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

We described three septicemia cases in which blood cultures yielded gram-positive cocci identified as Leuconostoc spp. and Pediococcus spp. Patients were three male adults aged 63 to 71 years with severe underlying diseases, pancreatic cancer, esophageal cancer and diabetes mellitus with chronic renal failure. They had fever and chills at the onsets of septicemia with acute obstructive suppurative cholangitis, acute pneumonia, and infection complicated with invasion sites of esophageal cancer contagious to bronchus and subcutaneous tissue. Blood cultures yielded catalase and oxidase negative highly vancomycin-resistant (MIC: 1024 micrograms/ml <) gram-positive cocci showing alpha or gamma hemolysis on blood agar plates. Two cases were polymicrobial infections. In one case with esophageal cancer, clinical symptoms persisted after the start of antimicrobial chemotherapy and the patient died 10 days later associated with complications of esophageal cancer. Leuconostoc lactis, Leuconostoc mesenteroides subsp. dextranicum, and Pediococcus acidilactici wee identified by physiological reactions. These strains were also highly resistant to teicoplanin and fosfomycin, and tolerant to all rested beta-lactams such as benzylpenicillin. This is the first report in Japan to our knowledge on the identification of Leuconostoc spp. and Pediococcus spp. isolated from human infectious diseases.
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PMID:[Microbiological and clinical studies of vancomycin resistant Leuconostoc spp. and Pediococcus spp. isolated from septicemia patients]. 796 99

A 35-year-old homosexual man who had a remote history of cocaine abuse presented to the hospital with fever, chills, drenching night sweats, and progressive dyspnea of 3 months' duration. His condition had been diagnosed as AIDS 1 1/2 years before presentation. Multiple blood cultures and serological tests failed to yield an infective etiology. Bronchoscopy with transbronchial biopsy, both performed twice, also failed to reveal an etiology. Empirical treatment for infection with the Mycobacterium avium complex yielded no response; empirical treatment, based on abnormalities revealed by gallium scanning, for Pneumocystis carinii pneumonia led to some clinical improvement. Because of rapid respiratory deterioration at the end of this treatment course, a thoracoscopic lung biopsy was performed; this procedure demonstrated classic bronchiolitis obliterans organizing pneumonia. Corticosteroid therapy resulted in a rapid salutary response. It is important to aggressively pursue a definitive diagnosis for selected patients with a nonidentifiable infectious cause so that patients receive the correct treatment.
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PMID:Bronchiolitis obliterans organizing pneumonia in a patient with AIDS. 808 53

Pneumonias are inflammatory diseases of the lung parenchyma, infection is one of possible causes. With regard to the causes of community acquired pneumonias it is possible to distinguish those typical ones (caused by pneumococcus, legionella and other bacteria) and atypical ones (caused by mycoplasma, chlamydiae and others). Contrary to the atypical ones, typical pneumonias are characterized by sudden onset, high fever, chills, sometimes bloody expectoration and pains, as well as segmental or lobar changes and high leukocyte counts. Patients with tachycardia, diastolic blood pressure below 60 mm Hg and a blood urea nitrogen (BUN) of more than 7 mmol/l, as well as those with chronic basic diseases and a severe course should be hospitalized, further also those, who do not improve after 2 or 3 days therapy, in all cases of suspected pneumonia, with smokers and with patients aged over 40 years, a thorax X-ray should be executed. Typical pneumonias should be treated with penicillin or macrolide antibiotics, atypical ones with macrolide antibiotics, pneumonias with severe course additionally with a second generation cephalosporin. Where these simple rules are observed, a reduction of the still high mortality due to externally acquired pneumonias might be expected.
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PMID:[Community-acquired pneumonia]. 812 27

The authors review 35 cases of acute pneumonia (AP) in 30 patients with multifocal cancer. As a rule, AP was focal, ran a moderate or severe course, arose acutely with high temperature, chill, cough, purulent discharge. Auscultation registered weak vesicular breath, moist rale. Among pathological agents prevailed associations of pneumococci with gram-negative flora. AP resolved for 3-4 weeks in 2/3 of the patients, the rest of them developed lingering disease. From the point of view of antibacterial drugs efficacy, wide-spectrum drugs are preferable.
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PMID:[Acute pneumonia in patients with multiple primary malignant neoplasms]. 829 35

A 65-year-old man was admitted to our hospital because of syncope, hyperthermia and urinary disturbance. Neurological examination revealed cerebellar ataxia, muscular rigidity, hyperreflexia with Babinski sign in both sides, and various autonomic dysfunctions including anisocoria, orthostatic hypotension and neurogenic bladder. He was diagnosed as having Shy-Drager syndrome (SDS). Oral administration of L-threo-3,4-dihydroxyphenyl-serine (L-DOPS) (300 mg/day) was started for orthostatic hypotension. After discharge he suffered from pneumonia at his house, and he kept himself warm because of a chill. The patient then fell into hyperthermia (44.0 degrees C), resulting in unconsciousness and a state of shock. He was transferred to our hospital again and was treated by body cooling and drip infusion of dopamine after which he recovered completely within one day. Control of body temperature and blood pressure was examined by heat loading and head-up tilt after heat loading, with or without administration of L-DOPS. These examinations showed that his rectal body temperature rose easily during heat loading and that this phenomenon was enhanced by the administration of L-DOPS. Moreover as his body temperature became higher, he more easily developed syncope due to orthostatic hypotension. It is suggested that in SDS patients, L-DOPS facilitates orthostatic hypotension and syncope in high temperature conditions.
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PMID:[Hyperthermia in a Shy-Drager syndrome patient--pathophysiological effects of body temperature and L-DOPS on orthostatic hypotension]. 833 78

Lidocaine-induced seizures have been reported after topical administration. A 30-year-old, 48-kg women with acquired immunodeficiency syndrome, chronic end-stage renal failure, anemia, congestive heart failure (CHF), cardiomyopathy, and increased liver function tests was admitted to the hospital with fever, chills, and dry cough. Bronchoscopy was performed to rule out Pneumocystis carinii pneumonitis; the patient experienced seizure activity after administration of a total dose of topical lidocaine 300 mg. Plasma drug concentration measured shortly after seizure, and at 4 and 22 hours after seizure were 12.0, 7.6, and 1.4 mg/L, respectively. A direct correlation exists between clinical symptoms and blood level of lidocaine; as the level increases to 8-12 mg/L the probability of seizure increases. The extent of absorption and bioavailability after airway administration depends on tissue vascularity, sites and techniques of application, patient's disease state, and, most important, the dose/unit body weight. The lidocaine dose should be titrated slowly and patients monitored for altered mental status. The dose often has to be decreased empirically in patients with liver disease or CHF. Efforts should be made to deliver minimum amounts of the drug to the lower respiratory tract, since its pharmacokinetics at that site are similar to those with intravenous administration.
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PMID:Seizure after lidocaine for bronchoscopy: case report and review of the use of lidocaine in airway anesthesia. 843 71

The efficacy and tolerance of a new amphotericin B lipid emulsion (AmB-IL) in which amphotericin B was diluted in a lipid solution for parenteral nutrition (Intralipid) was assessed in fourteen episodes of candidaemia occurring in neutropenic patients. The strains isolated were Candida krusei (nine cases), Candida albicans (three cases), Candida parapsilosis (one case) and Candida lusitaniae (one case). An AmB-IL was administered at a mean dosage of 1.18 mg/kg/day (range 0.73-1.55) for 22 days (range 6-62). Flucytosine was added to AmB-IL in 12 patients (mean duration 10.6 days). Chills were noted in only 3/306 infusions of AmB-IL. A mild increase of serum creatinine level from 9.3 +/- 3 mg/L (baseline) to 10.9 +/- 3 mg/L (after completion of AmB-IL) and mild decrease of creatinine clearance from 83 +/- 28 mL/min to 56 +/- 21 mL/min were observed. These changes did not correlate with either daily or total dose of AmB-IL or length of therapy. Seven patients were cured and six improved (patients who subsequently died due to nonfungal cause) with AmB-IL. One patient died due to C. krusei pneumonia. In conclusion AmB-IL is a well-tolerated method of amphotericin B administration. It could facilitate the use of amphotericin B without impairing its efficacy for the treatment of candidaemia in neutropenic patients.
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PMID:Efficacy and tolerance of an amphotericin B lipid (Intralipid) emulsion in the treatment of candidaemia in neutropenic patients. 844 59

We report a case of ceftazidime-induced pneumonitis. A 76-year-old man had been treated with cefotiam for acute pneumonia; however, he developed a high fever. On November 8, 1991, cefotiam was changed to ceftazidime and S-sulfonated human immunoglobulin. The patient showed good improvement. Four days after commencement of ceftazidime therapy, he developed chills, rigors, and high fever, with interstitial infiltrates in the right lung of his chest X-ray. On physical examination, small bubbling and crepitant rales were heard at the right lung. Once ceftazidime therapy was discontinued, he showed rapid resolution of symptoms and marked regression of the pulmonary infiltrates in the right lung of his chest X-ray. In view of the above, ceftazidime-induced pneumonitis was considered to be the diagnosis in this case. To our knowledge, there has been no previous case report of pulmonary hypersensitivity to ceftazidime. Clinicians should be alerted to the possibility of the occurrence of such a complication in patients being treated with ceftazidime.
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PMID:[A case of ceftazidime-induced pneumonitis]. 851 26

Amphotericin B colloidal dispersion (ABCD; Amphocil) was evaluated in a phase I dose-escalation study in 75 marrow transplant patients with invasive fungal infections (primarily Aspergillus or Candida species) to determine the toxicity profile, maximum tolerated dose, and clinical response. Escalating doses of 0.5-8.0 mg/kg in 0.5-mg/kg/patient increments were given up to 6 weeks. No infusion-related toxicities were observed in 32% of the patients; 52% had grade 2 and 5% had grade 3 toxicity. No appreciable renal toxicity was observed at any dose level. The estimated maximum tolerated dose was 7.5 mg/kg, defined by rigors and chills and hypotension in 3 of 5 patients at 8.0 mg/kg. The complete or partial response rate across dose levels and infection types was 52%. For specific types of infections, 53% of patients with fungemia had complete responses, and 52% of patients with pneumonia had complete or partial responses. ABCD was safe at doses to 7.5 mg/kg and had tolerable-infusion-related toxicity and demonstrable antifungal activity.
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PMID:Phase I study of amphotericin B colloidal dispersion for the treatment of invasive fungal infections after marrow transplant. 862 74

Pseudomonas pickettii is a nonfermenting gram negative rod closely related to Pseudomonas aeruginosa that rarely causes human disease. We describe a case of P pickettii pneumonia in a 41-year-old diabetic patient. Two months prior to admission, patient was treated for a methicillin resistant Staphylococcus aureus pneumonia. Present illness started 2 days prior to admission with fever, chills, pleuritic chest pain, and productive cough. Chest x-ray showed a right lower lobe infiltrate with effusion. Thoracocentesis of the right chest brought a transudative fluid. P picketii was isolated from pleural fluid and blood. The patient was initially treated with aztreonam and piperacillin and therapy was changed to ampicillin according to sensitivity results. The pneumonia resolved after 10 days of antibiotic therapy. Our case is the first reported case of P pickettii pneumonia. P pickettii has been reported to cause nosocomial bacteremias associated with contaminated intravenous products and airway colonization from contaminated respiratory therapy solution. Our patient most likely had oropharyngeal colonization with P pickettii during his previous hospitalization. His underlying illnesses might have predisposed him to aspiration and development of P pickettii pneumonia. This case emphasizes the central role of the microbiology laboratory in the proper identification and sensitivity reporting in the management of respiratory infections caused by unusual organisms, such as P pickettii.
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PMID:Pseudomonas pickettii pneumonia in a diabetic patient. 877 13


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