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

Reports of the association of Mycobacterium haemophilum with disease in humans have greatly increased. At least 64 cases have now been reported, with symptoms ranging from focal lesions to widespread, systemic disease. The organism is now known to cause primarily cutaneous and subcutaneous infection, septic arthritis, osteomyelitis, and pneumonitis in patients who are immunologically compromised and lymphadenitis in apparently immunocompetent children. Underlying conditions in the compromised patients have included AIDS; renal, bone marrow, and cardiac transplantation; lymphoma; rheumatoid arthritis; marrow hypoplasia; and Crohn's disease. Reports have originated from diverse geographic areas worldwide. The epidemiology of M. haemophilum remains poorly defined; there appears to be a genetic diversity between strains isolated from different regions. The organism is probably present in the environment, but recovery by sampling has not been successful. M. haemophilum has several unique traits, including predilection for lower temperatures (30 to 32 degrees C) and requirement for iron supplementation (ferric ammonium citrate or hemin). These may in the past have compromised recovery in the laboratory. Therapy has not been well elucidated, and the outcome appears to be influenced by the patient's underlying immunosuppression. The organisms are most susceptible to ciprofloxacin, clarithromycin, rifabutin, and rifampin. Timely diagnosis and therapy require communication between clinician and the laboratory.
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PMID:Mycobacterium haemophilum: microbiology and expanding clinical and geographic spectra of disease in humans. 889 45

A recent study with isogenic strains constructed by recombinant DNA strategies unambiguously documented that a highly conserved extracellular cysteine protease expressed by Streptococcus pyogenes (group A Streptococcus [GAS]) is a critical virulence factor in a mouse model of invasive disease (S. Lukomski, S. Sreevatsan, C. Amberg, W. Reichardt, M. Woischnik, A. Podbielski, and J. M. Musser, J. Clin. Invest. 99:2574-2580, 1997). To facilitate further investigations of the streptococcal cysteine protease, recombinant proteins composed of a 40-kDa zymogen containing a C192S amino acid substitution that ablates enzymatic activity, a 28-kDa mature protein with the C192S replacement, and a 12-kDa propeptide were purified from Escherichia coli containing His tag expression vectors. The recombinant C192S zymogen retained apparently normal structural integrity, as assessed by the ability of purified wild-type streptococcal cysteine protease to process the 40-kDa molecule to the 28-kDa mature form. All three recombinant purified proteins retained immunologic reactivity with polyclonal and monoclonal antibodies. Humans with a diverse range of invasive disease episodes (erysipelas, cellulitis, pneumonia, bacteremia, septic arthritis, streptococcal toxic shock syndrome, and necrotizing fasciitis) caused by six distinct M types of GAS seroconverted to the streptococcal cysteine protease. These results demonstrate that this GAS protein is expressed in vivo during the course of human infections and thereby provide additional evidence that the cysteine protease participates in host-pathogen interactions in some patients.
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PMID:Expression and characterization of group A Streptococcus extracellular cysteine protease recombinant mutant proteins and documentation of seroconversion during human invasive disease episodes. 945 39

Twenty-one compromised neonatal foals hospitalised at the Rural Veterinary Centre (RVC) during 1993 were studied to determine i) serum gentamicin concentrations obtained when gentamicin was administered at 3.3 mg/kg bwt twice daily i.m.; ii) factors which contributed to inter-foal variation in serum gentamicin concentrations achieved and iii) clinical efficacy of gentamicin therapy in foals with confirmed septicaemia. Septicaemia was confirmed in 7 foals with positive blood cultures and suspected in 8 foals with a sepsis score > 11. Peak serum concentrations (Ps) were > 6 microg/ml in all foals and > 8 microg/ml in 60% of foals. Trough serum concentrations (Ts) were < 2 microg/ml in all foals. Factors found to produce inter-foal variation in the Ps achieved included age (< 24 h; decreased), bodyweight (< 38 kg; decreased) and severity of dehydration (8-12% bodyweight; increased). Clinical response was not associated with achievement of Ps > 8 microg/ml, but was negatively influenced by the severity of clinical signs of depression. None of the foals in this study developed septic arthritis or pneumonia during or after therapy. No serum biochemical evidence (i.e. elevated serum creatinine concentrations) of gentamicin-induced nephrotoxicity was noted during therapy.
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PMID:Serum gentamicin concentrations in compromised neonatal foals. 970 16

Haemophilus influenzae (Hi) causes a variety of severe clinical illnesses including meningitis, pneumonia, epiglottitis, and septic arthritis. In the prevaccine era (i.e., before 1988), Haemophilus influenzae type b (Hib) caused approximately 95% of the Hi invasive disease among children aged <5 years. In 1988, Hib conjugate vaccines were introduced for use among children aged 18 months-5 years; they were subsequently recommended for routine use in infants by the Advisory Committee on Immunization Practices (ACIP) in 1990. During 1989-1995, Hib invasive disease among children aged <5 years declined 95% nationally. To document the decline of Hib invasive disease and to examine the epidemiology of reported nontype b Hi invasive disease among children aged <5 years, CDC, in collaboration with the California Department of Health Services, analyzed reported cases in California from 1990 to 1996. This report summarizes the results of the analysis and documents the decline of Hib without an increase of nontype b Hi invasive disease among children aged <5 years.
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PMID:Haemophilus influenzae invasive disease among children aged <5 years--California, 1990-1996. 974 31

Streptococcus Pneumoniae infections are a common cause of bacteremia and community-acquired pneumonia in HIV-positive individuals. Bone and joint infections as a result of S. pneumoniae are extremely rare. We report the first case of S. pneumoniae septic arthritis and osteomyelitis in an HIV-positive adult patient. The patient was successfully treated with oral levofloxacin.
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PMID:Streptococcus pneumoniae septic arthritis and osteomyelitis in an HIV-seropositive patient. 991 33

Within a 6-year period from January 1991 to December 1996, 19 patients with Salmonella choleraesuis bacteremia were enrolled for clinical and microbiological analysis. Young children, the elderly and patients with hematological malignancy (36.8%), liver cirrhosis (26.3%), systemic lupus erythematosus (10.5%), chronic renal impairment (10.5%), and peptic ulcer (10.5%) were at high risk of this infection. The ratio of male to female was 3:1. Three cases (15.8%) were nosocomially acquired. Fever (89.5%), chills (57.9%) and anorexia (52.6%) were the most common clinical manifestations. Seven patients (36.8%) presented no gastrointestinal manifestations. Normal white blood cell count was noted in seven patients (36.8%), and neutropenia caused by underlying diseases or severe infection was found in six cases (31.6%). Various types of metastatic focal infections were found, such as septic arthritis, cutaneous infection, spontaneous bacterial peritonitis, and pneumonia. The severe immunocompromised status of patients and the high virulence of this pathogen may contribute to the high case fatality rate (21%). Higher resistance rate to commonly used antimicrobial agents was noted in ampicillin (94.7%), chloramphenicol (89.5%), and TMP/SMZ (63.8%). All strains of S. choleraesuis were susceptible to third-generation cephalosporins and fluoroquinolones. Generally, S. choleraesuis bacteremia should be taken into account in the differential diagnosis of sepsis in immunocompromised patients, even without gastrointestinal manifestations. The third-generation cephalosporins and fluoroquinolones may be the first choice for treatment of this invasive infections.
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PMID:Salmonella choleraesuis bacteremia in southern Taiwan. 1033 Jul 99

Pneumonia and meningitis are the 2 most frequent manifestations of Streptococcus neumoniae infection. Pneumococcal septic arthritis is considered to be relatively uncommon. Between 1985 and 1998, 32 (8. 2%) of 389 cases of septic arthritis seen in the 2 hospitals in Nottingham, United Kingdom, were due to S. pneumoniae. Six of 7 children with pneumococcal septic arthritis were aged <2 years. Of the 25 adults, 20 (80%) were aged >60 years, 11 (44%) had concomitant pneumococcal infection elsewhere, and 23 (92%) had articular or nonarticular diseases and/or other risk factors. In the elderly, a lack of febrile response was striking. S. pneumoniae was isolated from blood and joint cultures in >70% of cases, and gram-positive diplococci were seen in the joint fluids of 90% of patients. The mean duration of antimicrobial therapy for adults was twice as long as that for children. Eight (32%) of the adults died.
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PMID:Septic arthritis due to Streptococcus pneumoniae in Nottingham, United Kingdom, 1985-1998. 1058 94

Twenty-three cases of systemic pneumococcal infection diagnosed from October 1988 to September 1998 were analyzed retrospectively in order to characterize the epidemiology of systemic pneumococcal infections. The clinical diagnosis of those cases were 8 pneumonia, 8 meningitis, 3 septicemia, 3 septic arthritis, and 1 peritonitis. The patients ranged in age from 6 months to 21 years old (mean +/- SD = 3 years, 6 months +/- 5 years, 2 months), and 61% of the patients were younger than 24 months. Resistance to penicillin G (PCG) was detected in 57% of all cases. Resistance to cefotaxime (CTX), imipenem (IPM), erythromycin (EM), and clindamycin (CLDM) was 33%, 9%, 70%, and 65%, respectively. Of the 13 isolates resistant to PCG, 2 were resistant to IPM, 11 to EM and 11 to CLDM. Serotyping was performed on 17 isolates. The identified serotypes were 19 (6 isolates), 6 (5 isolates), 23 (3 isolates), 14 (2 isolates), and 5 (1 isolate). Eleven isolates resistant to PCG were limited to serotypes 6, 19, or 23. One patient had a recurrent episode of bacteremic pneumonia 7 months after the first episode. Streptococcus pneumoniae isolates from both episodes were compared by serotyping and pulsed-field gel electrophoresis with restriction digestion, and were confirmed as the same strain.
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PMID:Characterization of Streptococcus pneumoniae strains isolated from systemic infections in children. 1069 87

The purpose of this study was to determine the applicability of two accepted outpatient management protocols for the febrile infant 1-2 months of age (Boston and Philadelphia protocols) in febrile infants 1-28 days of age. We retrospectively reviewed charts of patients 1-28 days of age with a temperature greater than or equal to 38.0 degrees C. Criteria from each of the above-cited management protocols were applied to the patients to determine their applicability in screening for serious bacterial infection (SBI). An SBI was defined as bacterial growth in cultures from blood, urine, cerebrospinal fluid (CSF), stool, or any aspirated fluid. Overall, 372 febrile infants were included in the study. Ages ranged from 1 to 28 days of age. The mean age was 15 days. SBI occurred in 45 patients (12%). The mean age of the patients with an SBI was 13 days. Thirty-two infants (8.6%) had a urinary tract infection; 12 (3.2%), bacteremia; five (1.3%), bacterial meningitis; three (0.8%), cellulitis; one (0.3%), septic arthritis; one (0.3%), bacterial gastroenteritis; and one (0.3%), pneumonia. Ten infants had more than one SBI. Of 372 patients, 231 (62%) met the Boston's laboratory low-risk criteria; eight (3.5%) would have been sent home with an SBI with these criteria. Philadelphia's laboratory low-risk criteria would have been met by 186 patients (50%); six (3.2%) would have been sent home with an SBI with these criteria. The negative predictive value of both the Boston and Philadelphia protocols for excluding an SBI was 97%. We conclude that current management protocols for febrile infants 1-2 months of age when applied to febrile infants 1 to 28 days of age would allow 3% of febrile infants less than 28 days of age to be sent home with an SBI. Current guidelines recommending admitting all febrile infants less than 28 days of age should be followed until the outcome of those 3% of febrile infants with an SBI treated as outpatients can be determined.
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PMID:Applying outpatient protocols in febrile infants 1-28 days of age: can the threshold be lowered? 1069 44

Haemophilus influenzae is a small, nonmotile, non-spore-forming bacterium, and a strict parasite of humans found principally in the upper respiratory tract. The production of capsule is of major significance to clinicians since it is an important virulence factor. We described six antigenically distinct capsular types, designated a-f. Spread from one individual to another occurs by airborne droplets or by direct contagion with secretions. Haemophilus influenzae produces at least two factors that inhibit the ciliary activity of human epithelial cells in vitro. One of this has been shown to be lipopolysaccharide and the other factor is of low molecular weight, most likely a heat-stable glycopeptide. Type b strains are distinguished by the production of capsular polysaccharide composed of repeating units of ribosyl-ribitol phosphate, account for greater than 95 percent of systemic infections in children. Two contrasting patterns of Haemophilus influenzae disease can be identified. The first and the most serious in its consequences is invasive infection such as meningitis, septic arthritis, epiglottitis, and cellulitis in which bacteremia is a prominent feature; these infections are usually caused by type b strains and occur in young children. The second category includes less serious but numerically more common infections, that occur as a result of contiguous spread of Haemophilus influenzae within the respiratory tract; e.g. otitis media, sinusitis. These latter infections are usually, but not invariably, caused by unencapsulated strains. A provisional diagnosis of meningitis, epiglottitis, facial cellulitis, or septic arthritis will usually be prompted by the history and clinical findings. Confirmation requires microbiologic studies. Cultures of blood, CSF and other normally sterile fluids are diagnostic and therefore under the appropriate circumstances mandatory. Whenever feasible, specimens obtained for culture should also the gram-strained. Detection of capsular antigen in serum, CSF or concentrated urine using immunoelectrophoresis, latex agglutination or enzyme linked immunosorbent assay may be diagnosed and can be found in up to 90 percent of culture proved cases of meningitis. Without treatment, infection due to Haemophilus influenzae can be rapidly fatal, particularly by meningitis and epiglottitis. There is currently a trend to use certain parenteral third generation cephalosporins as initial therapy when lifethreatening Haemophilus influenzae infection is known or suspected in children beyond the neonatal period, commonly used agents included cefotaxime or ceftriaxone. Antibiotic therapy is only one facet of the management of the child with Haemophilus influenzae infection, and critical attention must also be given to supportive therapy. In the ambulatory setting, ampicillin or amoxicillin for 10 days is often satisfactory for the less severe Haemophilus influenzae infections. Cephalosporins are often chosen for treatment of adults, with pneumonia when Haemophilus influenzae is documented.
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PMID:[Clinical manifestations, diagnosis and treatment of Haemophilus influenzae infection]. 1089 74


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