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

We report a retrospective analysis of 75 children with hepatic portoenterostomies hospitalized because of fever. Bacterial cholangitis was the most commonly defined cause of fever within 3 months of surgery. Pneumonia and upper respiratory infections were more common 3 months to 2 years following the procedure; however, cholangitis continued to occur during this time period. Twenty percent of hospitalizations were associated with bacteremia or fungemia. Streptococcus pneumoniae was the most common pathogen isolated from the blood. Three children with presumed cholangitis continued to have fever until effective antipseudomonal antibiotic coverage was implemented. The findings in this study lead to the following suggestions: vaccinate all children with pneumococcal vaccine at 2 years of age; a chest radiograph and dental evaluation should be obtained when evaluating the febrile child; empiric treatment for possible cholangitis should include an antipseudomonal penicillin derivative with an aminoglycoside; and if signs of peritonitis are present antibiotic treatment should also include antimicrobials effective against Haemophilus influenzae.
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PMID:Diagnosis and treatment of the febrile child following hepatic portoenterostomy. 404 60

One hundred and ninety-five series of granulocyte transfusions in 144 patients were evaluated with respect to possible severe pulmonary toxicity from concomitant administration of granulocytes and amphotericin B. Dyspnea as a side effect of granulocyte transfusion was equally common among patients receiving amphotericin B and those in a matched control group not receiving amphotericin B. Granulocyte transfusions and amphotericin B were given simultaneously in 35 transfusion series, involving 32 patients. Respiratory deterioration, defined as the appearance of new pulmonary infiltrates on chest x-ray, occurred in 11 of these 35 episodes. Patients developing respiratory deterioration were similar to those not developing respiratory deterioration in age, diagnosis, disease status, duration of concomitant therapy, and outcome, but more often had positive fungal cultures as an indication for treatment (91% versus 58%; p = 0.1). In 8 patients, the episodes of respiratory deterioration were readily explained by congestive heart failure, by simultaneous bacteremia or fungemia, or by fungal pneumonia discovered at autopsy. One patient had a leukoagglutinin reaction (responsive to steroids) and the other 2 had unexplained, but reversible respiratory deterioration. We concluded that concomitant administration of granulocyte transfusions and amphotericin B is not associated with unexpected or rapidly fatal pulmonary toxicity and when appropriate, can be safely accomplished.
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PMID:Concomitant administration of granulocyte transfusions and amphotericin B in neutropenic patients: absence of significant pulmonary toxicity. 700 33

A case of congenital infection by Torulopsis glabrata in a premature 0.52-kg female infant born at 23 weeks' gestation to a 37-year-old, gravida 7 mother is reported. The infant succumbed to an intrauterine pneumonia and fungemia. Acute chorioamnionitis was present. Budding yeasts were found in the lungs and amniotic membranes and in large numbers within the lumen of the gut. The role of a retained intrauterine contraceptive device in predisposing to the ascending infection is discussed.
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PMID:Congenital Torulopsis glabrata infection in man. 718 18

Candida parapsilosis fungemia secondary to nasal colonization following application of nasal prongs for oxygen therapy developed in a 61-year-old man with known chronic lymphocytic leukemia and pulmonary infiltrates. Amphotericin B controlled the candidal infection, but the patient died of complications related to Aspergillus pneumonitis, intra-abdominal mucormycosis, and leukemia. The source of candidal infection was probably a combination of nasal ulceration resulting from oxygen administration by nasal prongs and alteration of the normal mucosal flora by multiple broad-spectrum antibiotics. Oxygen administration by mask to patients at risk of opportunistic infections may help obviate this potential complication, with its attendant danger of spread to the brain and cavernous sinuses. We discuss the rarity of triple infection with these three organisms.
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PMID:Colonization of nasal ulcers as a source of Candida parapsilosis fungemia. 738 34

Trichosporon beigelii is a fungus which usually produces cutaneous involvement in immunocompetent hosts, being rarely reported to cause systemic infection. A case of fungemia and metastatic pneumonia caused by Trichosporon beigelii in a trauma patient is reported.
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PMID:Trichosporon beigelii fungemia and metastatic pneumonia in a trauma patient. 780 91

For clinical trials of anti-infective drugs for the treatment of vascular access device-related bloodstream infections, patients should be identified and enrolled on the basis of current standards for the clinical diagnosis of such infections. To ensure comparability of patients, only those infected with staphylococci and Candida species should be included. A prospective, randomized, double-blind design is recommended. Future protocols may include abbreviated courses of therapy, treatment with combinations of drugs, or a progression from parenteral to oral therapy. Clinical response is judged as cure, failure, or indeterminate response; there is no "improved" category. Microbiological response is categorized as eradication, persistence, or relapse and is of paramount importance. Several months of follow-up may be necessary for the detection of late relapses or metastatic infections. This guideline does not apply to studies of bacteremia or fungemia secondary to non-device-related, organ-based primary infections (e.g., pneumonia, urinary tract infection), which should be assessed in relation to the primary disorder.
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PMID:Evaluation of new anti-infective drugs for the treatment of vascular access device-associated bacteremia and fungemia. The European Working Party of the European Society of Clinical Microbiology and Infectious Diseases. 826 67

Candidemia in critically ill patients is a significant source of mortality. To identify perioperative risk factors accounting for patient death, we performed a retrospective study of 46 surgical patients with fungemia during the period from 1981 to 1990. Twenty patients survived (43%), and 26 died (57%). Mortality was associated with age older than 46 (p < 0.02, unpaired Student's t-test) and concomitant renal failure, hepatic failure, postoperative shock, or adult respiratory distress syndrome (p < 0.0001, p < 0.0001, and p < 0.05, respectively, chi 2 test). Survival was not influenced by the presence of diabetes, chronic obstructive pulmonary disease, gastrointestinal hemorrhage, pneumonia, alcohol consumption, steroid use, or enteral/parental nutrition. Bacterial speticemia developed in 26 patients (11 lived, 15 died) and typically preceded or was concomitant with the onset of fungal sepsis (88%). Candida albicans was the fungal species most commonly isolated from blood cultures (30 of 46). Its was cultured from other sites in addition to blood in 30 patients. Candidemia carries a higher risk of mortality in older patients and in those with multiple organ dysfunction. Other immunocompromised conditions such as diabetes and steroid use did not increase mortality. These findings suggest that the pathogenicity of Candida sepsis is not solely related to opportunistic superinfections but may reflect failure of other host defense mechanisms. Moreover, the frequent occurrence of bacterial septicemia prior to the development of Candida sepsis further emphasizes the importance of fungal surveillance cultures to detect early fungal colonization in the critically ill.
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PMID:Candida sepsis in surgical patients. 784 Mar 97

Amphotericin B colloidal dispersion (ABCD; Amphocil) was evaluated in a phase I dose-escalation study in 75 marrow transplant patients with invasive fungal infections (primarily Aspergillus or Candida species) to determine the toxicity profile, maximum tolerated dose, and clinical response. Escalating doses of 0.5-8.0 mg/kg in 0.5-mg/kg/patient increments were given up to 6 weeks. No infusion-related toxicities were observed in 32% of the patients; 52% had grade 2 and 5% had grade 3 toxicity. No appreciable renal toxicity was observed at any dose level. The estimated maximum tolerated dose was 7.5 mg/kg, defined by rigors and chills and hypotension in 3 of 5 patients at 8.0 mg/kg. The complete or partial response rate across dose levels and infection types was 52%. For specific types of infections, 53% of patients with fungemia had complete responses, and 52% of patients with pneumonia had complete or partial responses. ABCD was safe at doses to 7.5 mg/kg and had tolerable-infusion-related toxicity and demonstrable antifungal activity.
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PMID:Phase I study of amphotericin B colloidal dispersion for the treatment of invasive fungal infections after marrow transplant. 862 74

Clinical efficacy of fluconazole on fungal infections was evaluated. Fluconazole was administrated orally or intravenously to 16 cases with fungal infections (chronic renal failure 4, congestive heart failure 2, cerebral infarction 2, etc). All cases were suspected of mycosis. The details of those administrated were 16 cases of pneumonia 3 cases, fungemia 9 cases (suspected 7 cases) and urinary tract infection 3 cases. Clinical efficacy rate was 71.4%. Side-effects were observed in only 1 case, and this consisted of transient increase of leukocytes and thrombocytes. Fluconazole is considered to be a potent, safe antifungal agent for the treatment of suspected fungal infection during intravenous hyperalimentation.
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PMID:[Clinical studies of fluconazole in patients with deep-seated fungal infection in intravenous hyperalimentation (IVH)]. 869 90

Flavimonas oryzihabitans is rarely reported as a pathogen in humans. Twelve cases of F. oryzihabitans bacteremia were diagnosed at National Taiwan University Hospital over a 3-year period. The clinical features of these patients were analyzed, and antimicrobial susceptibilities and random amplified polymorphic DNA (RAPD) patterns of the 12 isolates were studied. Among these 12 patients, eight (67%) had underlying neoplastic diseases and all acquired F. oryzihabitans bacteremia while hospitalized. The clinical syndromes included primary bacteremia in 5 patients (42%), biliary tract infection in 3 (25%), and peritonitis, subdural empyema, infusion-related bacteremia, and pneumonia in 1 each. Polymicrobial bacteremia or concomitant fungemia was seen in three patients (25%). All the patients survived after antibiotic treatment. All isolates were susceptible to piperacillin, third-generation cephalosporins, aminoglycosides, and quinolones but resistant to cephalothin, cefuroxime, and trimethoprim. Susceptibility to aztreonam was variable (25%). The RAPD patterns differed among the isolates, indicating the epidemiological unrelatedness of these infections. F. oryzihabitans should be included as an etiology of severe nosocomial infection in patients with underlying debilitating diseases.
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PMID:Flavimonas oryzihabitans bacteremia: clinical features and microbiological characteristics of isolates. 914 84


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