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

Jessica, a 14-year-old girl with a history of asthma, went to her pediatrician's office because of a persistent cough. She had been coughing for at least 3 months with occasional cough-free periods of less than a few days. The cough was nonproductive and was not accompanied by fever, rhinorrhea, or facial or chest pain. Jessica and her mother observed that the cough increased with exercise and typically was not present during sleep. She has used two metered-dose inhalers--albuterol and cromolyn--without any change in the cough pattern. For the past 5 years, Jessica has had mild asthma responsive to albuterol. She enjoys running on the cross-country team, soccer, and dancing. She is an average student and denies any change in academic performance. She has never been hospitalized or had an emergency department visit for asthma or pneumonia. There has been no recent travel or exposure to a person with a chronic productive cough, tobacco smoke, or a live-in pet. Jessica lives with her mother and younger sister in a 10-year-old, carpeted apartment without any evidence of mold or recent renovation. In the process of taking the history, the pediatrician noticed that Jessica coughed intermittently, with two or three coughs during each episode. At times, the cough was harsh; at other times, it was a quiet cough, as if she were clearing her throat. She was cooperative, without overt anxiety or respiratory distress. After a complete physical examination with normal findings, the pediatrician interviewed Jessica and her mother alone. Jessica's parents had been divorced for the past 6 years. She lived with her mother but visited her father, and his new family with two young children, every weekend. She spoke about this arrangement comfortably and said that she loved her father and mother but didn't like the tension she experienced at her father's home. "I don't like adults arguing when kids are around." When asked why she thought the cough persisted so long, she commented in a neutral tone, "I don't know. It's never been like this before." Jessica's pediatrician prescribed an inhaled steroid with the albuterol. When the cough did not respond after 1 week, he ordered a chest radiograph (normal) and a tuberculin skin test (purified protein derivative-negative), and he added montelukast (a leukotriene inhibitor) and monitored airway resistance with a peak flow meter. The cough persisted, and the peak flow recording showed normal airway resistance. At this time, Jessica's pediatrician suspected a conversion reaction and contemplated the next best therapeutic strategy.
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PMID:Persistent cough in an adolescent. 1060 74

Chlamydia pneumoniae is a common cause of pneumonia worldwide. This study examined the role of C. pneumoniae in 229 patients with community-acquired pneumonia. The ages of the patients ranged from 2 to 95 years. Sera were assayed for IgM and IgG antibodies with microimmunofluorescence (MIF). An IgM titer equal to or greater than 1:20 and IgG titer equal to or greater than 1:64 were considered positive. The prevalence of positive IgG among all of the patients was 75.1% (172/229). The seroprevalence was 81.8% (9/11) for patients in the 11- to 20-year-old group, 63.6% (14/22) in the 31- to 40-year-old group and 88.1% (52/59) in the 71- to 80-year-old group. All patients had a negative result for IgM antibody. Twenty-five of the patients had an IgG titer equal to or greater than 1:512, indicating the presence of current infection or reinfection. Age older than 60 years (vs. < or = 60 years) was a risk factor for C. pneumoniae seropositivity in patients with community-acquired pneumonia (p < 0.001). Males had a significantly higher seroprevalence of C. pneumoniae infection (p = 0.1010). Patients older than 60 years were more likely to have C. pneumoniae infection (p = 0.1107). In this series, C. pneumoniae infection accounted for 10.9% (25/229) of community-acquired pneumonia. The most common clinical manifestations included fever (92%), productive cough (52%), white blood cell more than 10,000/mm3 (56%), and bilateral pulmonary infiltrate (60%).
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PMID:Chlamydia pneumoniae infection in community-acquired pneumonia in Taiwan. 1080 62

Mycobacterium fortuitum was isolated in a sample of bronchial fluid collected by transtracheal aspiration from a 1-year-old Corgi dog with a productive cough of 10 days' duration and with radiographic and cytological features of acute suppurative bronchopneumonia. The dog responded favourably to intravenous gentamicin and cephalexin for three days and a six week course of oral ciprofloxacin. Saprophytic mycobacterial pneumonia should be considered in cases of severe pulmonary consolidation in young dogs.
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PMID:Acute bronchopneumonia associated with Mycobacterium fortuitum infection in a dog. 1084 May 71

An 82-year old man was admitted with dyspnea, productive cough and wheezing. In addition to antibiotics (meropenem trihydrate 0.5 g/day), glucocorticoids (hydrocortisone 1.250 mg, methylpredonisolone 4.250 mg) were administered for the severe bronchospasms. Since his respiratory condition deteriorated, he underwent mechanical ventilation using a muscle relaxant (vecuronium bromide, total dose 776 mg) in combination with high dose glucocorticoid. As his pneumonia improved on the 10th hospital day, we started weaning him from the ventilator. However, we were unable to complete weaning from the ventilator because of prolonged quadriplegia and paralysis of the respiratory muscles. A few days later, myoglobinuria appeared. Electrophysiological examinations suggested the involvement of both neuromuscular junctions and muscles. Muscle biopsy showed rhabdomyolysis. Acute necrotizing myopathy was diagnosed due to high doses of glucocorticoid, muscle relaxant, or both. He required about 3 months to be weaned from the mechanical ventilation, and another 3 months to leave the hospital. Based on our experience, we should consider acute myopathy as an adverse effect of glucocorticoids, muscle relaxants or both in elderly patients who require mechanical ventilation.
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PMID:[A senile case of acute necrotizing myopathy presenting prolonged severe muscle paralysis due to high dose glucocorticoid and muscle relaxant]. 1087 76

Community acquired pneumonia (CAP) is defined as pneumonia acquired outside of the hospital setting. Extensive studies of CAP in adolescents that characterize the true incidence of various etiologic pathogens are not available. However, Streptococcus pneumoniae, Mycoplasma pneumoniae, and Chlamydia pneumoniae appear to be the most frequently encountered pathogens. These organisms often cause CAP in adults as well; other infections are noted as well, including Legionella. "Atypical pneumonia" refers to pneumonia not presenting with the usual clinical picture of pneumococcal infection (which includes high fever, productive cough, chills, and other "classic" features). The term is frequently used in adolescents with CAP. However, this classification may not help in individual patients, who often show a high degree of variability in the clinical presentation of pneumonia; also it does not always predict microbial cause. There is currently a trend away from the concept of atypical pneumonia syndrome and more discussion of atypical pathogens as commonly causes of CAP. This article reviews recent literature on CAP with special emphasis on its diagnosis and management in adolescent patients.
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PMID:Community-acquired pneumonia in adolescents. 1106 May 62

A 58-year-old man had been treated with one intravenous injection of 120 mg of nimustine hydrochloride (ACNU), ten thrice-weekly doses of 3,000,000 U of interferon beta, and brain irradiation for cerebral glioblastoma. One month later he had fever, appetite loss, a productive cough and dyspnea. Chest radiography and CT showed diffuse, nonsegmental ground glass opacity in both lung fields. Hypoxemia and lung shadows were exacerbated day by day. Bronchoalveolar lavage revealed an increases in the total cell count and the percentages of lymphocytes and neutrophils, and a decrease of the CD 4/8 ratio. Interferon beta therapy was stopped, and steroid pulse therapy and prednisolone 40 mg administration were initiated. The symptoms, hypoxemia and lung shadows quickly improved. Reported cases of interferon beta-induced pneumonia are rare.
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PMID:[A case of interferon beta-induced pneumonia]. 1110 6

We report a 63 year old white man admitted to our hospital because of fever, productive cough and a severe respiratory failure. Bronchoalveolar lavage revealed a positive microscopy for acid-fast bacilli and a four drug scheme for tuberculosis was initiated. There was no improvement in the patient's condition and mechanical ventilation was needed. A thorax CT scan disclosed images that suggested lipoid pneumonia (lower lobes involvement, hypodensity and negative sign in the angiogram). At this point the patient's relatives indicated that he was a long term user of paraffin oil for chronic constipation. Treatment with high doses of steroids was initiated and after whole lung lavage, mechanical respiratory assistance could be interrupted. We comment the association of this entity with lung infections produced by atypical mycobacteria.
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PMID:[Acute respiratory failure due to lipoid pneumonia]. 1118

A rare case of pulmonary Nocardia otitidiscaviarum (N. otitidiscaviarum) was encountered in an immunocompetent host. A 74-year-old man was admitted to our hospital with a high fever and a productive cough. His chest radiograph and CT scan revealed infiltrative shadows in the right middle and lower lung fields. Although several antibiotics (third-generation cephalosporin, minocycline, imipenem) were administered, the fever and cough persisted, and C-reactive protein remained elevated. Repeated sputum cultures showed normal flora, so a transbronchial lung biopsy and bronchoalveolar lavage (BAL) were performed bronchoscopically at the right S5. The BAL fluid contained acid-fast, branching filamentous structures. The microorganism was identified as N. otitidiscaviarum by the Research Center for Pathogenic Fungi and Microbial Toxicoses (Chiba University). Trimethoprim-sulfamethoxazole was therefore administered, but the fever continued to rise daily, and C-reactive protein remained elevated. This isolated N. otitidiscaviarum showed resistance to multiple antimicrobial agents in vitro when examined by the disk diffusion method, and so, on the basis of the antibiogram, the patient was treated with clarithromycin (oral, 600 mg/day) plus amikacin (400 mg/day), which proved successful. Testing for pulmonary nocardiosis should be added to the differential diagnosis procedures for refractory pneumonia as an opportunistic infection and for community-acquired pneumonia.
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PMID:[Pulmonary Nocardia otitidiscaviarum infection in an immunocompetent host]. 1119 19

Actinomycosis is an infectious disease caused by certain Actinomyces species. Actinomyces are Gram-positive, non-spore forming organisms characterized by obligate or facultative anaerobic rods that normally inhabit anaerobic niches of the human oral cavity. Cervicofacial, abdominal, pelvic and thoracic infections of Actinomyces are not uncommon, but endobronchial actinomycosis is rarely reported. Endobronchial actinomycosis can be misdiagnosed as unresolving pneumonia, endobronchial lipoma or malignancies. Endobronchial actinomycosis should be included in the differential diagnosis of any endobronchial mass. We report a case of a 43-year-old man who presented with a productive cough and pulmonary consolidation at the right lower lobe on chest radiograph. Fiberoptic bronchoscopy revealed obstruction of the right superior segment of the lower bronchus with an exophytic endobronchial mass. Endobronchial actinomycosis was confirmed by demonstration of sulfur granules in the bronchoscopic biopsy of the mass. Intravenous administration of penicillin G followed by oral amoxacillin/clavulanic acid therapy for 3 months resulted in improving symptoms. Infiltrative consolidation on the chest X-ray was markedly decreased.
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PMID:A case of endobronchial actinomycosis. 1124 14

Nursing home acquired pneumonia (NHAP) is thought to be clinically distinct from community acquired pneumonia (CAP). This observation, based on studies conducted mainly in North America, may not be relevant in countries with a different healthcare system. The authors describe an 18-month prospective cohort study of 437 patients admitted to hospital with CAP, 40 (9%) of whom came from nursing homes. Detailed microbiological tests were performed in a subset of patients over 12 months. Patients with NHAP were less likely to have a productive cough (odds ratio (OR) 0.4, p=0.02) or pleuritic pain (OR 0.1, p=0.03), but they were more likely to be confused (OR 2.6, p<0.001). They had poorer functional status (p<0.001) and more severe disease (p=0.03). Mortality was higher compared to CAP (53% versus 13%), but this was mainly explained by prior functional status (OR 0.5, after adjustment for functional status). Pathogens were identified in 68% of 22 NHAP and 80% of 44 matched CAP patients. Streptococcus pneumoniae was the most common (55% NHAP, 43% CAP). Atypical pathogens, enteric Gram negative bacilli and Staphylococcus aureus were uncommon. In conclusion, differences in functional status accounted for the increased mortality in nursing home acquired pneumonia compared to community acquired pneumonia. The pathogens implicated were similar. No grounds for a difference in choice of empirical antibiotics were apparent.
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PMID:A prospective comparison of nursing home acquired pneumonia with community acquired pneumonia. 1152 97


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