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

The authors discuss the etiology, pathomechanisms, radiological features of lipid pneumonia. The role of bronchoalveolar lavage is stressed in determining this diagnosis. A case is presented of a patient receiving paraffin oil for chronic constipation. The diagnosis was made after identifying the lipid droplets (Sudan III stain) in alveolar macrophages sampled by BAL.
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PMID:[A case of lipid pneumonia]. 814 66

A review is presented of the microbiological data, and the methods for obtaining these data, which are relevant for the diagnosis of lower respiratory tract infection. The necessity for adequate information exchange between the microbiology laboratory and the clinic is stressed. Once the specimen (usually sputum) has reached the laboratory, it is screened macroscopically and microscopically for adequacy, and cultures are set up. Many patients with acute community-acquired pneumonia (CAP) have no sputum, and some produce purulent sputum containing no obvious infecting micro-organisms. Despite modern microbiological techniques, only 110 out of 250 acute CAP patients had positive bacteriological cultures and 41 more yielded only positive serological results, so that an aetiological diagnosis was reached in 60%. Invasive methods of specimen collection (bronchoscopy, BAL, protected brush, etc) have also been studied, together with quantitative bacterial counting, but the results have not yielded so much useful information that these procedures can be unreservedly recommended. Molecular biological methods (DNA probes, PCR, etc) are only now becoming available. The bacteriological findings in patients with acute CAP have been compared with those in acute exacerbations of chronic bronchitis (CB), and several differences have emerged in the order of frequency of occurence. H. influenzae is in first place with exacerbations of CB, but is second to S. pneumoniae in acute CAP. The latter occupies third position in CB, with Moraxella catarrhalis second. The role of Chlamydia pneumoniae in acute CAP is not yet clear, but the serological results suggest an association in 42 out of 147 patients tested (29%), 15 of whom also had positive bacteriological cultures.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Critical review of microbiological data and methods in diagnosis of lower respiratory tract infections. 819 20

We describe the cases of two individuals with advanced AIDS who sought treatment for rapidly progressive respiratory failure due to T gondii pneumonia. The first patient responded to specific therapy after an early diagnosis but died 2 months later of bacterial sepsis. In the second case, the diagnosis was made at autopsy. This led to a meticulous retrospective review of the original slides of material obtained from BAL. T gondii tachyzoites not previously identified during the initial analysis of the slides were seen on both GIE and PAP stains. Neither of our severely immunocompromised patients had evidence of central nervous system involvement. Even though we cannot exclude dissemination to other organs, a progressive pneumonitis mimicking a classic P carinii infection was the primary presentation. Trophozoites were identified by BAL in both cases, underscoring the diagnostic potential of this minimally invasive procedure.
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PMID:Toxoplasma gondii pneumonia in patients with the acquired immunodeficiency syndrome: diagnosis by bronchoalveolar lavage. 820 79

In general, lung involvement in connective tissue disorders has not been as well defined as has isolated interstitial lung disease; this applies particularly to bronchiolitis, which occurs infrequently. The low prevalence of bronchiolitis may reflect difficulties in making the diagnosis in mild to moderate disease; at present, most reported disease is severe. This is likely to account for the lack of therapeutic success in obliterative bronchiolitis and in many patients with follicular bronchiolitis. There is a need for earlier intervention if treatment is to be effective, and thus there is a need to refine the noninvasive diagnosis of bronchiolitis. This goal is unlikely to be achieved without the systematic noninvasive evaluation and surveillance of large groups of patients with connective tissue diseases. The role of the pulmonary function laboratory in identifying early bronchiolitis remains entirely uncertain; whether silent "small airways disease," defined physiologically, predicts the eventual development of bronchiolitis is unclear. The reversibility of this asymptomatic lesion with inhaled steroid therapy and the role of inhaled treatment in bronchiolitis, in general, have not been evaluated. More work needs to be done to determine the predictive value of CT appearances and BAL findings, to try to identify a subgroup of patients at greater risk of developing severe bronchiolitis. Further histocompatibility studies may serve as a basis for the selection of patients with an increased likelihood of developing airways disease. The role of open lung biopsy requires further clarification. Better noninvasive evaluation should reduce the need for this invasive procedure; in some patients, however, including those with concomitant interstitial lung disease, histologic assessment will remain an essential component of management. In recent years, in contrast to early reports, it has become apparent that organizing pneumonia has a better prognosis than fibrosing alveolitis in the connective tissue diseases; overall, stability or regression of disease, usually with corticosteroid therapy, was documented in 28 of 39 reported cases. In these patients, a tissue diagnosis serves to identify the need for aggressive therapeutic intervention. Finally, the compilation of larger clinical series would improve our understanding of severe bronchiolitis. This is likely to require multicenter collaboration, which often is impracticable; without this approach, however, the description of bronchiolitis will remain anecdotal.
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PMID:Bronchiolitis in association with connective tissue disorders. 831 70

The opsonic activity of plasma fibronectin (FN) by rat alveolar macrophage (AM) was examined, and the in vivo effect of FN in Staphylococcus aureus (S. aureus) experimental rat pneumonia was evaluated. The chemiluminescence response of AM was enhanced by the presence of FN (300 micrograms/ml) in S. aureus and Streptococcus pneumoniae, but was not enhanced in gram-negative rods (Haemophilus influenzae, Branhamella catarrhalis, Pseudomonas aeruginosa). FN (300 micrograms/ml) promoted the phagocytosis of S. aureus by AM, but did not promote the bactericidal activity of that by AM. In the experimental rat pneumonia with S. aureus inoculation, plasma FN concentration decreased with time, but increased by the administration of FN (1 mg). The number of bacteria in the lung, peripheral white blood cell and BAL fluid cell also decreased by the administration of FN. Furthermore, FN was significantly improved on inflammatory findings of rat lung tissue 24 hours after inoculation with S. aureus. These results suggest that FN plays an important role as an opsonic by alveolar macrophage, and that FN has utility for clinical trials in patients with pneumonia.
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PMID:[Efficacy of fibronectin on opsonic activity by alveolar macrophage and experimental rat pneumonia]. 833 12

The purpose of this prospective postmortem study was to assess the diagnostic accuracy of bronchoscopic techniques (bronchoalveolar lavage [BAL] and protected specimen brush [PSB]) and nonbronchoscopic techniques (blind bronchial sampling [BBS] and mini-BAL) in the diagnosis of ventilator-associated pneumonia (VAP). The results of each technique were compared with histology and culture of lung tissue specimens obtained by surgical pneumonectomies in 38 patients who died after at least 72 h of mechanical ventilation. Histology was positive for VAP in 18 patients and negative in 20 patients. There were 12 definite VAP (positive histology and positive lung cultures) and 6 histologic VAP (positive histology and negative cultures). Clinical pulmonary infection score (CPIS) at a threshold of 6 achieved a sensitivity of 72% and a specificity of 85%. When the CPIS was combined with the logarithmic concentration of the predominant microorganism obtained from the BBS sample culture, specificity was increased to 95%, for a threshold of 10. Using 10(3) cfu/ml as the threshold of positivity for cultures obtained with PSB and mini-BAL samples and 10(4) cfu/ml for cultures obtained with BBS and BAL, the respective sensitivities of these techniques for definite VAP were 42, 67, 83, and 58%. The sensitivity of BBS was significantly higher than that of PSB (p < 0.05). The area under the receiver operator characteristic curve was significantly greater for BBS than PSB (p < 0.05). Given that it is more sensitive and noninvasive, BBS is preferable to PSB for the diagnosis of VAP.
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PMID:Bronchoscopic or blind sampling techniques for the diagnosis of ventilator-associated pneumonia. 852 Jul 66

Drug-induced eosinophilic lung disease commonly presents as a simple pulmonary eosinophilia-like syndrome consisting of transient pulmonary infiltrates, peripheral eosinophilia, and mild pulmonary symptoms that disappear promptly upon withdrawal of the offending medication. However, a more fulminant presentation most resembling acute eosinophilic pneumonia has been recently described. We present a patient with BAL-confirmed eosinophilic pneumonia (EP) and respiratory failure after a trazodone overdose. This is the first case of EP associated with trazodone and only the third drug-mediated EP reported to precipitate respiratory failure.
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PMID:Eosinophilic pneumonia and respiratory failure associated with a trazodone overdose. 852 Jul 92

Nosocomial pneumonia continues to be a major problem plaguing hospitalized patients, especially those on ventilators. Gram-negative bacteria and S. aureus are the most common causitive organisms. Alteration of the normal oropharyngeal flora and contamination of the respiratory tract from the pharynx and stomach are now recognized to be important factors in its development. As there is no definitive diagnostic test, nosocomial pneumonia remains a clinical diagnosis; however bronchoscopy with protected specimen brush cultures and BAL are diagnostic methods under study. Noninvasive radiologic examinations and clinical criteria have poor specificity in diagnosis.
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PMID:Nosocomial pneumonia. 853 53

Bronchoalveolar lavage fluids (BALF) were analyzed for surfactant abnormalities in 153 patients with acute respiratory failure necessitating mechanical ventilation. Diagnoses were acute respiratory distress syndrome (ARDS) in the absence of lung infection (n = 16), severe pneumonia (PNEU; n = 88), ARDS and PNEU (n = 36), and cardiogenic lung edema (CLE; n = 13). The PNEU group was subdivided into groups with alveolar PNEU (n = 35), bronchial PNEU (n = 16), interstitial PNEU (n = 18) and nonclassified PNEU (n = 19). Comparison with healthy controls (n = 20) was undertaken. Total phospholipids (PL), proteins, PL classes (HPTLC) and surfactant apoproteins SP-A and SP-B (ELISA) were quantified in the original BALF. The 48,000 x g pellet from centrifugation of the BAL was used to assess the percentage of large surfactant aggregates (LSA) and the biophysical properties of the surfactant (pulsating bubble surfactometer). All groups with inflammatory lung injury (PNEU and/or ARDS) showed some decrease in the lavageable PL pool, a reduced LSA content in BALF, and a manifold increase in alveolar protein load. Marked changes in the PL profile were noted throughout the groups (a decrease in phosphatidylcholine (PC) and phosphatidylglycerol (PG) and an increase in phosphatidylinositol [PI] and sphingomyelin [SPH]). Concentrations of SP-A but not of SP-B in BALF were reduced. Minimum surface-tension values approached 0 mN/m in controls, and ranged from 10 to 25 mN/m in the absence of supernatant protein and from 20 to 35 mN/m in recombination with leaked protein in the groups with ARDS and/or PNEU. Abnormalities in alveolar PNEU surpassed those in bronchial PNEU, and interstitial PNEU presented a distinct pattern with extensive metabolic changes. All surfactant changes were absent in CLE except for a slight inhibition of surface activity by proteins. We conclude that pronounced surfactant abnormalities, comparable to those in ARDS in the absence of lung infection, occur in different entities of severe PNEU, but not in CLE.
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PMID:Surfactant alterations in severe pneumonia, acute respiratory distress syndrome, and cardiogenic lung edema. 854 13

Bacterial community-acquired respiratory infections are usually sustained by strains highly responsive to antibiotic therapy. Thus, the clinical approach is based on an empirical treatment and does not require the isolation of the causative pathogen and the determination of the bacterial susceptibility to antibiotics. On the other hand, Gram-negative bacteria, most commonly multidrug resistant, frequently affect immunocompromised and nosocomial patients and their identification in cultures is absolutely necessary for proper antibacterial treatment. To this aim, two conventional methods are used, i.e. the blood culture, which is positive only in 20% of pneumonia cases, and the sputum culture, which is not invasive but easily contaminated by oropharyngeal flora. Consequently, invasive techniques for sampling the pathologic specimen, such as the BAL and the PSB, performed with the help of fiberoptic bronchoscope, are needed. The diagnostic power and the limits of both these techniques are analyzed. Moreover, the opportunity to obtain quantitative cultures, which may discriminate between contamination and infection is considered.
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PMID:Evaluation of the invasive techniques for diagnosing bacterial respiratory infections. 856 40


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