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PubMed1970

[Metronidazole In Amoebiasis: 1. The Use Of Metronidazole On The Treatment Of Hepatic And Pulmonary Amoebiasis]

Total 9 cases of extraintestinal amoebiasis, amebic liver abscess and amebic lung abscess, were treated with metronidazole. The diagnosis and progress check were done by (1) stool examination, (2) size and pain of liver, (3) hematological examination, (4) urinanalysis, (5) X-ray or liver scanning (6) examination of aspirated pus from liver and (7) immobilization test of E. histolytica. Results are summarized as follows: 1. Amebic hepatitis: Metronidazole was given to 3 cases with daily dose of 0.9-1.2 gm for 3-7 days. Clinical symptoms were completely restored by the treatment. 2. Amebic lung abscess: One case was treated with metronidazole for 3 days with the daily dose 1.2 gm. X-ray findings showed remarkable improvement by the treatment. An additional administration of the drug for 6 days resulted complete resolution of the pneumonic changes. 3. Amebic liver abscess: Four cases were treated with metronidazole. The daily doses were 0.4-2.4 gm and continued for 2-10 days. Aspiration of the abscess for 1-10 times or continuous drainage of pus were performed during the course supplementarily. All cases were recovered to normal by the combining treatment. No remarkable side effect was noticed by the drug administration, and no relapse was experienced up to date.

Journal Article↗
PubMed1996

[Pulmonary abscess treated with postural drainage].

Case record of patients with lung abscess treated by postural drainage is presented in this paper. In young man with multiple explosive injuries lung abscess was formed two months after injury. A postural drainage with parenteral application of antibiotics has been performed. The expectoration was painful. At the seventh day there was no temperature, ESR was described at the tenth day. The general status was becoming better. At the seventeenth day patient was discharged from Hospital. Rig imaging was shown nearly completely resolution of lung abscess. Postural drainage was effective because of favorable localisation of abscess near the large bronchus and basely part of the lung.

Adult↗
PubMed2005

[Bacterial infections of the lung in the elderly].

Many cases of the lung abscess of the elderly ages are the outcome of aspiration pneumonia attributable to miss-swallowing. These cases basically have the risky conditions of repeated miss-swallowing such as cerebrovascular diseases, regurgitation from stomach to esophagus and so on. Even if the infected lung tissues were resected completely, habitual miss-swallowing can produce the aspiration pneumonia or lung abscess again. Non-surgical therapy is superior for the lung abscess caused by miss-swallowing. The group of the lung abscess due to lung cancer requires the surgery because other treatments can not cure the severe inflammation. This surgery aims primarily the recovery from infected condition of the lung, and sometimes the curative resection is impossible. The prognosis of the group is not always good. The lung abscess often accompanies severe adhesion to the thoracic wall due to inflammation, consequently the surgeons are obliged to stressful surgery with bleeding and a long time.

Aged↗
PubMed2000

Effects of pulmonary abscesses on racing performance of horses treated at referral veterinary medical teaching hospitals: 45 cases (1985-1997).

OBJECTIVE: To determine whether results of physical or radiographic examination or biochemical analyses in adult racehorses with primary lung abscesses were associated with ability to race following treatment. DESIGN: Multiple-center retrospective study. ANIMALS: 25 Standardbreds and 20 Thoroughbreds. PROCEDURE: Medical records of horses with a primary lung abscess that were admitted to any of 4 veterinary teaching hospitals were reviewed. Results of physical examination, laboratory testing, and thoracic radiography were reviewed. Racing performance after treatment was compared with performance before illness and with performance of the general population of racehorses of similar age, sex, and breed. RESULTS: 23 of 25 Standardbreds and 13 of 20 Thoroughbreds raced after diagnosis and treatment of a lung abscess. Most horses had a solitary abscess in the dorsal to caudodorsal lung fields. Results of initial physical examination, biochemical analyses, and culture and identification of the microbial isolate were not associated with whether a horse returned to racing. For horses that had raced prior to the illness, race performance after treatment of the lung abscess was not significantly different from performance before the illness. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of racing performance in those horses that resumed racing after treatment, long-term residual lung damage did not develop in horses with primary lung abscesses that were treated appropriately. It is not known whether horses that recovered would be more likely to bleed from the site of a prior infection when resuming strenuous exercise and whether lung abscesses contributed to a failure to resume racing.

Animals↗
PubMed1995

Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients.

BACKGROUND: Streptococcus milleri is increasingly being recognised as an important pulmonary pathogen which may lead to the development of empyema or lung abscess. Although several small series have been reported, the clinical and laboratory features have yet to be fully characterised. METHODS: Twenty five cases were identified and the clinical and laboratory data from case records were analysed. RESULTS: There were 16 empyemas, five lung abscesses, and four with both lung abscess and empyema. The mean age of the patients was 61 years (range 36-89) and 84% were men. The most common symptoms at presentation were shortness of breath, chest pain, cough, and weight loss; only 36% had a fever. Four of the nine patients with lung abscess required a diagnostic lobectomy because of suspected malignancy. Predisposing factors were present in 80% of patients and included the following: pneumonia, periodontal disease, excess alcohol intake, previous thoracic surgical procedures, and malignancy. Laboratory features of S milleri infection were leucocytosis, neutrophilia, anaemia, abnormal liver function tests, and hypoalbuminaemia. In the group with empyema five patients had a pneumothorax on initial presentation and pleural loculation occurred in 10 of these patients. The median stay in hospital was 34 days (range 11-88). Six patients died, five of whom had significant underlying illnesses. CONCLUSIONS: Pulmonary infection with S milleri may result in considerable morbidity and mortality, and is characterised by a strong male predominance, non-specific symptoms (often without toxicity), the presence of predisposing factors, pleural loculation, pneumothorax, and a protracted stay in hospital.

Adult↗
PubMed1991

[Multiple aspergillus brain abscess complicated with systemic lupus erythematosus--case report].

A 15-year-old female was hospitalized for the treatment of systemic lupus erythematosus complicated with nephritis. She improved with administration of steroid hormones and an immunosuppressant, plasma exchange, and dialysis. However, a lung abscess developed 6 months after admission, and multiple brain abscesses appeared 2 months after the onset of the lung abscess. The lung abscess faded with oral administration of fluocytosine and intravenous administration of miconazole, but the brain abscesses enlarged. Intrathecal administration of miconazole was not effective. Therefore, the abscess in the right frontal lobe was surgically removed and an Ommaya's reservoir was placed in the anterior horn of the right lateral ventricle. Aspergillus was identified in the removed abscess. Subsequently, miconazole was administered intraventricularly through the Ommaya's reservoir 10 mg daily for 1 month. The abscesses in the left parietal lobe gradually diminished. One year later, she complained of right hypesthesia again. Computed tomography scan revealed enlargement of the abscess. Miconazole was administered intravenously and intraventricularly for 1 month. Second craniotomy was performed 16 months after the first surgery and the abscess was completely removed. She was discharged with mild hypesthesia of the right leg. It is concluded that intraventricular administration of miconazole through an Ommaya's reservoir is an effective therapy for central nervous system aspergillosis.

Adolescent↗
PubMed1987

Limitations in the use of indium-111-oxine-labeled leucocytes for the diagnosis of occult infection in children.

Fifteen children underwent scintigraphy with indium 111 (111In)-labeled white blood cells (WBC) for the detection of a local suppuration. The procedure generally contributed to a correct diagnosis. False negative results were observed in 5 children, but in two of them positive foci were also present. The missed lesions were 2 liver abscesses, 1 lung abscess, foci of osteomyelitis and 1 pericarditis. Two cases of chronic granulomatous disease are presented in which increased leucocyte accumulation was not observed in proven instances of infection.

Adolescent↗
PubMedDate not supplied

Value of ultrasound-guided core-needle biopsy for peripheral intrathoracic and mediastinal lesions.

To evaluate the value of ultrasound (US)-guided core-needle biopsy (CNB) for peripheral intrathoracic and mediastinal lesions. Fourteen patients who had intrathoracic or mediastinal lesions underwent US-guided CNB with 17- or 18-gauge needles. The lesions in this study were seven cases of lung carcinomas including four cases of adenocarcinomas and three cases of squamous cell carcinomas, two cases of thymomas, and one case each of aspergillosis, sarcoidosis, MFH, lung abscess, and lung fibrosis. Diagnosis was possible in 13 of 14 (92.8%) cases histologically. There were three cases of complication (21.4%); one case each of pneumothorax, pleuritis, and hemosputum. They were all cured with medication. We concluded that real-time US-guided CNB is a useful and safe method for the examination of peripheral intrathoracic and mediastinal lesions.

Adenocarcinoma↗
PubMed1993

Invasive Haemophilus influenzae infections in older children and adults in Seattle.

We recently saw two unusual manifestations of Haemophilus influenzae infection in adults in the Seattle area: fulminant sepsis in an otherwise-healthy man and three episodes of bacteremia in a woman with chronic liver disease. We retrospectively identified 79 bacteremic and 40 non-bacteremic cases of invasive H. influenzae infection developing in patients > or = 9 years of age between 1 January 1980 and 31 December 1990. The most common clinical presentations among patients with bacteremia included pneumonia (52%), septicemia (27%), meningitis (8%), gynecologic infection (5%), and epiglottitis (5%). Underlying illnesses were common in these patients, and overall mortality was 35.5%. Factors associated with mortality included underlying neurological disease, polymicrobial bacteremia, and advanced age. The clinical presentations of the 40 patients without bacteremia included soft-tissue abscesses (45%), lung abscesses (18%), peritonitis (13%), meningitis (8%), gynecologic infection (8%), epididymitis (5%), mastoiditis (3%), and osteomyelitis (3%). Thus H. influenzae disease has a variety of presentations and is associated with significant mortality in older children and adults. Further study is required to determine whether widespread administration of H. influenzae type b conjugate vaccine to infants will alter the development of subsequent disease in later life.

Adolescent↗
PubMed1986

Evaluation of imipenem/cilastatin against nosocomial infections and multiresistant pathogens.

Thirty-five patients suffering from soft tissue infections (12), upper UTIs (6), bronchopneumonia (6), septicaemia (2), chronic osteomyelitis (2), intra-abdominal abscess (2), liver abscess (1), lung abscess (1), acute cholangitis (1), thoracic empyema (1) and chronic prostatitis (1) were given imipenem/cilastatin for 6-21 days. In 22 patients several aggravating factors coexisted, while infection in 16 patients was polymicrobial. The following pathogens were implicated: Pseudomonas aeruginosa (21), Escherichia coli (15), Enterobacter cloacae (6), Proteus spp. (3), Klebsiella pneumoniae(3), Citrobacter freundii (1), Salmonella enteritidis (1), Acinetobacter spp. (4), Haemophilus influenzae (2), Bacteroides fragilis (1) and Peptococcus saccharolyticus (1) with MICs to imipenem ranging between 0.5 and 8 mg/l. A successful clinical response was observed in 91.4% of the patients, while pathogens were eradicated in 75.9%, persisted in 24.2% and recurred, in 9.1% of patients, with development of resistance to imipenem in two Ps. aeruginosa strains. Against 150 multiresistant strains of Ps. aeruginosa, 40% of which were resistant to amikacin, 86.4% and 88.9% were found sensitive to ceftazidime and imipenem respectively. It is concluded that imipenem provides the possibility of treating successfully multiresistant and polymicrobial infections with a single antimicrobial.

Adult↗
PubMed1997

Foreign body aspiration into the lower airway in Chinese adults.

OBJECTIVES: Foreign body aspiration into the lower airway in adults is uncommon. We designed this study to investigate the clinical presentations, precipitating factors, management choice, and complications of foreign body aspiration in Chinese adults. PATIENTS AND METHODS: We analyzed 43 consecutive adult patients with foreign body aspiration between February 1980 and December 1995 from the medical record registry and cross index system of a tertiary medical center. RESULTS: The most common symptoms are chronic cough, hemoptsis, fever, and dyspnea. Only three patients (7%) presented with choking. Chest radiograph demonstrated the foreign body in nine cases (21%). The most common foreign body was bone fragments (21/43, 49%). Lodgment is more common in the right, especially the right intermediate bronchus and basal bronchus. Three patients were also diagnosed as having lung cancers. Precipitating factors include CNS dysfunction, facial trauma, intubation, dental procedure, and underlying pulmonary diseases. Flexible fiberoptic bronchoscopy removed the foreign body in 25 cases (58%) during the first attempt and 32 cases (74%) in total. Complications include obstructive pneumonitis (including one case of actinomycosis infection), atelectasis, bronchiectasis, lung abscess, and lung torsion (two cases). CONCLUSION: The nature of foreign body in Chinese adults was different from the Western adults. The initial clues to foreign body aspiration in adults are usually obscure or indirect. We suggest flexible fiberoptic bronchoscopy as the first-line approach. Follow-up bronchoscopy and chest radiograph are recommended to detect chronic complications or coexisting lung cancer.

Adult↗
PubMed1979

Metronidazole in the treatment of anaerobic infections.

Using metronidazole in oral dosages of 1.5 to 2 g daily, we treated 13 adults who had anaerobic pleuropulmonary infections, including 11 with lung abscess, one with necrotizing pneumonia, and one with thoracic empyema. Five patients (four with lung abscess and one with necrotizing pneumonia) were cured. The lung abscesses of 5 patients did not respond. For 3 patients (one with epigastric distress who refused metronidazole, one with undrained empyema, and one who died while receiving metronidazole), therapy could not be evaluated. Side effects included leukopenia (2 patients), leukopenia and neutropenia (one), neutropenia (one), dark urine (two), bitter taste (two), and epigastric distress (one). In light of our findings, metronidazole is not uniformly effective in the treatment of anaerobic pleuropulmonary infections.

Adult↗
PubMed2001

[Usefulness of three-dimensional color Doppler sonography for the differential diagnosis of subpleural lesions].

The purpose of our investigation was to assess the usefulness of three-dimensional color Doppler sonography (velocity mode and power mode) for the differential diagnosis of subpleural lesions. Thirty lesions (11 pneumonias, 5 lung abscesses, 11 primary lung cancers, 3 metastatic lung cancers) were examined. Three-dimensional images were reconstructed by a maximum intensity projection method. Three-dimensional representations of intralesional blood flow became available for all lesions approximately 11 seconds after scanning. In every case, the entire vasculature of the tumor, the pneumonia, the abscess, or the inflamed region of the lung was appreciated more easily from three-dimensional images than from two-dimensional images. We classified the color flow pattern of subpleural lesions depicted by color flow imaging into seven groups. Color flow was depicted better by the three-dimensional color Doppler power mode than the velocity mode. Three-dimensional color flow patterns observed in power mode, patterns of the pneumonias and the lung cancers differed significantly. Our results suggest that the three-dimensional color Doppler power mode is useful for the differential diagnosis of subpleural lesions.

Adult↗
PubMed2004

[Bronchobiliary fistula associated with combined abscess of lung and liver].

HISTORY AND PHYSICAL EXAMINATION: A 43-year-old, cachectic, alcohol-addicted patient was admitted to the hospital due to hemoptysis and fever of up to 40 degrees C for the last 4 days. Physical examination revealed pleural rubs in the right lower lung and a diffuse pain in the right upper quadrant of the abdomen. The right upper quadrant of the abdomen also showed scars from several surgical interventions on the small intestine, the liver and the biliary tract and deformed caudal ribs due to an accident 23 years earlier. DIAGNOSTICS, THERAPY, AND CLINICAL COURSE: Chest X-ray, ultrasound and computed tomography (CT) showed abscess cavities in lung and liver communicating through the diaphragm. Under antibiotic therapy the abscess was drained. Cultures showed Klebsiella pneumoniae and Streptococcus viridans. Continuous lavage of the abscess cavities and antibiotic therapy led to an improvement in parameters of inflammation and clinical status. Imaging after 10 days of treatment showed a contrast enrichment in the abscess cavities and a bronchobiliary fistula accounting for temporary biliptysis. The drainage was removed after 29 days, when similar imaging revealed no further sign of an abscess cavity and a previous CT follow-up had proven a distinct decrease of the abscesses. CONCLUSION: Bronchobiliary fistulas are very rare. In most cases they are caused by hepatic or subphrenic abscesses, resulting from different conditions. The development of an bronchobiliary fistula originating from a Klebsiella pneumoniae pneumonia, as indicated by this report, has not been described so far. In the patient presented here, treatment was achieved due to continuous drainage despite the large extent of the abscess.

Adult↗