Episodes Of Pulmonary Infection Research Articles

Imaging findings of pulmonary manifestations of chronic granulomatous disease in a large single center from Shanghai, China (1999\u20132018)

Chronic granulomatous disease (CGD) is characterized by recurrent infections and granuloma formation in multiple organs, especially the lung. We aimed to investigate pulmonary manifestations by computed tomography (CT). In total, 100 patients with 117 episodes of pulmonary infection were included. Chest CT scans of every episode were analyzed. Random nodules were the most common findings (79.49%), followed by ground-grass opacities (74.36%), focal consolidations (62.39%), and masses (59.83%). Cavities (12.82%) and multiple small abscesses (17.09%) could be found in the consolidations and masses. CT revealed interstitial pneumonia with tree-in-bud opacities (17.09%), interlobular septal thickening (23.08%) and emphysema (35.04%), which were more severe in the bilateral upper lobes. Mediastinal and hilar lymphadenopathy (78.63%) and axillary lymphadenopathy (65.81%) were common. Fungal infection (n = 27) was the most common and presented with multiple nodules and masses. Approximately 1/4 of fungal infections had interstitial pneumonia. In Staphylococcus aureus (n = 6) and Klebsiella pneumoniae (n = 3) infections, large areas of consolidation were common. In tuberculosis infection, the pulmonary infections were more severe and complex. For Bacillus Calmette-Guérin disease, left-sided axillary lymphadenopathy was a characteristic manifestation. CT images of CGD demonstrated variable pulmonary abnormalities. The main infectious organisms have unique imaging features.

A Case of Unilateral Hyperlucency of the Lung: a Rare Adult Occurrence of Swyer-James-MacLeod Syndrome.

Swyer-James-MacLeod syndrome is a rare pulmonary disorder that exhibits unilateral hyperlucency of a part of or the entire lung and because it is usually asimptomatic the diagnostic of this illness is discovered accidentally after a chest X-ray. Although the cause of this disorder is not completely understood, most authors believe that this is due to late sequela of infectious bronchiolitis that occurs during childhood. The symptoms presented by the individuals are often scarce at the moment of diagnostic, but a history of recurrent episodes of pulmonary infection accompanied by dyspnea, hemoptysis and/or chronic productive cough should raise the suspicion for such a diagnosis. Swyer-James-MacLeod syndrome can be interpreted as asthma or pulmonary embolism and this can result in inappropriate therapy. This case report describes a 38-year-old patient with chronic respiratory symptoms diagnosed on the findings of the chest X-ray and high resolution CT.

Severe airflow obstruction in vertically acquired HIV infection.

It is becoming increasingly clear that human immunodeficiency virus (HIV) infection, either independently or in concert with opportunistic infections like pulmonary tuberculosis, is a risk factor for the development of chronic airflow limitation. In the majority of patients the etiology of this obstructive ventilatory defect is multifactorial. Post-infectious obliterative bronchiolitis, post-tuberculous lung damage (including bronchiectasis), immune reconstitution and the direct effects of HIV viral infection may all play a role. With increases in life expectancy and decreases in infectious complications in patients taking antiretroviral medications, the importance of HIV-associated chronic lung disease as a cause of pulmonary disability is likely to increase. This is particularly relevant in regions like sub-Saharan Africa, where both HIV infection and tuberculosis are highly prevalent. Here, to illustrate the complexity of this interaction, we present the case of a 15-year-old girl with vertically acquired HIV infection, multiple episodes of pulmonary infection, and severe airflow obstruction.

P1-178 Heterogeneity of the 23-valent pneumococcal polysaccharide vaccine efficacy due to various underlying conditions of chronic pulmonary disease in elderly patients

IntroductionThe efficacy of 23-valent pneumococcal polysaccharide vaccine (PPV23) against pneumonia in elderly with chronic illness remains controversial.MethodsA total of 1378 elderly outpatients with chronic pulmonary disease were informed of the...

Respiratory Failure of Williams-Campbell Syndrome is Effectively Treated by Noninvasive Positive Pressure Ventilation

Williams-Campbell syndrome is a rare disease, characterized by a congenital deficiency of cartilage in the fourth to sixth order bronchi, leading to chronic respiratory failure with recurrent pulmonary infections. An effective and practical treatment has not yet been established. A 31-year-old man who was diagnosed as Williams-Campbell syndrome by inspiratory and expiratory computed tomography findings developed recurrent pulmonary infections and showed progressive deterioration of dyspnea. Domiciliary NPPV was administered, followed by a dramatic improvement of respiratory failure and a decrease in the episodes of pulmonary infections. NPPV may have an advantage in adults with Williams-Campbell syndrome who have severe respiratory failure and recurrent pulmonary infections.

Pulmonary infections increase exhaled nitric oxide in lung transplant recipients: a longitudinal study

The aim of this longitudinal study was to test whether pulmonary infections influence fractional exhaled nitric oxide levels (FENO) in otherwise clinically-stable lung transplant recipients. Levels of FENO were measured at least on 11 occasions in nine lung transplant recipients who attended for routine or urgent clinical review over 27.0 +/- 3.2 months period. Diagnosis of infection was based on clinical symptoms, functional measurements and radiological findings. Concentrations of FENO were also determined in 12 healthy volunteers. During follow-up, six patients had one, two had three, and one had four episodes of pulmonary infections. Overall, six upper and 10 lower respiratory tract infections were noted. Recipients with active infections developed increased FENO levels as compared with their own baseline levels measured in the clinically well period (10.8 +/- 1.3 vs. 7.6 +/- 1.1 ppb, p < 0.05). After antibiotic treatment, elevated FENO concentrations returned to baseline in association with full clinical recovery. Baseline FENO levels in lung transplant recipients and in healthy volunteers (6.0 +/- 0.5 ppb) were similar. The sensitivity and specificity of FENO measurement in detecting pulmonary infections were 57 and 96%, respectively. Our data suggest that pulmonary infections are associated with increased FENO levels in patients with lung allografts. Nevertheless, the measurement of FENO by itself as a screening tool for infections seems to be limited by its low sensitivity.

Pulmonary infections after bone marrow transplantation: clinical and radiographic findings.

To assess the clinical and radiographic findings of pulmonary infections diagnosed by using invasive means. Fifty-nine episodes of pulmonary infection were diagnosed in 52 (7.2%) of a consecutive series of 725 adult bone marrow transplant recipients. Causative organisms, time of diagnoses, radiographic patterns, and mortality rates were reviewed. Cytomegalovirus and Aspergillus species were the two most common pathogens, accounting for 22 and 17 episodes, respectively. During the first 30 days after bone marrow transplantation, fungi caused the majority (nine [82%] of 11 episodes) of pulmonary infections; from days 31 to 100, viruses predominated (21 [62%] of 34 episodes). Recipients of allogeneic transplants had a higher probability of developing Cytomegalovirus pneumonitis than did the recipients of autologous and syngeneic transplants (P < .001). Radiographic findings of Cytomegalovirus pneumonia consisted of parenchymal opacification (90%) and innumerable nodules smaller than 5 mm (29%); in two patients, radiographs were normal. Nodules, masses, or nodules and masses, present in nine (69%) of the 13 patients with Aspergillus infection, were the most common radiographic findings in invasive aspergillosis. Bone marrow transplant recipients with a documented pulmonary infection were found to have a lower event-free survival than recipients without infection (P < .001). Opportunistic pathogens account for the majority of pulmonary infections requiring invasive diagnosis and tend to manifest at predictable times in the course of events following recovery from bone marrow transplantation. Cytomegalovirus, the most common pathogen, causes a spectrum of radiographic findings that includes normal findings. Occurrence of a pulmonary infection is associated with an increased mortality rate.

A CLINICAL STUDY OF INFECTIONS AFTER RENAL TRANSPLANTATION

A clinical study of infections was made of 66 patients undergoing renal transplantation from 33 living related donors and 33 cadaveric donors at our institute from July 1982 to June 1994. Twenty-six episodes of infection occurred in 23 patients. Infections occurred in 5 cases out of 11 patients treated with azathioprine (AZ) and prednisolone (PD), 9 cases out of 22 treated with ciclosporin (CYA) and PD, and 9 cases out of 33 treated with CYA, AZ and PD. There occurred 9 episodes of pulmonary infection, 9 episodes of herpes zoster, 2 episodes of meningitis, 3 episodes of hemorrhagic cystitis, and one episode of conjunctivitis, including viral infection in 17, pneumocystic carinii in 4, bacterial infection in 3 and fungal infection in 2 cases. Four patients died of infection. Seventeen episodes occurred from 1 to 6 months after renal transplantation. Cadaveric donor was relatively associated with infectious death, and acute rejection was also relatively associated with infections. The significant differences were observed in the levels of albumin and IgG between infectious and non-infectious patients. In conclusion, infections after renal transplantation would be associated with the dose of PD and acute rejection, and the levels of albumin and IgG could be predicting factors of infection.

Bronchopulmonary dysplasia.

Neonatal pulmonary diseases may require mechanical ventilation and supplemental oxygen therapy. These supportive measures can damage the immature lung or distort the normal maturation processes of the developing lung. The formation of hyaline membranes occurs acutely, often complicated by left-to-right cardiac shunts. Pulmonary edema occurs next, followed by interstitial fibrosis and finally by parenchymal emphysema. This process is termed bronchopulmonary dysplasia. Significant morbidity and mortality are associated with this developmental pulmonary dysplasia, particularly during the first two years of life. A delay in normal growth and development is often present, acute episodes of pulmonary insufficiency are seen, and multiple episodes of pulmonary infection occur. Subsequently, the radiographic appearance and the clinical symptoms improve. Therapy is mainly supportive throughout the course of the disease and the bronchopulmonary dysplasia tends to resolve slowly. Residual pulmonary dysfunction is usually mild or absent.

Pulmonary Infections in Renal Transplant Recipients

Forty-six episodes of pulmonary infection occurred in 41 patients during a seven year period in which 187 renal transplants were performed in 168 patients. Thirty-seven episodes followed 152 cadaveric transplants (24.39%), and four episodes followed 35 living related donor transplants (11.4%). Five patients had two episodes of pulmonary infection. Twenty-four patients recovered, and 17 died (41.5%). Pulmonary infections appeared from two days to three years after transplantation, but predominated in the first four months (32/46). They were caused primarily by bacterial agents (74%) with protozoa, fungi, and viruses appearing less frequently. In 35 episodes, a single etiologic agent was found, but 11 were caused by two or more agents. When compared with noninfected recipients, there was no significant difference with regard to number of rejection crises, maintenance prednisone dosage, or blood glucose. However, subnormal renal function was significantly associated with the development of infection. Azathioprine dosages were actually higher for the noninfected patients, reflecting a tendency to lower the dose of azathioprine in the presence of decreased renal function. Fever was the most common presenting symptom. Transtracheal aspiration with Gram stain and direct sensitivity plating routinely provided early and accurate identification of the organism and a guide for therapy in bacterial infections. Pulmonary infection in renal transplant recipients is associated with a high mortality rate. Early diagnosis and specific treatment are essential to successful management.