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

Seventy-three subjects with primary pneumonia in a hospital in Northern Nigeria were given antibiotics until they had been afebrile for 24 hours. The average duration of therapy was 2.54 days (about 60 hours), which is considerably shorter than the current recommended practice. Subjects with hepatosplenomegalic schistosomiasis and tropical splenomegaly syndrome required antibiotics for a significantly longer period (3.75 days) than those without either of these conditions. Those with an antigenaemia did not require antibiotics for a significantly longer period than those without an antigenaemia. There were no deaths, no increase in morbidity and in virtually all cases complete resolution of the lung lesion occurred within the expected time. It is suggested that in primary pneumonia it is more rational to stop antibiotics after the patient has been afebrile for 24 hours. This leads to a shorter stay in hospital and to the use of less antibiotic.
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PMID:Length of antibiotic therapy in in-patients with primary pneumonias. 49 74

Records from 910 autopsies performed at a university hospital in Salvador, Bahia, Brazil were examined in order to assess the accuracy of clinical diagnoses of the patients' underlying causes of death. This study found inaccurate clinical diagnoses in 31% of the cases. The overall rate of diagnostic error appeared to remain fairly stable from 1970 to 1982, being highest for older patients. Thirty-six percent of the 263 cancer deaths were incorrectly diagnosed, and a number of pathologies considered relatively easy to diagnose were not always correctly identified--the underlying cause of death being incorrectly diagnosed in many of the fatalities caused by such ailments as arterial hypertension, chronic obstructive lung disease, pneumonia/bronchopneumonia, and schistosomiasis. Quite aside from their direct medical implications, diagnostic errors of the magnitude observed in this and other studies seriously jeopardize the quality of vital statistics and such statistics' usefulness for improving public health.
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PMID:[Clinical diagnosis versus autopsy]. 183 Oct 25

The availability of new biotechnologies has led to the prediction that new or improved vaccines can be developed for 27 diseases within the next decade. The reasons why such optimism cannot be extended to the availability of vaccines for many other infectious diseases are considered by reviewing the steps in vaccine development, from identification of the etiologic agent to construction of attenuated or inactivated vaccines. Impediments to development may exist or arise at any point in this pathway (e.g., multiplicity of serotypes, inability to cultivate the pathogen, multistage life cycles with multiple antigens, unpredictability of epidemics, inadequate knowledge of pathogenesis and immunity, fear of gene splicing, need for an adjuvant, and lack of profitability). Diseases for which vaccines are not likely to be available in the next decade include trachoma, onchocerciasis, pneumonia due to Legionella and to mycoplasmas, amebiasis and giardiasis, schistosomiasis, syphilis, chlamydial urethritis, trypanosomiasis, leishmaniasis, and filariasis, and non-A, non-B hepatitis.
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PMID:Impediments to the development of additional vaccines: vaccines against important diseases that will not be available in the next decade. 266 4

There is conflicting and incomplete information in the literature on the pulmonary reaction which can occur following treatment of schistosomiasis. We examined the pulmonary function, bronchoalveolar lavage profile, and lung histopathology of a patient with pneumonia and peripheral eosinophilia following oxaminquine chemotherapy for intestinal Schistosoma mansoni infection. Spirometry revealed restrictive rather than obstructive impairment, and lavage showed eosinophil prominence which was also seen in the interstitial and alveolar-filling process in transbronchial biopsies.
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PMID:The "lung shift" in treated schistosomiasis. Bronchoalveolar lavage evidence of eosinophilic pneumonia. 308

An analysis is presented of data on all 30 129 inpatient admissions to a mission hospital in the West Nile District of Uganda in the 27 year period from July 1951 to August 1978. For most of this period the hospital was staffed by the same two doctors. For each patient admitted, a record was made of their age (adult or child), sex, place of residence, duration of stay in hospital, diagnosis and vital status at discharge. The annual number of admissions increased steadily from around 300 in 1952 to over 1600 in 1966 and subsequently declined to about 900 in 1977. Sixty-five per cent of admissions were medical, 12% surgical, 11% obstetric and 9% gynaecological. Thirty per cent of admissions were children (aged 0-9 years). Forty-five per cent of admissions were from those resident in the same county as the hospital and another 20% were from an immediately adjacent county. Infective and parasitic conditions (including respiratory diseases) accounted for over 60% of admissions among children and over 38% of admissions among adults (excluding obstetric patients). The six most common causes of admission were: uncomplicated delivery (2308 admissions), pneumonia (2020), hookworm (1999), malaria (1806), schistosomiasis (1742) and diarrhoea (1041). In total 1960 deaths were recorded (6.5% of all admissions). High case fatality rates were observed for tetanus (61%), immaturity (54%), meningitis (38%), kwashiorkor (21%), other malnutrition (19%) and anaemia (19%). A striking increase in the number of admissions for measles was observed in the period 1976 to 1978. Admission rates for schistosomiasis (S. mansoni) appeared to be highest from counties adjacent to the Nile and 104 deaths were recorded among the 1742 patients with this as the primary diagnosis. Admissions for diabetes, as a percentage of all admissions increased from 0.2% in 1951-54 to 1.5% at the end of the study period. Marked seasonal variations in admission patterns were found for diarrhoea, measles, meningitis and respiratory infections, the last two, but not diarrhoea, being most common in the wettest months. Admissions for malaria showed no strong seasonal associations. Despite the limitations of hospital-based data, it is argued that the data analysed provide a reasonable indication of the important causes of severe morbidity and mortality in the district. Furthermore, some of the changes in admission patterns over time are likely to represent true changes in disease rates rather than artefacts of diagnosis or referral. The analyses presented indicate the value of simple record systems, carefully maintained.
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PMID:Admissions to a rural hospital in the West Nile District of Uganda over a 27 year period. 378 13

Loggerhead sea turtles (Caretta caretta) from the Atlantic seaboard (Florida to Massachusetts) were examined at the Marine Pathology Laboratory, University of Rhode Island, from March through December, 1980. Three genera of blood flukes (spirorchids) were found in 14 (33%) of the 43 turtles. Gross signs in heavily infected animals included cachexia, anemia and enteritis. Histopathological lesions were similar to those present in homeotherms with schistosomiasis. Granulomatous gastritis, enteritis, hepatitis, pneumonitis, and nephritis were present. Acute and chronic vasculitis accompanied metastasis of eggs. Infected animals had severe hepatic hemosiderosis, indicative of the anemia observed grossly. Evidence is presented that spirorchidiasis is prevelent in sub-adult loggerhead sea turtles, is responsible for extensive lesions and may be responsible for significant debilitation and mortality.
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PMID:Spirorchidiasis in loggerhead sea turtles (Caretta caretta): pathology. 709 82

We present 5 cases of Schistosoma hematobium infestation recently acquired during travel to Lake Malawi. Clinical presentations ranged from asymptomatic to prolonged pneumonitis. The laboratory diagnosis in suspected cases rests on both searching for ova in the urine, and on serological tests which may become positive before the appearance of ova. One of the returning travelers also acquired trichinosis and another amebiasis. Because of the sharp increase in those traveling to the tropics, especially young people, physicians should be aware of the possibilities of their acquiring schistosomiasis.
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PMID:[Schistosomiasis imported from Africa]. 772 Nov 80

We investigated prospectively the cause of fever in patients requiring hospitalization after returning from the tropics. All consecutive admissions (n = 195) with oral temperature > 37.0 degrees C at the time of admission were enrolled. Final diagnosis as recorded on the discharge summary by the attending physician and results of any relevant laboratory or radiological investigations were recorded on standard proforma. Malaria accounted for 42% of admissions; two patients had returned to Britain more than 6 months before presentation. The second largest group was assumed to have a non-specific viral infection (25%). Cosmopolitan infections (urinary tract infection, community-acquired pneumonia, streptococcal sore throat, etc.) accounted for 9%. Coincidental infections (schistosomiasis, filariasis, intestinal helminths) were found in 16%. Serology was positive for HIV infection in 3%. The most useful investigation was a malaria film, which was positive in 45% of cases in which it was performed. The combination of thrombocytopaenia (platelet count < 100 x 10(9)) and hyperbilirubinaemia (bilirubin > 18 IU/ml) were useful predictive markers of malaria: all 23 patients with both abnormalities had positive malaria films. Malaria must be excluded in any febrile patient returning from the tropics. In the absence of a positive malaria film, the combination of a low platelet count and raised bilirubin may suggest the need for an empirical course of therapy.
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PMID:Fever as the presenting complaint of travellers returning from the tropics. 779 78

Because of an increasing number of patients suffering from Leishmania infections and because of the serious consequences of these infections more thorough knowledge of the host factors responsible for resistance and susceptibility to the diseases is needed. In murine models of Leishmania infections the cytokine production by CD4+ T cells has been identified as a major factor in determining the outcome of the infection. In these models Th1 cells producing IFN-gamma provide protection against the infection whereas Th2 cells producing IL-4 and IL-10 aggravate the disease. The fatal outcome of Leishmania infections in humans with defects in T-cell functions illustrates that these cells are fundamental in the defence against Leishmania in humans also. However, as for many other infectious diseases (meningococcal disease and other septicaemic conditions, pneumonia, viral hepatitis, schistosomiasis) the immune reactions to Leishmania parasites in humans can be associated with both protection and pathogenesis. Many individuals without previous exposure to Leishmania parasites have T cells which can respond to Leishmania antigens. These cells have the potential to generate either Th1 or Th2 like responses. During infection with Leishmania parasites humans develop specific T-cell recognition of well-characterized parasite antigens. T cells producing disease-exacerbating factors such as IL-4 in response to Leishmania antigen stimulation have been identified in humans as well as in mice. Both Th1 like and Th2 like cells recognizing Leishmania antigens can be expanded during infection. At the polyclonal level Th1 like responses to Leishmania antigens are found in individuals who have had self-healing or asymptomatic infections. Factors secreted by such Leishmania specific Th1 like cells can induce killing of intracellular parasites in infected macrophages. In individuals who have been cured from uncontrollable disseminating disease both Th1 and Th2 like responses can be detected. A restriction in the antigen recognition to particular protein fractions could not be demonstrated in the Th1 or Th2 like responses. These findings suggest an association between the pattern of cytokines produced by parasite specific T cells and the clinical course of the infection similar to the one seen in mice. In the murine model the cytokine pattern present in the animal at the time of infection can determine whether a Th1- or a Th2 response will develop. In vitro studies on human and murine cells have confirmed that certain cytokines (e.g. IFN-gamma, IL-12) will favour maturation of Th1 responses whereas others (e.g. IL-4, IL-10) support Th2 development. If similar immunoregulatory mechanisms operate in mouse and man, design of vaccines against human leishmaniasis should aim at introducing powerful Th1 like responses. Importantly, once generation of either Th1 or Th2 has started, the immune response seems to be locked in this pattern, even when it is harmful to the host. Therefore new vaccines against leishmaniasis should be designed in a way that they generate controlled Th1 like primary responses.
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PMID:Regulator and effector functions of T-cell subsets in human Leishmania infections. 906 93

This document presents an interview with Dr. Anthony Fauci on the development of a new generation of vaccines to prevent and possibly eradicate a legion of deadly diseases ranging from tuberculosis to AIDS. Infections that have caused major devastations in the world today include tuberculosis, malaria, schistosomiasis, filariasis, pneumococcal pneumonia, influenza, AIDS, and Ebola. Agencies should be making sure that the basic research base in microbiology, immunology, antimicrobials, and vaccinology is at the very highest level. The integration of research efforts between countries depends on collaboration between the investigators of home countries with foreign investigators. Among new developments in vaccinology are an acellular pertussis vaccine for pertussis/whooping cough (an extremely contagious disease that causes death), DNA immunization (a new technique applicable to all types of diseases), and transgenic plants for immunization against hepatitis, pertussis, and polio. As of now, AIDS in Western countries has declined, while in Africa and Asia its spread has accelerated. Combination therapy for AIDS has had a profound impact on the level of the virus in the body; however, the treatment is still vague. The good news with regard to AIDS is that education is having an impact; this is exemplified by the situation in Thailand, where the government together with nongovernmental organizations and the military has begun a crash education campaign regarding prostitutes and the use of condoms. Progress is being made in the search for better vaccine candidates. AIDS-like epidemics involving new diseases are bound to emerge at some future point, though, given the long-term historical trend.
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PMID:New drugs, new vaccines, new diseases. An interview with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID). 1234 52


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