[Lung abscess caused by Prevotella oralis and Prevotella ruminicola in a HIV-positive patient].
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A 46-year-old man with diabetes mellitus and cadaveric kidney transplant, maintained on a regimen of prednisone and azathioprine, developed a necrotizing pneumonia. The abscess cavity became secondarily infected with Rhizopus and was cured by surgical resection. Secondary invasion of an abscess cavity by Rhizopus and the successful surgical treatment of pulmonary phycomycosis in an immunosuppressed patient have not previously been reported.
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A fatal case of community acquired pneumonia due to Lactobacillus casei ss rhamnosus is reported. Clinicians should be aware of this type of pneumonia.
Results of cytological examination of smears obtained after brush-biopsy from mucosa of ostium of bronchus which drains cavity of acute abscess were analyzed in 96 patients. Correlation between number of neutrophils, eosinophils, monocytes and fibroblasts was demonstrated. Criteria of inflammation intensity evaluation in endobronchitis were developed. It is necessary to combine endoscopic examination with cytological examination of smear.
Necrotizing pleuropulmonary infection in a patient with acquired immunodeficiency syndrome developed due to Corynebacterium afermentans subspecies lipophilum. Long-term combination antibiotic therapy was successful in eradicating the infection without surgery.
A case report of a 26 year-old asthmatic male is outlined in order to show the clinical features and unusual development pattern of pulmonary disorders and pleural effusion with a Mycoplasma pneumoniae pneumonia. A literature review is included in order to put this unusual case into perspective.
Lymphomatoid granulomatosis (LG) is a rare T cell rich, B cell non-Hodgkin's lymphoma which is difficult to diagnose. We present a patient with LG who demonstrated many of the difficulties in diagnosis and highlighted the importance of reviewing the diagnosis if treatment does not have the anticipated effect.
Under analysis were data of 107 patients with acute pulmonary abscesses. Such patients need a complex intensive conservative therapy. Indications for surgical treatment of acute pulmonary abscesses were considered to be concomitant complications (hemorrhage, pyopneumothorax, empyema of the pleura), atypical forms badly differentiated from a cavitary form of carcinoma, as well as suppurative processes not treated conservatively and disposed to turn into a chronic stage.
The use of the anaerobic technique in bacteriological investigations has made it possible to establish the leading role of asporogenous anaerobes in the etiological structure of the causative agents of pulmonary abscesses. Asporogenous anaerobes have been isolated from 93% of all examined patients, and in 54.4% of such patients these microorganisms have proved to be an independent etiological factor. Among asporogenous anaerobes, the main causative agents of pulmonary abscesses have been found to belong to four genera: Bacteroides, Fusobacterium, Peptococcus and Peptostreptococcus. Pulmonary abscesses of purely aerobic etiology are rather rare (5.3%). The schemes of the antibacterial treatment of patients with pulmonary abscesses, developed with regard to the leading etiological role of asporogenous anaerobes and clinically approved, have permitted achieving a considerable improvement in the results of treatment and an essential economic effect.
Large abscess cavities are not commonly encountered in patients with cystic fibrosis (CF). One such patient is reported in whom an abscess developed secondary to aspiration of sand and salt water. Material obtained at bronchoscopy revealed anaerobes as well as the aerobic organisms previously cultured from her sputum. Rapid improvement occurred after institution of antibiotic therapy specifically directed against the anaerobic organisms.
Anaerobic bacteria are relatively common and important pathogens in the lower airways, but are rarely detected due to problems in obtaining adequate specimens for anaerobic bacterial culture. As a consequence, therapeutic decisions are generally empiric and made on the basis of suspected involvement of these organisms according to various clinical clues. With respect to antibiotic options, there is probably a multitude of drugs that would be effective, but there are only three that have a sufficient experience according to published reports: clindamycin, penicillin, and metronidazole combined with penicillin. Recent studies suggest that many of the bacteria involved in these infections produce beta-lactamase, consequently favoring drugs other than penicillins for these infections. Nevertheless, the in vivo experience continues to be relatively good for penicillin when given for orodental or pulmonary infections involving anaerobes derived from the upper airways. For a serious anaerobic infection, such as putrid abscesses associated with large cavities or severe toxicity, the usual drug recommendation is clindamycin. For less serious infections, regimens with established merit are noted above. It is likely that almost any beta-lactam (other than antistaphylococcal penicillins, ceftazidime, or azthreonam) would be adequate; metronidazole should not be used as a single agent.
The method of occlusion of the draining bronchus in combination with a one-step percutaneous drainage of the purulent cavity by the Monaldi principle was used in 12 children for the treatment of giant pulmonary abscesses. It was shown that the proposed method unlike traditional procedures allows effective sanitation to be performed. It relieves symptoms of intrathoracic strain and thereby allows avoiding operations at the height of purulent intoxication. No complications and lethality followed the treatment.
Examined were 70 patients with an uncomplicated pulmonary abscess. It was established that a giant abscess had developed against the background of chronic bronchitis with valvular mechanism of impairement in bronchial patency and increased pressure in the cavity of an abscess. Therefore, the performance of decompression by means of transthoracic drainage was required. In patients with a small abscess, bronchitis was secondary, and bronchial patency was restored during abscessoscopy by means of sanation of the cavity and transthoracic administration of antibiotics. Patients with "dry" cavity didn't require the specialised aid. The conservative treatment was effective in 64 (91.4%) patients, 1 (1.6%) died; operated on were 5 (7%), 1 (20%) died. Total lethality was 2.9%.
An immunocompromised patient developed pneumonia in which both Legionella micdadei and L. pneumophila, serogroup 6, were isolated from transtracheal aspirates in the absence of any other bacteria. Unusual features included the development of disseminated intravascular coagulation and multiple pulmonary abscesses during treatment with erythromycin, and relapse of the legionellosis after extended therapy with both erythromycin and rifampin, which was heralded by septic shock. Because simultaneous infection with two distinct species of Legionella occurs, concurrent increases in antibody titer to more than one Legionella may, in some instances, reflect multiple infection rather than cross-reacting antibody.
Pulmonary infection with Cryptococcus laurentii occurred in a patient with dermatomyositis receiving corticosteroid therapy. Infections with cryptococci other than C. neoformans are rare, and pulmonary involvement with C. laurentii has not been reported previously. The isolate was susceptible to amphotericin B but resistant to 5-fluorocytosine, and synergism could not be demonstrated with these 2 drugs. Amphotericin B without surgical resection, concurrent with reduction in the dosage of corticosteroids, resulted in clinical and roentgenogrphic resolution of the infection.
A 48-year-old male was admitted to our hospital because of fever, cough and of loss appetite. Chest X-P revealed an abnormal shadow in the left upper lobe. Bronchoscopy was performed and Capnocytophaga gingivalis was cultured from the bronchial lavage and bronchial curreting fluid. Ceftizoxime sodium and Clindamycin phosphate was administered intravenously. He was discharged after 30 days. He did not have any immunosuppressive underlying disease including HIV infection and diabetes mellitus which cause these lesions.