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PubMed1992

[Three cases of pulmonary actinomycosis].

Three cases of pulmonary actinomycosis are reported. Case 1 was a 33-year-old man complaining of hemosputum. A large mass lesion was noted in the right upper lobe and surgically resected. Actinomycosis was diagnosed pathologically. The second case was a 41-year-old man with lung abscess. An actinomyces species was cultured by percutaneous aspiration biopsy. He was effectively treated with clindamycin. The third case was a 46-year-old man with a chronic cough and cavitary lesion. Gram staining of sputum revealed sulfur granules. Piperacillin was administered with prompt response. All three cases had dental disease and two had diabetes mellitus. In patients with a mass lesion or those with lung abscess not effectively treated by cephem antibiotics, actinomycosis should be suspected especially when diabetes mellitus and/or dental disease coexists. Adequate treatment may not always require long-term antibiotics.

Actinomycosis↗
PubMed1981

Recent advances in the management of thoracic surgical infections.

Current management of infections in thoracic surgery is reviewed. The selection of patients for the use of antibiotics prophylactically, the diagnosis and treatment of pulmonary infection in immunosuppressed patients, indications for operation in patients with fungal infections, bronchiectasis, lung abscess, and empyema, and the management of mediastinitis after sternotomy and of postpneumonectomy space infections is described.

Amphotericin B↗
PubMed1996

Surgical management of bronchiectasis.

BACKGROUND: The prevalence of bronchiectasis has decreased significantly over recent decades. We reviewed the morbidity, mortality, and outcome of surgical treatment for pulmonary bronchiectasis in the modern era of antibiotic therapy. METHODS: From January 1976 through January 1993, 134 patients (55 male and 79 female patients) underwent pulmonary resection for bronchiectasis. The mean age was 48.4 years (range, 4 to 89 years). The indication for operation was failure of medical therapy in 85 patients (63.4%), hemoptysis in 26 (19.4%), lung abscess in 12 (9.0%), and a nondiagnostic mass in 11 (8.2%). Mean duration of symptoms was 6 years (range, 1 to 60 years) and included a productive cough in 104 patients, fetid sputum in 91, recurrent infections in 81, and hemoptysis in 56. Thirteen patients (9.7%) had no prior symptoms and presented with either hemoptysis, lung abscess, or unresolved pneumonia. The disease was bilateral in 26 patients (19.4%) and mainly confined to the lower lobe in 75 (56.0%). The mean number of segments involved was 4.4 (range, one to 14 segments). Surgical treatment included lobectomy in 86 patients (64.2%), pneumonectomy in 21 (15.7%), wedge resection or segmentectomy in 18 (13.4%), and a combination of these approaches in 9 (6.7%). Disease was considered completely resected in 108 patients (80.6%). RESULTS: The operative mortality rate was 2.2% and the morbidity rate was 24.6%. The mean follow-up in 103 patients was 6 years (range, 1 to 16 years). Overall, 61 patients (59.2%) were asymptomatic after operation. Symptoms were improved in 30 patients (29.1%) and unchanged in 12 (11.7%). Complete resection resulted in a significantly better result than incomplete resection (p < 0.05). CONCLUSIONS: Pulmonary resection for bronchiectasis can be done with low mortality and morbidity. When possible, complete resection should be performed.

Adolescent↗
PubMedDate not supplied

[Intralobular pulmonary sequestration: apropos a case].

The authors report their experience with a patient suffering from an intralobar bronchopulmonary sequestration (IBS). The lesion was misdiagnosed as metapneumonic lung abscess. IBS is a rare, diagnostically binding lung congenital malformation. So far, TC and MR angiography achieve pathognomonic findings with low invasivity. The best treatment of IBS could be surgical resection.

Adult↗
PubMed1987

Use of erythromycin-rifampin combination in treatment of Rhodococcus equi pneumonia.

The selection of lipid-soluble antibiotics capable of intracellular penetration is considered critical for the successful treatment of Rhodococcus equi pneumonia and lung abscesses in foals. Two such antibiotics: erythromycin (25 mg kg-1, three times daily) and rifampin (5 mg kg-1 twice daily) have been used in combination for this purpose at the University of Florida since 1981. Positive evidence of R. equi was present on culture of tracheal aspirates in 57 foals, most of which exhibited radiographic evidence of extensive lung abscessation. The duration of therapy ranged from 4 to 9 weeks. Mild diarrhea was sometimes noted, but was never severe enough to require the termination of therapy. No other adverse side effects were apparent. Judged by a return of chest radiographs and hematologic parameters to normal, 50 of the 57 foals were considered to have recovered from the disease; a success rate of 88%.

Actinomycetales Infections↗
PubMed2003

[Pasteurella multocida infection of cavitated lung squamous carcinoma].

Pasteurella multocida has rarely been reported to cause lung disease in humans. Infection usually arises from bites or scratches from animal carriers of the pathogen. Cases of pneumonia, lung abscess, airway infection or infection of pre-existing bronchiectasis have been described, usually in individuals who are in direct contact with carrier animals and who have a chronic debilitating disease. It is unusual for P. multocida to be ingested and appear among oropharyngeal flora in humans. We report the first case published (Medline search 1966-2002) of a cavitated lung with squamous carcinoma that became infected by P. multocida in an elderly patient who denied contact with potential carrier animals. We believe that the P. multocida infection in humans is underdiagnosed because clinical suspicion is low and the bacterium is highly susceptible to common antibiotics.

Aged↗
PubMed1999

[Clinical evaluation of anaerobic infections in patients with bronchopulmonary infections diagnosed by transtracheal aspiration].

We evaluated the clinical and bacteriologic features in the patients with bronchopulmonary infections isolated anaerobes from transtracheal aspirates between April 1990 and March 1998. Some anaerobe was isolated in 42 (10.9%) in 387 patients whom we performed transtracheal aspiration (TTA), in 42 (15.7%) of 268 in whom some organism was isolated from TTA, or in 42 (16.3%) of 257 patients in whom some bacterium excluding acid-fast bacteria, fungi or mycoplasma from TTA. The isolation rate of anaerobic bacteria was 93.3% in the patients with lung abscess, 22.7% in the patients with nosocomial pneumonia, 19.4% in the patients with community-acquired pneumonia, 26.7% in the patients with acute exacerbation of chronic lower respiratory tract infection (CLRTI), 1.6% in the patients with persistent infection of CLRTI, and 3.0% in the patients with acute bronchitis, respectively. The major anaerobes, isolated from TTA, were Peptostreptococcus micros and Prevotella melaninogenica. The aerobic bacteria were isolated with anaerobic bacteria in 32 of 42 patients at the same time. The quantitive grade of colonial growth of anaerobes was equal to or more than aerobes in the patients with lung abscess and pneumonia. We mostly administrated 3rd generation cephems or carbapenems with or without clindamycin for the treatment of anaerobic infections. Forty-one of 42 patients were cured only by the therapy of antimicrobial agents, but pneumonia patient with lung cancer died in spite of adequate antimicrobial therapy. These results suggest that the anaerobic infections are important in the bronchopulmonary infections.

Bacteria, Anaerobic↗
PubMed1979

Infective pericarditis in Nigerian children.

53 children with infective pericarditis were seen at the University College Hospital, Ibadan, between 1967 and 1976. Their ages ranged from 10 days to 15 years but 53% of them were aged 5 years and below. Cough, fever, and breathlessness were the most common symptoms; cardiac decompensation was evident in over 30% of them, 23% had muffled heart sounds, but a pericardial friction rub was audible in only one. The main pathogens identified were Mycobacterium tuberculosis (11 cases), Staphylococcus aureus (11 cases), Escherichia coli (4 cases), Pneumococcus and Pseudomonas (3 cases each). Most of the patients had some other associated infection--such as, bronchopneumonia (12 cases), empyema thoracis (10 cases), lung abscess (10 cases), septicaemis (6 cases), and osteomyelitis (3 cases). Errors in diagnosis were common, the diagnosis having been missed in 72% of the cases identified at necropsy. Even if the correct diagnosis had been made during life and appropriate treatment given, the mortality rate (36%) was high. It is suggested that the onset of cardiac failure in any child with bronchopneumonia, empyema, or lung abscess should always arouse a suspicion of infective pericarditis.

Adolescent↗
PubMed1987

"Pigtail" catheter drainage in thoracic surgery.

Small-bore percutaneous drainage catheters have been used extensively in the management of abdominal disorders and are gaining acceptance in thoracic problems. The records have been reviewed in 44 consecutive patients in whom 53 small-bore catheters were placed for thoracic disease, including empyema, 20; effusion, 9; pneumothorax, 10; lung abscess, 4; and mediastinal cyst, 1. Insertion was performed under fluoroscopy in 88%, computed tomography in 6%, and ultrasonography in 6%. Catheters ranged in size from 6.5F to 12F, but catheter size did not seem to influence outcome (p = 0.6). There was complete resolution of the problem in 75% (33 of 44) of the patients, although 20% of them required more than one catheter. Treatment was successful in all cases of lung abscess. These patients had been previously treated with standard medical therapy for 12 to 53 days without significant improvement in their clinical condition. Patients with empyema composed the largest group treated. Eighty percent (16 of 20) of them had a loculated (LOC) process. The LOC group appeared to have a slightly better success rate than did the non-LOC group (75 versus 50%, p = 0.33). When the catheters failed to resolve the problem (empyema, 6; chylous effusion, 1; malignant effusion, 3; and spontaneous pneumothorax, 1, either operation (9.1%) or a standard thoracostomy tube (13.6%) was required. The complications rate was 20%, but most of these were minor problems including pneumothorax, 5; catheter occlusion 3; fractured catheter, 1; infection, 1; and significant subcutaneous emphysema, 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2000

Percutaneous management of intrapulmonary air and fluid collections.

The radiologist's role in the management of intrapulmonary air and fluid collections is becoming more important. Improvements in percutaneous interventional techniques now allow the radiologist to offer patients an alternative treatment option with less morbidity and mortality than surgical resection. The use of CT allows optimal catheter placement and enables safe and effective percutaneous evacuation of intrapulmonary collections. In summary, image-guided percutaneous catheter drainage should (1) be the initial procedure performed to diagnose and treat lung abscesses not responding to conservative therapy; and (2) because of its effectiveness and safety, be considered as a treatment option in the management of symptomatic patients with intrapulmonary mycetomas.

Aspergillosis↗
PubMed1999

[Ultrasound-guided transthoracic puncture].

The diagnosis of peripheral lung foci may prove difficult. In addition to transthoracic puncture under X-ray fluoroscopy or CT control, ultrasound-guided puncture was shown to be a useful alternative. A prerequisite, however, is that the lesion should extend up to the pleura. This overview covers 97 original papers, of which 26 mainly consisted of lung punctures in a total of 1876 patients. The accuracy in carcinomas and metastases was 70 to 97%, on average markedly higher than 90%. Benign lesions are histologically more difficult to distinguish; here the accuracy is 70%. Partly due to pre-selection the method has a very low rate of complications. The rate of pneumothorax is 2.6%, those requiring drainage are about 1%. Haemoptyses occur 1-2% of the punctures, most commonly in cases of chronic pneumonia; colour-coded Duplex sonography is especially recommended in these cases because of the strong and regular vascularisation. The rate of complication increases in direct proportion to needle thickness. The possibilities of ultrasound-guided lung abscess drainage are also discussed. An intrathoracic lesion that is accessible to ultrasound imaging should be punctured today under ultrasound guidance, as this procedure is minimally stressful for the patient, is accurate, has a low rate of complications and is also cost effective.

Drainage↗
PubMed1996

Incidence of anaerobic infections among patients with pulmonary diseases: Japanese experience with transtracheal aspiration and immediate bedside anaerobic inoculation.

We conducted a study to assess the precise incidence of anaerobic infections among patients with pulmonary diseases in Japan. To avoid false-negative results of anaerobic cultures, we used percutaneous transtracheal aspiration and subsequent immediate bedside anaerobic inoculation onto a set of plates with appropriately selected culture media. Fifty-six episodes of pulmonary disease occurred in 50 patients; anaerobes were isolated in 20 (36%) of these episodes. Bacteria were recovered in 30 (94%) of 32 episodes not associated with prior antimicrobial therapy, and anaerobes were isolated in 15 (47%) of these 32 episodes. Rates of anaerobic isolation in episodes of pneumonia (7 of 14), lung abscess (3 of 3), and acute exacerbation of chronic lower respiratory tract infection (5 of 15) that were not associated with prior antimicrobial therapy were 50%, 100%, and 33%, respectively.

Bacteria, Anaerobic↗
PubMed1989

[Three cases of traumatic lung cyst].

There are few reports of nonpenetrating blunt chest trauma causing traumatic lung cyst. Three young male cases of traumatic lung cysts from motor vehicle accident were reported. Two of them, 25 and 17 years old male, had benign clinical courses by conservative management. But in another case of 25-year-old male, lung abscess followed infection of lung cyst occurred despite antibiotic therapy. A left lower lobectomy and a partial resection of left upper lobe was performed 46 days after the injury. Culture of the contents of the abscess confirmed Acinetobacter. His subsequent recovery was uneventful and he was discharged one month after the operation.

Accidents, Traffic↗
PubMed1979

The clinical and aetiological pattern of finger clubbing and hypertrophic osteoarthropathy in Nigerians.

A study of the clinical and aetiological patterns of finger clubbing and hypertrophic osteoarthropathy was carried out over a 15-year period. 116 patients were studied. Pain is not a common symptom in patients with finger clubbing and osteoarthropathy in Nigerians, contrary to what has been reported in the literature. The cause of finger clubbing is predominantly pulmonary in origin, being responsible in 84 per cent of cases. The commonest cause in bronchiectasis, followed by empyema thoracis, bronchial carcinoma and lung abscess. Among the nonpulmonary causes are infective endocarditis, endomyocardial fibrosis and cirrhosis of liver. Hypertrophic osteoarthropathy is found in 15 cent of the patients with finger clubbing, the commonest cause being carcinoma of the bronchus.

Adolescent↗
PubMed2003

Detection of telomerase activity in bronchial lavage as an adjunct to cytological diagnosis in lung cancer.

OBJECTIVE: Definitive diagnosis of lung cancer with conventional methods may sometimes be difficult in clinical practice. Telomerase is a ribonucleoprotein DNA polymerase that maintains the telomeric region of chromosomes during successive rounds of cell division. Telomerase activity in body cavity fluids has been advocated to be a potential diagnostic marker for malignancy. We investigated the diagnostic value of telomerase activity in bronchial lavage samples of patients undergoing diagnosis of lung cancer. METHODS: A total of 29 bronchial lavage samples were collected from patients in whom the diagnosis was confirmed with cytological and/or histological examinations. Patients were classified as lung cancer patients (Group 1, n = 22) and patients with benign disease (Group 2, n = 7). Telomerase activity was determined with polymerase chain reaction-based TRAP (The telomeric repeat amplification protocol) assay. RESULTS: Cytological examination was diagnostic in 12 (54.5%) of 22 patients in Group 1, and in all seven patients of Group 2 (P = 0.063). Telomerase activity was positive in 16 (72.7%) of Group 1 patients, while it was positive in only 1 (14.3%) sample of a lung abscess in Group 2 (P = 0.011). The sensitivity rate of cytological examination when combined with telomerase activity (81.8%) was significantly greater than that of cytological examination alone (54.5%) (P = 0.031). The sensitivity and specificity of telomerase activity were 72.7 and 85.7%, respectively. Telomerase activity had a positive predictive value as 0.94 and negative predictive value as 0.50. Diagnostic accuracy of telomerase activity was 75.8%. CONCLUSION: Telomerase activity in bronchial lavage is a highly sensitive diagnostic biomarker for malignancy and a potential complementary diagnostic technique to cytological examination in the diagnosis of lung cancer.

Adult↗
PubMed2004

[Clinicopathologic analysis of organizing pneumonia in elderly autopsies].

OBJECTIVE: To study the clinicopathologic characteristics of organizing pneumonia of the autopsies in elder and to analyze the possible underlying etiologic factors. METHODS: Ninety-five cases of organizing pneumonia were found from 635 elderly autopsy reports of the Beijing Hospital since 1980. The morphologic and imaginal features were analyzed. RESULTS: The foci of organizing pneumonia in our series were often small, patchy, scattered and adjacent to other lung lesion. There were, however, some variations in cases with different underlying conditions. The conditions associated with organizing pneumonia, as detected in our series, were: (1) 36 cases with suppurative inflammation, lung abscesses and chronic relapsing pneumonia; (2) 17 cases with fungal or viral infection; (3) 16 cases with aspiration pneumonia; (4) 5 cases with radiation pneumonia. We observed that it was not uncommon for organizing pneumonia coexisting with atelectasis and chronic pleuritis. The image of organizing pneumonia was varied. CONCLUSIONS: Organizing pneumonia is a common finding in autopsies of the elder. It occurs in association with many diseases and the basic pathologic changes are similar. All of which represent secondary phenomenon. Possible etiologic factors include infection (due to bacteria, fungi or virus), aspiration and radiation. The possibility of organizing pneumonia should be considered if the shadow of lung is undisappeared in imagin.

Aged↗
PubMed1996

Bilateral pulmonary aspergilloma: case report.

Bilateral pulmonary aspergilloma colonising an old tuberculous cavity and a pyogenic lung abscess in a 25-year old Ethiopian lady is reported. The diagnosis was based on the findings of a rounded density with typical air crescent sign on a chest x-ray and isolation of Aspergillus species from a bronchoscopic aspirate. Despite the high prevalence of cavity pulmonary tuberculosis, pulmonary aspergilloma is rarely reported from this and other African countries and the likely reasons for this are discussed.

Adult↗