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PubMed1993

Etiologic diagnosis of pulmonary infection by ultrasonically guided percutaneous lung aspiration.

Ultrasonically (US) guided percutaneous lung aspiration was performed for patients clinically diagnosed as having pneumonia (n = 18) or lung abscess (n = 16) and thus taking antibiotics. The procedure was done because of either unsatisfactory clinical or roentgenographic responses, critical underlying disease or poor general condition in the patients. Most cases with pneumonia showed hypoechoic lesion with irregular margin and typical consolidated change, while some cases showed central necrosis. Microorganisms were identified by stains in 9 cases. The overall sensitivity of needle aspiration and culture was 72.2% (13/18). Five cases failed to grow microorganism in culture, mostly due to delayed resolved pneumonia. In cases with lung abscess, the typical ultrasonographic finding was hypoechoic lesion with irregular margin associated with central necrosis or air-fluid level. The overall sensitivity for needle aspiration and culture was 81.2% (13/16). Only one case of pneumothorax was seen, which was recovered with chest intubation and oxygen inhalation. Our result showed that US-guided percutaneous lung aspiration is a technique with high diagnostic yield and low complication rate for cases with pneumonia or lung abscess.

Adult↗
PubMed1997

Evaluation of pentavalent Tc-99m DMSA scintigraphy in small cell and nonsmall cell lung cancers.

AIM: The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma. METHODS: Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex. RESULTS: Histopathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 +/- 0.32) and NSCLC (1.43 +/- 0.19) tumour types did not show statistical difference (p > 0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases. CONCLUSION: Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.

Bone Neoplasms↗
PubMed1980

[The bioptical exploration of non-tuberculous cavities in the lungs].

Considering the difficulties in X-ray differentiating, every lung abscess should be submitted to a bronchologic-bioptical control. In using the fine needle biopsy for the cytological evaluation, no severe complications could be observed so far. A promising therapy of the lung abscess is given by perthoracal local treatment.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMedDate not supplied

[Single-dose administration in the treatment with penicillin G (PG) and metronidazole (Me) in primary pulmonary abscesses (a preliminary study)].

The anaerobic bacteria play the main role in the etiology of the lung abscesses (Finegold, 1989). From this reason, the administration of the association PG and Me (endovenously or per os) gives a high healing rate in our country; 90.5%. The objective of this work was to study the influence of the drug-administration rhythm on the therapeutical results. The drugs were given once daily, several times daily, or in a combination of those 2 modalities. A lot of 38 patients hospitalized between 1.01.94-31.12.95 in the Institute of Pneumophthisiology, was divided in 3 groups: U (11 cases--28.9%), treated with PG: 5-10 mill and Me: 1.5-2 g in one endovenous perfusion, daily: M (18 cases--47.3%), treated with PG: 5-10 mill, one endovenous perfusion daily and Me: 1.5-2 g, 2-4 times daily: F (9 cases--23.8%), treated with both PG: 5-10 mill and Me: 1.5-2 g, 2-4 times daily. Cases with lung abscess and advanced neoplasia, hepato-renal or cardio-pulmonary insufficiencies, were excluded. The hospitalization period was 15-77 days, with an average of 38.3 +/- 26. The proportion of the therapeutical successes, estimated as the disparition of the clinical suppurative symptomatology and the reduction > or = 90% of the lesions and cavity surfaces on the chest X-ray, was for the group U: 90.9% (10 from 11 cases), for M: 94.4% (17 from 18 cases) and for F: 88.9% (8 from 9 cases), the difference being statistical non-significant.

Administration, Oral↗
PubMed1994

[Anaerobic respiratory infection--evaluation of methods of obtaining specimens].

Anaerobic cultures were performed on various kinds of specimens obtained from 67 patients with respiratory infections. The infections consisted of 33 cases of pneumonia, 14 cases of lung abscess, 6 cases of pyothorax, 9 cases of chronic lower respiratory tract infection, and 5 cases of infection of pulmonary cyst. Specimens included bronchoscopic specimens obtained using a single tube or protected catheter brush (PCB), transtracheal aspirate, percutaneous lung aspirate, aspirate using a suction tube through the tracheostomy or intubation tube, and pleural fluid. Anaerobes were isolated in 80% of pyothorax, 43% of lung abscess, and 15% of pneumonia (42% of aspiration pneumonia), respectively. Anaerobes isolated frequently in respiratory infections included Prevotella spp., Fusobacterium spp., and Peptostreptococcus spp. In regard to the type of specimen, bronchial aspirate obtained by bronchoscopy was useful in examination of pneumonia, and was useful as percutaneous lung aspirate in examination of lung abscess. But there was discrepancy of culture results between specimens obtained by different methods in the same patient. To confirm anaerobes as pathogens in respiratory infections, it is necessary to select an appropriate method to obtain specimens and to interpret the culture results comprehensively.

Adult↗
PubMed1992

The role of surgery in treating pleuropulmonary suppurative disease--review of 77 cases managed at Queens Hospital Center between 1986 and 1989.

Despite the generally salutary experience in recent years of managing suppurative pleuropulmonary disease, empyemas and lung abscesses have persisted and increased in incidence in hospitals such as Queens Hospital Center that serve large numbers of the socioeconomically disadvantaged. This study documents the etiology, clinical presentation, treatment, and treatment results of suppurative pleuropulmonary disease at Queens Hospital Center, which serves a large segment of the urban poor, many of whom are black. Results indicate that contributory or antecedent etiologic factors include a history of prior disease (specifically pneumonia, lung abscess, obstructive lung disease, pulmonary neoplasia, and tuberculosis); a predisposition to constitutional or immunologic deficiencies (specifically, alcoholism, anemia/malnutrition, drug abuse, and acquired immunodeficiency syndrome [AIDS]); conditions contributing to tracheobronchial aspiration (specifically, alcoholism and seizure disorders); and a miscellaneous group such as prior surgery, cardiovascular disease, and sepsis syndrome. The patients in this study were young with maximal incidence occurring in the third to fifth decades of life. Patients were predominantly male (75%) and black (66%). There were 18 deaths (23%), with sepsis being the cause in 10 (56%). Most surgical interventions were conservative, ie, bronchoscopies (48), thoracenteses (43), and tube thoracotomies (39). Thirty-one open thoracotomies were performed for drainage, decortication, or pulmonary resection. The surgical mortality was three cases or 5% of the patients who underwent surgery. The designated incidence of proven AIDS in this series (29%) was low, undoubtedly because many patients refused testing, and the multiple gram-positive and gram-negative infections that were seen did not conform to the Centers for Disease Control criteria for diagnosis and case reporting for AIDS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Nephrobronchial fistula secondary to xantogranulomatous pyelonephritis.

We report a case of staghorn nephrolithiasis that evolved into xanthogranulomatous pyelonephritis with perinephric abscess, nephrobronchial fistula, and lung abscess. The patient was an intravenous drug abuser who tested positive for human immunodeficiency virus, without evidence of acquired immunodeficiency syndrome. He presented with a 2-month history of untreated repeated episodes of left flank pain and hyperpyrexia. Treatment involved left nephrectomy, debridement of abscess, tube drainage, and intravenous antibiotics. The patient illustrates the need to consider untreated nephrolitiasis as a predisposing factor for pulmonary complications.

AIDS-Related Opportunistic Infections↗
PubMed1990

[Clinical significance of Streptococcus milleri isolated from various suppurative lesions].

Seventy-one strains of Streptococcus milleri were isolated from 68 patients admitted to Tamana Central Hospital. (1985.2-1989.1) S. milleri was isolated from the following specimens: sputum (15 strains), urine (10), ascites (9), postoperative wound (9), pleural effusate (6), bile (5), genital discharge (3), aspirated fluid from lung abscess (2) and others (12). In 12 patients (18%), S. milleri was isolated in pure culture and in 56 patients (82%) as part of a mixed flora. Other bacteria isolated in association with S. milleri were obligate anaerobes (41%), Gram-negative rods (40%), Gram-positive cocci (16%) and others (3%). In 71 strains of S. milleri, 9 strains (13%) were beta-haemolytic, 62 (87%) were alpha-haemolytic (week) or non-haemolytic. In 68 patients, type specific male-female ratio was 15:9 for S. milleri I, 20:15 for II and 1:8 for III respectively. The patient's age ranged from 7 to 86 years and 75% of patients were more than 50 years old. In respiratory infection, 10 cases (pyothorax, 6; pneumonia, 3; lung abscess, 1) were related to S. milleri infection and considered clinically significant. 8 cases had underlying disease, however, 2 cases (pyothorax, lung abscess) had no underlying disease. In these 2 cases, S. milleri was isolated in pure culture. Successful treatment of these ten cases usually required either antibiotic therapy or drainage of the lesion. S. milleri was isolated from various clinical specimens and some cases were associated with serious infections. S. milleri was more commonly associated with suppurative infections than other viridans group streptococci. S. milleri may therefore have different characteristics which other streptococcal species of normal flora have not.

Abscess↗
PubMed1981

Aspiration pneumonia in institutionalized children. A retrospective comparison of treatment with penicillin G, clindamycin and carbenicillin.

The antibiotic therapy of aspiration pneumonia was retrospectively reviewed in 74 institutionalized children with lung abscess (10), necrotizing pneumonia (12), and pneumonitis (52). Anaerobic bacteria were isolated in 69 patients (93%); and in 67 (90.5%), they were mixed with aerobic bacteria. Penicillin G was given to 20 patients, clindamycin to 20, and carbenicillin to 34. Gentamicin was concurrently given to 35 of the patients. The mean duration of therapy in the three types of pulmonary infection was: lung abscess 30.2 days, necrotizing pneumonia 26.6 days, and pneumonitis 15.1 days. The mean duration of fever after initiation of therapy was 5.8 days, 8.1 days, and 3.4 days, respectively. The mean time for radiologic clearance was 35.6 days for lung abscess, 39.2 days for necrotizing pneumonia, and 13.5 days for pneumonitis. The three antibiotics were equally effective in all patients, including those from whom Bacteroides fragilis was recovered.

Bacteroides fragilis↗
PubMed1991

Child neglect followed by marked thymic involution and fatal systemic pseudomonas infection.

The case of a 9-month-old baby girl who failed to develop normally due to nutritional neglect and secondary immunodeficiency characterized by marked thymic involution is reported. The child died of systemic Pseudomonas aeruginosa (P. aeruginosa) infection manifested in pneumonia, lung abscesses, bacterial endocarditis and ecthyma gangrenosum. At autopsy the child was 64 cm in height (normal for a 4- to 5-month-old child) and 5.1 kg in weight (normal for a 2- to 3-month-old child). Multiple gangrenous ecthymas, consisting of deep ulcers, induration and inflammation, were observed in the skin over the entire body. The lungs showed hemorrhagic pneumonia, multiple lung abscesses, and necrotizing arteritis in the abscesses and surrounding areas. The thymus weighed 2.3 g and showed marked involution. Histological examination showed so-called nutritional thymectomy characterized by severe cortical atrophy and clustering, cystic dilation and amorphous changes of the Hassall's corpuscles. In the heart, dark brown verrucae were present at the attachment sites of the tendinous cords of the papillary muscle in the anterior and posterior cusps of the mitral valve, suggesting infectious endocarditis. Bacteriological examination demonstrated P. aeruginosa in the ecthymas, lung abscesses and blood. As primary immunodeficiency was considered unlikely, immunodeficiency secondary to thymic involution following malnutrition seemed to have led to a fatal systemic infection with P. aeruginosa, whose virulence is generally weak. This suggests a close association of the development of such infection and immunodeficiency with child neglect.

Child Abuse↗
PubMed2001

Fiberoptic bronchoscopic balloon dilatation in malignant tracheobronchial disease: indications and results.

STUDY OBJECTIVES: Bronchoscopic balloon dilatation (BBD) has become a valuable tool in the treatment of benign tracheobronchial stenoses. The objective of this study was to assess indications for and results of fiberoptic BBD in treating malignant lesions. DESIGN: One hundred twenty-six balloon dilatation procedures were performed in 78 patients with predominantly bronchial carcinoma. BBD was only performed when alternative modes of local treatment (eg, laser therapy or stent implantation) were not indicated or were inappropriate. Indications were symptomatic stenoses of the tracheobronchial tree: dyspnea or stridor (52%), retention pneumonia (15%), atelectasis (10%), retention of secretions (21%), or lung abscess (2%). RESULTS: Fifty-five percent of all procedures consisted of dilatations of tracheal or bronchial lesions (group 1). In 22% of procedures, a stent was dilated (group 2). In 13%, BBD was used to facilitate stent placement (group 3), and in 10% to enable the correct positioning of irradiation probes for brachytherapy (group 4). In group 1 and group 2, 2 of 2 lung abscesses resolved, 5 of 8 atelectases resolved, and 11 of 12 retention pneumonias resolved. Dyspnea improved in only 12 of 32 patients. No abscess recurred. Two pneumonias and two atelectases reappeared due to restenosis. Stent implantation and brachytherapy procedures were facilitated in 90% of cases. In 52% of cases, BBD was supported by high-frequency jet ventilation. Complications consisted of one fatal hemoptysis caused by a lacerated pulmonary artery, and minor bleeding not necessitating specific therapy. CONCLUSIONS: Fiberoptic BBD is useful in the management of airway stents prior to and postimplantation, as well as in the placement of brachytherapy catheters. BBD is also successful in the resolution of poststenotic lung abscesses, retention pneumonias, and atelectases.

Adult↗
PubMed1992

Detection of localized Salmonella infection by gallium-67 citrate scan.

Fifteen cases (9 males, 6 females, ages: 18-73 y/o) of salmonella bacteremia were referred for a Gallium-67 citrate (Ga-67) scan to detect the focal site(s) of salmonella infection. Among them, 8 were finally proved to have focal infection(s). Their underlying diseases were systemic lupus erythematous (SLE, 4 cases), malignancies (2 cases), immunocompromise (1 case) and unknown disease (1 case). The focal infections detected were septic arthritis in 6, soft tissue abscesses in 4 and lung abscesses in 2. This report suggests that Ga-67 scan is of great value in detection of localized salmonella infection.

Adolescent↗
PubMed2001

[Diagnosis and therapy of abscess forming pneumonia].

Aspiration of oro-pharyngeal secretions and gastric content is the most frequent cause of formation of primary lung abscess. A compromised mental status (e.g. alcoholism, sedatives, stroke) and esophageal dysfunction (e.g. herniation, vomiting) are important risk factors. Aspiration pneumonia presents as a subacute disease and is usually not distinguishable from other causes of pneumonia, until typical radiological signs of cavitation and putrid sputum appear 8 to 14 days after the initial event of aspiration. Anaerobic bacteria play a pivotal role in an almost exclusively mixed spectrum of causative organisms. Aerobic pathogens are also frequently isolated, but whether they are an active part of infection or merely represent colonizers remains unclear in many instances. Differential diagnosis includes bronchial neoplasms, either as necrotizing carcinoma or as the cause of poststenotic cavernous pneumonia, other infectious diseases like tuberculosis, Pneumocystis carinii pneumonia or endocarditis with septic metastases, and lung artery embolism or vasculitis (M. Wegener). Fiberoptic bronchoscopy is extremely helpful in determining cause and etiology of the disease and should be carried out in all patients presenting with cavernous lung lesions. Bacteriological sampling should be performed using protected specimen brushing (PSB) technique. Broncho-alveolar lavage might serve as a less expensive but also less sensitive alternative measure. Since anaerobic bacteria resemble ubiquitous commensals of the oral cavity, sputum is of no use in anaerobic culture. Principal therapeutic strategy is antibiotic therapy for an extended period, usually four weeks to four months, unless radiologic changes and as well laboratory as clinical indicators of infection are completely resolved. Clindamycin, optionally supplemented with a second or third generation cephalosporin and Ampicillin/Sulbactam proved equally effective in treating aspiration pneumonia and primary lung abscess. The role of Moxifloxacin and other new flouroquinolones with their favorable pharmacodynamics is currently evaluated. Provided that antibiotics are prescribed for a sufficient period of time and patients' compliance is ensured, surgical procedures are limited to a negligible number of complications, e.g. recurrent severe hemoptysis, empyema or broncho-pleural fistula.

Diagnosis, Differential↗
PubMed1985

Use of gas liquid chromatography in the clinical diagnosis of anaerobic pleuropulmonary infection.

Evidence of anaerobic infection was sought in 83 patients with pulmonary disease with anaerobic culture and gas liquid chromatography (GLC) of mucopurulent sputum, or pleural fluid where appropriate. Saliva samples from nine healthy controls and 14 patients with cystic fibrosis were examined by the same methods to assess anaerobic content. Clinically significant anaerobic pleuropulmonary infection was not found in our patients with bronchitis, bronchiectasis and cystic fibrosis and occurred in only some of our patients with empyema and lung abscess. GLC of pleural fluid (empyema) or sputum (lung abscess) was helpful in identifying these cases, when a strongly positive reading was obtained. The gas liquid chromatogram was negative or only weakly positive in those patients where the presence of anaerobes was clinically insignificant, most probably resulting from contamination of the sputum samples by saliva. Results were rapidly available and the need for transtracheal aspiration to obtain specimens of bronchial secretion uncontaminated by mouth flora was avoided. The semiquantitative GLC would therefore appear to be a useful method for investigating specimens from patients with suspected anaerobic pleuropulmonary infection.

Adult↗
PubMed1997

Role of coagulase in a murine model of hematogenous pulmonary infection induced by intravenous injection of Staphylococcus aureus enmeshed in agar beads.

We describe a novel mouse model of acute staphylococcal pneumonia induced by intravenous injection of Staphylococcus aureus enmeshed in agar beads. For comparison, we also used various strains of bacteria, including three strains of S. aureus, two strains of Staphylococcus epidermidis, one strain of Streptococcus pyogenes, three strains of Pseudomonas aeruginosa, and one strain of Klebsiella pneumoniae. All except two strains of S. aureus were cleared rapidly from the lungs. When S. aureus NUMR1 enmeshed in agar beads was injected intravenously, the organisms concentrated and remained in the lung for a period longer than several weeks. Multiple lung abscesses were evident macroscopically, and histological examination of the infected lung showed multiple lung abscesses around the pulmonary arterioles, consisting of bacterial colonies encircled with fibrin filaments and surrounded by inflammatory cells of neutrophils and macrophages. When 14 strains of clinically isolated S. aureus were injected intravenously, the number of bacteria recovered from the lung tissue 7 days after infection correlated with the titer of staphylocoagulase (P < 0.01) but not with the titer of clumping factor. Injection of coagulase-deficient mutant strain DU5843 was associated with a markedly reduced number of viable bacteria isolated from the lung, compared with its coagulase-positive parental strain DU5789. Our results suggest that coagulase may play a role in the development of blood-borne staphylococcal pneumonia in our model. Our animal model is simple and reproducible and resembles blood-borne staphylococcal pneumonia in humans, and it could be useful for investigating the pathogenicity or treatment of staphylococcal pulmonary infection, including infections with methicillin-resistant S. aureus.

Agar↗
PubMed1992

Abscess and empyema caused by Legionella micdadei.

Legionella micdadei is the second most common species implicated in the occurrence of Legionella pneumonia (D. J. Bremer, Semin. Respir. Infect. 4:190-205, 1987). Although there has been a reported lung abscess caused by dual infection (L. micdadei and L. pneumophila), there are no known cases of L. micdadei as the only causative organism. We report a case of a patient with a lung abscess from which L. micdadei was the sole organism isolated.

Empyema↗