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The Toxic Environment and Its Medical Implications with Special Emphasis on Smoke Inhalation
Published in Jacob Loke, Pathophysiology and Treatment of Inhalation Injuries, 2020
Jacob Loke, Richard A. Matthay, G. J. Walker. Smith
The above findings may in part explain the clinical picture of tracheobronchitis seen in patients with smoke inhalation (Beal et al., 1968). As is discussed separately in this volume by Young and Reynolds, bronchoalveolar lavage (BAL) has been used to evaluate the cellular, immunological, and biochemical functions of the lungs in response to injury (Hunninghake et al., 1979). In inhalational lung injury a spectrum of inflammatory responses with mobilization of inflammatory cells has been demonstrated using BAL techniques. The pulmonary alveolar macrophage acts as the primary defense cell of the lung (Hocking and Golde, 1979), and this is the predominant cell lavaged from the lungs of acute smoke inhalation victims (Demarest et al., 1979) and laboratory animals (Fick et al., 1984; Loke et al., 1981). In patients with acute smoke inhalation studied by Demarest et al. (1979), the cellular yield of alveolar macrophages was 51.2 million versus 15.7 million in nonsmoking controls. Similar results have been reported in laboratory animals. However, the timing of the lavage procedure in relation to the acute inhalational insult may cause a variance in the BAL cellular yield. For instance, the overall cellular yield obtained by BAL decreased after 24 hours, contrasted with the yield immediately after smoke inhalation (Loke et al., 1984).
Nosocomial Infections Caused by Acinetobacter spp. — Therapeutic Problems
Published in E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner, Acinetobacter, 2020
A major potential problem is that increased use of imipenem has recently led to the development of imipenem resistance in a few strains of Acinetobacter spp. An outbreak caused by an Acinetobacter strain resistant to imipenem has been reported in a surgical ICU in New York (Urban et al., 1993). Pneumonia or tracheobronchitis was diagnosed in nine patients. All were given a combination of ampicillin and sulbactam at a dosage of 3 g every 6 or 8 h. Bacterial eradication was obtained in five cases.
Pulmonary Disease of Parasitic Cause
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Though more common in other countries, ascariasis may be acquired in the U.S. The infective stage is the fertilized eggs on unwashed or poorly prepared food or lodged under fingernails of contaminated hands. After ingestion, the egg shells are digested in the upper small bowel, liberating larvae that burrow their way through the bowel wall to portal vein branches and lymphatics and, finally, the bloodstream that carries them to the pulmonary circulation. In the lungs they bore through the alveolar walls, climb the respiratory tree to reach the esophagus, and find their way back to the small intestine where they reach maturity. During the pulmonary phase, there may be cough, fever, and rusty sputum suggestive of tracheobronchitis. Less commonly, there may be nocturnal asthma, rash, or urticaria, but almost always there is remarkable eosinophilia. Sensitization to the parasites and their products explain the eosinophilia and the asthma. Roentgenographically, transient parenchymal patches or miliary infiltrates may be observed. The pulmonary phase of the disease has no known treatment.
An eight-year-old girl with tracheal mass treated as a difficult asthma case
Published in Journal of Asthma, 2021
Emmanouil Paraskakis, Marios Froudarakis, Evanthia A. Tsalkidou, Savvas Deftereos, George Sarris, Aggelos Tsalkidis
An 8-year-old girl was referred to our department suffering from gradually worsening dyspnea unresponsive to bronchodilators. Her symptoms started one year before admission and were described as recurrent stridor or dyspnea during exercise. She was treated ever since as a difficult asthma case with inhaled corticosteroids (500 mcg fluticasone/day) and per need bronchodilators (8 puffs salbutamol/day). One month before admission to our tertiary center she was hospitalized at the pediatric department of a general hospital for short interval of time for a lower respiratory infection which was treated successfully with antibiotics and bronchodilation. Regarding her medical history, four episodes characterized as tracheobronchitis and one laryngitis were recorded two years before admission, all treated on an outpatient basis. Her personal history was free from allergies and her family history was uneventful. Due to the progression of her stridor despite the treatment with high dose inhaled corticosteroids and bronchodilators the family visited our center for an evaluation at the pediatric respiratory unit. On admission, she had biphasic stridor and no additional lung sounds or clubbing.
Novel insights into the pathogenesis of virus-induced ARDS: review on the central role of the epithelial-endothelial barrier
Published in Expert Review of Clinical Immunology, 2021
Jun Feng, Lina Liu, Yang He, Min Wang, Daixing Zhou, Junshuai Wang
Respiratory viruses can result in several pathological manifestations of lower respiratory tract infections, including tracheobronchitis, bronchiolitis, and pneumonia. Some of these pathogens, such as influenza A and human CoVs, have occasionally caused epidemics or pandemics, and are associated with more serious clinical diseases and even mortality. Influenza A is the predominant viral etiology of ARDS in adults, and can precede a pneumonia episode caused by a secondary bacterial infection [12]. Influenza virus infection alone, or in conjunction with bacterial infection, can cause severe pneumonia and ARDS. SARS-CoV, MERS-CoV, and SARS-CoV-2 infections may also cause significant hypoxemia, ARDS, shock, and multiorgan dysfunction [13]. It is clear that the involvement of viruses in pneumonia may have been underestimated; however, until recently there has been a considerable deficit in the etiologic diagnosis of pneumonia, and no clear efficacy of specific antivirals to treat viral pneumonia, despite the existence of neuraminidase inhibitors for treating pneumonia caused by influenza viruses.
Prevalence, clinical expression, invasiveness and outcome of Staphylococcus aureus containing Panton-Valentine leukocidin in children treated in a university hospital of Lithuania
Published in Infectious Diseases, 2020
Birute Petraitiene, Pablo Rojo Conejo, Lina Jankauskaite, Rimantas Kevalas, Giedre Trumpulyte, Ausra Snipaitiene, Astra Vitkauskiene, Vaidotas Gurskis
Invasive infection suffering patients were determined by the presence of positive S. aureus culture taken from naturally sterile body site and systemic inflammatory response syndrome (SIRS). Pneumonia was also included if the following criteria were met: symptoms of respiratory system and SIRS, positive S. aureus culture (in bronchoalveolar lavage, protected tracheal aspiration or pleural effusion) and signs of pneumonia in lung radiography. SSTI and tracheobronchitis were defined as non-invasive infections. Community-acquired infection (CAI) was defined as infection manifesting in the community or within 48 h after admission to the patient without any previous encounter with healthcare. Hospital-acquired infection (HAI) was defined as infection acquired in a hospital at 48 h or later after admission.