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

To investigate the impact of nutritional and inflammatory factors on short- and long-term prognosis for patients hospitalized for community-acquired pneumonia (CAP), 97 patients, 50-85 years old, admitted to the Department of Infectious Diseases at Danderyd Hospital were enrolled in a prospective study. 13 enrolment variables were examined for association with 6 outcome variables. Serum orosomucoid concentration, acute physiology and chronic health evaluation (APACHE) II score, body mass index (BMI) and triceps skinfold (TSF) were each associated with duration of hospital stay. A low TSF and BMI, and a high APACHE II score were all associated with death. A high APACHE II score and a high TSF were both associated with readmission within 6 months of discharge. The alfa-1-antitrypsin concentration was the most closely correlated with duration of fever. We conclude that the admission concentrations of alfa-1-antitrypsin and orosomucoid are better predictors of hospital morbidity than the more commonly used albumin and C-reactive protein (CRP) levels. Measurement of APACHE II and TSF on admission may give additional prognostic information on the interval from admission to 6 months after discharge.
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PMID:Short- and long-term prognosis for middle-aged and elderly patients hospitalized with community-acquired pneumonia: impact of nutritional and inflammatory factors. 754 Mar 16

A total of 1,622 daily measurements of the level of C-reactive protein (CRP) in the serum of 40 hospitalized patients with neutropenia were made during 55 study periods from October 1990 through February 1993 (mean, 29.5 measurements per period). Clinical events were categorized into four groups: group I (bloodstream infection), group II (significant bacterial or fungal infection without bloodstream infection), group III (fever without an obvious source), and group IV (drug-related fever). There was a strong association between baseline elevation of the CRP level (> or = 100 mg/L) and tumor-associated fever (P = .0005); the resolution of such fever coincided with a decrease in the CRP level following chemotherapy. Levels of CRP increased by > or = 40 mg/L in 10 (31%) of 32 cases during the 48-72 hours preceding the clinical diagnosis of a subsequently demonstrable infection--often pneumonia without bloodstream infection. CRP values on day 2 (1 day after the diagnosis of a clinical event) were significantly higher for events in groups I and II than for those in group III (P < .01) but not those in group IV. With regard to significant infections, a day-2 CRP value of > or = 40 mg/L was 100% sensitive and an increase in CRP level of > or = 50 mg/L from day 1 to day 2 had a positive predictive value of 95%. We conclude that serial measurements of serum CRP levels may be helpful in determining the extent of evaluation required for a newly febrile neutropenic patient and possibly in accelerating the detection of an otherwise unsuspected infection.
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PMID:A prospective study of daily measurement of C-reactive protein in serum of adults with neutropenia. 757 19

Clinical and pathological studies on cryptogenic organizing pneumonitis (COP) were performed in 19 cases diagnosed with transbronchial lung biopsy (TBLB). All patients suffered from fever and several respiratory symptoms. Laboratory data showed increases in erythrocyte sedimentation rate, positivity for C-reactive protein, negative tuberculin reactions and increases in complement level. Pathological findings demonstrated that there were two kinds of organizing processes. Fourteen of the 19 cases were treated with prednisolone, and two cases were observed without administration. The remaining three cases could not be followed up after therapy. In 11 of the 16 cases, abnormal shadows in chest X-ray disappeared, but remained present in five cases. As for the relationship between pathological findings and shadows in chest X-ray, Masson bodies without fibrin were observed in the 11 cases which were without shadows on X-ray, but Masson bodies containing or related to fibrin were observed in the five cases in which abnormal shadows remained. These results suggest that there are two types of organizing process in COP. Type I is an unexplained organizing process in which fibrin is not present or involved. It responds well to steroids and the prognosis is favourable. Type II is an organizing process which involves fibrin, and the character of the fibroblast-like cells is very similar to that of myofibroblasts. Type II organizing process responds poorly to steroids. Both processes can be notified relatively easily, even by TBLB tissues.
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PMID:Clinicopathological study on two types of cryptogenic organizing pneumonitis. 759 66

L-selectin is a glycoprotein which is one of three members in a family of cell adhesion molecules called selectins. L-selectin is present in distinct forms on both neutrophil granulocytes and lymphocytes, and it appears to play an important role in the early stages of leukocyte-endothelial cell interaction. Activation of leukocytes leads to shedding of the extracellular part of L-selectin which thus forms a soluble adhesion molecule, sL-selectin, which retains functional capacity and can be detected in serum. In the present study we have developed a specific, sensitive sandwich ELISA to measure the serum level of sL-selectin in patients with hematological and infectious disorders. Three patients with acute myeloid leukemia in remission and 1 patient with chronic myeloid leukemia in chronic phase were followed during bone marrow transplantation and the level of sL-selectin was found to correlate closely to the leukocyte counts with no detectable sL-selectin during periods of severe leukopenia. In 11 patients with chronic phase chronic myeloid leukemia and 13 patients with chronic lymphocytic leukemia the sL-selectin level was also found to correlate closely to the leukocyte count (R = 0.98; p = 0.001 and R = 0.83; p = 0.004 respectively). One CML patient with a leukocytosis of 385 x 10(9)/l was found to have an sL-selectin concentration 625 times above normal. Ten patients with acute pneumonia were evaluated at diagnosis and at the time of follow-up 4-8 weeks later. In all patients the initial sL-selectin level was higher than at follow-up. However, no close correlation between sL-selectin and leukocyte count or CRP (C-reactive protein) at the time of diagnosis was found. In summary, we have found that the sL-selectin level in human serum closely correlates to the leukocyte count in both CML and CLL and during bone marrow transplantation.
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PMID:Correlation between serum level of soluble L-selectin and leukocyte count in chronic myeloid and lymphocytic leukemia and during bone marrow transplantation. 769 Mar 31

In pediatric patients with community-acquired pneumonia, most of the patients have received antibiotics before admission. In this study, we tried to determine whether we could identify the etiology of pneumonia by clinical and laboratory findings on admission. The etiology of acute pneumonia was studied in 596 pediatric inpatients. A pathogen was identified in 384 (64.4%) episodes of pneumonia. These 384 episodes were divided into six groups as follows; I: pneumonia with blood culture positive or pneumonia with bacterial antigen positive in urine, II: pneumonia with dominant bacterial pathogens in washed sputum. III: Mycoplasma pneumonia, IV: viral pneumonia, V: bacterial (I, II) + viral pneumonia, VI: bacterial (I, II) + Mycoplasma pneumonia. These groups were analyzed by clinical symptoms, physical examination and simple laboratory findings on admission. Patients with Mycoplasma pneumonia have increased blood sedimentation rate, high value of positive C-reactive protein and normal white blood cell count. It was difficult to distinguish bacterial pneumonia from viral pneumonia only based upon clinical symptoms, physical examination and simple laboratory findings.
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PMID:[Etiology of pediatric inpatients with pneumonia--analysis of clinical symptoms, physical examination and simple laboratory findings]. 774 5

50 consecutive cases of pneumonia were treated using a standardized diagnostic-therapeutic protocol. The variations of the more common phlogosis indices (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], leucocytes) during the antibiotic therapy were evaluated, together with clinical progress. Comparative evaluations of the phlogosis indices were taken as well as the X-ray picture. The data analysed, according to the literature, showed a significantly faster and more widespread response to the therapy by the CRP, in respect to ESR and the leucocytes number. This data has been substantially confirmed even in individual groups into which the case study was subdivided. In the "compromised" (according to the British Thoracic Society) patients, the fall in the CRP level was not so early as in the "uncompromised" group. There did not seem to be however different behaviour of ESR and leucocytes between these two groups. Modifications in these two tests over time were rarely significant. An age equal to or greater than 70 appears the element which best defines the state of "compromised host". A comparison of the clinical progress with the variations of the tests of phlogosis and the radiographic tests confirms the usefulness of CRP as an early index of the clinical evolution and the lateness of X-ray tests.
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PMID:Modification of phlogosis indices in pneumonia during antibiotic therapy. 775 74

Fifty-seven patients with decompensated cirrhosis were studied prospectively to assess the sensitivity and specificity of early clinical or biological signs of bacterial infection. Among them, 19 had proven infection on admission (7 spontaneous bacterial peritonitis, 5 bacteraemia, 3 urinary tract infections, 2 pneumonia, 1 dental abscess and 1 cholangitis). Fever, polymorphonuclear cell count, fibrinogen and C-reactive protein levels were found to be of little or no help in diagnosing bacterial infection on admission. Interleukin-6 plasma levels were, however, significantly different between infected (median: 1386 pg/ml, range: 237-20,000) and non-infected patients (median: 34 pg/ml, range: 0-4500, p < 0.00001). Levels above 200 pg/ml were always found in infected patients, giving a sensitivity of 100% and a specificity of 74%. C-reactive protein correlated weakly with interleukin-6 levels, indicating a defective acute-phase response in cirrhosis. Tumor necrosis factor alpha plasma levels were less sensitive (95%) and specific (68%) for the diagnosis of bacterial infection at a threshold of 50 pg/ml, but were more closely related to a poor patient outcome. In decompensated cirrhosis, interleukin-6 plasma levels on admission provided the most sensitive and specific tool for the diagnosis of bacterial infection.
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PMID:Interleukin-6: an early marker of bacterial infection in decompensated cirrhosis. 793 Apr 84

Tumour necrosis factor alpha (TNF alpha) is a critical inflammatory mediator in rheumatoid arthritis, and may therefore be a useful target for specific immunotherapy. In support of this hypothesis, we previously observed beneficial responses in patients with active rheumatoid arthritis after open-label administration of a chimeric monoclonal antibody to TNF alpha (cA2). We now report the results of a four-centre, randomised double-blind trial of a single infusion of 1 or 10 mg/kg cA2 compared with placebo in 73 patients with active rheumatoid arthritis. The primary endpoint of the study was the achievement at week 4 of a Paulus 20% response, an amalgam of six clinical, observational, and laboratory variables. Intention-to-treat analysis of data from individual patients showed only 2 of 24 placebo recipients responding at this time, compared with 11 of 25 patients treated with low-dose cA2 (p = 0.0083) and 19 of 24 patients treated with high-dose cA2 (p < 0.0001). Over half of the high-dose cA2 patients responded by the more stringent 50% Paulus criteria at this time (p = 0.0005). The magnitude of these responses was impressive, with maximum mean improvements in individual disease-activity assessments, such as tender or swollen-joint counts and in serum C-reactive protein, exceeding 60% for patients on high-dose treatment. There were two severe adverse events. 1 patient on 1 mg/kg cA2 developed pneumonia ("possibly" treatment-related) and 1 on 10 mg/kg had a fracture ("probably not" treatment-related). The results provide the first good evidence that specific cytokine blockade can be effective in human inflammatory disease and define a new direction for the treatment of rheumatoid arthritis.
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PMID:Randomised double-blind comparison of chimeric monoclonal antibody to tumour necrosis factor alpha (cA2) versus placebo in rheumatoid arthritis. 793 91

Bacterial infections of the respiratory tract are a major cause of morbidity and mortality in elderly people. The inflammatory response to such infection is an important protective process and has been suggested to be less effective in elderly patients. To investigate the inflammatory response in respiratory infections acquired in the community by elderly people we studied 52 consecutive patients who met the criteria for either a non-pneumonic chest infection or pneumonia. After exclusion, 41 patients were available for evaluation, with 25 fulfilling the criteria of pneumonia and 16 the criteria of chest infection. Pyrexia was a feature of the patients with pneumonia. Circulating levels of neutrophil elastase-alpha-1-antitrypsin complex and C-reactive protein were greater in the patients with pneumonia than in those with a chest infection and were reduced following antibiotic treatment. No changes occurred in the chest infection group for these markers of inflammation. In both groups, a further neutrophil granule protein, lactoferrin, was unaffected by antibiotic treatment. This study indicates that elderly patients with pneumonia can initiate an appropriate inflammatory response as demonstrated by clinical indicators and circulating mediators of the inflammatory response.
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PMID:Inflammatory markers of lower respiratory tract infection in elderly people. 797 76

Among 72 adult patients with a diagnosis of acute bronchitis, serological investigation established the presence of an aetiologic agent in 29 (40%). Influenza virus was the most common pathogen. Seven patients had bacterial infection, caused by pneumococci in four patients and Mycoplasma pneumoniae in three. Five of the patients had pneumonia as diagnosed by radiography, and mycoplasmal aetiology was established in one of these. Altogether, 11 patients either had bacterial infection or radiographic pneumonia. Although the doctors' recording of wheezes was strongly associated with prescription of antibiotics (p < 0.0001), wheezes were heard only in two of the 11 patients with pneumonia or bacterial infection, compared with 30 of the 61 patients with viral or unspecified bronchitis. The median value of C-reactive protein (CRP) was 52 mg/l in the 11 patients, significantly higher than < 11 mg/l in the 61 other patients (p < 0.0001). The corresponding values for erythrocyte sedimentation rate were 45 and 14 mm/h (p < 0.0005). The results indicate that certain patients with acute bronchitis should be treated with antibiotics, and that the erythrocyte sedimentation rate and the CRP-test may be useful in detecting which patients this applies to.
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PMID:[Acute bronchitis in adults. Clinical findings, microorganisms and use of antibiotics]. 800 31


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