Radiology of Infectious Diseases and Their Potential Mimics in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Interstitial pneumonia is characterized by cellular inflammation in the walls of the bronchioles and alveolar septa, and by inflammatory exudate or mucus partially filling the bronchiolar lumen. It commonly presents with atypical “walking” pneumonia symptoms, and reticulonodular opacities on imaging. The most common bacterial pathogen is Mycoplasma pneumoniae, but viruses, Legionella, and Pneumocystis are other common causes of interstitial pneumonia. Serology and risk factors such as immunodeficiency are sometimes the best clue to the diagnosis. Mycoplasma pneumonia has variable appearance on imaging, with bronchial wall thickening the most common feature on CT. While not specific to Mycoplasma, centrilobular or branching tree-in-bud patterns of nodules strongly suggest an acute infectious process in the distal airways on CT, as opposed to non-infectious causes of interstitial lung disease (ILD). Radiologic resolution of pneumonia often lags behind clinical improvement, and may take up to 12–14 weeks [88,89].
Inflammatory, Hypersensitivity and Immune Lung Diseases, including Parasitic Diseases.
Fred W Wright in Radiology of the Chest and Related Conditions, 2022
The term 'interstitialpneumonia' implies a disease process in the lung which takes place predominantly in the supporting tissues, rather than within the alveoli. Liebow (1975) wrote 'while exudation into the alveoli occurs, this is a relatively minor component of the total response, and when healing takes place, either by restitution to the initial state (resolution), or by fibrosis, the lumina of the distal air spaces remain essentially patent'. He also felt that the term 'fibrosing alveolitis' stressed only one possible end result of earlier injury, ignored the possibility of resolution, neglected the fact that extra-alveolar interstitial tissues such as those of the bronchioles, septa and pleura are often involved, and paid no heed to the initial diversity in morphology, probable pathogenesis, natural history, and in associated laboratory and clinical manifestations, of conditions that can all terminate in interstitial fibrosis.
Overview of HIV Infection
Mark J. Rosen, James M. Beck in Human Immunodeficiency Virus and the Lung, 1998
Noninfectious pulmonary diseases are important causes of lung disorders in patients with human immunodeficiency virus (HIV) infection. An important class of such disorders is interstitial pneumonitis. The diagnosis of interstitial pneumonitis is further subclassified and characterized histopatho-logically as either lymphocytic interstitial pneumonitis (LIP) or nonspecific interstitial pneumonitis (NIP). Not only are there histopathological differences between the two types of interstitial pneumonia, but there are also etiologic, demographic, and clinical distinctions. This chapter will provide demographic, clinical, roentgenographic, histopathological, and therapeutic information about nonspecific interstitial pneumonitis.
Therapeutic targets and early stage clinical trials for pulmonary fibrosis
Published in Expert Opinion on Investigational Drugs, 2019
Seidai Sato, Toyoshi Yanagihara, Martin R. J. Kolb
Bardoxolone methyl (Reata Pharmaceuticals) is an orally bioavailable semi-synthetic triterpenoid, based on the scaffold of the natural product oleanolic acid. Bardoxolone methyl acts as an activator of the Nrf2 pathway and an inhibitor of the NF-κB pathway [71]. In a preclinical model, bardoxolone methyl reduced the histopathological score and the number of inflammatory cells and concentrations of total protein in BALF, suppressed secretion and expression of proinflammatory cytokines, including TGF-β and IL-6, elevated expression of the anti-inflammatory cytokine IL-10. It also downregulated the mRNA level of profibrotic genes, including fibronectin, α-smooth muscle actin, and collagen-I in the bleomycin- [72] and a radiation-induced lung injury mouse model [73]. In an ongoing Phase II study, the safety and efficacy of bardoxolone were evaluated in about 165 patients whose pulmonary hypertension is associated with several lung diseases including IPF and idiopathic interstitial pneumonia. The latest results covered eight patients with IPF who were treated with bardoxolone or a placebo. After 16 weeks of bardoxolone, the IPF patients were able to walk 38 m further than before treatment in an exercise-capacity assessment known as the 6-min walking distance test. In contrast, placebo-treated patients were able to walk 13 fewer meters [NCT02036970].
Demystifying idiopathic interstitial pneumonia: time for more etiology-focused nomenclature in interstitial lung disease
Published in Expert Review of Respiratory Medicine, 2022
Nevins W. Todd, Sergei P. Atamas, Stella E. Hines, Irina G. Luzina, Nirav G. Shah, Edward J. Britt, Andrew J. Ghio, Jeffrey R. Galvin
Interstitial lung disease (ILD), or interstitial pneumonia, comprises a wide array of diffuse parenchymal lung diseases that encompasses close to one hundred disorders generally characterized by a combination of pulmonary inflammation and pulmonary fibrosis. The classification system, nomenclature, and acronyms used for ILD are complex, and are often confusing to general medicine physicians and pulmonary disease specialists alike. Part of the complexity is related to an incomplete understanding of several of the disease entities, whereas much of the complexity relates likely to the nomenclature used for multidisciplinary diagnoses in ILD. Confusion and complexity surrounding ILD nomenclature applies perhaps most particularly to the group of disorders termed the idiopathic interstitial pneumonias (IIPs).
Pyoderma gangrenosum with pulmonary involvement: a pulmonary special report and literature review
Published in Expert Review of Respiratory Medicine, 2022
Fanfan Xing, Kelvin Hei-Yeung Chiu, Jin Yang, Haiyan Ye, Lijun Zhang, Chenjing Liu, Kwok-Yung Yuen
Concerning further investigation among the 51 patients included in this review, 46 patients (90.2%) received a CT of the thorax for further delineation of underlying pulmonary pathology. The most common radiological findings were pulmonary infiltrates (84.8%, 39/46), followed by cavitary lesions (39.1%, 18/46), pleural effusion (13.0%, 6/46), and consolidation (10.9%, 5/46). Other radiological findings included interstitial lung disease and interstitial pneumonia. Only 27 patients (52.9%, 27/51) received bronchoscopy or open/radiological guided lung biopsy for further confirmation of the diagnosis as well as exclusion of other similar etiologies. Neutrophil infiltration or inflammation (85.2%, 23/27) was a common finding in the histopathology of the respiratory specimen, with 2 patients (11.1%, 3/27) showing pulmonary fibrosis and 5 patients (22.2%, 6/27) showing granulomatous inflammation, and with negative bacterial and fungal staining excluding the possibility of opportunistic infection in these patients.
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