Critical Incidents
Elizabeth Combeer in The Final FRCA Short Answer Questions, 2019
C:Ensure cardiovascular stability; manage as appropriate. Sustained hypoxia.Bronchospasm.Pneumonitis.Complications of barotrauma, including pneumothorax due to ongoing high airway pressures.Lobar collapse.Pulmonary infection.ARDS.
Neonatal Pneumonia
Lourdes R. Laraya-Cuasay, Walter T. Hughes in Interstitial Lung Diseases in Children, 2019
Nursery epidemics due to the Gram negative enteric organisms such as Klebsiella pneumoniae, Proteus mirabilis, and E. coli have occurred.41 The primary manifestations of these acquired infections are sepsis and meningitis. Pneumonia is infrequent, probably because bacteremia is treated before significant pulmonary disease develops. This is in contrast to infants who aspirate the bacteria directly into the pulmonary tree. Other microrganisms such as Candida spp., Pseudomonas aeruginosa, Serratia marcescens, and Flavobacteria, normally of low virulence, may cause nosocomial infections. Risk factors for these infections include prolonged use of antibiotics, longstanding indwelling catheters, prolonged ventilator therapy, prematurity, and central venous hyperalimentation. When pulmonary infection occurs with these organisms it is usually associated with disseminated infection.
Respiratory Tuberculosis
Peter D O Davies, Stephen B Gordon, Geraint Davies in Clinical Tuberculosis, 2014
The characteristic feature of post-primary tuberculosis is the granuloma [105]. This is an organised mass of activated macrophages, antigen-specific lymphocytes and fibroblasts (see Chapter 5 for more details) previously known as a Simon focus. High levels of IFN-γ and TNF are produced, and extensive tissue destruction with fibrosis results. Many of the clinical symptoms can be explained by the aggressive host response that accompanies active pulmonary infection. Experimental models have shown that immunosuppression can result in decreased tissue destruction and decreased symptoms but at the price of very high numbers of proliferating mycobacteria. This observation was confirmed by De Cock et al. [106] in a careful clinical observational study of patients with HIV infection and varying degrees of immunosuppression. HIV-infected patients with peripheral blood CD4 lymphocyte counts of 500/μL or more presented with cavitating pulmonary disease typical of patients not infected with HIV. Patients with CD4 counts in the range 200–400/μL presented with lymphatic spread and serous tuberculosis. Immune-compromised patients with CD4 counts of less than 200/μL (a case definition of AIDS) presented with disseminated mycobacterial infection.
Low TT4 as a predictor of poor outcomes in severe encephalitis: a multivariate analysis of 94 patients
Published in Expert Review of Neurotherapeutics, 2018
Guibo Feng, Xin Tian, Liang Wang, Libo Zhao, Xuefeng Wang
All laboratory tests were divided into low, normal, and high values based on reference intervals. The patients were divided into two groups based on body temperature at admission (normal body temperature [36.0–38.2°C] and fever [>38.2°C] groups). Pulmonary infection was defined as the presence of respiratory symptoms during hospitalization and was determined by chest imaging. Viral and nonviral infectious encephalitis were defined by culture, serology, positive polymerase chain reaction, or histopathology. Autoimmune encephalitis was defined by the presence of antigen-specific antibodies in the serum or CSF or cases with histopathologic evidence. Patients in whom antigen-specific antibodies were not identified were considered to have autoantibody-negative autoimmune encephalitis if they met the following criteria: MRI abnormalities suggestive of autoimmune encephalitis; CSF pleocytosis, CSF-specific oligoclonal bands or elevated CSF IgG index, or both; and reasonable exclusion of other causes [17].
Toothbrushes may convey bacteria to the cystic fibrosis lower airways
Published in Journal of Oral Microbiology, 2019
Rebeca Passarelli Mantovani, Angela Sandri, Marzia Boaretti, Alessandra Grilli, Sonia Volpi, Paola Melotti, Gloria Burlacchini, Maria M. Lleò, Caterina Signoretto
In this study, we aimed to evaluate the presence of typical and emerging CF bacterial species, namely P. aeruginosa, S. aureus, S. maltophilia, A. xylosoxidans and S. marcescens in saliva and in toothbrushes of CF patients, both adults and pediatrics. Our results indicated the presence of the investigated species in about 16% of the toothbrushes. These are comparable with data from Genevois and colleagues who detected S. aureus in 22% of analyzed toothbrushes [17]. As regards the saliva, a consistent presence of potentially pathogenic microorganisms was observed. The association between oral conditions and several respiratory conditions has been previously noted [29], and typical respiratory pathogens have shown to colonize the dental plaque of hospitalized intensive care and nursing home patients. Once established in the mouth, these pathogens may reach the lungs and cause pulmonary infection. The high percentage of potentially pathogenic microorganisms found in the saliva of the enrolled CF patients might be explained by recent findings on the saliva composition of CF patients. A significant decrease in the total, free and combined concentration of sialic acid in the saliva of CF patients compared to healthy subjects was identified [30]. Moreover, a decreased functioning of the salivary peroxidase system was observed in CF patients, resulting in lower levels of thiocyanates, which elicit antibacterial, antiviral and antifungal properties [31].
Invasive pulmonary aspergillosis secondary to microwave ablation: a multicenter retrospective study
Published in International Journal of Hyperthermia, 2018
Guanghui Huang, Xin Ye, Xia Yang, Chuntang Wang, Licheng Zhang, Guangdong Ji, Kaixian Zhang, Huili Wang, Aimin Zheng, Wenhong Li, Jiao Wang, Xiaoying Han, Zhigang Wei, Min Meng, Yang Ni
Inclusion criteria were as follows: (a) patients undergoing percutaneous lung MWA during the past two months; (b) symptoms of lower respiratory tract infection (fever, cough, expectoration, hemoptysis, chest pain, dyspnea, pleural effusion); (c) confirmed signs of infection at the ablation site by imaging; (d) a positive Aspergillus result by sputum smear and culture, smear and culture of aseptic specimens derived from the ablation zone, or galactomannan antigen detection; (e) the initial exclusion of a bacterial infection; (f) poor effect of broad-spectrum antibacterial treatment; (g) proven and probable cases of IPA; (h) good efficacy of the appropriate empirical therapy against molds. Exclusion criteria were: (a) infection that occurred more than 2 months after MWA; (b) infection of a non-ablation site; (c) the absence of aforementioned mycological evidence; (d) positive bacterial cultivation results from the original specimen; (e) excellent efficacy following antibacterial treatment.
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