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

Although AIDS was largely recognized and defined because of the increased presence of diseases that reflect deficiencies in cell-mediated immunity, susceptibility to common extracellular bacterial pathogens has also been shown to be increased. To our knowledge, adults with concurrent infection due to human immunodeficiency virus (HIV) and Streptococcus pneumoniae whose cases have been described to date have all had pneumococcal pneumonia and/or bacteremia. We describe five cases of HIV-infected patients who had unusual manifestations of pneumococcal infection, which include recurrent exudative pleural effusion, pyopneumothorax, purpura fulminans, mediastinitis with chest wall abscess, and multiple brain abscesses. Such complications of pneumococcal infection occurred more or less commonly in the preantibiotic era, but on the basis of our experience and an exhaustive literature search, these complications have been exceedingly rare in the past few decades. In four of our five patients, the unusual, complicated pneumococcal disease preceded and prompted a search for HIV infection. Because concurrent HIV infection increases the susceptibility to pneumococcal disease, other such cases are likely to be seen.
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PMID:Unusual manifestations of pneumococcal infection in human immunodeficiency virus-infected individuals: the past revisited. 157 28

In spite of the great advances of the antibiotherapy and of the respiratory resuscitation techniques, the staphylococcal pneumonia continues to be one of the most severe bacterial pneumonias of the child, fact which may be explained not only by the poor immunogenic capacity of the infection, but especially by the virulence characteristics of the staphylococcus: necrotizing capacity, toxigenicity (complex), resistance to antibiotics, diffusion capacity of the infection (percontiguum or at distance), resistance to phagocytosis and bacterial lysis etc. The etiology (bacteriology and immunity), the epidemiological data (the disease represents 1/3 of the primitive bacterial pneumonias occurring during the first two years of life), data regarding the pathogenesis and the pathological anatomy are reviewed. The clinical picture, the radiological examination and the laboratory data are extensively analysed, after which the positive diagnosis, based on the correlation of anamnestic, clinical, radiological and bacteriological data, is discussed. Authors point out the contribution of the radiological examination that detects the typical lesions, the aspect of which changes characteristically very rapidly (from day to day), namely: aspect of frank pleurisy (common and very evocative), pyopneumothorax, pneumatocele, excavated staphylomas (abscesses), less frequently mediastinal pneumothorax or emphysema. The clinical differential diagnosis with a number of diseases: suppurative pneumonias, solitary pulmonary cyst, polycystic lung, infected pulmonary sequestration etc., and the radiological differential diagnosis with bilateral diffuse alveolar pulmonary opacities, excavated pulmonary opacities, images under the form of pulmonary "bullae" and "cysts" are discussed. The final part contains a detailed description of the treatment and its basic components: etiological (antibacterial) treatment, treatment by decompression and pleural drainage, resuscitation treatment, as well as of the course, complications and prognosis of staphylococcal pneumonia.
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PMID:[Staphylococcal pneumonia]. 166 2

A rare case of a severe anaerobic necrotizing pneumonia complicated by pyopneumothorax and monoarthritis due to anaerobic Peptostreptococcus magnus is described in a 20-year-old soldier. The patient's immunological status was normal. There were no predisposing underlying factors, and he was treated successfully without any residual damage. To our knowledge, a similar case has never been reported in the literature.
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PMID:Severe anaerobic necrotizing pneumonia complicated by pyopneumothorax and anaerobic monoarthritis due to Peptostreptococcus magnus. 174 61

Nasopharyngeal secretions and throat-swab specimens from 809 children less than 6 years old with acute respiratory infection were examined by culture and indirect immunofluorescence for the presence of virus or viral antigen. Blood was cultured for the presence of bacteria in selected cases of lower respiratory infection (LRI); pleural fluid also was cultured in cases of empyema. Viruses were detected in 163 (49%) of 331 children with LRI. Respiratory syncytial virus (RSV) was the commonest agent isolated (106 children). Other viruses isolated included parainfluenza viruses (36 children), adenoviruses (12), and influenza viruses (five). Outbreaks of infection due to RSV occurred during August through October. Pneumonia was the commonest LRI encountered (178 children). Among children with pneumonia, viruses were detected in 65 (37%) of 178 children, and bacteria were isolated from 27 (18%) of the 147 children for whom blood cultures were done. Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus were the common bacterial pathogens isolated. In cases of empyema and pyopneumothorax, S. aureus was the commonest organism isolated. There were 116 children with bronchiolitis, 83 (72%) of whom had viral infections; the majority of these children (81%) had RSV infection. Croup was uncommon (eight cases) and was caused mainly by parainfluenza viruses.
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PMID:Etiology of acute respiratory infections in children in tropical southern India. 186 77

Emergency pulmonary resection was performed because of complicated pneumonia in eight patients (5 pneumonectomies, 2 lobectomies, 1 bilobectomy) over a 2-year period. The patients' age range was 5 months to 43 years. The indications were rapid aggravation of respiratory insufficiency in children with staphylococcal pneumonia and enlarging pneumatoceles, and massive hemoptysis in patients with chronic destructive pneumonia. Two patients died after pneumonectomy, one from contralateral aspiration and one from cardiogenic shock. Postoperative complications occurred in four cases--bronchopleural fistula and pyopneumothorax in three and thoracic empyema with massive chest-wall infection in one. Only two patients had an uneventful postoperative course. Complications of pulmonary necrosis in pneumonia may dictate urgent pulmonary resection, often pneumonectomy. Surgery will be life-saving in most cases, but high morbidity is to be expected.
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PMID:Emergency pulmonary resection for pneumonia. High morbidity and mortality. 206 57

Coccidioidomycosis is a highly variable disease. Initial respiratory tract infection can lead to self-limited pneumonia, pulmonary complications, and extrapulmonary disease. The early infection requires no therapy, except in immunosuppressed patients and other selected patients. Treatment for pulmonary complications may include surgery for cavities or pyopneumothorax (resulting from rupture of a cavity) and antifungal therapy for chronic pneumonia. The majority of extrapulmonary disease occurs in the skin, bones and joints, or meninges and is an indication for treatment with antifungal agents and sometimes adjunctive surgery. Meningitis is a particularly serious consequence of dissemination and currently is best treated with intrathecal instillation of antifungal agents. Antifungal agents useful in the treatment of coccidioidomycosis are amphotericin B, which is administered intravenously and is relatively toxic, and ketoconazole, which is administered orally and whose toxicities are less serious and reversible. Because studies to compare the efficacy of these two drugs have not been performed, selecting between them for use in individual patients is most rationally based on the pharmacologic differences, which lend themselves to different clinical settings. In future years, new antifungal agents will likely be available, some of which will offer significant advantages over present therapies. Itraconazole is an imidazole related to ketoconazole, which appears to be effective and possibly less toxic than ketoconazole. Fluconazole, another imidazole, has broad antifungal activity, a long serum half-life, and excellent penetration into the cerebrospinal fluid. Thus, the pharmacology of this agent would appear ideal for use in treating coccidioidal meningitis. In addition, other compounds with different modes of action are now under investigation in preclinical studies. It is therefore likely that continued improvements will occur in the coming years in the treatment of this disease.
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PMID:Systemic fungal infections: diagnosis and treatment. I. Coccidioidomycosis. 306 91

A prospective study of staphylococcal lower respiratory infection in 31 children aged 1-48 months has shown that radiologically, patchy consolidation was the single most common lesion, followed by pleural effusion with or without pneumothorax. Although the mean respiratory rate was 65/minute, it was below 50/minute in 8 cases. Complications include heart failure in 9 cases and severe anaemia necessitating blood transfusion in 9 others, seven (78%) of whom had pleural effusion. Finally diagnoses were bronchopneumonia alone in 16 (52%) cases, pyopneumothorax alone in 6 (19%), pyopneumothorax plus pneumonia in 5 (16%), pleural effusion in 2 (6%) cases and one case each of lobar pneumonia alone and a combination of lobar and bronchopneumonia. Staphylococcus aureus was isolated from the blood in 8 (62%) of 13 children with pleural effusion, indicating a need to consider parenteral antibiotic administration in the initial management of children with staphylococcal pleural effusion. Three (9.7%) patients died; they were all malnourished children who did not receive antibiotics prior to presentation; they all had bronchopneumonia, positive blood cultures and respiratory rates of 60/minute.
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PMID:Staphylococcal lower respiratory infection in children. 808 Aug 38

The complex microbiological study of tracheobronchial washings and the detection of antibodies to surface components of whole bacterial cells in the indirect fluorescence test permitted the determination of the pneumococcal etiology of acute pneumonia (AP) in 134 children aged 1 month to 13 years (97.1%). In the course of AP 13 patients (9.4%) were found to have acute infectious processes caused by Haemophilus influenzae (5 cases), different enterobacteria (4 cases), Moraxella catarrhalis (2 cases), as well acute infectious destruction of the lungs and pyopneumothorax (1 case), whose etiological factors were Staphylococcus aureus and nontyping H. influenzae strains.
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PMID:[The etiology of sporadic acute pneumonia in children]. 978 7

Bacterial pneumonias are the most common pulmonary complication in HIV-infected patients. Up to now, H. influenzae and S. pneumoniae have been described as the most important germs. Within a period of 4 years we diagnosed 15 cases of pneumonia caused by P. aeruginosa. All patients were in HIV stage C3; 3F, 12M; median age 34 (24-54) years; median CD4 count 10 (0-130) microliters. Except for 3 nosocomial pneumonias, all others were community-acquired. Only 3 patients had neutropenia < 1000/microliter; 7 were intravenous drug abusers. Morphologically there were 6 cases of abscess pneumonia, in 3 of which pleural drainage was necessary because of pyopneumothorax. 4 patients showed bilateral infiltrates that could not be differentiated from those of P. carinii pneumonia. Our diagnosis was based on quantitative cultures of broncho-alveolar lavage fluid (9 cases, two of them with concurrent positive blood cultures/positive cultures of the pleural fluid), pleural puncture (one case), sputum in pneumonias responding only to antipseudomonas therapy (3 cases), and autopsy (2 cases). 8 patients died of pseudomonas pneumonia within 1-3 months despite therapy. 7 patients received pseudomonas-specific combination therapy, but all died after median 9 (4-15) months of the underlying illness. In 3 cases recurrent pseudomonas pneumonia could be documented bacteriologically. We conclude that in HIV-infected patients pneumonia caused by P. aeruginosa is a significant and severe pulmonary complication.
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PMID:[Pseudomonas pneumonia--an important differential pulmonary infiltration diagnosis in AIDS]. 1008 89

Staphylococcus aureus (S. aureus) is responsible for a small proportion of acute respiratory infections in children. Nevertheless a high index of suspicion is required because of the potential for rapid progression, the need for antibiotics different to those routinely administered in the treatment of pneumonia, and the high incidence of complications. There are few data from developing countries. The objective of this retrospective review was to document the natural history of primary staphylococcal pneumonia at Red Cross Childrens' Hospital in Cape Town over a 7-year period (1989-1995). Staphylococcal pneumonia was defined as acute pneumonia with microbiological evidence of S. aureus or with characteristic radiological features. One hundred patients were identified. The median age was 5 months, 78 patients being below one year of age. Cough and fever were present in almost all patients at the time of presentation. Tachypnoea, recession, dullness, and crepitations were commonly elicited signs. Initial chest radiographs revealed empyema, pleural effusion, or pyopneumothorax in 67 patients. A further 26 patients developed such changes on subsequent chest radiographs. Pneumatocoeles were identified in 37 patients--most of these were only noted on radiographs taken some days after admission. Microbiological confirmation was obtained in 92 cases. S. aureus was isolated in 23/98 blood cultures, 62/67 pleural aspirates, and from tracheal aspirates in 16 cases. Intercostal drains were inserted in 67 cases and 20 children underwent thoracotomy. The case fatality rate was 7 per cent. This study shows that primary staphylococcal pneumonia is chiefly a disease of infants. Symptoms and signs were similar as for other forms of acute pneumonia, although in the majority of cases chest radiographs taken at the time of admission suggested the diagnosis. Treatment with antibiotics and drainage of empyema resulted in a good outcome in the majority of cases.
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PMID:Primary staphylococcal pneumonia in young children: a review of 100 cases. 1046 36


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