1
|
Kim CH, Lee J. Mycoplasma pneumoniae Pleural Effusion in Adults. J Clin Med 2022; 11:jcm11051281. [PMID: 35268372 PMCID: PMC8911427 DOI: 10.3390/jcm11051281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/20/2022] [Accepted: 02/24/2022] [Indexed: 11/28/2022] Open
Abstract
Parapneumonic effusions often complicate Mycoplasma pneumoniae (MP) pneumonia, contrary to the notion that they are a rare feature of MP infection. Increased research and evidence on MP parapneumonic effusions (MPPE) can help elucidate its clinical significance as one of the variable manifestations of MP infection. This article aims to summarize the existing literature about the clinical characteristics of MPPE in adults and discuss its diagnostic implications from the perspective of pleural fluid analysis. Approximately 20–25% of adult patients with MP pneumonia develop MPPE, and its frequency in children and adults seems to be similar. Although the pathogenesis of MPPE remains to be elucidated, MP-induced cell-mediated immune mechanisms might be partially associated with the development of MPPE. MPPE usually shows mononuclear leukocyte predominance with elevated adenosine deaminase (ADA) activity, similar to tuberculous pleural effusion (TPE). The degree of increase in pleural fluid ADA levels and serum inflammatory biomarkers may help differentiate between MPPE and TPE. During the acute phase, a single positive IgM and positive polymerase chain reaction results allow for a precise and reliable MP infection diagnosis. The mainstay of treatment is the selection of adequate anti-mycoplasma antibiotics with or without corticosteroid, based on the local epidemiologic data on macrolide resistance.
Collapse
Affiliation(s)
| | - Jaehee Lee
- Correspondence: ; Tel.: +82-53-200-5536; Fax: +82-53-426-2046
| |
Collapse
|
2
|
Li H, Li T, Cai Q, Wang X, Liao Y, Cheng Y, Zhou Q. Development and Validation of a Radiomics Nomogram for Differentiating Mycoplasma Pneumonia and Bacterial Pneumonia. Diagnostics (Basel) 2021; 11:diagnostics11081330. [PMID: 34441265 PMCID: PMC8392308 DOI: 10.3390/diagnostics11081330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: To develop and validate a radiological nomogram combining radiological and clinical characteristics for differentiating mycoplasma pneumonia and bacterial pneumonia with similar CT findings. Methods: A total of 100 cases of pneumonia patients receiving chest CT scan were retrospectively analyzed, including 60 patients with mycoplasma pneumonia and 40 patients with bacterial pneumonia. The patients were divided into the train set (n = 70) and the test set (n = 30). The features were extracted from chest CT images of each patient by AK analysis software, then univarite analysis, spearman correlation analysis, and least absolute shrinkage and selection operator (LASSO) were utilized for dimension reduction in training set. A radiomics model was built by multivariable logistic regression based on the selected features, and a radiomics-clinical multivariable logistic regression model was built by combining imaging radiomics and clinical risk factors (age and temperature). ROC, AUC, sensitivity, specificity, and accuracy were calculated to validate the two models. The nomogram of the radiomics-clinical was built and evaluated by calibration curve. The clinical benefit of the two models was measured by using decision curve. Results: A total of 396 texture features were extracted from each chest CT image, and 10 valuable features were screened out. In the radiomics model, the AUC, sensitivity, specificity, and accuracy for the train set is 0.877, 0.762, 0.821, 78.6%, and for the test set it is 0.810, 0.667, 0.750 and 70.0%, respectively. In the radiomics-clinical model, the AUC, sensitivity, specificity, and accuracy for the train set is 0.905, 0.976, 0.714, 87.1%, and for the test set is is 0.847, 0.889, 0.667 and 80.0%, respectively. Decision curve analysis shows that both the two models increase the clinical benefits of the patients, and the radiomics-clinical model gains higher clinical benefits, compared to the radiomics model. Conclusion: The radiomics-clinical nomogram had good performance in identifying mycoplasma pneumonia and bacterial pneumonias, which would be helpful in clinical decision-making.
Collapse
Affiliation(s)
- Honglin Li
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
| | - Ting Li
- Department of Respiratory Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China;
| | - Qinxin Cai
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
| | - Xiaozhuan Wang
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
| | | | - Yuanxiong Cheng
- Department of Respiratory Medicine, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China;
- Correspondence: (Y.C.); (Q.Z.)
| | - Quan Zhou
- Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, China; (H.L.); (Q.C.); (X.W.)
- Correspondence: (Y.C.); (Q.Z.)
| |
Collapse
|
3
|
Dueck NP, Epstein S, Franquet T, Moore CC, Bueno J. Atypical Pneumonia: Definition, Causes, and Imaging Features. Radiographics 2021; 41:720-741. [PMID: 33835878 DOI: 10.1148/rg.2021200131] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pneumonia is among the most common causes of death worldwide. The epidemiologic and clinical heterogeneity of pneumonia results in challenges in diagnosis and treatment. There is inconsistency in the definition of the group of microorganisms that cause "atypical pneumonia." Nevertheless, the use of this term in the medical and radiologic literature is common. Among the causes of community-acquired pneumonia, atypical bacteria are responsible for approximately 15% of cases. Zoonotic and nonzoonotic bacteria, as well as viruses, have been considered among the causes of atypical pneumonia in a patient who is immunocompetent and have been associated with major community outbreaks of respiratory infection, with relevant implications in public health policies. Considering the difficulty of isolating atypical microorganisms and the significant overlap in clinical manifestations, a targeted empirical therapy is not possible. Imaging plays an important role in the diagnosis and management of atypical pneumonia, as in many cases its findings may first suggest the possibility of an atypical infection. Clarifying and unifying the definition of atypical pneumonia among the medical community, including radiologists, are of extreme importance. The prompt diagnosis and prevention of community spread of some atypical microorganisms can have a relevant impact on local, regional, and global health policies. ©RSNA, 2021.
Collapse
Affiliation(s)
- Nicholas P Dueck
- From the Department of Radiology and Medical Imaging (N.P.D., S.E., J.B.) and Department of Infectious Diseases and International Health (C.C.M.), University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908; and Department of Radiology, Hospital de Sant Pau-Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Samantha Epstein
- From the Department of Radiology and Medical Imaging (N.P.D., S.E., J.B.) and Department of Infectious Diseases and International Health (C.C.M.), University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908; and Department of Radiology, Hospital de Sant Pau-Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Tomás Franquet
- From the Department of Radiology and Medical Imaging (N.P.D., S.E., J.B.) and Department of Infectious Diseases and International Health (C.C.M.), University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908; and Department of Radiology, Hospital de Sant Pau-Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Christopher C Moore
- From the Department of Radiology and Medical Imaging (N.P.D., S.E., J.B.) and Department of Infectious Diseases and International Health (C.C.M.), University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908; and Department of Radiology, Hospital de Sant Pau-Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| | - Juliana Bueno
- From the Department of Radiology and Medical Imaging (N.P.D., S.E., J.B.) and Department of Infectious Diseases and International Health (C.C.M.), University of Virginia Medical Center, 1215 Lee St, PO Box 800170, Charlottesville, VA 22908; and Department of Radiology, Hospital de Sant Pau-Universidad Autónoma de Barcelona, Barcelona, Spain (T.F.)
| |
Collapse
|
4
|
Li J, Long X, Wang X, Fang F, Lv X, Zhang D, Sun Y, Hu S, Lin Z, Xiong N. Radiology indispensable for tracking COVID-19. Diagn Interv Imaging 2020; 102:69-75. [PMID: 33281082 PMCID: PMC7685040 DOI: 10.1016/j.diii.2020.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022]
Abstract
Currently, chest computed tomography is recommended as the first-line imaging test for detecting COVID-19 pneumonia. The most typical CT imaging finding of COVID-19 patients is ground-glass opacity, combined with reticular and/or interlobular septal thickening and consolidation. CT is useful for monitoring patients with COVID-19, identifying associated vascular abnormalities and making differential diagnosis.
With the rapid spread of COVID-19 worldwide, early detection and efficient isolation of suspected patients are especially important to prevent the transmission. Although nucleic acid testing of SARS-CoV-2 is still the gold standard for diagnosis, there are well-recognized early-detection problems including time-consuming in the diagnosis process, noticeable false-negative rate in the early stage and lacking nucleic acid testing kits in some areas. Therefore, effective and rational applications of imaging technologies are critical in aiding the screen and helping the diagnosis of suspected patients. Currently, chest computed tomography is recommended as the first-line imaging test for detecting COVID-19 pneumonia, which could allow not only early detection of the typical chest manifestations, but also timely estimation of the disease severity and therapeutic effects. In addition, other radiological methods including chest X-ray, magnetic resonance imaging, and positron emission computed tomography also show significant advantages in the detection of COVID-19 pneumonia. This review summarizes the applications of radiology and nuclear medicine in detecting and diagnosing COVID-19. It highlights the importance for these technologies to curb the rapid transmission during the pandemic, considering findings from special groups such as children and pregnant women.
Collapse
Affiliation(s)
- Jingwen Li
- Department of Neurology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China
| | - Xi Long
- Department of Radiology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China
| | - Xinyi Wang
- Department of Neurology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China
| | - Fang Fang
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Xuefei Lv
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Dandan Zhang
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Yu Sun
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Shaoping Hu
- Department of Radiology, Wuhan Red Cross Hospital, Wuhan, Hubei, China
| | - Zhicheng Lin
- Harvard Medical School, Mclean Hospital, 02478 Belmont, MA, USA
| | - Nian Xiong
- Department of Neurology, Tongji Medical College, Huazhong University of Science and Technology, Union Hospital, Wuhan, Hubei, China; Wuhan Red Cross Hospital, Wuhan, Hubei, China.
| |
Collapse
|
5
|
Wen P, Wei M, Guo X, Xu YR. Mycoplasma pneumoniae infection mimicking tuberculous pleurisy in a young woman: a case report and literature review. J Int Med Res 2020; 48:300060520918701. [PMID: 32340523 PMCID: PMC7218461 DOI: 10.1177/0300060520918701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 30-year-old woman was admitted to a different hospital with a 2-day history of fever, cough, and expectoration. She had a history of left pulmonary tuberculosis 8 years previously. Chest computed tomography showed an infiltrate in the inferior lobe of the left lung and spot-like calcifications in the anterior lobe of the upper left lobe and lower lobe of the left lung. After antibacterial treatment, the patient’s condition deteriorated and she developed significant pleural effusion on the left side. The pleural effusion assay showed a lymphocyte-predominant exudate with a significantly increased adenosine deaminase level. The patient was transferred to our hospital with a suspected diagnosis of tuberculous pleuritis. A serum test for Mycoplasma pneumoniae-specific immunoglobulin M was positive. Because of the limitations of this test in determining the occurrence of recent infection, a thoracoscopic pleural biopsy was performed, and M. pneumoniae DNA was detected in the biopsy tissue using M. pneumoniae-specific polymerase chain reaction. Thus, the patient was diagnosed with M. pneumoniae-related parapneumonic effusion. Clinicians must be aware of the usefulness and limitations of a high adenosine deaminase level and know that lymphocyte predominance in pleural effusion does not always indicate tuberculous pleurisy, especially in areas of high tuberculosis prevalence.
Collapse
Affiliation(s)
- Peng Wen
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, China.,Department of Respiratory Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Min Wei
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, China
| | - Xue Guo
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, China
| | - Yu-Rong Xu
- Department of Respiratory Medicine, Shandong Provincial Chest Hospital Affiliated to Shandong University, Jinan, China
| |
Collapse
|
6
|
Abstract
Community-acquired pneumonia refers to an acute infection of the lung in patients who did not meet any of the criteria for health care-acquired pneumonia, and is associated with at least some symptoms of acute infection, accompanied by the presence of an acute infiltrate on a chest radiograph. Chest radiography remains an important component of the evaluation of a patient with a suspicion of pneumonia, and is usually the first examination to be obtained. The diagnosis of community-acquired pneumonia is based on the presence of select clinical features and is supported by imaging of the lung, usually by chest radiography. Infection of the lower respiratory tract typically presents radiologically as one of 3 patterns: (a) focal nonsegmental or lobar pneumonia, (b) multifocal bronchopneumonia or lobular pneumonia, and (c) focal or diffuse "interstitial" pneumonia. High-resolution computed tomography allows a better depiction of the pattern and distribution of pneumonia than the radiograph but is seldom required in the evaluation of patients with suspected or proven bacterial pneumonia. However, high-resolution computed tomography is a useful adjunct to conventional radiography in selected cases.
Collapse
|
7
|
Kim JH, Kwon JH, Lee JY, Lee JS, Ryu JM, Kim SH, Lim KS, Kim WY. Clinical features of Mycoplasma pneumoniae coinfection and need for its testing in influenza pneumonia patients. J Thorac Dis 2018; 10:6118-6127. [PMID: 30622783 DOI: 10.21037/jtd.2018.10.33] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the clinical features of coinfection due to Mycoplasma pneumoniae (M. pneumoniae), a common copathogen in influenza, in influenza pneumonia patients. Methods We reviewed 4,465 patients with influenza who visited a tertiary care hospital emergency department in Seoul (Korea) from 2010 through 2016, and underwent immunoglobulin M (IgM) serology or polymerase chain reaction (PCR) for M. pneumoniae. Influenza pneumonia was defined as laboratory-confirmed influenza plus radiographic pneumonia. Patients with healthcare-associated pneumonia or non-mycoplasma bacterial coinfection were excluded. Clinical, laboratory, and radiographic findings and outcomes of the influenza pneumonia patients with and without M. pneumoniae coinfection were compared. Multivariable logistic regression analysis was performed to identify factors associated with the coinfection. Results Of 244 influenza pneumonia patients, 41 (16.8%) had M. pneumoniae coinfection. These patients were younger with a higher frequency of age of 5-10 years, and had higher white blood cell (WBC) and lymphocyte counts; lower concentration of C-reactive protein (CRP). The coinfection had no association with specific radiographic findings and poor outcome. Multivariable analysis showed the age of 5-10 years (adjusted odds ratio, 18.83; 95% confidence interval, 5.899-60.08; P<0.001) as the factor associated with the coinfection. Conclusions M. pneumoniae coinfection in influenza pneumonia may be associated with the age of 5-10 years, and otherwise clinically indistinct from influenza pneumonia without the coinfection. This finding suggests the need for M. pneumoniae testing in patients aged 5-10 years with influenza pneumonia.
Collapse
Affiliation(s)
- Jung Heon Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Hyun Kwon
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Jeong-Yong Lee
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Seung Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong-Min Ryu
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyoung Soo Lim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
8
|
Seo H, Cha SI, Shin KM, Lim JK, Yoo SS, Lee SY, Lee J, Kim CH, Park JY. Relationship Between Clinical Features and Computed Tomographic Findings in Hospitalized Adult Patients With Community-Acquired Pneumonia. Am J Med Sci 2018; 356:30-38. [PMID: 30049328 PMCID: PMC7093861 DOI: 10.1016/j.amjms.2018.03.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/05/2023]
Abstract
Background Data on the relationship between the clinical and microbiological features of community-acquired pneumonia (CAP) and its computed tomography (CT) findings are limited. The aim of the present study was to investigate the clinic-microbiological features of patients with CAP presenting with ground-glass opacity (GGO) and centrilobular nodules or tree-in-bud pattern on CT images. Methods Patients with CAP who underwent a CT scan at presentation were retrospectively classified using CT findings into consolidation, GGO and bronchiolitis groups. These 3 groups were compared in terms of clinical parameters and microbiological data. Results A total of 40 patients (2.4%) were allocated to the bronchiolitis group and 46 (2.8%) to the GGO group. The most common pathogen in the bronchiolitis group was Mycoplasma pneumoniae, which was significantly more frequently isolated in this group. The bronchiolitis group was characterized by a higher percentage of cough, a lower percentage of chest pain and lower blood levels of inflammatory markers. Common pathogens in the GGO group were not significantly different from those in the other 2 groups. Unlike that observed in the consolidation group, complicated parapneumonic effusion or empyema was not observed in the bronchiolitis or GGO group. Outcome variables were similar in the 3 groups. Conclusions The bronchiolitis group was characterized by a higher frequency of M. pneumoniae and a less severe form of CAP. The GGO and consolidation groups was similar with respect to causative microorganisms and the clinical features of CAP. No patient in the bronchiolitis or GGO group exhibited complicated parapneumonic effusion or empyema.
Collapse
Affiliation(s)
- Hyewon Seo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Ick Cha
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea.
| | - Kyung-Min Shin
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Kwang Lim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Seung-Soo Yoo
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Shin-Yup Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jaehee Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Chang-Ho Kim
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| | - Jae-Yong Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, South Korea
| |
Collapse
|
9
|
Chest High-resolution Computed Tomography Findings in 601 Patients with Inflammatory Bowel Diseases. Acad Radiol 2018; 25:407-414. [PMID: 29195785 DOI: 10.1016/j.acra.2017.10.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES Pulmonary involvement in inflammatory bowel disease may reflect the common embryonic origin of the gastrointestinal tract and the bronchial tree. No studies have compared pulmonary high-resolution computed tomography (HRCT) findings between ulcerative colitis (UC) and Crohn disease (CD). This study aimed to assess the relationship between pulmonary HRCT findings and inflammatory bowel disease activity and to compare HRCT findings between UC and CD. MATERIALS AND METHODS We retrospectively identified 601 consecutive patients (350 with UC and 251 with CD) who had undergone chest HRCT examinations at our institutions between April 2004 and April 2016. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT. RESULTS One hundred sixty-seven patients (94 men, 73 women; aged 12-86 years, mean: 47.2 years) with UC and 93 patients (61 men, 32 women; aged 12-71 years, mean: 37.9 years) with CD had abnormal findings on chest HRCT. The HRCT findings of UC and CD mainly consisted of centrilobular nodules (in 49.1% and 45.2% of cases, respectively) and bronchial wall thickening (in 31.7% and 54.8%, respectively). There was no relationship between HRCT findings and disease activity. Bronchial wall thickening was significantly more frequent in patients with CD than in those with UC (P < .001). CONCLUSION The main chest HRCT findings in UC and CD are centrilobular nodules and bronchial wall thickening. There are differences in HRCT findings between UC and CD.
Collapse
|
10
|
Mittal S, Singh AP, Gold M, Leung AN, Haramati LB, Katz DS. Thoracic Imaging Features of Legionnaire's Disease. Infect Dis Clin North Am 2017; 31:43-54. [PMID: 28159175 DOI: 10.1016/j.idc.2016.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Imaging examinations are often performed in patients with Legionnaires' disease. The literature to date has documented that the imaging findings in this disorder are relatively nonspecific, and it is therefore difficult to prospectively differentiate legionella pneumonia from other forms of pneumonia, and from other noninfectious thoracic processes. Through a review of clinical cases and the literature, our objective is for the reader to gain a better understanding of the spectrum of radiographic manifestations of Legionnaires' disease.
Collapse
Affiliation(s)
- Sameer Mittal
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA.
| | - Ayushi P Singh
- Department of Medicine, Maimonides Hospital, Fort Hamilton Parkway, Brooklyn, NY 11219, USA
| | - Menachem Gold
- Department of Radiology, Lincoln Hospital, 234 East 149th Street, Suite 2C3, Bronx, NY 10461, USA
| | - Ann N Leung
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, Room S078, MC5105, Stanford, CA 94305, USA
| | - Linda B Haramati
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 200 East Gun Hill Road, Bronx, NY 10467, USA; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, 200 East Gun Hill Road, Bronx, NY 10467, USA
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA
| |
Collapse
|
11
|
Kishaba T. Community-Acquired Pneumonia Caused by Mycoplasma pneumoniae: How Physical and Radiological Examination Contribute to Successful Diagnosis. Front Med (Lausanne) 2016; 3:28. [PMID: 27379238 PMCID: PMC4904022 DOI: 10.3389/fmed.2016.00028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/30/2016] [Indexed: 11/29/2022] Open
Abstract
Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia (CAP), particularly in young adults. Vital signs are usually normal except for temperature. On physical examination, general appearance is normal compared with that of typical pneumonia such as pneumococcal pneumonia patients. Mycoplasma sometimes causes ear infections such as otitis media. It is important to distinguish between typical pneumonia and atypical pneumonia such as mycoplasma pneumonia because having the right diagnosis allows for the use of the correct antibiotic to treat CAP while preventing development of drug-resistant bacteria and also decreasing medical cost. The symptoms and diagnosis of mycoplasma pneumonia is multi-fold. Auscultation of patients can demonstrate trace late inspiratory crackles or normal alveolar sounds; however, bilateral polyphonic wheezes can sometimes be heard because of bronchiolitis. With regard to radiological findings, a chest radiogragh often shows bilateral reticulonodular or patchy consolidation in both lower lobes. Pleural effusion is rarely observed in adult cases. Immunocompetent patients tend to reveal more extensive shadowing compared with immunocompromised patients. As serological diagnostic methods are not able to offer 100% reliable diagnosis, integration of physical and radiological examination is crucial to accurately diagnose mycoplasma pneumonia. Herein, I review the typical findings from physical examination and imaging patterns of patients with mycoplasma pneumonia.
Collapse
Affiliation(s)
- Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital , Uruma City, Okinawa , Japan
| |
Collapse
|
12
|
High-resolution Computed Tomography Findings in Patients with Pulmonary Nocardiosis. Acad Radiol 2016; 23:290-6. [PMID: 26774738 DOI: 10.1016/j.acra.2015.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/21/2015] [Accepted: 11/26/2015] [Indexed: 01/30/2023]
Abstract
RATIONALE AND OBJECTIVES Nocardiosis is difficult to diagnose, and the diagnosis is thus frequently delayed. High-resolution computed tomography (HRCT) findings of patients with pulmonary nocardiosis have been documented in few reports. Our study objective was to assess HRCT findings of patients with pulmonary nocardiosis. MATERIALS AND METHODS This was a retrospective study of 20 consecutive patients with pulmonary Nocardia infections who underwent HRCT of the chest at our institutions from January 2011 to August 2014. After the exclusion of two patients with concurrent infections, the study group comprised 18 patients (11 men, 7 women; age range, 39-83 years; mean, 67.9 years) with pulmonary Nocardia infections. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on HRCT. RESULTS Underlying conditions included respiratory disease (n = 6, 33.3%), collagen diseases (n = 5, 27.8%), and diabetes mellitus (n = 4, 22.2%). All patients showed abnormal HRCT findings, including the presence of a nodule/mass (n = 17, 94.4%), ground-glass opacity (n = 14, 77.8%), interlobular septal thickening (n = 14, 77.8%), and cavitation (n = 12, 66.7%). Pleural effusion was seen in two patients. There were no cases of lymph node enlargement. CONCLUSIONS Among the HRCT findings in patients with pneumonia, a nodule/mass with interlobular septal thickening and/or cavitation are suggestive of pulmonary nocardiosis.
Collapse
|
13
|
Scaglione M, Linsenmaier U, Schueller G, Berger F, Wirth S. Infection. EMERGENCY RADIOLOGY OF THE CHEST AND CARDIOVASCULAR SYSTEM 2016. [PMCID: PMC7120007 DOI: 10.1007/174_2016_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Community-Acquired Pneumonia (CAP) is the first leading cause of death due to infection worldwide.Many gram-positive, gram-negative bacteria, funguses and viruses can cause the infectious pulmonary disease, and the severity of pneumonia depends on the balance between the microorganism charge, the body immunity defenses and the quality of the underlying pulmonary tissue. The microorganisms may reach the lower respiratory tract from inhaled air or from infected oropharyngeal secretions. The same organism may produce several different patterns that depend on the balance between the microorganism charge and the body immunity defenses.CAP is classified into three main groups: lobar pneumonia, bronchopneumonia and interstitial pneumonia.Lobar pneumonia is characterized by the filling of alveolar spaces by edema full of white and inflammatory cells. Necrotizing pneumonia consists of a fulminant process associated with focal areas of necrosis that results in abscesses. Bronchopneumonia or lobular pneumonia, is characterized by a peribronchiolar inflammation with thickening of peripheral bronchial wall, the diffusion of inflammation to the centrilobular alveolar spaces and development of nodules.The interstitial pneumonia represents with the destruction and esfoliation of the respiratory ciliated and mucous cells. The interstitial septa, the bronchial and bronchiolar walls become thickened for the inflammation process and lymphocytes interstitial infiltrates.Chest radiography represents an important initial examination in all patients suspected of having pulmonary infection and for monitoring response to therapy.Its role is to identify the pulmonary opacities, their internal characteristics and distribution, pleural effusion and presence of other complications as abscesses and pneumothorax.High spatial CT resolution allows accurate assessment of air space inflammation.The CT findings include nodules, interlobular septal thickening, intralobular reticular opacities, ground-glass opacities, tree-in-bud pattern, lobar-segmental consolidation, lobular consolidation, abscesses, pneumatocele, pleural effusion, pericardial effusion, mediastinal and hilar lymphoadenopaties, airway dilatation and emphysema.
Collapse
Affiliation(s)
- Mariano Scaglione
- Dept of Radiology, Pineta Grande Medical Center, Castel Volturno, Caserta, Italy
| | | | | | - Ferco Berger
- VU University Medical Center, Amsterdam, The Netherlands
| | | |
Collapse
|
14
|
|
15
|
Community-acquired pneumonia: a correlative study between chest radiographic and HRCT findings. Jpn J Radiol 2015; 33:317-28. [PMID: 25895159 DOI: 10.1007/s11604-015-0420-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To elucidate what kinds of lesions tend to be overlooked or misinterpreted and why they were overlooked or misinterpreted on chest radiographs in the diagnosis of community-acquired pneumonia (CAP) by comparing radiographic findings with HRCT findings. MATERIALS AND METHODS In 129 patients with CAP (107 bacterial and 22 atypical) and 105 healthy subjects, the chest radiographic findings were correlated with the HRCT findings. The diagnostic accuracy of each chest radiographic finding was evaluated by comparing it with the HRCT finding. RESULTS The false negative rate of radiographic interpretation tended to be higher for nodules and thickening of the bronchial wall, especially in patients with atypical pneumonia. The most frequent reason for false negative interpretations of nodules and bronchial wall thickening was the overlapping of these findings with airspace consolidation or ground-glass opacity (GGO). Thin lesions were the most frequent reasons for the false negative interpretation of airspace consolidation and GGO. CONCLUSION The chest radiographic interpretations of GGO and airspace consolidation were influenced by the thickness of lesions, and those of nodules and thickening of bronchial walls were influenced by coexisting GGO and airspace consolidation and may contribute to a misinterpretation of these lesions and an incorrect diagnosis of CAP.
Collapse
|
16
|
Okada F, Sato H, Omeri AK, Ono A, Tokuyama K, Ando Y, Matsumoto A, Ogata M, Kohno K, Takano K, Mori H. Chest HRCT findings in acute transformation of adult T-cell lymphoma/leukemia. Eur Radiol 2015; 25:1607-13. [PMID: 25576228 DOI: 10.1007/s00330-014-3565-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/24/2014] [Accepted: 12/11/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess chest high-resolution computed tomography (HRCT) findings in patients with acute transformation of adult T cell leukaemia/lymphoma (ATLL). METHODS We retrospectively identified 72 consecutive patients at our institution with ATLL between October 2000 and March 2014. The cases included acute type (n = 20), lymphoma type (n = 21), smouldering type (n = 24) and chronic type (n = 7). Sixteen (7 men, 9 women; aged 36-85 years, mean 63.3 years) of 31 patients (24 with smouldering and seven with chronic type; 51.6 %) developed acute transformation of ATLL, and had undergone chest HRCT examinations. Parenchymal abnormalities, enlarged lymph nodes, pericardial effusion, pleural effusion and skin lesions were evaluated on HRCT. RESULTS Chest HRCT of 15 of the 16 patients showed abnormal findings, including ground-glass opacity (GGO) (n = 8), consolidation (n = 5), interlobular septal thickening (n = 5) and nodules (n = 5). Pleural effusion was found in five patients, lymph node enlargement in 10 patients and multiple skin thickening in two patients. CONCLUSIONS Almost all patients with acute transformation of ATLL had abnormal findings on chest HRCT, which consisted mainly of lymph node enlargement, GGO, interlobular septal thickening, nodules and bilateral pleural effusions. KEY POINTS • The recognition of CT findings of acute transformation is important • Almost all patients with acute transformation have abnormal findings on HRCT • Characteristic CT features are present in acute transformation of indolent ATLL.
Collapse
Affiliation(s)
- Fumito Okada
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan,
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
[Mycoplasma pneumoniae respiratory infections in adults: beware atypical cases!]. Rev Mal Respir 2013; 30:743-5. [PMID: 24267763 DOI: 10.1016/j.rmr.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 09/23/2013] [Indexed: 11/21/2022]
|
18
|
Okada F, Ono A, Ando Y, Nakayama T, Ishii H, Hiramatsu K, Sato H, Kira A, Otabe M, Mori H. High-resolution CT findings in Streptococcus milleri pulmonary infection. Clin Radiol 2013; 68:e331-7. [PMID: 23518496 DOI: 10.1016/j.crad.2013.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/10/2013] [Accepted: 01/14/2013] [Indexed: 12/23/2022]
Abstract
AIM To assess pulmonary high-resolution computed tomography (CT) findings in patients with acute Streptococcus milleri pulmonary infection. MATERIALS AND METHODS Sixty consecutive patients with acute S. milleri pneumonia who had undergone high-resolution CT chest examinations between January 2004 and March 2010 were retrospectively identified. Twenty-seven patients with concurrent infections were excluded. The final study group comprised 33 patients (25 men, 8 women; aged 20-88 years, mean 63.1 years) with S. milleri infection. The patients' clinical findings were assessed. Parenchymal abnormalities, enlarged lymph nodes, and pleural effusion were evaluated on high-resolution CT. RESULTS Underlying conditions included malignancy (n = 15), a smoking habit (n = 11), and diabetes mellitus (n = 8). CT images of all patients showed abnormal findings, including ground-glass opacity (n = 24), bronchial wall thickening (n = 23), consolidation (n = 17), and cavities (n = 7). Pleural effusion was found in 18 patients, and complex pleural effusions were found in seven patients. CONCLUSION Pulmonary infection caused by S. milleri was observed mostly in male patients with underlying conditions such as malignancy or a smoking habit. The CT findings in patients with S. milleri consisted mainly of ground-glass opacity, bronchial wall thickening, pleural effusions, and cavities.
Collapse
Affiliation(s)
- F Okada
- Department of Radiology, Oita University, Faculty of Medicine, Oita, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Atelectasis caused by macrolide-resistant Mycoplasma pneumoniae pneumonia in an adult patient. J Infect Chemother 2013; 19:1161-6. [PMID: 23471569 DOI: 10.1007/s10156-013-0575-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
A 27-year-old, previously healthy woman was admitted to our hospital for mild pneumonia. After 2 days ceftriaxone sodium administration, her chest radiograph revealed a rightward mediastinal shift caused by atelectasis of the upper portion of the right lung. Bronchoscopic examination showed swelling in the right upper lobe bronchus and obstruction in the B1 segmental bronchus caused by complete edematous swelling. Histopathology showed acute cellular bronchitis with edema of the bronchial wall containing lymphocytes, plasma cells, and macrophages. Mycoplasma pneumoniae was detected by culture and a polymerase chain reaction test using sputum collected during bronchoscopy, and treatment was changed to minocycline. After 7 days antibiotic therapy, her condition improved and no relapse was observed. Identification of point mutations in domain V of the 23S rRNA for macrolide-resistant M. pneumoniae was performed, and an A-to-G transition at position 2063 in domain V of the 23S rRNA gene was identified. Atelectasis caused by M. pneumoniae is thought to be a common associated finding in pediatric patients, but it is rare in adults. In addition, our patient showed extremely unusual findings with obstruction caused by complete edematous swelling.
Collapse
|
20
|
Okada F, Ono A, Ando Y, Nakayama T, Ishii R, Sato H, Kira A, Tokimatsu I, Kadota J, Mori H. Thin-section CT findings in Pseudomonas aeruginosa pulmonary infection. Br J Radiol 2012; 85:1533-8. [PMID: 22844034 DOI: 10.1259/bjr/54468236] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess clinical and pulmonary thin-section CT findings in patients with acute Pseudomonas aeruginosa (PA) pulmonary infection. METHODS We retrospectively identified 44 patients with acute PA pneumonia who had undergone chest thin-section CT examinations between January 2004 and December 2010. We excluded nine patients with concurrent infections. The final study group comprised 35 patients (21 males, 14 females; age range 30-89 years, mean age 66.9 years) with PA pneumonia. The patients' clinical findings were assessed. Parenchymal abnormalities, enlarged lymph nodes and pleural effusion were evaluated on thin-section CT. RESULTS Underlying diseases included malignancy (n=13), a smoking habit (n=11) and cardiac disease (n=8). CT scans of all patients revealed abnormal findings, including ground-glass opacity (n=34), bronchial wall thickening (n=31), consolidation (n=23) and cavities (n=5). Pleural effusion was found in 15 patients. CONCLUSION PA pulmonary infection was observed in patients with underlying diseases such as malignancy or a smoking habit. The CT findings in patients with PA consisted mainly of ground-glass attenuation and bronchial wall thickening. ADVANCES IN KNOWLEDGE The CT findings consisted mainly of ground-glass attenuation, bronchial wall thickening and cavities. These findings in patients with an underlying disease such as malignancy or a smoking habit may be suggestive of pneumonia caused by PA infection.
Collapse
Affiliation(s)
- F Okada
- Department of Radiology, Oita University Faculty of Medicine, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Cha SI, Shin KM, Jeon KN, Yoo SS, Lee J, Lee SY, Kim CH, Park JY, Jung TH. Clinical relevance and characteristics of pleural effusion in patients with Mycoplasma pneumoniae pneumonia. ACTA ACUST UNITED AC 2012; 44:793-7. [DOI: 10.3109/00365548.2012.681696] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
22
|
Morikawa K, Okada F, Ando Y, Ishii R, Matsushita S, Ono A, Maeda T, Mori H, Yamashita S, Kawahara K. Meticillin-resistant Staphylococcus aureus and meticillin-susceptible S. aureus pneumonia: comparison of clinical and thin-section CT findings. Br J Radiol 2011; 85:e168-75. [PMID: 21750126 DOI: 10.1259/bjr/65538472] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The purpose of this study was to compare the clinical and thin-section CT findings in patients with meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-susceptible S. aureus (MSSA). METHODS We retrospectively identified 201 patients with acute MRSA pneumonia and 164 patients with acute MSSA pneumonia who had undergone chest thin-section CT examinations between January 2004 and March 2009. Patients with concurrent infectious disease were excluded from our study. Consequently, our study group comprised 68 patients with MRSA pneumonia (37 male, 31 female) and 83 patients with MSSA pneumonia (32 male, 51 female). Clinical findings in the patients were assessed. Parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed. RESULTS Underlying diseases such as cardiovascular were significantly more frequent in the patients with MRSA pneumonia than in those with MSSA pneumonia. CT findings of centrilobular nodules, centrilobular nodules with a tree-in-bud pattern, and bronchial wall thickening were significantly more frequent in the patients with MSSA pneumonia than those with MRSA pneumonia (p = 0.038, p = 0.007 and p = 0.039, respectively). In the group with MRSA, parenchymal abnormalities were observed to be mainly peripherally distributed and the frequency was significantly higher than in the MSSA group (p = 0.028). Pleural effusion was significantly more frequent in the patients with MRSA pneumonia than those with MSSA pneumonia (p = 0.002). CONCLUSIONS Findings from the evaluation of thin-section CT manifestations of pneumonia may be useful to distinguish between patients with acute MRSA pneumonia and those with MSSA pneumonia.
Collapse
Affiliation(s)
- K Morikawa
- Department of Radiology, Oita University Faculity of Medicine, Oita, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Okada F, Ando Y, Tanoue S, Ishii R, Matsushita S, Ono A, Maeda T, Mori H. Radiological findings in acute Haemophilus influenzae pulmonary infection. Br J Radiol 2011; 85:121-6. [PMID: 21224303 DOI: 10.1259/bjr/48077494] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The aim of this study was to assess pulmonary thin-section CT findings in patients with acute Haemophilus influenzae pulmonary infection. METHODS Thin-section CT scans obtained between January 2004 and March 2009 from 434 patients with acute H. influenzae pulmonary infection were retrospectively evaluated. Patients with concurrent infection diseases, including Streptococcus pneumoniae (n=76), Staphylococcus aureus (n=58) or multiple pathogens (n=89) were excluded from this study. Thus, our study group comprised 211 patients (106 men, 105 women; age range, 16-91 years, mean, 63.9 years). Underlying diseases included cardiac disease (n=35), pulmonary emphysema (n=23), post-operative status for malignancy (n=20) and bronchial asthma (n=15). Frequencies of CT patterns and disease distribution of parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed by thin-section CT. RESULTS The CT findings in patients with H. influenzae pulmonary infection consisted mainly of ground-glass opacity (n=185), bronchial wall thickening (n=181), centrilobular nodules (n=137) and consolidation (n=112). These abnormalities were predominantly seen in the peripheral lung parenchyma (n=108). Pleural effusion was found in 22 patients. Two patients had mediastinal lymph node enlargement. CONCLUSION These findings in elderly patients with smoking habits or cardiac disease may be characteristic CT findings of H. influenzae pulmonary infection.
Collapse
Affiliation(s)
- F Okada
- Oita University Faculty of Medicine, Yufu, Oita, Japan
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Okada F, Ando Y, Nakayama T, Tanoue S, Ishii R, Ono A, Watanabe M, Takaki H, Maeda T, Mori H. Pulmonary thin-section CT findings in acute Moraxella catarrhalis pulmonary infection. Br J Radiol 2010; 84:1109-14. [PMID: 21123308 DOI: 10.1259/bjr/42762966] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Moraxella catarrhalis is an important pathogen in the exacerbation of chronic obstructive pulmonary disease. The aim of this study was to assess the clinical and pulmonary thin-section CT findings in patients with acute M. catarrhalis pulmonary infection. METHODS Thin-section CT scans obtained between January 2004 and March 2009 from 292 patients with acute M. catarrhalis pulmonary infection were retrospectively evaluated. Clinical and pulmonary CT findings in the patients were assessed. Patients with concurrent infection including Streptococcus pneumoniae (n = 72), Haemophilus influenzae (n = 61) or multiple pathogens were excluded from this study. RESULTS The study group comprised 109 patients (66 male, 43 female; age range 28-102 years; mean age 74.9 years). Among the 109 patients, 34 had community-acquired and 75 had nosocomial infections. Underlying diseases included pulmonary emphysema (n = 74), cardiovascular disease (n = 44) or malignant disease (n = 41). Abnormal findings were seen on CT scans in all patients and included ground-glass opacity (n = 99), bronchial wall thickening (n = 85) and centrilobular nodules (n = 79). These abnormalities were predominantly seen in the peripheral lung parenchyma (n = 99). Pleural effusion was found in eight patients. No patients had mediastinal and/or hilar lymph node enlargement. CONCLUSIONS M. catarrhalis pulmonary infection was observed in elderly patients, often in combination with pulmonary emphysema. CT manifestations of infection were mainly ground-glass opacity, bronchial wall thickening and centilobular nodules.
Collapse
Affiliation(s)
- F Okada
- Department of Radiology, Faculty of Medicine, Oita University, Oita, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Cunha BA. Legionnaires' disease: clinical differentiation from typical and other atypical pneumonias. Infect Dis Clin North Am 2010; 24:73-105. [PMID: 20171547 PMCID: PMC7127122 DOI: 10.1016/j.idc.2009.10.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, 259 First Street, Mineola, Long Island, NY 11501, USA
| |
Collapse
|
26
|
Miyashita N, Sugiu T, Kawai Y, Oda K, Yamaguchi T, Ouchi K, Kobashi Y, Oka M. Radiographic features of Mycoplasma pneumoniae pneumonia: differential diagnosis and performance timing. BMC Med Imaging 2009; 9:7. [PMID: 19400968 PMCID: PMC2680832 DOI: 10.1186/1471-2342-9-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 04/29/2009] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The Japanese Respiratory Society guidelines propose a differential diagnosis for atypical pneumonia and bacterial pneumonia using a scoring system for the selection of appropriate antibiotic. In order to improve this scoring system, the guidelines are seeking new specific parameter. The purpose of this study was to clarify the pattern of abnormalities with Mycoplasma pneumoniae pneumonia on chest computed tomography (CT) and whether the radiographic findings could distinguish M. pneumoniae pneumonia from Streptococcus pneumoniae pneumonia. METHODS A retrospective review was performed of the CT findings of 64 cases and 68 cases where M. pneumoniae and S. pneumoniae, respectively, were the only pathogen identified by the panel of diagnostic tests used. RESULTS Of the 64 patients with M. pneumoniae pneumonia, bronchial wall thickening was observed most frequently (81%), followed by centrilobular nodules (78%), ground-glass attenuation (78%), and consolidation (61%). Bronchial wall thickening and centrilobular nodules were observed more often in M. pneumoniae patients than in S. pneumoniae patients (p < 0.0001). The presence of bilateral bronchial wall thickening or centrilobular nodules was only seen in patients with M. pneumoniae pneumonia. Using the scoring system of the Japanese Respiratory Society guidelines and chest CT findings, 97% of M. pneumoniae patients were suspected to be M. pneumoniae pneumonia without serology. When comparing the CT findings between early stage and progressed stage in the same patients with severe pneumonia, the radiographic features of early stage M. pneumoniae pneumonia were not observed clearly in the progressed stage. CONCLUSION The present results indicate that the diagnosis of M. pneumoniae pneumonia would appear to be reliable when found with a combination of bronchial wall thickening and centrilobular nodules in the CT findings. However, these CT findings are not observed in progressed severe M. pneumoniae pneumonia patients.
Collapse
Affiliation(s)
- Naoyuki Miyashita
- Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Figueira-Coelho J, Lourenço S, Pires AC, Mendonça P, Malhado JA. Mycoplasma pneumoniae-associated mucositis with minimal skin manifestations. Am J Clin Dermatol 2009; 9:399-403. [PMID: 18973408 DOI: 10.2165/0128071-200809060-00008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Mycoplasma pneumoniae-associated mucositis is a rarely described complication of M. pneumoniae infection presenting with ocular, oral, and genital involvement but without the typical skin lesions seen in Stevens-Johnson syndrome. A 27-year-old man with a past history of asthma presented at the emergency room with a 1-week history of cough (initially non-productive but subsequently associated with non-bloody mucopurulent sputum), fever, myalgias, headache, and progressive dyspnea. Two days before admission he had commenced amoxicillin/clavulanic acid with no improvement. The patient reported bilateral conjunctival injection and hemorrhagic ulcers on the lips commencing the day prior to admission. Physical examination revealed fever (39 degrees C), bilateral exudative conjunctivitis, painful hemorrhagic ulcers on the lips, tongue, and oral mucosa, small scrotal erosions, erythema of the penile meatus, and small erythematous bullae on the dorsum of each hand; subsequently, the patient developed bullae at the venipuncture site on his right arm. Laboratory tests revealed positive IgM serology for M. pneumoniae, with titer elevation. The patient was successfully treated with levofloxacin and prednisolone. Our case appears to be the first adult patient described with M. pneumoniae-associated mucositis, which has previously been reported only in pediatric patients. This is also the first reported instance of a case of M. pneumoniae-associated mucositis treated with levofloxacin and prednisolone. M. pneumoniae infection should be considered in all cases of mucositis, and treatment of this condition with levofloxacin and prednisolone seems to be effective.
Collapse
|
28
|
Clinical and pulmonary thin-section CT findings in acute Klebsiella pneumoniae pneumonia. Eur Radiol 2008; 19:809-15. [PMID: 19034459 DOI: 10.1007/s00330-008-1233-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Accepted: 10/25/2008] [Indexed: 01/15/2023]
Abstract
The aim of this study was to assess the clinical and pulmonary thin-section CT findings in patients with acute Klebsiella pneumoniae pneumonia. We retrospectively evaluated thin-section CT examinations performed between January 1991 and December 2007 from 962 patients with acute Klebsiella pneumoniae pneumonia. Seven hundred and sixty-four cases with concurrent infectious diseases were excluded. Thus, our study group comprised 198 patients (118 male, 80 female; age range 18-97 years, mean age 61.5). Underlying diseases and clinical findings were assessed. Parenchymal abnormalities were evaluated along with the presence of enlarged lymph nodes and pleural effusion. CT findings in patients with acute Klebsiella pneumoniae pneumonia consisted mainly of ground-glass attenuation (100%), consolidation (91.4%), and intralobular reticular opacity (85.9%), which were found in the periphery (96%) of both sides of the lungs (72.2%) and were often associated with pleural effusion (53%). The underlying conditions in patients with Klebsiella pneumoniae pneumonia were alcoholism or smoking habit.
Collapse
|
29
|
Differentiation of bacterial and non-bacterial community-acquired pneumonia by thin-section computed tomography. Eur J Radiol 2008; 72:388-95. [PMID: 18835120 PMCID: PMC7127011 DOI: 10.1016/j.ejrad.2008.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 07/15/2008] [Accepted: 08/11/2008] [Indexed: 11/22/2022]
Abstract
Background and objective The management of community-acquired pneumonia (CAP) depends, in part, on the identification of the causative agents. The objective of this study was to determine the potential of thin-section computed tomography (CT) in differentiating bacterial and non-bacterial pneumonia. Patients and methods Thin-section CT studies were prospectively examined in hospitalized CAP patients within 2 days of admission, followed by retrospective assessment by two pulmonary radiologists. Thin-section CT findings on the pneumonias caused by each pathogen were examined, and two types of pneumonias were compared. Using multivariate logistic regression analyses, receiver operating characteristic (ROC) curves were produced. Results Among 183 CAP episodes (181 patients, 125 men and 56 women, mean age ± S.D.: 61.1 ± 19.7) examined by thin-section CT, the etiologies of 125 were confirmed (94 bacterial pneumonia and 31 non-bacterial pneumonia). Centrilobular nodules were specific for non-bacterial pneumonia and airspace nodules were specific for bacterial pneumonia (specificities of 89% and 94%, respectively) when located in the outer lung areas. When centrilobular nodules were the principal finding, they were specific but lacked sensitivity for non-bacterial pneumonia (specificity 98% and sensitivity 23%). To distinguish the two types of pneumonias, centrilobular nodules, airspace nodules and lobular shadows were found to be important by multivariate analyses. ROC curve analysis discriminated bacterial pneumonia from non-bacterial pneumonia among patients without underlying lung diseases, yielding an optimal point with sensitivity and specificity of 86% and 79%, respectively, but was less effective when all patients were analyzed together (70% and 84%, respectively). Conclusion Thin-section CT examination was applied for the differentiation of bacterial and non-bacterial pneumonias. Though showing some potential, this examination at the present time would not be applicable for patients with underlying lung diseases, severe conditions of pneumonia, or immunocompromised conditions.
Collapse
|
30
|
Atypical pneumonias: current clinical concepts focusing on Legionnaires' disease. Curr Opin Pulm Med 2008; 14:183-94. [PMID: 18427241 DOI: 10.1097/mcp.0b013e3282f79678] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review provides clinicians with an overview of the clinical features of the atypical pneumonias. Atypical community-acquired pneumonia pathogens cause systemic infections with pneumonia. The key to the clinical diagnosis of atypical pneumonias depends on recognizing the characteristic pattern of extrapulmonary organ involvement different for each pathogen. As Legionella is likely to present as severe pneumonia and does not respond to beta-lactams, it is important to presumptively diagnose Legionnaires' disease clinically so that Legionella coverage is included in empiric therapy. This study reviews the clinical features and nonspecific laboratory markers of atypical pathogens, focusing on Legionnaires' disease. RECENT FINDINGS Case reports/outbreaks increase our understanding of Legionnaires' disease transmission. Both Mycoplasma pneumoniae and Chlamydophilia pneumoniae may cause asthma. Antimicrobial therapy of Chlamydophilia pneumoniae/Mycoplasma pneumoniae is important to decrease person-to-person spread and to decrease potential long-term sequelae. SUMMARY Atypical pulmonary pathogens cause systemic infections accompanied by a variety of characteristic extrapulmonary features. Clinically, it is possible to differentiate Legionnaires' disease from the other typical/atypical pneumonias. Rapid clinical diagnosis of atypical pathogens, particularly Legionnaires' disease, is important in selecting effective empiric therapy and prompting definitive laboratory testing.
Collapse
|