Previous Pulmonary Infection Research Articles

The Impact of Postoperative Pulmonary Complications on Perioperative Outcomes in Patients Undergoing Pneumonectomy: A Multicenter Retrospective Cohort Study of the German Thorax Registry.

Postoperative pulmonary complications have a deleterious impact in regards to thoracic surgery. Pneumonectomy is associated with the highest perioperative risk in elective thoracic surgery. The data from 152 patients undergoing pneumonectomy in this multicenter retrospective study were extracted from the German Thorax Registry database and presented after univariate and multivariate statistical processing. This retrospective study investigated the incidence of postoperative pulmonary complications (PPCs) and their impact on perioperative morbidity and mortality. Patient-specific, preoperative, procedural, and postoperative risk factors for PPCs and in-hospital mortality were analyzed. A total of 32 (21%) patients exhibited one or more PPCs, and 11 (7%) died during the hospital stay. Multivariate stepwise logistic regression identified a preoperative FEV1 < 50% (OR 9.1, 95% CI 1.9-67), the presence of medical complications (OR 7.4, 95% CI 2.7-16.2), and an ICU stay of more than 2 days (OR 14, 95% CI 3.9-59) as independent factors associated with PPCs. PPCs (OR 13, 95% CI 3.2-52), a preoperative FEV1 < 60% in patients with previous pulmonary infection (OR 21, 95% CI 3.2-52), and continued postoperative mechanical ventilation (OR 8.4, 95% CI 2-34) were independent factors for in-hospital mortality. Our data emphasizes that PPCs are a significant risk factor for morbidity and mortality after pneumonectomy. Intensified perioperative care targeting the underlying risk factors and effects of PPCs, postoperative ventilation, and preoperative respiratory infections, especially in patients with reduced pulmonary reserve, could improve patient outcomes.

Mucormycosis and It’s Prevalence in the Patients of COVID-19

The world today is going through a series of uncalled events, that has hindered the balance of livelihood in the current population. This is due to the emergence of the COVID-19 but along with that, the COVID-19 has accompanied several other rare and extremely fatal fungal infections under its shadows, such as the Mucormycosis. Mucormycosis is caused particularly in the immunocompromised hosts by the saprophytic fungi of Mucorales species. This infection leads to several clinical conditions, under the influence of the COVID-19 Associated Mucormycosis, commonly being the conditions such as the rhino-cerebral disease. This condition occurs mainly in the patients with diabetes mellitus. Several other respiratory, gastrointestinal and cutaneous contaminations also occur during this condition. COVID-9 accompanied with diabetes mellitus can be extremely life threatening. Now, there are several predisposing factor to the Mucormycosis which could accompany the severity of the conditions such as the Ketoacidosis in the patients with diabetes mellitus, patients on the immunosuppressive therapies, previous pulmonary infections and other nosocomial contaminations. There are no specific biomarkers available to diagnose Mucormycosis; Histopathological examination of the biopsied tissue and imaging of the involved area are most important in diagnosis. Mucormycosis being an angioinvasive fungus, usually is present in the surroundings with wet surfaces and dead and decaying vegetable matter. The term black fungus is used as in for the dematiaceous fungi, which are an entirely different group. Since the COVID-19 pandemic is on it’s massive widespread in the country, the new variant being more infectious, people are more tend to some other complications of the COVID-19 contamination such as that of the secondary fungal infections causing high mortality rates.

Thoracoscopic surgery for congenital lung malformations: Does previous infection really matter?

Background/ PurposeElective resection of congenital lung malformations (CLMs) is still debatable. The two main risks are malignant transformation and recurrent pulmonary infections. Our study aimed to assess the effect of previous pulmonary infection on the intraoperative and postoperative courses of thoracoscopic surgery for CLMs. MethodsThis is a retrospective study including all thoracoscopic lung resections for CLMs between 2010 and 2019. Ninety patients were included. There was a history of previous pulmonary infection in 28 patients (group A) and no such history in 62 patients (group B). ResultsThe median age at operation for group A was 20.4 months (IQR:14.9–41.4) versus 15.1 months (IQR:9.7–20.8) in group B (p = 0.006). There were 10 conversions (35.7%) in group A and 8 (12.9%) in group B (p = 0.02). The operative time was significantly shorter in group B (p<0.002). In group A, 32.1% of patients experienced postoperative fever versus 11.3% of group B (p = 0.03), with higher antibiotics requirement (28.6% versus 6.5% respectively, p = 0.007). However, no significant differences were found in terms of postoperative complications (p = 0.99). ConclusionEarlier intervention for CLMs before the development of pulmonary infection carries higher chances for the success of the thoracoscopic approach with shorter operative time and more uneventful postoperative courses.

Musculoskeletal tuberculosis: A diagnostic approach

Musculoskeletal tuberculosis constitutes 3 percent of extra pulmonary secondary tuberculosis predominantly involving the spine. The variations in its presentation and unclear symptoms make diagnosis difficult in early period. The normal lab values like ESR, TLC, DLC and no clear history of previous pulmonary infection makes the picture unclear and delays the diagnosis. Present work is the overview of the presentation of various musculoskeletal presentations, efficacy of BCG vaccination, time delay in diagnosis, laboratory parameters, x rays and other radiological changes etc. The reliability of the various lab procedures like AFB stain, histopathology, tuberculosis bacteria culture and cartridge-based nucleic acid amplification test (CBNAAT) has also been overviewed.

Left pulmonary artery agenesis

Unilateral pulmonary artery agenesis is a rare malformation accounting for 1% of congenital heart defects. It can lead to several complications. We report the case of a 16-year-old female patient with no particular past medical history, presenting with recurrent low abundance hemoptysis within a context of preservation of patient’s general condition. Clinical examination showed no abnormalities and frontal (A) and lateral (B) chest x-ray revealed small left lung-field associated with decreased vascular pattern and mediastinal shift to the left. Given this radio-clinical presentation, diagnosis of suspected left pulmonary hypoplasia, sequelae of a previous pulmonary infection and endobronchial foreign body were made. Thoracic CT scan objectifies the absence of left pulmonary artery (C) and multiple systemic collateral circulation Left pulmonary parenchyma was hypoplastic, well ventilated and without bronchial abnormality (D). The descending aorta was located on the right. The electrocardiogram showed right bundle-branch block and transthoracic ultrasound did not reveal cardiac abnormality including sign of pulmonary arterial hypertension. Spirometry showed normal respiratory function as well as laboratory tests. Hemoptysis treatment was symptomatic and the patient was kept under medical monitoring.

Progressive ventilation inhomogeneity in infants with cystic fibrosis after pulmonary infection

Measures of ventilation distribution are promising for monitoring early lung disease in cystic fibrosis (CF). This study describes the cross-sectional and longitudinal impacts of pulmonary inflammation and infection on ventilation homogeneity in infants with CF.Infants diagnosed with CF underwent multiple breath washout (MBW) testing and bronchoalveolar lavage at three time points during the first 2 years of life.Measures were obtained for 108 infants on 156 occasions. Infants with a significant pulmonary infection at the time of MBW showed increases in lung clearance index (LCI) of 0.400 units (95% CI 0.150-0.648; p=0.002). The impact was long lasting, with previous pulmonary infection leading to increased ventilation inhomogeneity over time compared to those who remained free of infection (p<0.05). Infection with Haemophilus influenzae was particularly detrimental to the longitudinal lung function in young children with CF where LCI was increased by 1.069 units for each year of life (95% CI 0.484-1.612; p<0.001).Pulmonary infection during the first year of life is detrimental to later lung function. Therefore, strategies aimed at prevention, surveillance and eradication of pulmonary pathogens are paramount to preserve lung function in infants with CF.

Early Experience of Pediatric Thoracoscopic Lobectomy in the UK

The aim of this study was to report on the early experience of pediatric thoracoscopic lobectomy in two UK centers (Royal Hospital for Sick Children, Edinburgh, and Addenbrookes Hospital, Cambridge). Twelve patients between February 2000 and November 2005 were treated with a lobectomy for pulmonary disease. Diagnoses included 7 congenital cystic adenomatous malformations, 4 patients with bronchiectasis, and 1 thoracic mature teratoma. The patients' ages ranged from 8 months to 15 years. In all patients, a thoracoscopic lobectomy was attempted. In all cases, the lobectomy was completed; however, in 6 patients, the conversion to either video-assisted thoracoscopic surgery (VATS) or open thoracotomy was required. Of note, 9 of the 12 patients had had previous lung infections prior to lobectomy. Five of 6 that required a conversion to VATS or open thoracotomy had had significant previous pulmonary infection, causing hilar lymphadenopathy and adhesions that complicated the dissection. The other case requiring a conversion to thoracotomy had abnormal hilar anatomy with an incomplete oblique fissure. Patients with a previous history of pulmonary infection can cause difficulty in dissection of the hilum that can necessitate a conversion to VATS or open thoracotomy. An infection prior to lobectomy can cause difficulty in completing the procedure safely thoracoscopically. Consideration of patients with pulmonary disease for lobectomy should be made prior to the onset of infectious complications. The thoracoscopic lobectomy can still be performed in patients with a preceding history of infectious complications, though a higher rate of conversion is likely.

Kidney Biopsy Findings in a Patient With Fever, Bilateral Pulmonary Infiltrates, and Acute Renal Failure

Kidney Biopsy Findings in a Patient With Fever, Bilateral Pulmonary Infiltrates, and Acute Renal Failure

Cell-mediated Adaptive Immune Defense of the Lungs

Cell-mediated adaptive immune responses contribute to defense against all classes of pulmonary pathogens and are essential against viruses, mycobacteria, and fungi, including Pneumocystis carinii. Adaptive responses depend on sequential pairwise interactions between three cell types: T cells, natural killer (NK) cells, and dendritic cells (DC). Differential expression of specific adhesion molecules and chemokines regulates the location and timing of these interactions. Primary adaptive responses are triggered by immature myeloid DC, which carry antigen from the lungs to regional lymph nodes. Antigen presentation by these mature DC is required to activate naive CD4 T cells, which are essential to generate polarized type 1 or type 2 effector responses and for robust immunologic memory. Inflammation recruits NK cells and DC that interact in a contact- and tumor necrosis factor-alpha-dependent fashion within injured tissues to initiate immune response polarization. NK cells exposed to IL-12 favor survival of DC that prime for Th1 responses, whereas NK cells exposed to IL-4 do not exert DC selection, leading to tolerogenic or Th2 responses. Naive alphabeta T cells, NK cells, and DC also amplify secondary adaptive responses to previously encountered pathogens. However, secondary responses are accelerated because memory T cells can migrate directly to infected tissues where they can be activated without strenuous costimulatory requirements. Additionally, previous pulmonary infections or immune responses increase numbers of lung DC and populate the lungs with clones of memory B cells and T cells that are immediately available to respond to infections.

Non-endocrine late complications of bone marrow transplantation in childhood: part I.

Non-endocrine late complications of bone marrow transplantation in childhood: part I.

Lung abscess in patients with AIDS.

We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm3 (range, 2-50/mm3). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received > 4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.

Surgical management of pulmonary infections in chronic granulomatous disease of childhood

Chronic granulomatous disease of childhood is an inheritable disorder of phagocytic cell respiratory burst resulting in recurrent, life-threatening, catalase-positive infection. The lung is the most cummon site of infection, and pulmonary disease is the primary cause of death in greater than 50% of children with chronic granulomatous disease. Still, the role of surgery in management of this disease remains undefined. Between 1974 and 1990, 19 patients with chronic granulomatous disease required 31 thoracic interventions at our institution. Patients ranged in age from 2.5 to 27 years (mean age, 15 years). Seventeen of 19 patients (89%) had had previous pulmonary infections. Patients presented as toxic (temperature > 38.5 °C, chest pain, and cough) in 22 instances before the 31 procedures. Aggressive surgical intervention for diagnosis and extirpation of localized infections was undertaken with lobectomy/pneumonectomy with or without other procedures (5), bisegmentectomy (2), segmentectomy with or without other procedures (5), or wedge with or without other procedures (13). In five instances, an empyema was drained; a chest tube for a sterile collection was placed in one instance. There was one intraoperative death, and 3 patients died 22 to 600 days postoperatively with overwhelming sepsis. The mean hospitalization was 101 days (range, 24 to 600 days). Wound complications occurred in 5 patients, requiring 17 separate anesthetic debridements. A change in therapy was dictated by the results of the procedure in 23 of 31 instances (74%). Thoracic surgeons must be aware of this rare cause of immunosuppression in these children and, due to the unusual nature of the pulmonary infections, should follow an aggressive approach in their diagnosis and management.

Emphysema-like Pulmonary Disease Associated with Human Immunodeficiency Virus Infection

To describe a possible association between prolonged infection with human immunodeficiency virus (HIV) and a pathophysiologic process suggestive of pulmonary emphysema. Case series. The Ohio State University Hospital, Columbus, Ohio. We describe four HIV-seropositive individuals ranging in age from 32 to 55 years who presented with dyspnea. Radiographic examination of the chest showed no infiltrates. All patients were presumed to have had prolonged HIV infection (mean CD4 count, 99.8 +/- 43 cells/mm3), but none had a previous history of pneumonia or opportunistic infections. Comprehensive examination of bronchoalveolar lavage fluid showed no pathogens or other complications of HIV infection. All patients had markedly abnormal pulmonary function tests that were suggestive of emphysema with air-trapping, hyperinflation, and a markedly decreased diffusing capacity. However, only minimal evidence of airflow obstruction was noted. Three patients subsequently had high-resolution computed tomographic scans of the chest that revealed emphysema-like bullous changes. Known causes of emphysema were not present in these patients. Our findings support an association between prolonged HIV infection and an emphysema-like process. This syndrome may occur in the absence of previous pulmonary infections or apparent pulmonary complications and is characterized by unusual pulmonary function test abnormalities.

Epidemiology and risk factors of pneumonia in critically ill patients

Risk factors for pneumonia were analysed in a large population of critically ill patients, collected in two prospective multicentre "pneumonia studies" in Italy. Twenty-three intensive care units were involved and the study time was 150 unit months. Only patients without previous pulmonary infection, with intensive care unit stay greater than or equal to 48 hours and no rapidly irreversible illness at admission were included. The incidence of pneumonia in the 1475 selected patients was 15% (220 cases). 239 patients died in ICU; the mortality rate was significantly higher in patients developing pneumonia (p less than 0.0001); pneumonia was found to be an independent highly significant risk factor for death in critically ill patients (OR = 3.88; p less than 0.0001). Multivariate analysis of seven risk factors for pneumonia showed a significantly higher risk in patients with neuromuscular disease (OR = 3.8, p less than 0.002), impairment of airway reflexes at admission (OR = 2.93, p less than 0.0001), and greater than or equal to 24h respiratory assistance (OR = 3.05, p less than 0.0001). Impairment of airway reflexes at admission to the emergency room or intensive care unit identifies the population who will experience 3/4 of the overall lower respiratory tract infections. Rapid recognition of at-risk patients seems clinically important and may improve awareness programs and preventive approaches.

Early onset pneumonia: a multicenter study in intensive care units.

A prospective multicenter study concerning the incidence, onset time, risk factors and mortality of pneumonia was carried out by the Intensive Care Units Collaborative Group for Infection Control in Lombardy, Northern Italy. Out of 1304 patients admitted over 3 months in 16 intensive care units (ICUs), 441 met the criteria for the protocol (no previous pulmonary infection or irreversible terminal illness, ICU stay greater than 48 h). The incidence of acquired pneumonia was 21.3% (94/441), with 54.2% of cases diagnosed within 4 days of admission (early onset pneumonia). Impairment of airway reflexes on admission and more than 24 h respiratory assistance were shown as significant risk factors (RR) for early onset pneumonia (respectively RR = 12.4, with 95% confidence interval (CI) = 5.3-28.9 and RR = 3.3, with 95% CI = 1.8-5.9). A suggested pathogenetic mechanism is aspiration of oropharyngeal contents at the onset of acute illness, due to depression of protective reflexes with delayed clearance of bacterial contamination. No protection was offered by routinely applied prophylactic antibiotic therapy.

Pulmonary Function in Former Alcoholics

Pulmonary function was evaluated in 44 former alcoholics (abstinence, 0.5 to 32 years) without cardiac or specific pulmonary disease. All were members of Alcoholics Anonymous. Fourteen subjects (32 percent) were non-smokers, ex-smokers, and cigar or pipe smokers, yet 28 subjects (64 percent) had abnormal expiratory flow rates, and 17 (39 percent) had an elevated value for the ratio of the residual volume to the total lung capacity. Single-breath diffusing capacity was abnormal in seven subjects (16 percent). Of interest was the high incidence (77 percent) of obstructive phenomena among the women. This high incidence of abnormalities among both the men and women could not be attributed to previous pulmonary infection or smoking. Comparison of these patients with chronic alcoholics suggests that the obstructive component in these patients is, in part, a result of their past alcoholic intake and that it is not reversed by abstinence. On the other hand, the impairment in diffusion, which was so common in alcoholics, appears to be reversible with sobriety.

Pulmonary function in alcoholics

Twenty-three chronic alcoholics were investigated by means of pulmonary function studies. All 23 patients had respiratory symptoms. Clinically, 21 (91 per cent) of 23 patients were diagnosed as having chronic bronchitis, and 14 patients (60 per cent) had dyspnea. The maximal mid-expiratory flow and single breath diffusing capacity for carbon monoxide (SBDCO) were abnormal in 16 (70 per cent) and 14 (61 per cent) patients, respectively. Twenty-two of 23 patients had one or more abnormal function. The total lung capacity, residual volume, vital capacity, 1 second forced expiratory volume and SBDCO progressively declined with increasing alcohol consumption. An attempt was made to separate the pulmonary effects of alcohol from (1) the effects of previous pulmonary infections, (2) the effects of cigarette smoking, and (3) the effects of cirrhosis of the liver. The data suggest that either alcohol itself through some unknown mechanism may be a causative agent in producing lung disease or that alcohol makes a higher percentage of the population susceptible to the harmful effects of cigarette smoking.

Streptomycin in the Treatment of Extrapulmonary Tuberculosis

THIS report deals with 92 cases of extrapulmonary tuberculosis treated with streptomycin in various amounts and over different lengths of time. In all cases the lesions were proved to be tuberculous by guinea-pig inoculation or x-ray study or both. No pulmonary activity was found except in 2 cases, in which an incipient pulmonary lesion was readily controlled by streptomycin. In the majority of these cases residua from previous pulmonary infection with tuberculosis could be demonstrated. In every case the intradermal tuberculin reaction was positive. Many of these patients had more than one tuberculous lesion, and 157 active lesions were present. . . .

Pulmonary Fibrosis

Pulmonary fibrosis is not a primary disease, but the result of a previous pulmonary infection or irritation. It is of interest to the roentgenologist because of the similar appearance in the roentgenogram of fibrotic lesions that are the end-result of many different processes. Often the fibrotic changes seen in the roentgenogram are the only changes demonstrable, the primary lesions having disappeared. In the classification of fibrosis, most writers, as a matter of convenience, recognize two general types, local and massive. The massive type is subdivided into tuberculous and non-tuberculous types. However, from the roentgenologist's viewpoint, a classification based on the etiology is probably more practical. In such a classification two general subdivisions can be made: fibrosis due to an infection, and fibrosis due to irritation of the lung, or of a mechanical nature (Table 1). These may be further subdivided into local and massive types, depending on the degree of involvement. Thus the causes of fibrosis may be said to include every disease, acute or chronic, to which the lung is subject, the chronicity of the primary affection having a great deal to do with the process. Before the advent of the roentgen ray, fibrosis was regarded as an extremely rare condition; for example, in the Guy's Hospital reports, in a total of 21,317 necropsies performed in fifty years (1857 to 1906), there were only forty-six cases of pulmonary fibrosis (2). This is due to the fact that the pathologists were describing only the massive type of fibrosis, a condition which still remains as rare as the reports indicate. Morbid Anatomy Fibrosis of the lung presents an extremely variable appearance, depending, first, on the causative factor, second, on the degree of involvement, and third, on its starting point, which may be the connective tissue around the bronchi and blood vessels, the interlobular septa, the alveolar walls, or the subserous areolar tissue of the pleura. When the process has been one of long standing, any one or all of these structures may become involved, and any trace of the original location be obliterated (17). In this connection it might be well to review briefly the distribution of connective tissue in the normal lung, in order to obtain a more accurate conception of the abnormal distribution of fibrous tissue and its starting points (16), (21). First of all there is a general sheet of connective tissue which surrounds and invests the cartilages of the trachea and bronchi. This begins just below the larynx and continues to the terminal bronchioles, becoming thinner by degrees and changing into areolar tissue. The sheet does not end with the cartilages, but continues on around the tube, running transversely between the ends of the cartilages to make up the posterior flattened wall of the trachea and bronchi. The blood vessels and nerves of the lungs which accompany the bronchial tubes are imbedded in this sheet.