Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.
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PMID:Intestinal decontamination in a polyvalent ICU. A double-blind study. 221 55

Sarcinosporon inkin, a rare skin fungus, was found to have caused progressive pneumonia in a young male with chronic granulomatous disease. Histologic sections of right upper lobe lung tissue showed clusters of globose to oblong hyalin-walled, septate, sporangia throughout the necrotic areas within the pyogranulomas. Pure cultures of S. inkin were recovered from the surgical specimen of the lung. Current status of the taxonomy of S. inkin is reviewed and clarified. Treatment of the patient with Amphotericin B and white blood cell transfusions led to clinical and radiographic response. This is the first documented case of systemic infection caused by S. inkin.
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PMID:Invasive infection with Sarcinosporon inkin in a patient with chronic granulomatous disease. 239 8

Invasive pulmonary aspergillosis is an opportunistic pneumonia which is particularly common in immuno-depressed subjects. The most frequent risk factors are the intensity and duration of leucopaenia, cytotoxic drugs and steroid therapy. In the respiratory tract, the proliferation of Aspergillus fumigatus becomes possible when there is a failure of the reticulo-endothelial system and of the polymorphonuclear leucocytes. There is no typical clinical picture: one sees an acute febrile pneumonia resistant to antibiotics. However, the radiological signs are more suggestive with nodules and bilateral infiltrates with a tendency to cavity formation and sequestration. The prognosis is clinically linked to the rapidity of diagnosis. Broncho-alveolar lavage offers a new and non-invasive diagnostic method to search for Aspergillus mycelia or specific antigens. A direct examination and culture of sputum expectoration are both insensitive and non-specific but remain useful in some patients with leukaemia in a phase of agranulocytosis. Treatment rests on Amphotericin B taken orally.
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PMID:[Invasive pulmonary aspergillosis]. 329 30

A 16-year-old diabetic patient developed Rhizopus pneumonia and was initially treated with amphotericin B for 7 days. Because of clinical deterioration of the patient, rifampin was added empirically. The patient improved clinically, and lung tissue removed surgically 8 weeks later showed no fungal elements by histopathological studies or by culture. An in vitro study of amphotericin B alone and in combination with rifampin against the isolate from the patient and 11 additional isolates of Rhizopus spp. was designed. The activity of amphotericin B in the presence of rifampin (10 or 5 micrograms/ml) increased fourfold against 9 of 10 clinical and 1 of 2 environmental isolates. Amphotericin B activity in the presence of 2 micrograms of rifampin per ml increased fourfold against 6 of 10 clinical isolates and increased twofold against an additional 3 clinical isolates. Amphotericin B in the presence of 1 microgram of rifampin per ml inhibited 9 of 10 isolates at a concentration of one-half the MIC of amphotericin B alone. These findings were confirmed by dose-response curves calculated from fungal dry weight determinations of Rhizopus spp. incubated in serial dilutions of amphotericin B combined with rifampin. These observations demonstrate in vitro, and possibly in vivo, synergy between amphotericin B and rifampin against Rhizopus spp.
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PMID:Synergistic action of amphotericin B and rifampin against Rhizopus species. 343 24

Fungal infections in neutropenic cancer patients have increased in frequency and constitute an important cause of morbidity and mortality. Empiric antifungal therapy is often administered to those patients who have failed to respond to antibacterial antibiotics. We conducted a prospective, randomized trial of amphotericin B and ketoconazole for 172 neutropenic cancer patients with presumed or proven fungal infections. Overall, amphotericin B and ketoconazole were equally effective. Amphotericin B may have been more effective than ketoconazole for the treatment of pneumonia. Also, five of eight Candida tropicalis infections treated with amphotericin B responded, whereas all eight infections treated with ketoconazole failed to respond (P = 0.03). Response rates for localized fungal infections were similar with both drugs. Ketoconazole should not be used as empiric antifungal therapy at institutions where there is a high frequency of infections caused by Aspergillus spp. or C. tropicalis because this agent lacks activity in vitro against these species.
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PMID:Amphotericin B or ketoconazole therapy of fungal infections in neutropenic cancer patients. 356 34

A case of recurrent pulmonary aspergillosis in a young girl with common variable hypogammaglobulinaemia and the treatment adopted is described. We employed the plasma-exchange, at the beginning of immunosubstitutive treatment, to provide a high serum concentration of all classes of immunoglobulins and to better control the patient's state of shock. Intravenous immunoglobulins and Amphotericin B were also given in combination with plasma-exchange, having a synergic therapeutic effect. The good condition of the patient, despite the recurrent episodes of fungal pneumonia, suggests that such an approach can lead to long-term, high quality survival in humoral immunodeficient patients.
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PMID:Pulmonary aspergillosis in a case of humoral immunodeficiency. 358 70

Candida parapsilosis fungemia secondary to nasal colonization following application of nasal prongs for oxygen therapy developed in a 61-year-old man with known chronic lymphocytic leukemia and pulmonary infiltrates. Amphotericin B controlled the candidal infection, but the patient died of complications related to Aspergillus pneumonitis, intra-abdominal mucormycosis, and leukemia. The source of candidal infection was probably a combination of nasal ulceration resulting from oxygen administration by nasal prongs and alteration of the normal mucosal flora by multiple broad-spectrum antibiotics. Oxygen administration by mask to patients at risk of opportunistic infections may help obviate this potential complication, with its attendant danger of spread to the brain and cavernous sinuses. We discuss the rarity of triple infection with these three organisms.
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PMID:Colonization of nasal ulcers as a source of Candida parapsilosis fungemia. 738 34

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

On account of its high mortality, pneumonia is a particularly feared infectious complication in granulocytopenic patients. One of the main reasons for the fatal outcome is the increasing rate of pulmonary mycoses. Fungal infections offer considerable problems concerning diagnostics and therapy. To improve the prognosis of pulmonary mycoses undelayed diagnostics--even by more invasive methods like bronchoalveolar lavage--and immediate start of antifungal treatment (Amphotericin B/5-Flucytosine are still considered as standard therapy) is necessary. A further problem are gram positive organisms, insufficiently prevented by the standard prophylactic regimens. Particularly pneumonia by Staphylococcus aureus and Viridans-Streptococci may show lethal outcome. The initial treatment with glycopeptides is discussed. Treatment of infections by gram negative organisms however, is less controversial. Finally pneumonias in granulocytopenic patients present serious problems in diagnostics and therapy requiring interdisciplinary co-operation of hematology, radiology, pneumology and microbiology.
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PMID:[Pneumonia after cytostatic drug therapy]. 818 62

Eight patients with acute leukemia (AL) and invasive pulmonary aspergillosis (IPA) developing during previous antileukemic therapy underwent BMT (autologous in 6 cases and allogeneic 2). IPA was treated prior to BMT with full doses of amphotericin B, associated with surgical resection in three cases. One patient was treated with amphotericin B and itraconazole. Prior to BMT, seven patients had minimal residual pulmonary lesions. All patients received amphotericin B (0.5 mg/kg/day) during the aplastic period prior to engraftment. One patient died of Gram-negative septic shock before engraftment. Seven patients achieved complete hematological engraftment without any evidence of IPA reactivation. Amphotericin B was well tolerated with only minimal transient renal dysfunction in three patients. Later pulmonary complications related to IPA were observed in only one patient who developed a self-limited episode of hemoptysis. One patient died of CMV pneumonitis and two of leukemia relapse. Four patients survive disease-free and without complications related to IPA. We conclude that the reactivation of correctly treated IPA can be successfully prevented in BMT patients by use of prophylactic amphotericin B. With this approach, prior IPA is not a contraindication to BMT.
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PMID:Invasive pulmonary aspergillosis prior to BMT in acute leukemia patients does not predict a poor outcome. 824 83


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