Consolidating pneumonia and pneumothorax in a horse

A 3-year-old Thoroughbred mare with signs of acute abdominal pain and chronic pneumonia was found to have pneumothorax. A single application of suction was successful in resolving the pneumothorax. The underlying pneumonia was treated with long-term antibiotic administration selected on the basis of results of bacteriologic culture and antimicrobial susceptibility testing of a transtracheal aspirate. The pneumonia resolved, and the mare returned to competition as a show hunter.

Miliary pattern in neonatal pneumonia

We have seen 10 newborn babies who developed respiratory distress and whose chest radiographs showed a miliary nodular pattern of disease. Of these infants only 3 had blood cultures that were positive for staphylococcus aureus. Of the remaining 7, 2 had conjunctivitis from which Staphylococcus aureus was cultured, 4 had negative cultures and 1 did not have a blood culture done. All patients were diagnosed as having bacterial pneumonia and appeared to respond favourably to antibiotic therapy. The pulmonary abnormalities resolved. The children were clinically well in less than 3 weeks. The author suggests that the miliary pattern is one of the radiological patterns of neonatal pneumonia possibly produced by hematogenous bacterial dissemination.

Polymicrobial bacteremic pneumonia: report of three cases caused by Staphylococcus aureus and Streptococcus pneumoniae

Three patients are reported with simultaneous bacteremia caused by Staphylococcus aureus and Streptococcus pneumoniae complicating community-acquired pneumonia. Polymicrobial bacteremia caused by pyogenic organisms has rarely been reported. Two of the patients had severe underlying hepatic disease, and the third had suffered a recent myocardial infarction. The infection ultimately proved fatal in each patient. The pathophysiologic aspects and clinical consequences of polymicrobial bacteremia arising from respiratory as well as from other sources is briefly reviewed.

A boy with recurrent infections, impaired PMN-chemotaxis, increased IgE concentrations and cranial synostosis--a variant of the hyper-IgE syndrome?

A patient with coarse facies, craniosynostosis, recurrent staphylococcal infections with pneumatocele formation is described. Laboratory features included moderately elevated serum IgE, cutaneous anergy, decreased numbers of T-suppressor cells and variable inhibition of neutrophil chemotaxis. The combination of clinical findings suggests the diagnosis hyper-IgE syndrome, though the total IgE serum concentration (800 U/ml) and the level of IgE-specific antibodies to staphylococci (9.4%, normal less than 5%) were only slightly elevated.

Pneumatocele formation in adult pneumonia

Pneumatocele formation is unusual in adult pneumonia, particularly in pneumococcal pneumonia. We report three cases of pneumatocele formation in adults, including one with probable pneumococcal pneumonia. All three patients were severely ill and two expired. Although they are usually asymptomatic, pneumatoceles may enlarge and compress the adjacent lung and mediastinum. This occurred in two patients causing respiratory insufficiency and cardiovascular compromise. The placement of a chest tube into the enlarging pneumatocele resulted in successful decompression.

Purulent pericarditis

Eleven children under 16 years of age with purulent pericarditis were seen in one hospital in one year. The condition was always secondary to a septic focus elsewhere, usually staphylococcal pneumonia; its incidence after pneumonia was 0.64%, but this may be an underestimate. Clinical diagnosis can be difficult in patients with pneumonia as the heart is not always enlarged. Persistent or progressive liver enlargement was an important diagnostic feature. The presence of excess pericardial fluid was easily confirmed by echocardiography. Early diagnosis and drainage followed by continuous irrigation with 0.1% povidone iodine solution usually resulted in rapid recovery, but two patients died.

[Treatment of acute bilateral suppurative lung diseases complicated by pyopneumothorax]

An analysis of the complex treatment of 33 patients with acute bilateral suppurative diseases of the lungs complicated by pneumothorax has been made. It has been proved that early pleurectomy with resection of the lung is possible in a number of patients with such a pathology. Indications to surgery were established and a comparative analysis of conservative and surgical methods was made.

Infective endocarditis affecting the eustachian valve

A previously fit 44 year old man presented with acute staphylococcal pneumonia. Despite appropriate antibiotics he showed signs of continuing sepsis and eventually died. At necropsy endocarditis of the eustachian valve was found.

Pneumatocoeles associated with pneumonia: incidence and clinical course in Nigerian children

One hundred and twenty cases of pneumatocoele, admitted, treated and followed-up at the Lagos University Teaching Hospital in 1981 are presented. Radiologically the pneumatocoele cases were associated with either the bronchopneumonic or lobar/segmental pattern of pneumonia. There were significant differences between these patterns in respect of the time of occurrence, size and number of pneumatocoeles and associated bacterial agents. The contribution of measles infection to the development of pneumatocoele is noted. Although the ultimate course of pneumatocoele was towards spontaneous resorption, the process was slow in most of our patients. This was attributed to the poor nutritional status of the majority of them.

Asynchronous independent lung ventilation. Its use in the treatment of acute unilateral lung disease

The use of asynchronous independent lung ventilation is described in a patient presenting with acute respiratory failure due to a severe unilateral pneumonia. A polyvinyl chloride (Portex) double-lumen tube was inserted through a tracheostomy and the lungs ventilated independently using a combination of a Cape ventilator and a Servo 900B ventilator.

Nosocomial pulmonary mucormycosis with fatal massive hemoptysis

We postulate that the previously healthy woman reported here developed abnormal host defense mechanisms because of acute renal failure, metabolic acidosis, hyperglycemia, and glucocorticosteroid administration. Pneumonia unresponsive to antibiotics terminated in massive fatal hemoptysis that was due to mucormycosis with rupture of the pulmonary artery into the tracheobronchial tree.

Prolonged high-frequency jet ventilation

A 26-yr-old woman with bilateral staphylococcal pneumonia developed respiratory failure. Conventional ventilation failed and high-frequency jet ventilation (HFJV) was successfully instituted. Bronchopleural fistulas required prolonged (73 days) support with HFJV. A bronchoscopy performed after 37 days of mechanical support showed no abnormalities. Computed tomography (CT) of the chest demonstrated severe cystic abnormalities. Pulmonary function tests performed 1 and 6 months after recovery showed small-airway dysfunction. HFJV proved safe for prolonged use.

CME program. Tracheotomy and inhalation injury

Indications for tracheotomy in patients with respiratory burns have been unclear. Much of the literature is inconclusive or misleading. A thorough understanding of the pathogenesis, diagnosis, and therapy of inhalation injury is necessary to understand the role of tracheotomy. A critical review reveals relatively clearcut indications for the use of tracheotomy in inhalation injury, but many unanswered questions. Increased participation by otolaryngologists in burn management is recommended.

Pleurectomy in a 10 week old child to control staphylococcal associated pneumothoraces

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Pasteurella multocida pneumonia complicated by Staphylococcus aureus

A 71-year-old woman presented with acute non-cardiogenic pulmonary oedema. She proved to have a Pasteurella multocida pneumonia, with blood stream invasion by the organism, and required positive pressure ventilation for 53 days. Penicillin G., the drug of choice for this infection, failed to reverse the steady decline in her arterial oxygen-tension, and it was only after treatment with chloramphenicol and prednisolone that she began to improve. Serological tests strongly indicated the presence of a Staphylococcus aureus infection and the delay in giving antibiotics appropriate to this second pathogen may have been the reason for the patient's initial downhill course.

Multiple staphylococcal pneumatoceles in an adult

A 33-year-old male with staphylococcal pneumonia who presented radiographically with multiple thin-walled pulmonary cavities (pneumatoceles) is reported. The cavities rapidly altered following treatment with antibiotics and the patient clinically improved.

Pulmonary function following staphylococcal pneumonia in children

Twenty three subjects with proven staphylococcal pneumonia (19 with empyema) were studied 12-25 years after the original infection. Clinical radiological, and lung function status and airway response to histamine inhalation was assessed. No clinical or radiological changes resulted from the original staphylococcal infection. No subject had physiological evidence of chronic lung disease and there was no evidence of an increased incidence of airways hyperreactivity.

Massive hemoptysis and tension pneumothorax following pulmonary artery catheterization

We report a case of massive hemoptysis and bilateral tension pneumothorax immediately following placement of a fiberoptic pulmonary artery catheter. We postulate air entry into a traumatic communication caused by the catheter, traversing a parenchymal artery, the contiguous airspace and the interstitial space. Dissection of air through the perivascular sheath and into tissue planes of the thorax and abdomen followed. This sequence was rapidly fatal. Tension pneumothorax should be considered if dynamic respiratory system compliance remains poor despite aggressive evacuation of blood from the trachea of a patient with a recently inserted balloon-type catheter.

Severe staphylococcal pneumonia complicating pyomyositis

Severe staphylococcal pneumonia developed secondary to pyomyositis of the buttock in an adult male Melanesian in East New Britain, Papua New Guinea. Penicillin-resistant Staphylococcus aureus was cultured from the abscess, and S. aureus, together with Gram-negative organisms, were cultured from sputum. Despite treatment with high dose cloxacillin together with supportive chemotherapy, progressive deterioration of lung function occurred and acute respiratory failure developed. As suitable ventilators were unavailable, tracheal intubation was performed, and manual assisted ventilation was carried out for 4 days. Progressive improvement in ventilation and general status resulted, and the patient recovered without sequelae.

[Kidney lesion in acute suppurative septic diseases in children]

The examination of 122 children aged 2 to 14 with osteomyelitis, peritonitis and staphylococcal destruction of the lungs was performed. The first symptoms in developing pyelonephritis made their appearance in children following a purulent infection. So, the children after acute purulent process must be regularly examined in the outpatient clinics in order to prevent the development of chronic renal insufficiency.

Vancomycin therapy in severe staphylococcal infections

Vancomycin was developed in the 1950s, when available therapy for severe staphylococcal infections was unsatisfactory. Early clinical experiences with vancomycin indicated a cure rate of 70%. The introduction of beta-lactamase-resistant penicillins and cephalosporins, which have a lower potential for toxicity, resulted in limited use of vancomycin. The current renewal of interest in vancomycin for treatment of severe staphylococcal infections stems primarily from the efficacy of this drug against methicillin-resistant pathogens and its utility in a number of unique clinical situations. In addition, the development of more purified preparations of vancomycin has lowered the frequency of adverse side effects.

Diagnosis of nosocomial bacterial pneumonia in acute, diffuse lung injury

Nosocomial bacterial pneumonia as a complication of acute, diffuse lung injury may be difficult to distinguish clinically from other pathologic processes. To determine the reliability of findings commonly used to diagnose pneumonia in this setting, we compared clinical predictions of bacterial pneumonia with postmortem histology. Pneumonia was present histologically in 58 percent of the study patients, 36 percent of whom had been thought to have only lung injury. Among patients who had only diffuse lung injury histologically, 20 percent were thought to have pneumonia by clinical evaluation. Overall, 29 percent of cases were misdiagnosed. Improved diagnostic techniques will be required before the efficacy of preventive or therapeutic measures for pneumonia in the setting of acute, diffuse lung injury can be accurately determined.