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

A 44-year-old man was hospitalized because of exertional dyspnea that had progressed for one month. A chest X-ray film showed bilateral small nodular and reticular shadows. The patient presented with a positive inflammatory reaction and hypoxemia. Bronchoalveolar davage fluid had a high lymphocyte fraction and a low CD4/CD8 ratio. Trichosporon cutaneum antibodies were detected, and a specimen obtained by transbronchial lung biopsy showed alveolitis with granuloma formation. The patient reacted positively on a provocation test that was done by having him stay home for 5 days. Summer-type hypersensitivity pneumonitis was diagnosed, and a steroid was administered because of the prolonged abnormal chest roentgenographic findings. KL-6, a mucinous high-molecular-weight glycoprotein that is expressed on Type II pneumonocytes, was retrospectively used as a marker of pneumonitis. A new kit for enzyme-linked immunoassay (ED046) was used to measure the serum KL-6 level. The serum KL-6 level peaked approximately 10 days after the patient was admitted to the hospital and was thus kept away from antigens, and also after the provocation test. The steroid treatment was started, the KL-6 level decreased gradually. Within 2 months after steroid treatment began, the dose of the steroid was reduced and the KL-6 level decreased below the upper limit of normal. The KL-6 level remained low thereafter; it was not influenced by liver dysfunction or other inflammatory processes. However, the C-reactive protein level decreased rapidly after provocation and thereafter immediately returned to almost zero. The lactate dehydrogenose level peaked 8 days after provocation and decreased rapidly after steroid treatment. These results suggest that the serum KL-6 level provides new information regarding the clinical course and treatment of interstitial pneumonia. In addition KL-6 may be useful form monitoring disease activity, especially while tapering the dose of steroids in patients with interstitial pneumonia.
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PMID:[Hypersensitivity pneumonitis monitored with serum KL-6, a marker of interstitial pneumonia]. 881 Jul 69

During 12 months in 1981-82, 201 children were hospitalized due to radiologically verified definite or probable pneumonia. In 1985, 194 chest radiographs (anteroposterior views) were re-evaluated jointly by two radiologists, and classified into three categories: alveolar, interstitial and probable pneumonia. In 127 cases definite pneumonia was diagnosed on both occasions, alveolar in 48 cases and interstitial in 79 cases. Variation between the two evaluations 3 years apart was observed in 46 (24%) of the 194 cases; the adjusted kappa (0.47) was in the modest region. Factors contributing to this variation were young age, less than 12 months, and the presence of interstitial infiltration, bronchial obstruction and low C-reactive protein. Factors associated with less marked variation were the presence of alveolar infiltration, auscultatory fine rates and elevated C-reactive protein. The microbial aetiology of infection, assessed by viral and bacterial antigen and antibody assays, showed no association with diagnostic variation. A lateral view of the chest radiograph was obtained from 158 patients; it was positive in 99 (91%) of the 109 cases with definite pneumonia. In only three cases the diagnosis was based on the lateral view alone. Our results show that the radiological diagnosis of pneumonia is difficult in children, especially in young children with interstitial pneumonia.
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PMID:Radiological diagnosis of pneumonia in children. 893 9

Preliminary results have recently shown that an early switch from parenteral antimicrobials to an oral substitute provides an effective means of treating pneumonia in pediatric patients. In a controlled randomized study, 62 children with community-acquired lobar/segmental pneumonia were selected to receive 8 days of cefixime or amoxicillin-clavulanate after an initial therapy of two doses of parenteral ceftriaxone. Enrollment criteria included: age 6 months to 5 years, fever > 38.5 degrees C, white blood cell (WBC) count > or = 15,000/ mm3, and lobar/segmental pneumonia on chest radiograph. Twenty-nine patients were randomized to receive oral cefixime and 33 to oral amoxicillin-clavulanate. The two groups were comparable in the following pretreatment parameters: age, duration of illness, temperature, mean WBC count, erythrocyte sedimentation rate, C-reactive protein, and need for hospitalization. Days of resolution of high fever, tachypnea, cough, grunting, and laboratory test abnormalities were similar in the two groups. Clinical response at the end of treatment showed cure, improvement, and failure in 97%, 3%, and 0%, respectively, in the cefixime group and in 88%, 6%, and 6%, respectively in the amoxicillin-clavulanate group (P = NS). We conclude that young children with community-acquired lobar/segmental pneumonia can be successfully treated with 2 days of parenteral ceftriaxone followed by 8 days of oral cefixime or amoxicillin-clavulanate.
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PMID:Comparative evaluation of cefixime versus amoxicillin-clavulanate following ceftriaxone therapy of pneumonia. 897 Jul 55

We measured the platelet distribution width, the mean platelet volume, the volume percentage of platelets, and the platelet-to-large-cell ratio in 15 elderly patients with disseminated intravascular coagulation (DIC). Peripheral venous blood mixed with ehtylenediaminetetraacetic acid was analyzed with a Sysmex E-4000 analyzer. The underlying diseases were sepsis, pneumonia, pyelonephritis, and other inflammatory diseases. The mean duration of survival from the onset of DIC was 16.9 +/- 23.9 days. The distribution of red cell sizes before the onset of DIC did not differ significantly from that in patients without DIC, but fragmentation of erythrocytes on blood films was more common in the early stage of DIC (p < 0.01). Before the onset of DIC, the two groups did not differ significantly in the frequency of giant platelets on blood smears. At the onset of DIC, the platelet distribution width, the mean platelet volume, and the platelet-to-large-cell ratio were significantly higher than in patients without DIC. The concentration of glutamic-oxaloacetic transaminase and those of other serum enzymes did not change significantly, but the serum creatinine concentration and the blood urea nitrogen level increased as the platelet-to-large-cell ratio increased. No significant relation was evident between the levels of serum C-reactive protein and creatinine, between the platelet-to-large-cell ratio and the mean volume of red blood cells, or between the platelet-to-large-cell ratio and the distribution of red cell sizes. These data suggest that studies of platelets are more useful in the diagnosis of DIC at early stages of impaired organ function than are other indicators of inflammation such as the level of C-reactive protein.
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PMID:[Changes in erythrocyte structure and in platelets in elderly patients with disseminated intravascular coagulation]. 899 5

We encountered six patients with pneumonitis related to blended chinese traditional medicine (Kampo). The duration of treatment with kampo ranged from 14 to 110 days (mean: 38 days). The most common complaints were dyspnea, fever, and dry coughing. Fine crackles were heard at the bases of both lungs. Abnormal laboratory findings included high values of C-reactive protein and glutamic-oxaloacetic transaminase in all patients, lactate dehydrogenase in 5 patients, and eosinophil count in 1 patient. Chest X-ray films and CT films revealed diffuse reticulo-nodular interstitial shadows with consolidation in both lung fields in 3 patients and pleural effusion in 1 patient. Bronchoalveolar lavage was done in 4 patients; examination of the lavage fluid showed lymphocyte alveolitis, either pure or associated with neutrophilia and eosinophilia in 3 patients. Inverted CD4/CD8 lymphocyte ratios were found in 3 patients. Transbronchial lung biopsy was done in 4 patients and specimens from 3 of those 4 showed organizing pneumonitis with thickening of alveolar septa. Lymphocyte stimulation tests were positive in 4 patients. Discontinuation of the drug (2 patients) or administration of corticosteroids (4 patients) was followed by rapid improvement. Patients being treated with kampo preparations should be observed for signs and symptoms of drug-induced pneumonitis.
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PMID:[Six patients with pneumonitis related to blended Chinese traditional medicines]. 902 15

A study was carried out to determine whether bottle-blowing has any positive effects in patients with pneumonia. In a prospective open study 145 adults with untreated community-acquired pneumonia requiring hospitalization were randomized to early mobilization (group A), to sit up and take 20 deep breaths on 10 occasions daily (group B), or to sit up and to blow bubbles in a bottle containing 10 cm water through a plastic tube 20 times on 10 occasions daily (group C). Peak expiratory flow (PEF), vital capacity (VC), forced expiratory volume in 1 sec (FEV1) and serum concentration of C-reactive protein (CRP) were determined on admission, and on days 4 and 42. Fever duration and hospital stay were recorded. In a subset of 16 patients, single breath diffusion capacity of carbon monoxide was measured on 3 occasions. The patients in group A were hospitalized for a mean of 5.3 days, group B for 4.6 days and group C for 3.9 days. Treatment was a significant factor (p = 0.037) in a Cox regression model, with group C significantly better than group A (p = 0.01). The number of days with fever was 2.3, 1.7 and 1.6 in groups A, B and C respectively. These differences were not significant (p = 0.28). No significant differences were found between the groups regarding CRP, PEF, VC, FEV1, or diffusion capacity. Intensive bottle-blowing shortens the hospital stay in patients with pneumonia. The underlying mechanism is not clear.
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PMID:Bottle-blowing in hospital-treated patients with community-acquired pneumonia. 911 3

Our objective was to investigate the initial levels of circulating proinflammatory cytokines, such as interleukin 1 beta (IL-1 beta), interleukin 6 (IL-6), and tumour necrosis factor alpha (TNF-alpha), of certain acute-phase proteins, such as C-reactive protein (CRP), fibrinogen (FBN) and albumin, and of the glycoprotein fibronectin at presentation and their daily variation during the clinical course of community-acquired pneumonia (CAP) in relation to clinical and laboratory indices of infection. Thirty otherwise healthy hospitalized patients aged 48 +/- 3 years (mean +/- SEM) and with bacteriologically confirmed CAP were studied prospectively. IL-1 beta and IL-6 were found to be 15-fold higher on admission (122 +/- 9 pg mL-1 and 60 +/- 4 pg mL-1 respectively), whereas TNF-alpha was three-fold higher (102 +/- 5 pg mL-1) than those of controls, all of them showing a decline towards normal. Initial CRP levels were increased 90-fold (416 +/- 1 mg L-1), whereas fibronectin levels were reduced (242 +/- 9 mg dL-1). The presence of parapneumonic effusion was associated with a higher TNF-alpha serum level (127 +/- 7 vs. 86 +/- 4 pg mL-1, P = 0.0002), a more rapid daily decline in TNF-alpha (-7.2 +/- 0.7 vs. -3.8 +/- 0.5 pg mL-1 day-1, P = 0.0005), a slower rate of decline in CRP (-42.8 +/- 3.0 vs. -54.6 +/- 3.0 mg L-1 day-1, P = 0.02) and a slower rate of increase in FBN (5.9 +/- 1.0 vs. 11.7 +/- 1.0 mg dL-1 day-1), P = 0.001]. Furthermore, daily progression of serum levels of cytokines and acute-phase proteins correlated strongly with pyrexia, erythrocyte sedimentation rate (ESR), neutrophil count, alveolar-arterial oxygen difference and radiographic resolution, clinically manifested by improvement in the patients' condition.
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PMID:Daily variation in circulating cytokines and acute-phase proteins correlates with clinical and laboratory indices in community-acquired pneumonia. 913 79

We evaluated the applicability of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and absolute neutrophil count (ANC), in the screening of pneumococcal (PNC) pneumonia in children. In 1981-1982, 161 children were treated for radiologically verified community-acquired pneumonia in the hospital during a period of 12 months. The Streptococcus pneumoniae aetiology of infection was studied by antigen, antibody and immune complex assays in acute and convalescent sera. In acute blood samples, CRP was measured by the immunonephelometric method, ESR by the Westergren method, WBC using an automatic cell counter, and thereafter the ANC was calculated after microscopic examination of peripheral smears. CRP and ESR were significantly higher in patients with alveolar (n=53) than in those with interstitial (n=108) pneumonia. CRP, ESR and ANC were significantly higher in PNC (n=29) than in viral (n=23) pneumonia. The values in mixed PNC and viral infections (n=17) were approximately midway between PNC and viral cases. All cases with serologic evidence of S. pneumoniae aetiology were combined (n=46) for calculation of diagnostic parameters. When a cut-off limit of 60 mg x L(-1) was used, CRP had a sensitivity of 26% and a specificity of 83% in the screening of PNC pneumonia. We conclude that C-reactive protein and erythrocyte sedimentation rate have a limited capacity to differentiate between pneumococcal and nonpneumococcal pneumonia. C-reactive protein is recommended as the first-line method of screening, and the value of 60 mg x L(-1) as the cut-off limit.
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PMID:White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. 916 57

The aim of the present study was to describe the long-term sequential changes of the acute phase proteins and of commonly used so-called nutritional markers in patients with community-acquired pneumonia (CAP), and to calculate the normalization rate of serum C-reactive protein (CRP), defined as the time for a 50% decrease, during the initial treatment of these patients. The long-term sequential changes of inflammatory and nutritional markers in patients with CAP have not been previously well-documented. However, in the diagnostic work-up of patients with suspected infectious diseases CRP levels are often used nowadays. Serum albumin, transthyretin (prealbumin), and transferrin together with serum iron, have often been used as "nutritional markers" in patients. We therefore studied the long-term changes of these parameters in patients with CAP, as these markers also are influenced by inflammatory reactions, in pneumonia for example. All the patients within the age range 50-85 years, with the exception of immunocompromised patients, who were admitted with CAP to the Department of Infectious Diseases at Danderyd Hospital during a 12-month period (January 1992-January 1993), were reviewed for inclusion in a prospective study of the long-term sequential changes of inflammatory and nutritional markers in CAP patients. A total of 97 patients (50 men) with a mean age of 69.6 years were included in the study. Blood samples were drawn on admission, during the hospitalization period, and at the follow-up visits. Serum CRP, alpha 1-antitrypsin, haptoglobin and orosomucoid (alpha 1-acid glycoprotein) were used as acute phase proteins. However, albumin, transthyretin, and transferrin together with serum iron and percentage transferrin saturation were also included. Of all the parameters studied, CRP showed the greatest variation, already having the highest values at admission. CRP also showed, together with iron, the earliest response to recovery in the patients. The median time for a 50% decrease of CRP was 3.3 days for the patients (n = 73) with more than two CRP values measured during the first nine days. Transthyretin responded faster to patient recovery than did albumin. CRP showed the greatest amplitude of changes and together with iron and percentage saturation of transferrin it also showed the earliest response to recovery in patients with CAP. This indicates that CRP is the best of the parameters studied for use in diagnostic work-up and in follow up.
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PMID:Sequential changes of inflammatory and nutritional markers in patients with community-acquired pneumonia. 920 Feb 69

We studied the clinical characteristics of pneumonitis induced by Sho-saiko-to (SST). Of 94 cases reported to a drug maker, 72 were judged to be SST-induced pneumonitis (52 men and 20 women, mean age 63.7 years). Most patients took SST for chronic liver diseases due to infection with the hepatitis C virus. The mean duration of SST therapy before the onset of pneumonitis was 50.2 +/- 42.1 days. Most patients presented with coughing, dyspnea, and fever of acute onset. Chest X-ray films showed diffuse ground-glass shadows and infiltration. Abnormally high levels of C-reactive protein and lactate dehydrogenase were common, as was hypoxia. Analysis of bronchoalveolar lavage fluid revealed abnormally high percentages of lymphocytes and neutrophils and a low CD4/CD8 ratio. Although 64 of 72 patients survived after cessation of SST only or steroid therapy, 8 died of respiratory failure despite high-dose steroid therapy. Compared with patients who survived those who died were more likely to have an underlying lung disease, had been taking SST longer after the onset of pneumonitis, and had more severe hypoxemia.
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PMID:[Pneumonitis induced by the herbal medicine Sho-saiko-to in Japan]. 921 62


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