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

A 76-year-old man with chronic obstructive pulmonary disease who developed P multocida pneumonia and bacteremia has been described. The infection was treated with antibiotics, and the patient recovered. Pasteurella multocida is known to infect many species of animals. The instances of human infection due to this organism are frequently associated with exposure to animals. Pulmonary infection occurs principally in patients with underlying chronic bronchopulmonary disease.
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PMID:Pasteurella multocida pneumonia and bacteremia. 89 40

Pulmonary infection complicating intra-abdominal sepsis is a major clinical problem. An experimental model for intra-abdominal sepsis was created with implantation of gelatin capsules, containing 3 x 10(8) cfu E. coli strain no. 2554, in the peritoneal cavity of 20 rats (10 animals received and 10 did not receive antibiotic therapy with ceftriaxone) in order to verify the role of the primary site of infection in the pathogenesis of pneumonia. Ten rats were sacrificed to determine the relative pulmonary weight and 10 were submitted to simple laparotomy and insertion of a germ-free capsule (sham-operated group). In this group of animals there was only one death (10%). All the rats that received antibiotic therapy survived until sacrifice while all the rats that did not receive ceftriaxone died, 7 within the 2nd and 3 on the 6th postoperative day. Pneumonia and peritonitis developed only in the animals that did not receive ceftriaxone. Bacteriological findings of material obtained from peritoneal and pleural cavities revealed the same strain of E. coli used for the experiment, suggesting that bacteria involved in the pleuro-pulmonary infections may originate in the primary site of infection and that antibiotic therapy started at the moment of contamination, can prevent this major complication.
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PMID:Pneumonia complicating abdominal sepsis: an experimental model of hematogenous contamination of the lung. 140 76

In order to define the role of intracranial and extracranial complications in determining outcome from severe head injury, 734 patients from the Traumatic Coma Data Bank were analyzed. Nine classes of intracranial and 13 classes of extracranial complications occurring within the first 14 days after admission were analyzed, while controlling for age, admission Glasgow Coma Scale motor score, early hypoxia or hypotension, and severe extracranial trauma. Outcome for survivors was based on the last recorded Glasgow Outcome Scale score, obtained a median of 521 days after injury. Intracranial complications did not significantly alter outcome for the study group. Of the extracranial complications, pulmonary, cardiovascular, coagulation, and electrolyte disorders occurred most frequently at 2 to 4 days. Infections developed later, peaking at 5 to 11 days. Gastrointestinal, renal, and hepatic complications followed no specific time course. Electrolyte abnormalities were the most frequent occurrence (59% of patients) but did not alter outcome. Pulmonary infections (41%), shock (29%, systemic blood pressure < or = 90 mm Hg for 30 minutes or more), coagulopathy (19%), and septicemia (10%) were significant independent predictors of an unfavorable outcome. Backward-elimination, stepwise logistic regression modeling indicated that the estimated reduction of unfavorable outcome was 2.9% for the elimination of pneumonia, 3.1% for coagulation disturbances, 1.5% for septicemia, and 9.3% for shock. These data suggest that extracranial complications are highly influential in determining the outcome from severe head injury and that significant improvements in outcome in a sizeable proportion of patients could be accomplished by improving the ability to prevent or reverse pneumonia, hypotension, coagulopathy, and sepsis.
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PMID:Extracranial complications of severe head injury. 143 33

Pulmonary infections are the most life-threatening infections in mechanically ventilated patients. Methods to avoid these infections by prophylactic systemic or local administration of antibiotics may promote resistance and selection of distinct groups of pathogens. In mechanically ventilated patients we studied the impact of early diagnosis and specific therapy on the prevention of pulmonary infections. Due to the very short interval between colonization and infection, daily microscopic and microbiologic examinations of tracheobronchial secretions proved to be essential for early and successful therapy and even prevention of pulmonary infections. PATIENTS AND METHODS. The present study comprised a total of 190 patients admitted to the surgical intensive care unit who required mechanical ventilation for a period of at least 48 h: 56 were admitted for multiple trauma; 38 had peritonitis; and the remainder had postoperative complications such as renal failure, cardiac problems, septicemia or pneumonia. Multitraumatized patients (16.5 days) and those with peritonitis (13.8 days) needed the most extensive ventilatory support. After admission antibiotic therapy was started with a second-generation cephalosporin or amoxicillin/clavulanic acid. Further antibiotic treatment was directed strictly against the isolated pathogens. Tracheobronchial secretions were monitored daily by microscopy and cultures. Microscopic evaluation was essential to discriminate between colonization and inflammation, and often indicated the infective agent. If infections were suspected provisional antibiograms were performed on the material. This procedure allowed a specific antibiotic treatment to be initiated 8-12 h later. In patients with pulmonary infections, additional bronchoscopic material was taken in order to correlate these findings with those gained from the tracheobronchial secretions. RESULTS. In 85% of cases massive colonization of the trachea with Pseudomonas aeruginosa, enterobacteria, Staphylococcus aureus or Streptococcus pneumoniae resulted in pulmonary infections 24-48 h later. The reduced virulence of Pseudomonas species (non-aeruginosa) and Acinetobacter species is reflected by an infection rate of 50% and an extended period of time to establish an infection (2-4 days). Only 30% of patients highly contaminated with Candida developed pulmonary infections after 3-6 days. A fair correlation (86%) was found between pathogens isolated in tracheobronchial secretions and bronchoscopic material. In the population studied, 68 patients (35.7%) developed pulmonary infections, 32 of them pneumonia (16.8%), and the others purulent tracheobronchitis with fever. Both groups were treated with antibiotics. Patients with multiple trauma, often accompanied by lung contusion, were most frequently affected. In 59 patients (87%) pulmonary infections were treated successfully by specific antibiotic therapy; 9 patients died so rapidly, that the pulmonary complication could not account for the fatal outcome. In 38 patients with massive contamination of the tracheobronchial system by enterobacteria, Pseudomonas aeruginosa or Staph. aureus, progression from colonization to infection was prevented by early administration of specific therapy. CONCLUSIONS. Because pulmonary infections in most cases arise very soon after pathogens have gained access to the tracheobronchial system daily monitoring of tracheobronchial secretions is required for early initiation of specific therapy.
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PMID:[Microbiological care of ventilated intensive care patients. Feasibility of diagnosis and therapy of pulmonary infection]. 195 44

Respiratory syncytial virus is a common respiratory tract pathogen in infants. Pulmonary infection in adult and elderly populations can occur with severe and even fatal pneumonitis having been reported in several recent outbreaks. We present a previously healthy adult patient who developed respiratory syncytial virus pneumonia severe enough to require mechanical ventilation. Antiviral therapy with aerosolized ribavirin was successfully undertaken and the patient recovered completely. Respiratory syncytial virus infection should be considered in the differential diagnosis of atypical adult pneumonias. Aerosolized ribavirin therapy may be beneficial in treatment.
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PMID:Ribavirin therapy of adult respiratory syncytial virus pneumonitis. 195 37

Pulmonary infection is a major source of morbidity and mortality in recipients of lung allografts. The alveolar macrophage plays an important role in pulmonary host defense, and to fulfill this role it must have the ability to orient and migrate in the direction of a stimulus. Thus migratory activity was measured in cells recovered from lung transplant recipients by bronchoalveolar lavage. The primary patient group consisted of recipients who had no evidence of infection or rejection at the time of bronchoalveolar lavage. These patients were further subdivided into an early postoperative group (less than 6 wk posttransplant) and a late postoperative group (greater than 6 wk posttransplant). Other categories included patients with chronic rejection and a small group of patients with Pneumocystis carinii pneumonia. Alveolar macrophages recovered by bronchoalveolar lavage were assayed for migratory response to N-formylmethlonylphenylalanine and endotoxin-activated human serum. Stimulated migration of cells from healthy recipients obtained in the late postoperative course was similar to that of normal control subjects, but stimulated migration of cells from healthy recipients in the early postoperative period and those undergoing chronic rejection was greater than expected. Spontaneous migration was similar in all groups except those with P. carinii pneumonia, in whom it was greatly increased. We conclude that alveolar macrophage migration is not impaired in lung allograft recipients without apparent signs of infection or rejection and is in fact increased during periods of possible macrophage activation (shortly after transplantation and during chronic rejection).
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PMID:Alveolar macrophage migration after lung transplantation. 200 94

On well defined criteria a total of 102 fiberoptic bronchoscopies (FB) were done on HIV-infected patients with pulmonary symptoms. A microbiological agent was identified in 85 patients (83%). Pneumocystis carinii (PC) was histologically verified in 61 patients, bacteria cultured in 22 patients, and cytomegalovirus (CMV) cultured in 17 patients. A histological diagnosis of CMV was only established in 2/17 patients. In the present study, a CMV positive culture from bronchial lavage fluid did not appear related to the clinical picture. Patients with P. carinii pneumonia (PCP) had significantly higher IgA, lower CD4-count, more commonly dyspnea and an X-ray showing diffuse interstitial infiltration than patients without PCP. Patients with bacterial pneumonia had significantly higher CD4-count, lower IgA, more commonly productive cough and an X-ray showing focal infiltration. In more than 75% of the patients, microorganisms identified were responsible for the pulmonary symptoms leading to bronchoscopy. Mainly PC and bacterial pathogens, both of which are treatable, were responsible for these infections. Pulmonary infections of clinical relevance besides PCP and bacterial infections were rare (3%, 95% confidence limit 1-8%).
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PMID:Pulmonary pathogens in HIV-infected patients. 217 Nov 38

Pulmonary infection is a frequent and serious complication following kidney transplantation. Increased susceptibility to infection is due to a decrease in the patient's immunological response caused by immunosuppression through drug administration, and by other influences. The majority of bacterial sources are gram-negative, often hospital strains. The most important gram-positive bacterium is Staphylococcus aureus. Lung tb occurs with a 10-25 times higher frequency than in the rest of the population. Nocardial and Legionella pneumonias are no exception. Candida and Aspergillus are the most common fungus infections. They affect patients weakened by previous bacterial or virus infections. Cytomegalovirus is the most serious among the latter. The disease is usually accompanied by fever, leukopenia, thrombocytopenia and hepatitis. Pneumocystic pneumonia is characterized by a rapid progression of hypoxemia without any marked skiagraphical changes. Disseminated toxoplasmosis affects also the central nervous system simultaneously with the lungs, and the clinical picture shows a combination of interstitial pneumonia and a focal neurological finding with consciousness impairment.
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PMID:[Lung infection after kidney transplantation. I. Etiology, pathogenesis and clinical picture]. 236 54

Medical records of 11 patients with nontyphoid Salmonella pleuropulmonary disease studied from 1960 to 1986 in a general hospital were reviewed. Eight patients (73%) were 60 years old or older, and the median age was in the seventh decade. There was no seasonal variation in the prevalence. The infection was hospital acquired in 4 patients (36%). All patients had one or more (median, 1.5) major underlying diseases. Seven of them had previous abnormalities of the lung or pleura. Severe immunosuppression was present in 7 cases. Pneumonia occurred in 8 patients, lung abscesses in 2, and empyema in 1. All patients with pneumonia had positive blood cultures. A gastrointestinal source of pulmonary infection was not probable because only 2 patients had positive stool cultures. We suggest that the reticulo-endothelial system could be the source of hematogenous spread of nontyphoid Salmonella. The overall mortality was 63%. Pulmonary infection due to Salmonella should be considered among the pathogens associated with gram-negative bacillary pneumonia in elderly patients who are immunosuppressed and have underlying pulmonary disease. Pathogenesis of this infection remains to be clarified.
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PMID:Pleuropulmonary infections due to nontyphoid strains of Salmonella. 198 97

During a winter epidemic, 87 infants were admitted to Necker-Enfants-Malades hospital with a severe respiratory syncitial virus (RSV) infection. These infants fell into two groups: 37 infants without any medical history and 50 showing an underlying pathology (immune deficiencies, heart disease, CNS disorders, digestive malformations, allergic manifestations). Of the 37 infants with no medical history, most were below the age of 6 months and the RSV infection was manifested clinically by bronchiolitis or bronchitis. Most of the infants in the other group were more than 6 months of age and presented mostly with pneumonia or bronchiolitis. A respiratory distress syndrome was observed in 17 of the 87 infants, and virtually all of them were younger than 6 months. No significant difference was observed between the two groups with regards to the incidence of respiratory distress. Pulmonary infections complicating the course of the illness, most often due to commensal flora bacteria of the upper respiratory tract, were observed in 19 infants but with no greater frequency in the group at risk. Direct detection of viral antigens in nasopharyngal secretions not only enabled rapid diagnosis in all the infants but also allowed antiviral therapy to be started rapidly. Antiviral treatment by ribavirine, administered over a period of 5 days in 20 mg/ml doses by aerosol was instituted in 10 patients whose course might have become serious. In 8 of these patients, disappearance of the virus from secretions and recovery occurred. Two patients in the group at risk died despite treatment, with one case being considered a true therapeutical failure since the virus was still present in nasopharyngeal secretions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Severe respiratory syncytial virus infections. Study of 87 infants hospitalized in an epidemic]. 240 74


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