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

In July-August 1989, 2 primary health care (PHC) workers (nurses and nurse's assistants) and a pediatrician used WHO case management protocol to assess the conditions of 362 2-59 month old children who came to Mbabane Government Hospital and the Salvation Army Clinic in Mbabane, Swaziland, with coughing (99%) and difficulty in breathing (29%). The PHC workers had earlier undergone a 5-day training period on identifying signs and symptoms of pneumonia. A consulting pediatrician and a public health official conducted this study to compare the ability of the PHC workers to recognize the clinical signs of pneumonia with that of the pediatrician (gold standard). 64% of the children had a history of fever, but only 12% had a fever (38.3 degrees Celsius) at admission. 4 children had had convulsions. The PHC workers did not do well at recognizing the danger signs of stridor and abnormal sleepiness (sensitivity 50% and 0-14%, respectively). They were able to correctly recognize the danger sign of severe undernutrition in 2 children, however. They correctly identified most children with true fever (sensitivity 73-76%), yet they also claimed that many children with normal temperature had a fever (specificity 62-78%). Thus they would have administered antipyretics to 2-3 times too many children. The nursing assistants detected audible wheeze in only 4 of 14 children with audible wheeze (sensitivity 29%), while the nurses only detected 2 such children (sensitivity 14%). Further, they diagnosed audible wheeze in 18 children who actually had blocked nostrils. They correctly identified fast breathing in almost 75% of cases. Nurses were more likely to correctly diagnose chest wall indrawing than the nursing assistants (sensitivity 68% vs. 34%; p = .0048). Overall, the training helped the PHC workers to diagnose pneumonia quit well (sensitivity 71-83%, specificity 84-85%). Future training programs must focus on recognition of 2 danger signs, stridor and abnormal sleepiness, however.
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PMID:Recognition of pneumonia by primary health care workers in Swaziland with a simple clinical algorithm. 136 98

Complement evaluation was performed in two patients with active eosinophilic pneumonia and in one in remission, to determine the role of complement activation in the pathogenesis of this disorder. All three had cough, dyspnea, malaise, and blood eosinophilia; two patients also had pyrexia. In all 3 cases the pulmonary eosinophilic infiltrates (radiographic findings) and symptoms responded rapidly to steroid administration. The two patients with active eosinophilic pneumonia showed elevated CR3 but reduced FcrR on the PMN before and during steroid administration. In contrast PMN from four patients with bronchial asthma exhibited slightly elevated expression of both CR3 and FcrR during their asthma attack. It is suggested that clinical symptoms disappear soon after the beginning of steroid but changes of complement receptors on PMN may last for longer periods. On the basis of the combined results, this study indicates that estimation of complement activation may provide a useful indicator for disease activity in patients with eosinophilic pneumonia of unknown etiology.
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PMID:Evaluation of complement in patients with eosinophilic pneumonia. 138 33

Seven patients (mean age, 50.7 +/- 20.4 years; range 21-77) with plasma cell granuloma (PCG) of the lung are reported. Cough and sputum were the most common presenting symptoms, followed by fever. Elevated erythrocyte sedimentation rate and serum C-reactive protein levels were found in all patients tested. Radiologically, five cases presented as solitary, well-circumscribed masses and two as ill-defined, pneumonia-like densities. One showed focal calcification. No predilection of occurrence was observed in either lobe of the lung. Histologically, the lesions consisted of a proliferation of mature plasma cells and reticulo-endothelial cells supported by a stroma of granulation tissue, with varying degrees of myxoid change or collagenization. Angioinvasion within the lesion was observed in 4 of the 7 cases. Immunohistochemical staining revealed the IgG-predominant polyclonal nature of the plasma cells, indicating a reactive inflammatory process rather than a neoplastic one. Electron microscopy confirmed the benign nature of the plasma cells with fibroblast and myofibroblast proliferation admixed with that of other inflammatory cells.
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PMID:Seven patients with plasma cell granuloma (inflammatory pseudotumor) of the lung, including two with intrabronchial growth: an immunohistochemical and electron microscopic study. 139 77

The clinical features, radiographic and computed tomographic findings of nine patients with histological proof of cryptogenic organizing pneumonia were analysed. Patients present with cough, dyspnoea and malaise and commonly have bilateral multifocal consolidation on chest radiography, which may show resolution or relapse with or without steroid treatment. A good response to steroids is the rule, usually with complete radiological resolution or minimal residual scarring. The relative merits of the terms cryptogenic organizing pneumonia and bronchiolitis obliterans organizing pneumonia, both currently used to describe this entity, are discussed.
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PMID:The radiology and terminology of cryptogenic organizing pneumonia. 139 93

20 cases of tuberculosis in the superior segment of the lower lobe of the lung were misdiagnosed as lung cancer, pneumonia, bronchiectasis and inflammatory pseudoneoplasm were reported. The final diagnosis were confirmed by fiberoptic bronchoscopy (FOB). The causes of the misdiagnoses were: (1) the hilar mass shadow found on the PA chest film, mistaken for central type lung cancer; (2) the mass shadow found on the lateral chest film, mistaken for peripheral lung cancer; (3) the patients with fever, cough and expectoration accompanied by exudative infiltrative shadow, mistaken for pneumonia; (4) patients with recurrent attacks of hemoptysis but the lesions overshadowed by the spinal column on the lateral chest film were misdiagnosed as bronchiectasis. The author suggested PA and lateral chest films taken simultaneously were needed. The special points, to which should be pay attention during reading the films were listed and noted. FOB examination including TBLB, brushing and BALF for pathologic and AFB determination could be of help to confirm the diagnosis.
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PMID:[The diagnosis of smear negative pulmonary tuberculosis in superior segment of lower lobe]. 139 85

One of the disabilities in patients with cerebral palsy (CP) is dysphagia. To establish the prevalence of dysphagia in a population of children with CP, and to determine if any factors are related to dysphagia, we studied 56 CP patients, 5-21 years, enrolled in a primary school for the disabled. Fifteen patients (27%) had either radiographic or clinical evidence of dysphagia. These 15 patients were compared to the remaining 41 patients without dysphagia. Using data obtained from chart review and interviews with speech pathologists, several factors that contributed to dysphagia were found. These included: bite reflexes, slowness of oral intake, poor trunk control, inability to feed independently, anticonvulsant medication, coughing with meals, choking, and pneumonia. We also noted trends in the following factors: presence of tongue thrusting, presence of drooling, severity of CP, poor head control, severity of mental retardation, seizures, and speech disorders. Factors not related to the presence of dysphagia include: subject age, cause of CP, and type of CP. Early, aggressive work-up and identification in CP patients with the risk factors outlined above can reduce the associated pulmonary complications.
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PMID:Swallowing disorders in a population of children with cerebral palsy. 139 5

A 20-year-old woman took 1.2 g of acetaminophen for toothache. She subsequently developed a dry cough, pyrexia, and dyspnea. Chest X-ray revealed diffuse reticulo-nodular shadows in both lung fields. Broncho-alveolar lavage examination showed a marked increase in the total cell number and an increase in the percentage of eosinophils, neutrophils, and lymphocytes. Because drug-induced pneumonitis was suspected, all drugs were stopped and she was administered methylprednisolone. Consequently her symptoms resolved, and pulmonary function and chest X-ray findings improved remarkably. The lymphocyte stimulation test was positive for Norshin and its acetaminophen element. Based on these findings, the diagnosis of acetaminophen-induced pneumonitis was made. Acetaminophen intoxication is well-known, but to our knowledge this is the first reported case of acetaminophen-induced allergic pneumonitis in Japan.
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PMID:[A case of acetaminophen-induced pneumonitis]. 140 11

The diagnostic value of typical symptoms and abnormal chest signs for pneumonia have been evaluated against a radiographic reference standard in 402 adult patients with respiratory tract infection in general practice. Pneumonia was diagnosed in 20 patients by a positive chest radiograph. The doctors diagnosed pneumonia in seven of these on the basis of history and physical examination alone, and in addition in 22 patients with normal radiographs. The diagnostic value of the typical symptoms cough, chest pain, and dyspnoea, reported by the patients on a questionnaire, increased with increasing intensity of the symptoms, and both "very annoying lateral chest pain" and "very annoying dyspnoea" had likelihood ratios (LR) between 4 and 5. The LR of crackles was 3.7. When evaluated against the doctor's clinical diagnosis of pneumonia as reference standard, crackles achieved an LR of 14.8, while the typical symptoms achieved lower LRs than when evaluated against the radiographic reference standard. These discrepancies, which were confirmed by logistic regression, indicate that crackles and other abnormal chest findings are interpreted too frequently as features of pneumonia and that the importance of typical symptoms is underestimated in the diagnosis of pneumonia.
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PMID:Diagnosis of pneumonia in adults in general practice. Relative importance of typical symptoms and abnormal chest signs evaluated against a radiographic reference standard. 141 Sep 55

Pneumocystis carinii pneumonitis (PCP) can occur in immunocompromised hosts, especially AIDS and cancer patients. Although recent research has focused on PCP in AIDS patients, few studies have described the clinical presentation of PCP in recipients of bone marrow transplantation (BMT). Between 1976 and 1991, of 1454 BMT patients at the University of Minnesota, PCP was documented in only 19. Eighteen of these had not been receiving PCP prophylaxis. Patients presented with a brief period (2-10 days) of symptoms including dyspnea, cough, and fever in greater than 75% of patients, but had only scant abnormal physical findings. Chest X-rays showed bilateral infiltrates in 58% of all patients, though 15% had no or minimal X-ray findings. Bronchoscopic alveolar lavage confirmed the diagnosis most often, but 13% of lavages were negative and required biopsy for the diagnosis. High dose trimethoprim-sulfamethoxazole was the initial treatment for 84% of the patients though 25% of these patients were later switched to pentamidine due to poor response or hypersensitivity reactions. Despite prompt diagnosis and therapy, overall survival was poor, with only 37% of patients surviving pneumonitis. Patients developing PCP less than 6 months post-BMT had greater mortality (89%) versus only 40% in later onset PCP (p less than 0.0001). Despite this better survival in the late-onset PCP cohort, the development of pneumonitis in these patients underscores the necessity for continued PCP prophylaxis beyond 1 year in some patients. Ongoing immunocompromise and need for prophylaxis should be appreciated in patients with graft-versus-host disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pneumocystis carinii pneumonitis following bone marrow transplantation. 142 81

Pneumonia is one of the most serious infections in elderly persons. For example, individuals with nursing-home acquired pneumonia requiring hospitalization have a mortality rate of approximately 40%. In the frail, elderly patient, the clinical manifestations may be very nonspecific and consist only of confusion and falls; these individuals often may not present with either fever or cough. Sputum is frequently not available for culture in this population, and chest radiography for pneumonia may be confounded by underlying pulmonary or cardiac disease. Antibiotic therapy for pneumonia in older patients must often be empirical.
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PMID:Pneumonia. 142 31


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