Cases Of Lobar Pneumonia Research Articles

Epidemiology of Streptococcus pneumoniae Serotypes in Jordan Amongst Children Younger than the Age of 5: A National Cross-Sectional Study.

Streptococcus pneumoniae infections are a major cause of mortality and morbidity worldwide. In Jordan, pneumococcal conjugate vaccines (PCVs) are not included in the national vaccination program. Due to the current availability of several PCVs, including PCV-10, PCV-13, and PCV-15, along with PCV-20, currently undergoing pediatric approvals globally, the decision to introduce PCVs and their selection should be based on valid local data on the common serotypes of Streptococcus pneumoniae. This cross-sectional study aimed to identify the frequency of serotypes of Streptococcus pneumoniae in children aged below 5 years hospitalized with invasive pneumococcal diseases (IPDs), including pneumonia, septicemia, and meningitis, during the study's duration in representative areas of Jordan. Serotyping for culture-positive cases was based on the capsular reaction test, known as the Quellung reaction. qPCR was conducted on the blood samples of patients with lobar pneumonia identified via X-ray or on cerebrospinal fluid for those with a positive latex agglutination test for Streptococcus pneumoniae. This study was based on the analysis of the serotypes of 1015 Streptococcus pneumoniae cases among children younger than the age of 5: 1006 cases with pneumonia, 6 cases with meningitis, and 3 cases with septicemia. Only 23 culture-positive cases were identified in comparison to 992 lobar pneumonia cases, which were PCR-positive but culture-negative, with a PCR positivity rate of 92%. Serotypes 6B, 6A, 14, and 19F were the most common serotypes identified in this study, with prevalence rates of 16.45%, 13.60%, 12.12%, and 8.18%, respectively. PCV-10, PCV-13, PCV-15, and PCV-20 coverage rates were 45.32%, 61.87%, 64.14%, and 68.47%, respectively. To the best of our knowledge, this is the largest prospective study from the Middle East and one of the largest studies worldwide showing the serotypes of Streptococcus pneumoniae. It reveals the urgency for the introduction of a PCV vaccination in Jordan, utilizing recently developed vaccines with a broader serotype coverage.

A Performance-Based Competency Assessment of Pediatric Chest Radiograph Interpretation Among Practicing Physicians.

There is limited knowledge on pediatric chest radiograph (pCXR) interpretation skill among practicing physicians. We systematically determined baseline interpretation skill, the number of pCXR cases physicians required complete to achieve a performance benchmark, and which diagnoses posed the greatest diagnostic challenge. Physicians interpreted 434 pCXR cases via a web-based platform until they achieved a performance benchmark of 85% accuracy, sensitivity, and specificity. Interpretation difficulty scores for each case were derived by applying one-parameter item response theory to participant data. We compared interpretation difficulty scores across diagnostic categories and described the diagnoses of the 30% most difficult-to-interpret cases. 240 physicians who practice in one of three geographic areas interpreted cases, yielding 56,833 pCXR case interpretations. The initial diagnostic performance (first 50 cases) of our participants demonstrated an accuracy of 68.9%, sensitivity of 69.4%, and a specificity of 68.4%. The median number of cases completed to achieve the performance benchmark was 102 (interquartile range 69, 176; min, max, 54, 431). Among the 30% most difficult-to-interpret cases, 39.2% were normal pCXR and 32.3% were cases of lobar pneumonia. Cases with a single trauma-related imaging finding, cardiac, hilar, and diaphragmatic pathologies were also among the most challenging. At baseline, practicing physicians misdiagnosed about one-third of pCXR and there was up to an eight-fold difference between participants in number of cases completed to achieve the standardized performance benchmark. We also identified the diagnoses with the greatest potential for educational intervention.

Differences of TNF-α, IL-6 and Gal-3 in lobar pneumonia and bronchial pneumonia caused by mycoplasma pneumoniae.

To investigate the differences of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and galectin-3 concentrations in lobar pneumonia and bronchopneumonia induced by mycoplasma pneumoniae (MP) in children and to explore these related factors predicting the severity of MP. A total of 148 children with mycoplasma pneumoniae pneumonia (MPP) and 32 healthy controls were analyzed from March 2017 to August 2018 in our province. Clinical information was collected from the hospitalized MP patients. The 148 patients with MPP were divided into two groups: lobar pneumonia group and bronchial pneumonia group. The 32 healthy children were considered the control group. The concentrations of TNF-α, IL-6 and Gal-3 were examined in the serum of 148 children patients with MPP and 32 healthy children by double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). The TNF-α, IL-6 and Gal-3 levels were obviously higher in both the lobar pneumonia and bronchial pneumonia groups, compared to those in the control group. Furthermore, these levels were significantly higher in the lobar pneumonia group, compared to the bronchial pneumonia group. After treatment, the levels of TNF-α, IL-6 and Gal-3 totally descended during the recovery period. There are differences in serum TNF-α, IL-6 and Gal-3 concentrations in lobar pneumonia and bronchial pneumonia caused by MP in children. In general, the TNF-α, IL-6 and Gal-3 levels were significantly higher in the lobar pneumonia group, when compared to the bronchial pneumonia group. This was because most lobar pneumonia cases are much more serious than bronchial pneumonia. Moreover, it has been proven that TNF-α, IL-6 and Gal-3 may play an important role in the pathogenesis development of MPP. At the same time, these are important issues in diagnosing MPP.

Clinical Study and Analysis of 700 Cases of Pneumonia in Children

Introduction: Pneumonia is a common acute disease of the respiratory tract in childhood. In this paper, 700 cases of pneumonia in Changan Hospital of Xi’an city [1-3] were summarized. All seasons are easy to occur, especially in winter and spring. It is easy to recurrent attacks affect the growth and development of children, if the treatment is not complete. The clinical data of the children are reported as follows: Background: From January 2016 to December 2016, 700 cases of children pneumonia in Changan hospital in Xi’an were investigated in 1 pairs of 1 [4]. Among the 700 children, 437 were boys and 263 were women; 252 cases aged 2 were occupied 23%. Accessory Examination: In 700 cases of chest radiography，23 cases of lobar pneumonia accounted for 3.28% of the total. 87 cases of double pulmonary bronchitis were 12.42%, 488 cases of bronchitis were 69.71%, 11 cases of interstitial pneumonia were 15.71%,and 4 cases of lobule in chest.198 cases of WBC ≥ 10 were 28.28%, 76 cases of neutrophils ≥ 70 were 10.86%,402cases of lymphoid ≥ 40 were 57.43%, 267 cases of mononuclear ≥ 10 were 38.14%.196 cases of syncytial virus positive were took up 28%,4 cases of adenovirus positive were made up 0.57%, 3 cases of influenza virus positive were occupied 0.43% [5-7]. Complication: 2 cases of combined respiratory failure accounted for 0.28%,13 cases of combined enteritis were 1.85%,8 cases of combined myocardial injury were 1.14%, 1 case of combined heart failure were 0.14%,1 case of combined Anemia were 0.14%,2 cases of combined laryngitis were 0.28%. Treatment: 368 cases of the second generation cephalosporin’s +antivirus were 52.57%,183 cases of the third generation cephalosporin’s + antivirus were 26.14%,129 cases of Cephalosporin +Archie were 18.43%, 20 cases of Penicillin + antiviral were 2.85%,23 cases of >14 days of treatment were 3.28%,72 cases of 7-10 days of treatment were 10.28%,545 cases of 5-7 days of treatment were 77.86%, 60 cases of <5 days of treatment were 8.57%. Result: Treatment, Infantile pneumonia is the main anti infection and treat the complications. At the time of anti-infection, a wide range of antimicrobial spectrum, less drug resistant bacteria, and low toxicity of liver and kidney are used, combined use of two kinds of broad-spectrum antibiotics, Such as cephalosporin’s, macrolides,and antiviral drugs, and give oxygen therapy, nutritional support, Correcting the acid-base balance and electrolyte disturbance in some children, actively dealing with the complications and avoiding heart failure.

Chest X ray Imaging Patterns of Infectious Pneumonia among Immunocompetent Patients

Infectious Pneumonia is a worldwide public health problem. It is a single largest infectious cause of death in children worldwide. Chest X ray is a non invasive, economical medical test that helps physicians to diagnose and treat medical conditions including infectious pneumonia. The aim of this study is to know the prevalence of infectious pneumonia among immunocompetent individuals and the various patterns of pneumonia on chest X-ray. Patients attending General Medicine OPD with persisting symptoms of pneumonia were selected to do this study. Chest x-ray taken and findings were correlated with clinical features, blood and sputum investigations for accurate diagnosis. Cough and fever were the most common presenting features seen in 86.4% and 70.2% of the patients respectively. Lobar consolidation was predominant pattern seen in 46 (62.1%) patients, followed by diffuse consolidation among 10 (13.5%) patients. Out of 74 patients 47 (63.1%) were confirmed by bacterial culture. Sputum samples reported with Streptococcus pneumoniae, Klebsiella pneumoniae, Tuberculosis were identified mostly from lobar pneumonia cases. Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas, Enterobacter, Acinetobacter were isolated from bronchopneumonia cases. Diagnosing of Infectious pneumonia by various imaging patterns of chest x ray needs expertise. Studying Chest x-ray imaging patterns and their correlation with microbiological investigations helps us to diagnose accurately and start appropriate treatment

Non-specific inflammatory parameters in patients with pandemic H1N1 influenza

The measurement of non-specific inflammation parameters, such as erythrocyte sedimentation rate (ESR), fibrinogen, C-reactive protein (CRP) and procalctinon (PCT) are very important tools for diagnosis of infections, as well as for monitoring of treatment response. The aim of this study was to determine the significance of non-specific inflammatory parameters in patients with influenza H1N1 infection. ESR, fibrinogen, CRP and PCT were analyzed in patients with influenza H1N1 infection. The diagnosis of influenza H1N1 was established from the nasopharyngeal swabs using Real Time Polymerase Chain Reaction – (RT PCR) method. Chest X-ray was performed to diagnose pneumonia Sixty-three out of 340 hospitalized patients with influenza had pandemic influenza. Their mean age was 34.60±13.82years. They were referred to hospital 1 to 7 (4.06±2.0) days after onset of symptoms. Of these, 46 had pneumonia, while the majority (41 patients) had interstitial pneumonia, and only five had lobar or segmental pneumonia. Patients with pneumonia had significantly higher levels of CRP and PCT in comparison with those without pneumonia. Patients with lobar pneumonia had significantly higher CRP than those with interstitial pneumonia. However, mean values of PCT between interstitial and lobar pneumonia cases did not differ significantly. Interstitial pneumonia was the most common complication of H1N1 infection among our patients. Non-specific parameters of inflammation, especially CRP and PCT were increased in all pneumonia cases, regardless of the etiology. Monitoring of non-specific inflammatory parameters in patients with H1N1 infection allows recognition of patients with complications, their prompt hospitalization and early initiation of antimicrobial therapy.

Lobar pneumonia caused by Ralstonia pickettii in a sixty-five-year-old Han Chinese man: a case report

IntroductionRalstonia pickettii is a gram-negative, oxidase-positive bacillus and is an emerging pathogen found in infections described in hospital settings. The cases reported in the literature mostly are nosocomial infections due to contaminated blood products, sterile water, saline, treatment fluids and venous catheters. Human infection unrelated to contaminated solutions is rare. We report a case of lobar pneumonia and pulmonary abscess caused by Ralstonia pickettii in an older patient.Case presentationA sixty-five-year old Han Chinese man presented having had cough, expectoration, chest pain and fever lasting for twenty days. His medical history was notable for hypertension over the previous ten years, and the habit of smoking for forty years. A thoracic computed tomography scan supported the diagnosis of right-sided lobar pneumonia. A lung biopsy was done and pathological analysis confirmed lobar pneumonia. Two lung biopsy specimens from separate sites grew Ralstonia pickettii. After six days, a repeat thoracic scan revealed a right-sided abscess. A thoracentesis was performed and the purulent fluid grew Ralstonia pickettii. The chest tube remained inserted to rinse the cavity with sterile sodium chloride. He received an antibiotic course of intravenous cefoperazone sodium-sulbactam sodium for eighteen days and imipenem-cilastatin for twelve days. A repeat chest X-ray revealed resolution of the pulmonary abscess and improvement of pneumonia. He remained afebrile and free of respiratory symptoms after treatments.ConclusionThis case demonstrates a Ralstonia pickettii infection in the absence of an obvious nosocomial source. It is possible that such cases will become common in the future. Therefore, further studies are needed to evaluate its sensitivity to common antibiotics.

A puzzling omission in a great medical textbook edited by a pioneer of controlled trials

A puzzling omission in a great medical textbook edited by a pioneer of controlled trials

White blood cell count, C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract.

Laboratory findings such as white blood cell (WBC) count, C-reactive protein (CRP) concentration and erythrocyte sedimentation rate (ESR) level in patients with bronchiolitis, bronchopneumonia and lobar pneumonia caused by respiratory syncytial virus (RSV) were studied. The diagnosis of having RSV infection of the lower respiratory tract was made on the presence of RSV antigen in nasopharyngeal specimens by means of enzyme immunoassay, on chest X-ray appearances and clinical manifestations. The WBC counts in the lobar pneumonia cases (n = 25, 12,288 +/- 6296/mm3) were significantly greater than those for the bronchiolitis (n = 52, 9562 +/- 2720/mm3) and bronchopneumonia (n = 43, 8369 +/- 3714/mm3) cases. The concentrations of CRP in lobar pneumonia cases (n = 25, 6.5 +/- 7.3 mg/dL) were significantly greater than those in the bronchiolitis (n = 52, 1.9 +/- 2.0 mg/dL) and bronchopneumonia (n = 43, 2.1 +/- 2.4 mg/dL) cases. The ESR levels in the lobar pneumonia cases (n = 24, 43.8 +/- 29. mm/h) were also significantly higher than those in the bronchiolitis (n = 34, 20.1 +/- 12.3 mm/h) and bronchopneumonia (n = 40, 24.7 +/- 15.9 mm/h) cases. There were no significant differences in the WBC counts, the CRP concentrations and ESR levels between the bronchiolitis and bronchopneumonia cases. These results suggest that the RSV lobar pneumonia cases are coinfected with some bacterial organisms more heavily than in the RSV bronchiolitis and bronchopneumonia cases.

Prevalence ofMycoplasma pneumoniaein children with pneumonia in Zaria, Nigeria

The prevalence of Mycoplasma pneumoniae in children suffering from pneumonia was investigated, using complement fixation and growth inhibition tests. From the sera of 104 children with pneumonia, 32 (31%) showed a CF titre greater or equal to 1:64, while all the 52 control children of the same age and sex had a CF titre less than 1:16. Children 6-10 years of age had the highest positive titre (41%) while the age groups 3-5 years and 0-2 years had positive titres of 30 and 28%, respectively. Both sexes were equally affected (33% male, 29% female). Mycoplasma pneumoniae was isolated in two children whose CF antibody titres were 1:16. It is concluded that M. pneumoniae plays an important role as an aetiological agent of pneumonia in children in Zaria, Nigeria, and could be included in the routine diagnostic protocol of pneumonia, especially during the dry harmattan months when cases of lobar pneumonia are prevalent.

Panorama- und Gestaltwandel der Infektionskrankheiten im Sektionsgut des Pathologischen Institutes der Universität Heidelberg während drei Dezennien Chemotherapie

Previous studies have demonstrated changes in the frequency and pathomorphosis of infectious diseases in the initial years following the introduction of sulfonamides and antibiotics as compared to the years prior to their introduction. The object of this study is to determine whether the intervening decades have produced further such changes in view of the extensive use of highly effective chemotherapeutical agents and new vaccines. For this purpose, autopsy reports involving infectious diseases from 1930 to 1934 in the department of pathology of the University of Heidelberg were compared with reports from the years 1950 to 1954 and 1968 to 1972. The number of cases of bronchial pneumonia, meningitis, enterocolitis and syphilis were found to have decreased since the introduction of chemotherapy. The number of cases of lobar pneumonia increased slightly, but not enough to be of statistical significance. An increase was observed in the number of cases of interstitial nephritis and hepatitis. Osteomyelitis, typhus fever, dysentery, viral pneumonia and the childhood diseases diphtheria, scarlet fever, measles and poliomyelitis were rarely reported. Further morphopathological changes since the introduction of chemotherapy were evident in some infectious diseases such as syphilis and scarlet fever. The statistical evidence from these autopsy reports verifies that changes in the frequency and morphopathology of infectious diseases which were noted during the early years following the introduction of chemotherapy are still taking place today.

The significance of penumococcal types

The significance of penumococcal types

Lobar pneumonia with bacteremia caused by bacterium anitratum

A severe case of lobar pneumonia and bacteremia caused by B. anitratum is presented, together with a review of the literature on this organism and its bacteriological characteristics. Therapeutic experiences in general have shown the tetracyclines to be the most efficacious in treating infections caused by B. anitratum.

急性肺炎患者の呼吸・循環機能

Respiratory and circulatory function tests were done on three patients with severe acute pneumonia at the height of the disease. The course of the disease was followed with these tests. From the results obtained, the occurrence of hypoxemia and electrocardiographic changes were studied.1) Pulmonary function disturbance During the height of the disease, the changes found in the pulmonary function were a decrease in lung capacity and increases in the minute ventilatory volume and oxygen consumption. The blood gas analysis during this stage showed a marked decrease in the arterial blood oxygen saturation and partial pressure with a tendency of an increase in the arterial carbon dioxide partial pressure. No remarkable difference was found in the ventilatory function distubance between a case of bronchopneumonia with widely spread pathology on X-ray and a case of lobar pneumonia with the damage limited to one lobe, but the disturbance in the blood gas was stronger in the case of bronchopneumonia.2) Electrocardiographic changes The cases of lobar pneumonia with lowered arterial blood pressure showed only low T but the two cases of bronchopneumonia had low T and marked ST depression. Sinus tachycardia was seen in all cases.3) The cause of decreased arterial blood oxygen saturation Although it is commonly thought that there should be an increase in the ineffective pulmonary blood flow in such conditions as in the present cases, it was made clear that the decrease of alveolar air oxygen partial pressure and the disturbance of alveolar diffusion are the main factors which cause the decrease in the arterial blood oxygen saturation.4) The cause of the electrocardiographic changes By referring to the results obtained by coronary catheterization studies done in our medical department, it can be considered that the cause for the electrocardiographic changes in pneumonia is a decrease in the cardiac oxygen consumption while the cardiac work increases. And, it was made clear that, although the electrocardiographic findings may be minimal especially when the arterl blood pressure is low at the same time, the state of the patient should be estimated carefully by considering the results of various other tests.

Surgical Complications in the Thorax of Staphylococcal Pneumonitis

Staphylococcic pneumonitis occurring in childhood has been recognized for many years, but until recently it has been regarded as a comparatively rare disease. This is indicated by the relatively small number of cases reported in the literature. Staphylococcal pneumonitis occurring as a complication of epidemic influenza has been known for a long time. The acute, fulminating, prostrating type occurring during the influenza pandemic of 1918 was described in the writings of Chickering and Park (1919). 1,2 At that time mortality rates of 80%-90% were reported. The staphylococcal pneumonitis occurring principally in infants carries a grave prognosis and usually occurs in sporadic form. 3 The gross mortality, in spite of antibiotic therapy, however, still remains high, with mortality figures in the range of 0 to 20%. Relatively few cases of staphylococcal pneumonitis occurring in adults unassociated with major influenza epidemics were reported before 1950. In 1939 Heffon, 4 analyzing 3319 cases of lobar pneumonia,

Pneumococcal Antigenic Polysaccharide Substances from Human Tissues

Summary and Conclusions In view of the observations that, following a dose of pneumococcus polysaccharide sufficient to produce “immunological paralysis” and a hypersusceptible state, mice retained in their tissues polysaccharide substances which on isolation stimulated a high degree of immunity in other mice against pneumococcus infection, whereas similar polysaccharide fractions from normal animals were lacking in antigenicity, a study has been made of substances similarly isolated from human tissues obtained from 125 individuals at autopsy. This unselected group, ranging in age from newborn to 88 years, included 3 primary lobar pneumonia cases, 2 primary and 23 secondary bronchopneumonia cases, and a miscellaneous group of 97 non-pneumonic fatalities. Ninety per cent of the entire group contained in one or more tissues (liver, spleen, kidney) polysaccharide substances which on isolation stimulated some immunity in mice against pneumococcus infection, especially of types I and/or II. There was some indication that the polysaccharides from pneumonia cases more often stimulated a high degree of immunity than those from non-pneumonia cases; also it was indicated that those from older individuals were more often antigenic than those from younger. It is suggested that accumulation of polysaccharide antigen in human tissues may influence susceptibility to pneumococcus infection and hence perhaps be a contributing factor in the incidence of pneumonia.

Massive and Generalized Œdema Occurring in Two Cases of Lobar Pneumonia Under Sulphonamide and Penicillin Therapy

Massive and Generalized Œdema Occurring in Two Cases of Lobar Pneumonia Under Sulphonamide and Penicillin Therapy

Aureomycin in Treatment of Pneumococcal Pneumonia and Meningococcemia.

Aureomycin is a new antibiotic which is active in vitro and in experimental animals against gram-positive and gram-negative bacteria and is also effective against experimental infections with rickettsias and with viruses of the psittacosis lymphogranuloma venereum group.† The findings in 4 cases of pneumococcal pneumonia and in one case of meningo-coccemia are presented here briefly. The bac-teriologic methods are described elsewhere.1, 2The cases of lobar pneumonia were of moderate severity and a single lobe was involved in each instance. All were in males ranging in age from 16 to 65 years. Pneumo-cocci were identified and typed from the sputum in each instance and from the blood in one case before oral aureomycin therapy was started. One patient received an initial dose of 0.5 g followed by 0.25 g every 6 hours for a total of 5 g; the others received 0.5 g every 6 or 8 hours for a total of 10 g in 2 cases and 20 g in the oldest patient. No other chemotherapy or antibiotic was used. Some of the relevant...

THE MECHANISM OF RECOVERY IN ACUTE BACTERIAL PNEUMONIA

Excerpt Although the treatment of acute bacterial pneumonia has been revolutionized in recent years by the advent of chemotherapy, the exact mechanism of recovery is not known. Pertinent to the pro...

Effect of Sulfadiazine on Cholera *

Summary 1. In a cholera epidemic, 10 patients were given sulfadiazine in addition to saline infusions with 10 other patients without sulfadiazine treatment as control. 2. The average duration of diarrhea of the sulfadiazine-treated patients (4.6 days) is shorter than that of the controls (7.1 days). 3. One case of lobar pneumonia resulting in death and one case of parotitis occurred among the patients without sulfadiazine therapy. 4. Oral administration of fluid and alkalies in the treatment of cholera has been emphasized.