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

Pneumonia, the leading cause of death due to infectious disease in the elderly, can be difficult to diagnose in this age group because clinical signs and symptoms are often muted. Without a definitive isolate, the physician must institute empiric therapy with broad-spectrum antibiotics according to the patient's condition and the setting in which the pneumonia developed. The cephalosporins, because of their safety profiles, are often used alone or in combination with other drugs to achieve broad antimicrobial coverage in elderly patients with pneumonia. In general, elderly patients with pneumonia should be hospitalized, although nursing home residents may be managed in the nursing home if adequate staff and resources are available.
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PMID:Pneumonia in the elderly: empiric antimicrobial therapy. 155 82

Pneumococci remain the most common cause of community-acquired pneumonia, and there are still important questions concerning the pathogenesis, management, and prevention of this disease. Infection begins by aspiration of pneumococci from the oropharynx. Alveolar macrophages, granulocytes, and extra-cellular factors, including opsonins, are necessary for control of bacterial proliferation and cure of the infection. Clinically, pneumococcal pneumonia often presents with sudden onset of productive cough, fever, and a rigor, but symptoms may be muted in the young, elderly, or debilitated. About one-fourth of patients have a positive blood culture. Examination of sputum by Gram's stain and culture can provide useful information, but are not definitive. Tests for soluble pneumococcal antigen or the direct quellung reaction on sputum have not proved helpful. Pneumococci isolated from blood and spinal fluid should be tested for penicillin sensitivity routinely. Penicillin G and erythromycin are the mainstays of specific treatment, and rapid subjective improvement on narrow-spectrum therapy is an important point in diagnosis. The mortality rate continues to be about 18%, and prevention by vaccination remains a highly desirable goal.
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PMID:Pneumococcal pneumonia. 265 34

Clinical and radiologic signs and symptoms of gram-negative infections are often muted or obscured by a concurrent disease, and therefore, are not reliable for predicting the infecting organisms. Thus, initial therapy is nearly always empiric and based on the clinician's judgment that a patient's pneumonia is likely to be caused by particular pathogens. The choice of an appropriate regimen requires careful consideration of the extent and severity of coexisting illness and debilitation, the severity of the pneumonia, and the level of care required.
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PMID:Pneumonia in the elderly. Special diagnostic and therapeutic considerations. 807 66

Patients with an established diagnosis of Wegener's granulomatosis (WG) sometimes undergo lung biopsy when the disease does not behave in the expected manner. Treatment affects the tissue reaction. The microscopic recognition of partially treated disease is important, as the absence of expected lesions may lead to nonspecific diagnoses and inappropriate management. The appearance of treated disease over time may offer insight into its histogenesis and natural history. We correlated clinical features and pulmonary histology in 20 patients with WG after they had been treated with corticosteroids or cyclophosphamide or both. All patients had inflammatory or fibrotic pulmonary disease resulting from WG, but only 4 (20%) had macronodular necrosis typical of WG. Serum antineutrophil cytoplasmic antibody (ANCA) was elevated in all patients in whom it was measured. We divided the pathological findings into (1) vasculitis, (2) extravascular necrosis, (3) bronchiolitis, and (4) other lesions, and further divided them into (a) diagnostic for active disease, (b) suspicious for active disease, (c) suspicious for healing disease, (d) suspicious for residual disease, and (e) possible disease. Diagnostic or suspicious vascular lesions occurred in 15 patients (75%) and included granulomatous vasculitis, capillaritis or suspicious capillaritis, and neutrophilic vasculitis. Diagnostic or suspicious extravascular lesions occurred in 12 patients (60%) and included palisading granuloma, microabscess, macronodular pathergic necrosis, giant cell nodules, and micronodular scars. The giant cell nodules and nodular scars were an unusual healing pattern of palisading granulomas. Diagnostic bronchiolar lesions occurred in 1 patient (6%) and suspicious lesions in 13 patients (65%), including three novel patterns of bronchiolitis fibrosa (BF): (1) BF with giant cells, (2) BF with hemosiderin, and (3) BF with micronodular scars. Other features related to WG included diffuse alveolar damage, peculiar alveolar fibrin, interstitial fibrosis, pneumonitis resembling usual interstitial pneumonitis, and lipoid pneumonia. Classic necrotic nodules and vasculitis of WG should not be anticipated after therapy, but the diagnosis of pulmonary WG after treatment may be made if the effects of treatment on histology are considered. Changes in anticipated histology are found after therapy as short as 6 days. The histology typically has muted features. BF develops in most patients and may reflect a salutary effect of therapy. Palisading granuloma may convert to giant cell nodule or micronodular scar. Interstitial fibrosis is common, and pneumonitis resembling usual interstitial pneumonitis can develop. If only healing or residual disease is encountered, one should search further clinically and pathologically for active disease. Dampened inflammatory lesions represent smoldering disease that presumably needs additional therapy. Scarring presumably represents successfully treated but permanent disease.
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PMID:Treated Wegener's granulomatosis: distinctive pathological findings in the lungs of 20 patients and what they tell us about the natural history of the disease. 910 45