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

In children, community acquired pneumonia represent less than 10% of respiratory tract infections. In infants and toddlers, the diagnosis is difficult as, at any age, in case of isolated fever. Typical features of pneumonia are rare. Chest radiograph is necessary for confirmation and mandatory in children under 2 years of age, other diagnosis suspision or recurrent pneumonia. Identification of risk factors and/or severity criteria will guide the hospitalisation decision. Epidemiological data have a collective usefulness but help very little for the individual decision. Pneumococcus is observed at any age. Before 3 years of age, viruses and pneumococcus are predominant. After 3 years of age pneumococcus, Mycoplasma pneumoniae and Chlamydia pneumoniae are possible. Viral or virobacterial co-infections exist in 15 up to 25% of cases. An empiric and rapid antibiotherapy is given, pending on age, national or regional epidemiology, initial severity, risk factors. A clinical evaluation is mandatory at H48-72. Routine vaccination with the 7-valent conjugate anti-pneumococcal vaccine will modify the strategy of use of antibiotics in children's pneumonia.
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PMID:[Community acquired pneumonia in children]. 1455 63

We previously reported a hospital-based retrospective study on community-acquired pneumonia (CAP) at Tagami Hospital, which was a community hospital, between 1994 and 1997. This study was designed to clarify the etiology of CAP diagnosed between 2000 and 2002. We analyzed a total of 124 cases of CAP in our hospital during the study period, and compared the results with the previous data. Identification of the causative organisms of CAP was based on gram staining, the morphology of the colonies, quantitative culture of the sputum, and the serological tests. During the study period, we determined the causative organisms in 42 cases (33.8%). Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis were the major causative organisms. The severity of the cases was classified into three groups according to the guideline for CAP, which was edited by the Japanese Respiratory Society. The survival rates in the moderate and severe groups were significantly (p < 0.001) higher than that of the mild group, as analyzed by the Kaplan-Meier method, as follows: 70% (moderate) vs 100% (mild); and 40% (severe) vs 100% (mild). In a total of 7 patients who died, we found the following risk factors: elderly male patients, bedridden status with cerebral infarction, and micro-aspiration, including recurrent pneumonia at short intervals of less than 17 days. Our study indicated that the JRS-edited guideline for CAP is a very useful tool for analyzing cases with CAP in Japan.
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PMID:[A retrospective analysis of community-acquired pneumonia between 2000 and 2002 in a community hospital]. 1476 67

A case is described of a 78-year-old British veteran of the Second World War (1939-45) who was stationed in Southeast Asia and who developed a recurrent pneumonia with blood eosinophilia. He was treated with steroids, and eventually died with a severe Pseudomonas pneumonia. Just prior to death, larvae of Strongyloides stercoralis were identified in his sputum, and a specific serum ELISA test was later positive. At autopsy no other organs were involved, but bronchoalveolar carcinoma was found. Longstanding (57 years) chronic strongyloidiasis in a veteran who served in Southeast Asia but who was not a prisoner of war is very unusual. The pattern of dissemination was also not that of a true hyperinfection syndrome, and the case demonstrates the continued need for diagnostic vigilance amongst former soldiers who were based in the Far East.
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PMID:A British Second World War veteran with disseminated strongyloidiasis. 1509 96

Respiratory tract infections are the leading cause of death due to infectious disease in the elderly. Many factors, especially waning immune responses and the onset of age-associated organ dysfunction, likely account for an increase in susceptibility to respiratory tract infection in the elderly, and morbidity and mortality rates are substantially greater for the elderly when outcomes are compared to that of younger individuals. The presence of underlying disease states such as chronic obstructive pulmonary disease (COPD) or other organ system disease further increases the likelihood of developing severe pneumonia in the elderly population, and the frail elderly, particularly when institutionalized in chronic care facilities, are at high risk for developing severe and recurrent pneumonia. This article will discuss various factors associated with advanced age that predispose the elderly to respiratory infections and summarize current approaches to treatment and prevention.
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PMID:Lung infections and aging. 1516 2

Pneumonia remains a significant cause of morbidity and mortality in surgical patients. Though most studies have focused on pneumonia in trauma or special respiratory intensive care units (ICU), we examine postoperative ventilator-associated pneumonia in patients undergoing elective operations. We hypothesized that a study of multiple clinical variables would disclose factors influencing morbidity and mortality in these patients. We conducted a retrospective review of 1969 patients who underwent elective general, cardiac, and general thoracic procedures during a 6-month period in a private teaching hospital. A total of 77 patients (3.9%) developed postoperative ventilator-associated pneumonia. Thirty-eight (49%) patients had a history of smoking and 27 (35%) had chronic obstructive pulmonary disease (COPD). Among these 77 patients, 20 (26%) experienced recurrent pneumonia. The overall mortality rate for patients developing pneumonia was 34 per cent. At diagnosis of pneumonia, 33 patients were receiving enteral nutrition through nasogastric feeding tubes, whereas 41 received no enteral feeding. The method of nutritional intake was not known in 3 patients. The feeding/nonfeeding groups were similar in age and underlying disease, differing significantly only in the higher number of smokers in the patients not receiving enteral nutrition (P = 0.03). To our surprise, the mortality rate from all causes was higher (P = 0.018) in the patients who received tube feedings through soft, nasogastric feedings (33%) than in those not enterally fed (17%). Parenteral nutrition, COPD, number of ventilator days, and the location of the tip of the feeding tube did not correlate with mortality. The mortality rate from all causes was higher in patients with postoperative pneumonia who received tube feedings, despite similar underlying medical illnesses. Enteral feeding of postoperative surgical patients has many desirable effects, but prospective studies should address harmful effects, such as presumed aspiration and related pneumonia.
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PMID:A retrospective study of nosocomial pneumonia in postoperative patients shows a higher mortality rate in patients receiving nasogastric tube feeding. 1548 3

We describe a previously independent T11 paraplegic patient who had delayed-onset hand weakness and recurrent pneumonia caused by myotonic dystrophy. A man in his late thirties suffered a thoracic spinal cord injury (SCI) from a gunshot wound at the age of 17 years, with resultant T11 American Spinal Injury Association class A paraplegia. He lived independently until the age of 36 years when he was hospitalized multiple times for pneumonia. During a rehabilitation stay after one of the acute hospitalizations, the patient's hand weakness and diffuse muscular atrophy were noted. Electrodiagnostic testing was performed, which showed myotonic discharges. Genetic testing was consistent with myotonic dystrophy. This case shows the importance of considering causes of weakness that affect the population as a whole when evaluating a patient with SCI who presents with delayed-onset weakness.
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PMID:Myotonic dystrophy presenting as new-onset hand weakness and recurrent pneumonia in a patient with paraplegia: a case report. 1552 Sep 88

Although frequently asymptomatic, homozygous C2 deficiency (C2D) is known to be associated with severe infections and rheumatic disease. We describe the clinical findings in 40 persons with C2D from 33 families identified in Sweden over 25 years. Medical records covering 96% of the accumulated person-years were reviewed, giving a mean observation time of 39 years (range, 1-77 yr). Severe infection was the predominant clinical manifestation in the cohort: 23 patients had a past history of invasive infections, mainly septicemia or meningitis caused by Streptococcus pneumoniae, and 12 patients had repeated infections of this kind. Nineteen patients had at least 1 episode of pneumonia, and recurrent pneumonia was documented in 10 patients. Repeated infections occurred mainly during infancy and childhood. Systemic lupus erythematosus was found in 10 patients. Another 7 patients had undifferentiated connective tissue disease (n = 4) or vasculitis (n = 3). We found no correlation between susceptibility to invasive infection and rheumatologic disease. Cardiovascular disease occurred at a high rate, with a total of 10 acute myocardial infarctions and 5 cerebrovascular episodes in 6 patients. Causes of death among the C2D patients were infection (n = 5), acute myocardial infarction (n = 3), and cancer (n = 1). We suggest that severe infection may be the principal clinical manifestation of C2D. We also provide novel evidence for a possible role of C2D in the development of atherosclerosis consistent with findings in mannan-binding deficiency and experimental C3 deficiency. In addition, we confirm the well-known association between C2D and systemic lupus erythematosus.
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PMID:Hereditary C2 deficiency in Sweden: frequent occurrence of invasive infection, atherosclerosis, and rheumatic disease. 1564 97

Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare cause of chronic lung disease in children and adolescents. We described four-years old boy presenting with recurrent pneumonia and symptoms of bronchial asthma. Because of peripheral eosinophilia and bilateral pulmonary infiltrates patient investigated comprehensive and chronic eosinophilic pneumonia determined histopathologically. Other conditions causing eosinophilic pneumonia were ruled out. He showed a dramatic response to oral corticosteroid therapy. This report emphasizes that ICEP should be considered in pediatric age group on a cause for chronic hypoxemi or intractable symptoms of respiratory system.
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PMID:[Idiopathic chronic eosinophilic pneumonia: a case report]. 1610 Jun 54

Although elderly hospitalized patients, irrespective of the cause of hospitalization, are known to be at a high risk of subsequent development of pneumonia, some studies suggest the risk to be even higher in those hospitalized for pneumonia than in those hospitalized for other diseases. The aim of this retrospective study was to determine the association of hospitalization for pneumonia and some other diseases with subsequent pneumonia morbidity and mortality. The risk of recurrent pneumonia in patients hospitalized for pneumonia was investigated. Rehospitalization of pneumonia patients previously hospitalized for the same disease was followed-up and compared with rehospitalization of patients hospitalized for other diseases during the same study period. The study included patients aged overl8, initially hospitalized in 1998 for pneumonia (J12-J18), or for some particular gastrointestinal (K20-K31) and urogenital diseases (N10-N12, N30-N39). All rehospitalizations for pneumonia in nine Zagreb hospitals were followed-up during a 3-year study period (1998-2000). Out of 975 patients followed-up for rehospitalization, 227 (23.3%) had initially been hospitalized for pneumonia, and 748 (76.7%) for other diagnoses. During the 3-year period, 30 patients were rehospitalized for pneumonia, out of which number 22 had initially been hospitalized for pneumonia, yielding a statistically significant difference between the two study groups (chi2 = 34.780, p < 0.001). The mortality directly caused by pneumonia was also significantly higher in the group of patients with the initial diagnosis of pneumonia than in the group of patients with other diagnoses (chi2 = 15.82, p < 0.001).
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PMID:Risk of pneumonia recurrence in patients previously hospitalized for pneumonia--a retrospective study (1998-2000). 1611 25

Can all congenital cystic lung lesions be treated conservatively, without the need for surgery? Our purpose here is to present the morbidity associated with symptomatic cystic lung lesions which have failed to respond to medical treatment. In the past 8 years, 22 consecutive cystic thoracic lesions were retrospectively assessed for clinical presentation, diagnostic modalities, operative findings, technical tribulations, and outcome. The endpoint was complete cessation of recurrent pneumonia and dysphagia. Age at presentation was 7.7 +/- 2.2 years, with 4 +/- 2 episodes per year of lower respiratory tract infection, which had been treated for the past 2.6 +/- 0.3 years. Cough and dyspnea (100%) were the common symptoms, with episodes of cyanosis occurring in 58%. Other significant clinical presentations were dysphagia (55%), failure to thrive (55%), chest pain (46%), haemoptysis (18%), and pleuritic pain (18%). Definitive growth was seen in 91% of the excised specimens. Preoperative morbidity resulted from intractable pneumonia, dysphagia, and failure to thrive. Surgical excision was curative. All 22 children after resection are thriving, with an absence of pneumonia and dysphagia, with normal ventilation/perfusion scans, at 48 +/- 6 months of follow-up. In conclusion, surgical excision of a symptomatic cystic lung lesion that has not responded to medical treatment is recommended.
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PMID:Congenital cystic lung lesions: is surgical resection essential? 1620 Jun 19


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