Cases Of Bacterial Pneumonia Research Articles

Adenosine deaminase activity and free IL-2 receptor levels in serum from patients with mycoplasma pneumonia.

Adenosine deaminase (ADA) activity and free interleukin (IL)-2 receptor levels were assayed in serum samples from patients with mycoplasma and bacterial pneumonia to evaluate the usefulness of these parameters in distinguishing between these diseases at an early stage. Serum ADA and free IL-2 receptor levels in patients with mycoplasma pneumonia (32.4 +/- 9.2 U/l, 960 +/- 204 U/ml) were significantly higher than those in patients with bacterial pneumonia (12.5 +/- 3.3 U/l, 425 +/- 86 U/ml) and in healthy controls (14.0 +/- 3.4 U/l, 286 +/- 49 U/ml) (p less than 0.001). Of the 20 mycoplasma pneumonia cases, 19 showed increased levels of ADA over 20.8 U/l; in 17 of the 19, the increase of ADA was seen before the elevation of the specific antibody to Mycoplasma pneumoniae. In contrast, serum ADA levels in all 20 cases of bacterial pneumonia were lower than 20.8 U/l. There results indicate that assays for serum ADA and free IL-2 receptor levels are useful in distinguishing between bacterial and mycoplasma pneumonia at an early stage.

Quantitative C-reactive protein in pulmonary infections.

A total of 207 cases were selected to evaluate the diagnostic value of C-reactive protein (CRP) in pulmonary infections. The mean +/- SD of CRP values in various pulmonary infections were as follows: 18.62 +/- 11.34 micrograms/ml for 32 cases of exudative-fibrotic tuberculosis; 15.98 +/- 16.66 micrograms/ml for 15 cases of tuberculous pneumonia; 25.61 +/- 18.96 micrograms/ml for 29 cases of tuberculous effusion; 16.66 +/- 10.18 micrograms/ml for 11 cases of tuberculous cavity; 81.1 +/- 24.9 micrograms/ml for 10 cases of miliary tuberculosis; 36.4 +/- 22.1 micrograms/ml for 19 cases of mycoplasmal pneumonia; 241 +/- 72 micrograms/ml for 38 cases of bacterial pneumonia; 225 +/- 65 micrograms/ml for 30 cases of bacterial pneumonia with effusion; 169 +/- 50 micrograms/ml for 16 cases of lung abscess. The CRP values of other pulmonary infections were as follows: 20.6, 20.8 micrograms/ml for two cases of Strongyloides stercoralis pneumonia; 7.4, 1.6 micrograms/ml for two cases of aspergilloma; 11.2, 12.4, 7.6 micrograms/ml for three cases of Pneumocystis carinii pneumonia. Serial changes in CRP values in 13 cases of well-treated bacterial pneumonia showed that values of CRP decreased to below half of the initial value on the 3rd to 4th day, and returned to about normal value on the 10th to 13th day. The study suggested that: a) various types of infections had different levels of CRP values, b) level of CRP values was determined both by the pathogen and the severity of inflammation, c) serial CRP values in bacterial infection could be used as a guide in treatment.

Primary Streptococcus viridans Pneumonia

We describe three cases of acute uncomplicated bacterial pneumonia due to viridans streptococci in previously healthy adults, which were indistinguishable from those caused by other well-known respiratory pathogens. On arrival, all of these patients were treated with IV aqueous penicillin based on Gram stain of sputum which showed predominant Gram-positive cocci in pairs and chains. These specimens of sputum grew normal oral flora in the three cases. The diagnosis was confirmed by positive blood cultures in all three patients from each of two separate samples of blood. The isolates were identified as S uberis. There is no precedent in the literature of primary pneumonia due to viridans streptococci complicated by bacteremia in normal adults. We wonder if primary pneumonia due to viridans streptococci is not as rare as has been reported in the literature. Also, Gram stain of the sputum had a very significant contribution in the initial management of these patients. All of these patients subjectively showed improvement in 24 hours and became afebrile within three days of starting penicillin therapy.

A Case of Bacterial Pneumonia Associated with SIADH

A Case of Bacterial Pneumonia Associated with SIADH

Use of the Protected Specimen Brush in Patients with Endotracheal or Tracheostomy Tubes

Twenty-one patients on mechanical ventilators for greater than 48 hours who had new localized infiltrates were evaluated using a quantitative culture technique of the involved lung compared to the non-involved lung. Based on the clinical course, response to antibiotics, or subsequent analysis of pathologic specimens, eight patients were felt to have acute bacterial pneumonia, while the remaining 13 were felt to have an alternative cause of their infiltrate. Cultures of the protected brush specimen of the involved lung in all eight cases of bacterial pneumonia had one or more organisms grown at a greater than 100 colony forming units (cfu) per ml while only one of the 13 cases of non-pneumonia had a culture from the involved area having greater than 100 cfu per ml (p less than 0.001). The non-involved area always grew fewer organisms than the involved area, and in 16 cases, there was no growth from the specimen obtained from the non-involved area.

Sputum analysis and culture

Sputum analysis and culture is the most common method of specific diagnosis of lower respiratory tract infections. Culture of a properly screened, expectorated sputum sample will identify the pathogen in most cases of bacterial pneumonia. Expectorated sputa, as well as those obtained by aspiration from the upper airway, are subject to oropharyngeal bacterial contamination. Other techniques, such as transtracheal aspiration, are more "sterile," but have a much higher incidence of morbidity. Microscopic screening of expectorated or aspirated sputum samples will reduce the number and increase the diagnostic accuracy of cultures, resulting in considerable cost savings. Mucopurulent material is selected by gross inspection, and microscopic examination of a wet mount and Gram stain yields information about cell type and predominant organism. More important, however, the presence of fewer than 25 squamous epithelial cells per low-power field indicates that true lower respiratory tract secretions have been collected. Culture results must be correlated carefully with semiquantitative grading, initial microscopic screening, clinical presentation, and response to initial therapy. When properly performed and interpreted, sputum analysis and culture are valuable tools in the diagnosis and treatment of lower respiratory tract infection.

Pulmonary protective mechanisms in human infants.

The flow of oral and nasal secretions into the pharynx is a recognized source of pulmonary aspiration during sleep in infants and adults alike. Such aspiration probably accounts for many cases of bacterial pneumonia. In infants, swallowing occurs frequently in sleep, and the rate of swallowing appears to be far greater than that of the sleeping adult. Such swallowing during sleep appears to be the major mechanism whereby oral and nasal secretions are transported to the digestive tract. Certain aspects of those swallows, such as "swallow-breaths" and their coordination with the respiratory cycle, have been documented. A brief period of airway closure is always seen during such nonfeeding swallows. Nonfeeding swallows are usually seen during mixed and obstructive apneic spells in preterm infants. The underlying reflex mechanisms responsible for such swallows during apnea are unclear. During ordinary postfeeding regurgitation, upper airway closure and swallowing occur in close temporal sequence. These events appear to be major mechanisms of airway protection during regurgitation. In certain infants, regurgitation and prolonged apnea often occur simultaneously. The mechanism underlying their association is unclear but may involve laryngeal chemoreceptors.

Bacterial Infections of the Lung

It has been estimated that greater than 1,200,000 cases of bacterial pneumonia (with 55,000 deaths) occur annually in the United States. The purpose of this article is to review bacterial pneumonia in adults.

Differential ventilation in unilateral lung disease: Effects on respiratory mechanics and gas exchange

Conventional PEEP ventilation has been recently reported to be deleterious in some cases of ARF with unilateral pneumonia. In such respect, two cases of unilateral bacterial pneumonia were intubated with a Carlens tracheal tube. Measurement of tidal volume, static compliance, and functional residual capacity of each lung showed marked inequality. Subsequently, both patients were ventilated with a selective distribution circuit, allowing the introduction of a PEEP valve in the expiratory line of the diseased lung. Evident improvement in blood gases was obtained within 24 hours, as tidal volume, static compliance, and FRC of the diseased lung were markedly improved. In one case equalisation of V/Q ratio was documented using the 81m Kr method. Final recovery was obtained in one case.

Bacterial or nonbacterial pneumonia: accuracy of radiographic diagnosis.

The initial chest radiographs of 31 patients with laboratory-proved pneumonia were evaluated by a panel of 6 radiologists who had no prior knowledge of the clinical data. No statistical reliability was found for distinguishing bacterial from nonbacterial pneumonia. Radiographic diagnoses were 67% accurate for the 16 cases of bacterial pneumonia, and 65% accurate for the 9 viral cases. Six cases of Mycoplasma pneumonia were diagnosed as nonbacterial 19% of the time, and as "bacterial pneumonia" 81% of the time.

Congenital Bacterial Pneumonia with Intact Fetal Membranes

This paper reports a case of intra-uterine bacterial pneumonia which occurred in the presence of intact fetal membranes. IgM immunoglobulin levels and histology of the umbilical cord aided in the documentation of the probable time sequence of events.

Treatment of bacterial pneumonia.

MOST FORMS of bacterial pneumonia can be treated successfully at the present time. As a result, the mortality rate has declined from over 30% to less than 10% during the past two decades. However, deaths still occur frequently among small infants, in elderly persons, and in patients in whom treatment is not instituted early. Widespread use of antibiotics may have caused some reduction in the total incidence, but the number of cases of bacterial pneumonia has not declined in proportion to the striking decline in the mortality rate. 1 Viral infections of the respiratory tract and other inciting factors which predispose to pneumonia have not been controlled. In most instances, treatment must be started before a precise bacteriological diagnosis is made. It is usually possible to conclude that the patient has a bacterial rather than a viral pneumonia because of the sudden onset, pleuritic pain, and rusty sputum. There is usually