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

A prospective study of 45 granulocyte transfusions in children using continuous flow centrifugation is reported. During 13 episodes of proven or presumed infection, only two children failed to show a favorable response to granulocyte transfusion. The neutropenic child shows a significantly increased absolute granulocyte count one hour after transfusion. The granulocyte counts at one hour after transfusion are inversely proportional to the child's size. A child with chronic granulomatous disease who had documented Nocardia asteroides sepsis and pneumonia exhibited complete recovery following granulocyte transfusion. Dramatic responses to the nonrandom use of granulocyte transfusion have been observed in children with major gram-negative bacterial infections. Endorsement of granulocyte transfusion for instances of presumed, but unproven, infection in the neutropenic child will require randomization to control the variables of antibiotic therapy and bone marrow remission.
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PMID:Granulocyte transfusion therapy in children. 26 30

Infections are an almost inevitable complication of human bone marrow transplantation and account for the majority of deaths in transplant recipients. Even prior to the initiation of the transplantation procedure, patients may present with infections complicating previously unsuccessful chemotherapy for hematological malignancy or aplastic anemia. Nevertheless, these pre-transplantation infections should not exclude the possibility of bone marrow transplantation if they can be successfully controlled with specific antimicrobial therapy and necessary adjunctive measures. The immediate post-transplantation period prior to engraftment is characterized by severe marrow aplasia that results from high-dose chemotherapy and total-body irradiation. Infections are primarily septicemias and localized processes caused by bacteria and fungi and their incidence increases as the intensity of immunosuppression is escalated. The high mortality associated with bacterial septicemia makes early, empirical antibacterial therapy mandatory. However, the reduction in mortality from bacterial infection resulting from such an aggressive approach may be offset by a higher mortality from invasive fungal infection, especially in patients with prior fungal colonization and undergoing prolonged conditioning therapy. Thus, until more specific and sensitive tests for the diagnosis of invasive fungal infection become available, empirical intravenous amphotericin should be considered in patients who are persistently febrile and deteriorate clinically in the face of appropriate antibacterial therapy. Interstitial pneumonia associated with severe GVHD is the major infectious complication after successful marrow engraftment and is the most significant barrier to long-term survival. Trimethoprim-sulfamethoxazole is effective prophylaxis against interstitial pneumonia due to Pneumocystis carinii, but one half of the patients still develop a pneumonitis either associated with CMV or of unknown etiology. Mortality from interstitial pneumonia is related to prior radiation therapy while survival is associated with a four-fold rise in CMV CF antibody titer. The latter observation supports the need to investigate passive immunization with CMV antibody as a means of preventing some interstitial pneumonias. Despite the progress made in many areas of human bone marrow transplantation, the majority of graft recipients still die of infectious complications. Thus, new approaches to the management of infections in transplant recipients are urgently needed. Better-tolerated oral nonabsorbable antibiotics, laminar-air-flow rooms, granulocyte transfusions, and chemotherapy and immunotherapy for CMV are among the prophylactic and therapeutic measures that must be critically evaluated in well-controlled, prospective studies. Continued assessment of the infectious complications of bone marrow transplantation is a critical aspect of any ongoing transplant program, not just a research goal...
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PMID:Infectious complications of human bone marrow transplantation. 36 7

Treatment with type-specific IgG antibody to Pseudomonas aeruginosa significantly increased rates of survival after experimental induction of pseudomonas pneumonia in leukopenic dogs. Longer survival times were correlated with higher titers of circulating antibody in serum; however, no animals treated with antibody alone were long-term survivors. Subsequent development of sepsis or the recovery of Pseudomonas from infected lung tissue was not altered by treatment with antibody. Therapy with granulocyte transfusions plus gentamicin was associated with a 27% rate of long-term survival. Passive immunization with IgG (reciprocal mean hemagglutination titer, 52) in addition to granulocyte transfusions and treatment with gentamicin resulted in a rate of long-term survival of 67% (P less than 0.05). Dogs that died while receiving this combination therapy still had a survival time significantly longer than those of controls or animals treated only with granulocytes and antibiotic.
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PMID:Experimental pneumonia due to Pseudomonas aeruginosa in leukopenic dogs: prolongation of survival by combined treatment with passive antibody to Pseudomonas and granulocyte transfusions. 40 42

A 3-year-old boy (patient A) with a congenital and a 24-year-old man (patient B) with an acquired granulocyte function defect received supportive granulocyte transfusions for the management of severe infections. The boy had suffered from recurrent infections since bith. His granulocytes showed in vitro almost no chemotactic responsiveness, an impaired phagocytosis and reduced intracellular killing of Candida albicans. Family studies suggested that it was an inherited autosomal recessive defect. The child developed a Pseudomonas pneumonia at the age of 3 years, which did not respond to antibiotic therapy. Granulocyte transfusions were then started and soon after the fever and pneumonia disappeared. Patient B showed the haematological signs of a preleukaemic state. He had 3 recurrent episodes of furunculosis which led each time to cellulitis and septic temperatures accompanied by symptoms of an enterocolitis. Tests of granulocyte function in vitro showed reduced intracellular killing of Staphylococcus aureus. Granulocyte transfusions were started, since no clinical improvement could be attained by antibiotics. With transfusion therapy, fever, cellulitis and enterocolitis disappeared each time.
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PMID:Beneficial effect of granulocyte transfusions in patients with defects in granulocyte function and severe infections. 42 96

Pseudomonas aeruginosa pneumonia was produced in dogs with radiation-induced leukopenia to study the comparative efficacy of several different therapies. In a randomized control trial, five treatment regimens were compared: no antibiotics or granulocytes (controls), gentamicin (5 mg/kg/day), carbenicillin (500 mg/kg/day), gentamicin and carbenicillin (same dosages), and daily granulocyte transfusion (minimum 5 x 10(9) cells/day) plus gentamicin (5 mg/kg/day). The most effective therapy was gentamicin plus granulocyte transfusions. Gentamicin alone was not significantly better than no specific therapy. Carbenicillin with or without gentamicin gave intermediate results. This study further supports the utility of granulocyte replacement therapy of infections in severely granulocytopenic subjects. The results also indicate that the relative value of granulocyte transfusions depends upon the specific antibiotic regimen with which these transfusions are compared.
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PMID:Experimental Pseudomonas pneumonia in leukopenic dogs: comparison of therapy with antibiotics and granulocyte transfusions. 81

Twenty-three children with various stages and morphologic types of leukemia were treated with multiple granulocyte transfusions obtained by filtration leukapheresis when neutropenia-associated infection appeared unresponsive to antibiotics. All children meeting the above qualifications were given granulocyte transfusions during this time period. Twenty-one of 23 became afebrile during or shortly after the transfusions; one died with disseminated Herpes simplex; and one became well enough to be discharged, although he was never free of fever. Frequent mild to moderate fever and chills were noted. One child developed a severe pulmonary reaction followed by resolution of pneumonia. Filtration leukapheresis is a useful adjunct in controlling severe infections in neutropenic children.
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PMID:Granulocyte transfusions in children using filter-collected cells. 82 3

A young man with X-linked chronic granulomatous disease of childhood, who is of the rare McLeod phenotype with antibodies in his serum shown to be hemolytic and reactive against all red cells with normal expressions of the Kell antigens, developed a severe Nocardia pneumonia with abscess formation and was subsequently treated successfully with granulocyte transfusions in spite of the presence of anti-KX in the patient's serum. The anti-KX did not appear to alter significantly the effectiveness of the transfused granulocytes; it did, however, cause a mild hemolytic transfusion reaction. The patient made a remarkable recovery from this episode and his condition has progressed to a state satisfactory enough for him to donate his own blood for storage and possible use in the future.
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PMID:Chronic granulomatous disease and the Mcleod phenotype. Successful treatment of infection with granulocyte transfusions resulting in subsequent hemolytic transfusion reaction. 83 62

A 10-year-old girl was first seen at age 5 years with pneumonia and neutropenia. Since then, she has remained leukopenic, although manifesting a leukocytosis only when she has pulmonary infection. A rapid fall in her peripheral WBC count occurs with initiation of antibiotic therapy. Despite her neutropenia, marked myeloid hyperplasia is evident on marrow smear examination; many cells being hypersegmented with fine intralobular bridging with chromatin strands and cytoplasmic vacuolation. The peripheral WBC response to epinephrine adminstration did not indicate a shift from the circulating to marginal neutrophil pool. Results from a Rebuck skin window test suggested poor neutrophil tissue migration. A defect in granulocyte release from the patient's marrow may explain these bizarre hematologic findings.
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PMID:'Myelokathexis'. Neutropenia with marrow hyperplasia. 86 17

Neutrophil granulocyte function was determined in three patients with systemic staphylococcal infection, clinical manifestations of generalized allergic disease, and hyperimmunoglobulinemia E. Each of the patients had urticarial skin rashes before or at the time of development of staphylococcal suppurative lymphadenitis, pneumonia, or sepsis. Neutrophil chemotaxis, random migration, phagocytosis, and bactericidal capacity were assessed to determine if an abnormality in these functions might have contributed to the development of severe staphylococcal infections. Each of the three patients with generalized urticaria was found to have a marked defect in neutrophil chemotaxis. The mean chemotactic index of the patients was 12 +/- 4, whereas that of 20 controls was 72 +/- 11. Neutrophil random migration, phagocytosis, and bactericidal capacity were normal in each patient. The serum or plasma of the patients did not inhibit chemotaxis of control neutrophils and did not contain an increased concentration of the chemotactic-factor inactivator found in normal serum. Treatment of the neutrophils of these three patients with the competitive histamine H2 receptor blocking agent, burimamide, produced a significant increase in chemotactic responsiveness. These studies suggest the possibility of pharmacologic modification of neutrophil granulocyte function.
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PMID:Severe staphylococcal disease associated with allergic manifestations, hyperimmunoglobulinemia E, and defective neutrophil chemotaxis. 97 42

Inability to accurately diagnose infection in granulocytopenic patients is a major cause for morbidity and mortality, and prompted this study of 344 infections (pharyngitis, skin infection, pneumonia, anorectal infection, and urinary tract infection) in a select group of cancer patients. Strikingly similar alterations in clinical presentation were found for all infections that developed in profoundly granulocytopenic patients. Physical findings of exudate, fluctuation, ulceration or fissure, local heat, swelling, and regional adenopathy were all less prevalent in the granulocytopenic patient, while fever was much more common. Only erythema and local pain or tenderness were present in practically all patients regardless of site of infection or level of granulocyte count. A better understanding of how granulocytopenia affects the presentation of infection should lead to earlier and more accurate diagnosis and potentially to more successful therapy.
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PMID:Clinical presentation of infection in granulocytopenic patients. 105 68


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