pneumonia and other infections where Mycoplasma is involved. There are concerns about the reported increases in the MICs of tiamulin and valnemulin for porcine Brachyspira hyodysenteriae isolates from different European countries, as only a limited number of antimicrobials are available for the treatment of swine dysentery where resistance to these antimicrobials is already common and widespread. The loss of pleuromutilins as effective tools to treat swine dysentery because of further increases in resistance or as a consequence of restrictions would present a considerable threat to pig health, welfare and productivity. In humans, only one product containing pleuromutilins (retapamulin) is authorized currently for topical use; however, products for oral and intravenous administration to humans with serious multidrug-resistant skin infections and respiratory infections, including those caused by methicillin-resistant Staphylococcus aureus (MRSA), are being developed. The objective of this review is to summarize the current knowledge on the usage of pleuromutilins, resistance development and the potential impact of this resistance on animal and human health.
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PMID:Pleuromutilins: use in food-producing animals in the European Union, development of resistance and impact on human and animal health. 2479 2


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