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

Legionellae are ubiquitous aquatic organisms. They are unique among the agents commonly responsible for bacterial pneumonia in humans in that they are not part of the normal human flora but are acquired from environmental sources. Prospective studies have shown that legionellae consistently rank among the top three bacteria as etiologic agents of community-acquired pneumonia. The clinical presentation of Legionnaires' disease is not distinguishable from that of other bacterial pneumonias. Culture of respiratory secretions using selective media, combined with one or more rapid diagnostic methods (direct fluorescent antibody staining, radiolabelled DNA probe, or urinary antigen detection) provides a specific diagnosis in the vast majority of cases. Sporadic cases have been linked to legionella colonization of water systems in homes and the work setting. Antibiotics commonly used in the therapy of community-acquired pneumonias, such as beta-lactam agents, are ineffective. Specific therapy with erythromycin reduces mortality to less than 10%.
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PMID:Community-acquired Legionnaires' disease. 265 33

Pulmonary responses to intratracheal challenge exposure with Pasteurella haemolytica, with or without Escherichia coli-derived endotoxin, E coli endotoxin alone, or saline solution were compared in anesthetized, mechanically ventilated neonatal calves. Baseline values for dynamic compliance, total pulmonary resistance, functional residual capacity, arterial blood gas tensions, hemogram, leukogram, and systemic and pulmonary arterial pressures were recorded for each calf. After baseline data were obtained, calves were challenge exposed with logarithmic-growth phase P haemolytica organisms with or without E coli endotoxin, E coli endotoxin alone, or saline solution (0.9% NaCl). Physiologic data were obtained immediately after challenge exposure and at various intervals over the next 6 hours. Calves challenge exposed with P haemolytica alone developed sever hypoxemia, had increased alveolar-arterial oxygen difference and threefold increases in total pulmonary resistance, became hypercarbic, had decreased functional residual capacity, and developed systemic hypotension without change in pulmonary arterial pressure. At necropsy, these calves had extensive multifocal areas of necrohemorrhagic and purulent pneumonia. Ratio of extravascular lung water to lung dry weight was not significantly increased in lung specimens obtained from calves challenge exposed with P haemolytica, but ratio of lung wet weight to dry weight was increased, indicating that increased lung wet weight was attributable largely to increased solids and not to fluid alone. (Extravascular lung water measurement excludes fluid from the vascular compartment.) Intratracheal challenge exposure with endotoxin failed to alter lung function and caused minor changes in lung structure consisting of focal areas of hemorrhage and edema.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of pathophysiologic changes in the lungs of calves challenge exposed with Escherichia coli-derived endotoxin and Pasteurella haemolytica, alone or in combination. 265 95

The fact that economic progress has a bearing on health can be seen in most developing countries where widespread poverty causes poor health and high mortality. Childhood mortality is highest in Africa and in Southern Asia. The rate of decline in mortality has decreased in these areas since the 1950s. In Sri Lanka, approximately 5% of the children 5 years old die, yet yearly 1/3 of the children 5 Afghanistan and a few West African countries die. In less developed countries, adult mortality is high: in places where the life expectancy of a 15-year-old is under 50 years, 30-40% will die before age 60. 80-90% of the deaths from water and food borne diseases are accounted for by diarrhea and dysentery, and 60-70% of the deaths from airborne diseases by pneumonia and bronchitis. Present estimates from 4 localities indicate that measles, malaria, tetanus, and acute respiratory infection account for more than 90% of all child mortality. Various estimates suggest that there are 100-300 million cases of malaria and 1-2 million malaria-related deaths annually. Estimates indicate a ratio of abortions varying between 9/1000 live births in East Africa to 325/1000 live births in Latin America. 1986 WHO data indicate that induced abortion is responsible for 7-50% of all maternal deaths in developing countries. More than 90 countries now that operational diarrheal disease control programs, 47 countries are producing oral rehydration solutions, 8450 health personnel have been trained in diarrhea program supervisory skills, and oral rehydration use rates are slowly rising.
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PMID:Identifying health problems and health research priorities in developing countries. 266 49

Between August 1982 and December 1985, seven patients at a children's hospital developed hospital-acquired pneumonia caused by Legionella pneumophila. Demographic data included the following: mean age 12.3 years (range 9 months to 20.5 years); male/female ratio 5:2; all patients were white. Some previously identified risk factors present in our patients included high-dose corticosteroid therapy (five patients), other immunosuppressive therapy (four), and chronic lung (five) or kidney (three) disease. Symptoms and signs included rapid onset, fever, cough, pleuritic chest pain, dyspnea, abdominal pain, diarrhea, and headache. Rhinitis, myalgia, and neurologic abnormalities were not noted. Chest roentgenograms revealed single-lobe consolidation in three patients, diffuse bilateral alveolar infiltrates in three, and pleural effusion in three. All patients were treated with erythromycin; three patients also received rifampin. Tracheal intubation and mechanical ventilation were required by four patients. Six patients improved after therapy. One child died of persistent lung disease 1 month after the onset of legionnaires disease. L. pneumophila was isolated from potable water in the hospital. Aerosol equipment cleansed with tap water and the showers were implicated as means of exposure by patients to contaminated potable water. No new nosocomial cases were seen after immunocompromised children were prohibited from taking showers, and sterile water was used to cleanse equipment for administering aerosol medications.
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PMID:Nosocomial legionnaires disease in a children's hospital. 273 94

Legionella pneumophila continues to play a role in both community- and nosocomially-acquired pneumonia. We investigated the ability of L pneumophila to adhere to various types of materials such as those found in the hospital air-cooling and portable water distribution systems. Through the use of a unique sampling apparatus, we were able to regularly acquire planktonic and sessile samples and determine the numbers of bacteria present in both populations, in vitro and in situ. Portions of these apparatuses could be aseptically removed for examination by scanning electron microscopy, or for the determination of the number of viable adherent L pneumophila. The number of bacteria present in each sample was determined by direct plate count, with presumptive L pneumophila colonies being positively identified by direct fluorescent antibody staining techniques. The results demonstrated that not only are legionellae capable of colonizing various metallic and nonmetallic surfaces but that they are preferentially found on surfaces. Surface-adherent bacteria may play a profound role as a reservoir of these potential pathogens in aquatic environments. Furthermore, these results suggest that any comprehensive legionella monitoring program must include not only water samples but also an examination of the adherent populations.
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PMID:Legionella pneumophila grows adherent to surfaces in vitro and in situ. 279 66

Three experiments were performed to evaluate the inflammatory response, the antibody response and protection from experimental challenge of various Actinobacillus pleuropneumoniae serotype 5 (Ap5) vaccines in swine. In the first experiment, subcutaneous injections of either a water-in-oil (W/O) emulsion or Freund's complete adjuvant (FCA) caused lesions at the site of injection, while intraperitoneal injection of the W/O emulsion caused no lesions. In the second experiment, intraperitoneal (IP) injection of a W/O emulsion containing unwashed Ap5 cells (6-h culture) and/or supernates from a 24-h culture resulted in severe peritoneal lesions, while W/O emulsion containing PBS-washed Ap5 cells resulted in minimal peritoneal lesions. Ap5 alone or W/O alone failed to cause peritoneal lesions. The third experiment compared the antibody response and protection from challenge of pigs immunized with either 6-h PBS-washed Ap5 cells emulsified in oil - IP, 6-hour Ap5 cells adjuvanted with dimethyl diodacyl ammonium bromide - IP, Ap5 antigen alone - IP, a commercial vaccine - subcutaneously or saline - IP. All groups, except the saline-treated group, responded with high antibody titers to Ap5 2 weeks following vaccination; however, titers from the W/O plus antigen group were significantly higher than the three other groups (P less than 0.05). Following intranasal challenge with Ap5, all animals responded with increased antibody titers. All pigs were euthanized 10 days after challenge and evaluated for pneumonia and the lungs cultured for bacteria. The lungs of all pigs, excepting the W/O plus antigen group, contained pneumonic lesions and A. pleuropneumoniae was cultured from these lesions. These results, along with results from other groups, suggest that intraperitoneal immunization using oil-adjuvanted vaccine may be an effective method for protecting pigs from pneumonia due to A. pleuropneumoniae. Its efficacy may be due to stimulation of local respiratory mucosal immunity.
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PMID:Comparison of protective immunity and inflammatory responses of pigs following immunization with different Actinobacillus pleuropneumoniae preparations with and without adjuvants. 281 78

A prospective pneumonia study was conducted simultaneously on head-and-neck surgery wards at two hospitals over 2 years; one hospital had a water supply contaminated with Legionella pneumophila but no record of having had a case of legionella pneumonia, and the other had just decontaminated its water supply because of known endemic nosocomial legionellosis. Special laboratory tests for legionella were done on all cases of nosocomial pneumonia irrespective of clinical impression. Over the first 18 months, the rate of nosocomial legionellosis was 30% at the first hospital and 0% at the second. Patients who underwent laryngectomy did not acquire the disease. Hyperchlorination at the first hospital was followed by a fall (p less than 0.01) in legionella pneumonias. Thus legionella pneumonias can be overlooked if special laboratory tests are not applied routinely, and surgical patients with head-and-neck cancer may be at high risk of nosocomial legionellosis because of the potential for pulmonary aspiration of contaminated water or orophyaryngeal microflora and/or frequent manipulation of the respiratory tract. This study demonstrates the benefits of examining the environment for legionella despite the absence of documented disease.
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PMID:Nosocomial legionellosis in surgical patients with head-and-neck cancer: implications for epidemiological reservoir and mode of transmission. 286 67

Legionellas are present in water distribution systems and cooling towers of many hospitals. No firm data are available regarding the need for prophylactic disinfection of these contaminated systems. Disinfection of water systems and cooling towers is an accepted and effective means of ending nosocomial Legionnaires' disease, but it should be performed in conjunction with good epidemiological and microbiological studies to pinpoint environmental reservoirs and disseminators. Chlorination, pasteurization, or both, are the only means of disinfection found to be effective in disease outbreaks. Prospective surveillance of immuno compromised patients with pneumonia is probably the most effective means to determine if a hospital is a source of Legionnaires' disease and, therefore, requires further investigations and disinfection.
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PMID:Control of Legionella in hospitals. 287 26

In 1 year 12 of 48 patients who developed fatal pneumonia following admission with non-respiratory disorders to the Hospital Molinette, Torino, yielded Legionella pneumophila serogroup 1 from lung at autopsy. Patients were hospitalized on seven different wards for different conditions; only two of the wards had air conditioning but legionellas were not isolated from these. All patients were in poor health or immunocompromised. Some patients had inhaled humidified oxygen from piped supplies and three had undergone surgery. Legionella pneumophila serogroup 1 was detected in the water of oxygen bubble humidifiers and an underwater chest drain. The contaminated devices had been filled with tap or distilled water and the hospital water supply was found to be contaminated with L. pneumophila serogroup 1. Our findings suggest that filling bubble humidifiers or underwater chest drains with tap water is a potential hazard and should be avoided.
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PMID:Nosocomial legionellosis associated with use of oxygen bubble humidifiers and underwater chest drains. 288 11

The contamination of disposable ('Conchapak') and reusable humidifying systems and their influence on the incidence of pneumonia was studied in 116 patients requiring continuous mechanical ventilation therapy. The water reservoirs of 11 (15.9%) of the 69 disposable systems became colonized, but all reusable systems were found to be sterile. In four of the 11 samples, the organisms isolated corresponded with those cultured from tracheal secretions several days before. Ventilator-associated pneumonia occurred in 36 (31.0%) of the patients, but there was no statistically significant difference in the incidence of pneumonia between the patients treated with the disposable or the reusable humidifying systems. Gram-negative bacteria were the predominant organisms isolated from tracheal aspirates of patients who developed ventilator-associated pneumonia. These results suggest that disposable humidifying systems do not influence the rate of ventilator-associated pneumonia in mechanically ventilated patients.
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PMID:Influence of disposable ('Conchapak') and reusable humidifying systems on the incidence of ventilation pneumonia. 289 85


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