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

Twenty-four cancer patients with diffuse interstitial pneumonitis (DIP) were randomized to undergo an open lung biopsy (OLB) within 8 hours of presentation (12 patients) or to receive empiric antimicrobial therapy (ET) with trimethoprim-sulfamethoxazole (TMP-SMX) erythromycin for a minimum of 4 days (12 patients). Patients whose condition deteriorated underwent an OLB on day 4. Eight of 12 patients (67%) having OLB survived versus 10 of 12 (83%) receiving ET (P = .64). Morbidity occurred in nine of 12 (75%) having OLB versus eight of 12 (67%) receiving ET (P = 1.0). Concurrently, there were 14 additional cancer patients with DIP who were not randomized (nine refused, three had a coagulopathy contraindicating surgery, two were excluded by primary care physicians) and who were comparable demographically to the randomized group. Two received OLB and 12 ET. Combining the randomized and nonrandomized groups, eight of 14 (57%) having an initial OLB survived versus 18 of 24 (75%) of ET-treated patients (P2 = .19). Results of the OLB were seven Pneumocystis carinii pneumonia (PCP), five nonspecific pneumonitis (NSP), one cytomegalovirus, and one lymphoma. Results of OLB led to discontinuation of antibiotics in three patients. Of the 24 ET patients, eight failed to improve by day 4 and had an OLB. Results were two NSP, two PCP, two cancer, one blastomycosis, and one Candida pneumonia. Complications were seen in 10 of 14 (72%) initial OLB patients versus 14 of 24 (58%) patients on the ET arm (P = .65). When the complication rate between patients receiving only empiric antibiotics was compared with all patients having an OLB (initially or on day 4), the difference was greater in patients undergoing OLB (37% v 72%, respectively) (P2 = .14). ET with TMP-SMX plus erythromycin and broad spectrum antibiotics in granulocytopenic patients appeared to be as successful and potentially less toxic than an OLB in this study. Although the number of patients in this study was small, these data suggest that a trial of empiric antibiotic management may be reasonable in cancer patients presenting with DIP, especially if they are nonneutropenic.
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PMID:A randomized trial of open lung biopsy versus empiric antimicrobial therapy in cancer patients with diffuse pulmonary infiltrates. 229 67

Because immunosuppression is required to control rejection, liver allograft recipients are susceptible to a variety of opportunistic pathogens. A total of 191 bronchoalveolar lavage (BAL) specimens from 89 patients (53 adults and 36 children) who underwent orthotopic liver transplantation was reviewed. One case each of cytomegalovirus (CMV), staphylococcal and Enterobacter pneumonia was diagnosed with the aid of pretransplant BAL. The pretransplant BAL in 62 patients showed rare yeasts in 24.2%; these probably represent oropharyngeal contaminants since the patients involved had no symptoms of Candida pneumonia. Among 54 patients who developed respiratory symptoms and underwent posttransplant BAL, 23 (42.6%) were infected with opportunistic pathogens, including Pneumocystis carinii (22.2%), CMV (22.2%) and herpes simplex virus (HSV) (7.4%). Frequently, infection with multiple organisms was present. Adults constituted 100% of the HSV-infected group, 69.2% of the CMV-infected group and 16.6% of the group infected with P carinii. The diagnosis of these infections was aided by a combination of cytology, microbial culture and in situ hybridization techniques. Although BAL permitted the diagnosis and treatment of opportunistic infections, high mortality (62.5%) occurred with CMV and HSV pneumonia. Further studies into methods that permit earlier diagnoses of these infections are necessary.
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PMID:Bronchoalveolar lavage in liver transplant patients. 254 52

Acute respiratory failure has a high mortality in patients with acquired immunodeficiency syndrome (AIDS). This study was undertaken to determine the etiology of acute respiratory failure and the outcome of children with AIDS and AIDS-related complex. Records of 31 children with AIDS or AIDS-related complex admitted to the pediatric intensive care unit for acute respiratory failure throughout a 46-month period were reviewed. Acute respiratory failure was due to Pneumocystis carinii pneumonia in 13, cytomegalovirus pneumonia in six, bacterial pneumonia in five, severe bacterial sepsis in four, Candida pneumonia in two, and a giant cell pneumonia in one patient. In addition, 11/19 patients with acute respiratory failure due to P carinii pneumonia or cytomegalovirus had superinfections with bacteria or Candida. Of the total of 19 primary and secondary bacterial infections, Pseudomonas aeruginosa was responsible in ten and Klebsiella pneumoniae in three children. Five children (16%) survived until pediatric intensive care unit discharge; three died within 6 months. The causes of acute respiratory failure were not significantly different in survivor and nonsurvivor groups. It is concluded that, in addition to P carinii pneumonia and cytomegalovirus pneumonia, bacterial infections (especially due to Pseudomonas and other Gram-negative organisms) are important causes of respiratory failure. The high mortality and grim ultimate prognosis seen may have implications for pediatricians attempting to identify the proper limits of medical intervention for this group of patients.
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PMID:Respiratory failure in children with acquired immunodeficiency syndrome and acquired immunodeficiency syndrome-related complex. 326 Oct 5

Between 1983 and 1985, 71 patients with the acquired immunodeficiency syndrome (AIDS) were evaluated. Pulmonary manifestations were present in 42 patients (59%). Pneumocystis carinii pneumonia (PCP) was the most common pulmonary manifestation, present in 32 patients (45%). Other pulmonary findings were cytomegalovirus pneumonia (one patient), Candida pneumonia (one patient), cryptococcal pneumonia (one patient), bacterial pneumonia (three patients), nonspecific pneumonitis (three patients), Kaposi's sarcoma (one patient), and non-Hodgkin's lymphoma (one patient). The presenting features of PCP were reviewed and in seven patients the chest X-ray and blood gases were normal at the time of diagnosis of PCP. Bronchoscopy was a safe and useful technique for obtaining specimens for diagnosis promptly, and a combination of samples obtained by bronchial washings/brushings and transbronchial biopsy was found to give a higher diagnostic yield than any single sample. Drug side-effects were common during therapy, requiring change of therapy in 16 patients. At one month after diagnosis 16% of patients with PCP had died. PCP is a common pulmonary manifestation in patients with AIDS which is treatable and has an initially favourable outcome.
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PMID:Pulmonary manifestations of the acquired immunodeficiency syndrome. 350 22

In a prospective study, 178 patients with fever > 38.4 degrees C and newly diagnosed pulmonary infiltrates underwent bronchoscopy with bronchoalveolar lavage (BAL), aspiration of bronchial secretions (BS) and, in 71 cases, protected specimen brushing (PSB). In 42/143 immunocompromised patients (haematological malignancies, n = 92; AIDS, n = 22; immunosuppressant therapy, n = 29) and in 4/35 patients with no defined underlying disease fungal pneumonia was present (candidosis, n = 35; aspergillosis, n = 8 mixed fungal infection, n = 3). Candidosis was combined, in 17 cases, with Aspergillus (n = 3), bacterial (n = 15) or cytomegalovirus (n = 2) infection. Aspergillosis was combined in eight cases with infection with Candida (n = 3), Pneumocystis carinii (n = 1) or bacteria (n = 5). The sensitivity of BAL and PSB in Candida pneumonia was 48% and 50%, respectively; specificity was 75% and 74% respectively. Bronchial secretions were more sensitive in detecting Candida pneumonia, but specificity was only 55%. In aspergillosis, the specificity of BAL, BS and PSB in each case was 100%; the sensitivity of BAL, BS and PSB was 38%, 64% and 100%. Twenty-four fungal infections were fatal. Unfavourable prognostic factors were respiratory failure needing mechanical ventilation, diffuse bilateral pulmonary infiltrates, mixed fungal infections and start of i.v. antifungal treatment > 14 days after fever onset, which were associated with a mortality rate of 74%, 67%, 67% and 63% respectively.
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PMID:Pulmonary fungal infections in immunocompromised patients: incidence and risk factors. 774 91

A 24 week gestation survivor of congenital Candida pneumonia who received prompt antifungal treatment and modern neonatal intensive care is reported. It was an unusual case in that fungal chorioamnionitis occurred without a foreign body in the maternal genital tract. Early diagnosis and treatment of congenital fungal pneumonia was possible because of prior knowledge of the obstetric history. Amphotericin B was successfully used for the treatment of this condition but combination with fluconazole (a fungistatic agent) was unsatisfactory and may be undesirable. Dexamethasone therapy to assist extubation was instituted once the fungal infection had been successfully controlled.
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PMID:Congenital Candida pneumonia in a preterm infant. 786 75

The study included 6 children (aged 4-14 years) receiving a conditioning regimen for bone marrow transplantation (BMT) and 14 children (aged 2 14 years) with bone marrow transplants (13 allogeneic, 1 autologous). The children underwent flexible fibre-optic bronchoscopy (FFB) with bronchoalveolar lavage during 6 and 17 episodes of pneumonia, respectively. The aim was to compare the results of the two groups with respect to bronchoscopy findings, pneumonia-causing agents and outcome. During the conditioning regimen, the aetiological agents were recovered by bronchoscopy in 1/6 (17%) episodes and revealed by autopsy in another episode. In three episodes where the aetiology was uncertain, bacterial pneumonia was suspected in two, and Candida pneumonia in one. In episodes after transplantation the aetiological agents were recovered from bronchoscopy material in 14/17 (82%) patients. Autopsy confirmed the premortal diagnosis in the four children who died. In three episodes, bacterial pneumonia was clinically suspected. Based on clinical manifestations, FFB and autopsy findings, bacterial and fungal pneumonia were the most common diagnoses both during conditioning and after BMT. Fungal pneumonia was the most common cause of death in both groups.
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PMID:Fungal pneumonia: the predominant lung infection causing death in children undergoing bone marrow transplantation. 864 44

The occurrence of community-acquired pneumonia due to yeast-like fungi of the genus Candida in patients without manifest immunodeficiency has previously been discounted. However, such pneumonias may indeed occur in patients with chronic parenchymal lung damage, e.g. from nicotine. Candida pneumonia can be triggered in these patients for example by trivial viral infections. Three corresponding cases are discussed.
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PMID:[Candida pneumonia in patients without definitive immunodeficiency]. 1269 Sep 66

Primary Candida pneumonia is rare, and detailed reports of Candida glabrata pneumonia have not been described. A 71-year-old woman had been treated for heart failure and developed aspiration pneumonia, which was refractory to antibacterial treatment. Antifungal treatment against C. glabrata resulted in resolution of pneumonia and candidemia. We report a probable case of C. glabrata pneumonia.
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PMID:A probable case of aspiration pneumonia caused by Candida glabrata in a non-neutropenic patient with candidemia. 1635 60

A 54-year-old alcoholic woman developed fulminant community-acquired pneumonia. Despite receiving intensive support measures, she died four days after admission. An autopsy revealed bronchopneumonia with clusters of pseudohyphae and yeast-like fungi, and Candida albicans was isolated from both tracheal aspiration specimens obtained on admission and the postmortem lungs. The absence of vessel invasion or any other organ involvement led to a diagnosis of primary Candida pneumonia secondary to aspiration, rather than pulmonary seeding from systemic infection. Candida species isolated from respiratory tract samples are usually regarded as originating from colonization; however, the possibility for true Candida pneumonia should be taken into account, even in the setting of community-acquired pneumonia.
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PMID:Fatal community-acquired primary Candida pneumonia in an alcoholic patient. 2315 24


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