Sample records for acute eosinophilic pneumonia

  1. Eosinophilic pneumonias. A clinical case of acute eosinophilic pneumonia associated with sertraline and literature review

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    Roberto Serini


    Full Text Available Background: Acute eosinophilic pneumonia (AEP is one of the heterogeneous group of disorders termed eosinophilic lung diseases showing an abnormal accumulation of eosinophils in distal airways, air spaces, and the interstitial compartment of the lung. AEP is characterized by acute febrile respiratory failure, a typical radiographic pattern similar to that of acute pulmonary edema, eosinophilia in bronchoalveolar lavage (BAL, a dramatic response to corticosteroid therapy with no relapse when tapering or withdrawing treatment in the absence of infection. It can be idiopathic o secondary to known causes such as drugs, or fungal and parasitic infections. Clinical case: We report a case of a 76-year-old woman who developed symptoms, respiratory signs, and radiological and histological findings compatible with secondary AEP, we assessed as being associated with sertraline assumption (second case in literature. Discussion: The AEP we detected could be related to a secondary hypersensitivity syndrome to drug exposure (DRESS syndrome: Drug Rush with Eosinophilia and Systemic Symptoms characterized by 1 skin rush, 2 increased eosinophilia, and 3 systemic involvement. The presence of all three criteria confirmed our diagnosis.

  2. The utility of thoracic ultrasound in patients with acute eosinophilic pneumonia.

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    Hee Yoon

    Full Text Available Thoracic ultrasound (TUS is an easy-to-use imaging modality that aids physicians in the differential diagnosis of respiratory diseases. However, no data exist on the TUS findings of acute eosinophilic pneumonia (AEP or their clinical utility in patients with AEP. Thus, we performed an observational study on TUS findings and their clinical utility for follow-up in patients with AEP. We prospectively screened patients who visited the emergency department for acute respiratory symptoms at the Armed Forces Capital Hospital in South Korea between February 2014 and July 2014. Of them, patients suspected to have AEP underwent an etiological investigation, including flexible bronchoscopy with bronchoalveolar lavage and TUS, and we evaluated TUS findings and serial changes on TUS during the treatment course compared with those from chest radiographs. In total, 22 patients with AEP were identified. The TUS examinations revealed that all patients exhibited multiple diffuse bilateral B-lines and lung sliding, with (n = 5 or without pleural effusion, which was consistent with alveolar-interstitial syndrome. B-line numbers fell during the course of treatment, as the lines became thinner and fainter. A-lines were evident in 19 patients on day 7 of hospitalization, when B-lines had disappeared in 13 patients, and all pleural effusion had resolved. All patients exhibited complete ultrasonic resolution by day 14, along with clinicoradiological improvement. Chest radiographs of five patients taken on day 7 seemed to show complete resolution, but several abnormal B-lines were evident on TUS performed the same day. As a result, our data show common TUS findings of AEP and suggest that AEP may be included as a differential diagnosis when multiple diffuse bilateral B-lines with preserved lung sliding are identified on a TUS examination in patients with acute symptoms, and that TUS is a useful modality for evaluating the treatment response in patients with AEP.

  3. Cisplatin-Induced Eosinophilic Pneumonia

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    Hideharu Ideguchi


    Full Text Available A 67-year-old man suffering from esophageal cancer was admitted to our hospital complaining of dyspnea and hypoxemia. He had been treated with cisplatin, docetaxel, and fluorouracil combined with radiotherapy. Chest computed tomography revealed bilateral ground-glass opacity, and bronchoalveolar lavage fluid showed increased eosinophils. Two episodes of transient eosinophilia in peripheral blood were observed after serial administration of anticancer drugs before the admission, and drug-induced lymphocyte stimulation test to cisplatin was positive. Thus cisplatin-induced eosinophilic pneumonia was suspected, and corticosteroid was effectively administered. To our knowledge, this is the first reported case of cisplatin-induced eosinophilic pneumonia.

  4. Minocycline-induced acute eosinophilic pneumonia: A case report and review of the literature

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    Sharon W. Hung


    Minocycline is commonly used for pneumonia, acute bronchitis, urinary tract infections, and acne and is likely the cause of AEP in our patient. There are 26 case reports of minocycline-induced AEP. In most cases, outcomes were favorable and symptoms rapidly resolved upon discontinuation of minocycline, with 11 cases employing steroids, one case twelve hours of CPAP and another 5 days of intubation. None resulted in mortality. Although it is difficult to evaluate without further studies, steroids should be recommended for minocycline-induced AEP, especially for those with severe or persistent symptoms.

  5. A rare cause of pulmonary infiltrates one should be aware of: a case of daptomycin-induced acute eosinophilic pneumonia. (United States)

    Rether, C; Conen, A; Grossenbacher, M; Albrich, W C


    We report a 69-year-old patient who developed fever and dyspnea 3 weeks after the initiation of daptomycin therapy for spondylodiscitis with lumbar epidural and bilateral psoas abscesses due to ampicillin- and high-level-gentamicin-resistant Enterococcus faecium. There was profound hypoxia and the chest X-ray showed extensive patchy infiltrates bilaterally. A bronchoalveolar lavage revealed 30% eosinophils and results of microbiological studies were normal. Daptomycin-induced eosinophilic pneumonia was diagnosed and the patient rapidly improved after the discontinuation of daptomycin and a brief course of prednisone. Increased attention must be paid to this rare but serious side effect of daptomycin.

  6. Pharm GKB: Leukemia, Eosinophilic, Acute [PharmGKB

    Lifescience Database Archive (English)

    Full Text Available Overview Alternate Names: Synonym Acute Eosinophilic Leukemia; Acute Eosinophilic Leukemias; Acute... eosinophilic leukemia; Eosinophilic Leukemia, Acute; Eosinophilic Leukemias, Acute; Leukemia, Acute... Eosinophilic; Leukemias, Acute Eosinophilic PharmGKB Accession Id: PA446179 External Vocabularies Me...SH: Leukemia, Eosinophilic, Acute (D015472) SnoMedCT: Acute eosinophilic leukemia... (277604002) UMLS: C0023439 (C0023439) NDFRT: Leukemia, Eosinophilic, Acute [Disease/Finding] (N0000003269)

  7. Asthma, tuberculosis or eosinophilic pneumonia?

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    Mitra Subhra


    Full Text Available A 45 year-old male presented with cough and expectoration for 8 months, short-ness of breath and wheeze for 3 months, and fever for 1 month. He remained symptomatic despite repeated courses of antibiotics with partial relief on oral and inhaled bronchodilators. Despite several sputum examinations being negative for acid fast bacilli (AFB, he was put on anti-tubercular drugs (ATD because of bi-lateral infiltrates on his chest radiographs. A mildly raised blood eosinophil count, eosinophilia in broncho-alveolar lavage (BAL fluid and eosinophilic infiltration on CT guided FNAC from his lung lesion raised the suspicion and the dramatic clinico-radiological improvement with oral corticosteroids clinched the diagnosis of CEP.

  8. EDTA-dependent pseudothrombocytopenia complicated by eosinophilic pneumonia. (United States)

    Ohashi, Naoko; Nakamura, Kensuke; Inokuchi, Ryota; Sato, Hajime; Tokunaga, Kurato; Fukuda, Tatsuma; Nakajima, Susumu; Yahagi, Naoki


    EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is a phenomenon that occurs in vitro when EDTA reacts with harvested blood. EDTA-dependent pseudothrombocytopenia usually does not indicate thrombocytopenia in vivo. Here, we report the first case of EDTA-PTCP complicated by eosinophilic pneumonia. A 70-year-old man with rectal cancer was admitted to the hospital for a liver abscess and rectal cancer. At the time of admission, his platelet count was 20,000/μL, but a peripheral blood smear showed platelet aggregation and the platelet count for a kanamycin-added EDTA blood sample was 180,000/μL. The patient's respiratory status worsened after treatment for the liver abscess and rectal cancer. The patient's bronchoalveolar lavage contained 45% eosinophils, and a diagnosis of acute eosinophilic pneumonia was made. In recent studies, the occurrence of eosinophilic disease has been shown in idiopathic thrombocytopenic purpura. EDTA-dependent pseudothrombocytopenia is an in vitro phenomenon, although platelet activation that results in eosinophil invasion may occur in severe cases.

  9. One case of acute eosinophilic pneumonia and review of literature%急性嗜酸粒细胞性肺炎1例并文献复习

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    魏风芹; 刘学东


    Objective To explore the clinical manifestations, diagnosis, treatment and prognosis of acute eosinophilic pneumonia. Methods The clinical data of one case of acute eosinophilic pneumonia and literatures were comprehensively analyzed. Results The patient had cough and sputum for more than ten days, had chest tightness and chest pain for eight days,had fever for four days. Chest CT showed double pneumonia, bilateral pleural effusion. Anti-infective treatment failed, the condition progressively aggravated. Eosinophils were more than 50% in pleural effusion. Acute eosinophilic pneumonia was considered. After treatment with hormone on the basis of the anti-infection, the condition improved. Conclusions Acute eosinophilic pneumonia is a rare and self-limiting disease, and hormone treatment is effective.%目的 探讨急性嗜酸性粒细胞肺炎的临床表现、诊断、治疗方法及预后.方法 结合我院收治的1例急性嗜酸粒细胞性肺炎的临床资料及国内外文献报道的病例进行综合分析.结果 患者18岁,青年男性,咳嗽、咯痰10余天,胸闷、胸痛8 d,加重伴发热4 d入院.胸部CT示双肺炎,双侧胸腔积液,抗感染治疗无效,病情进行性加重,胸水中找到嗜酸粒细胞大于50%,考虑急性嗜酸粒细胞性肺炎,在抗感染基础上加用激素治疗后好转.结论 急性嗜酸粒细胞性肺炎是一种少见病,有自限性,激素治疗有效.

  10. Evidence for eosinophil degranulation in acute appendicitis

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    Santosh G


    Full Text Available Finding of increased numbers of eosinophils in the muscle in cases of acute appendicitis has led to the hypothesis that it may have an allergic origin. This study aimed to measure the eosinophil degranulation resulting in a rise in the serum of eosinophil granule proteins that would be expected in such cases. The levels of serum eosinophil cationic protein (ECP measured by chemiluminescence assay in acute appendicitis were compared, with those of appropriate controls. Mean (95% CI serum ECP (µg/L levels were: acute appendicitis 45.3 (27.7-63.0; normal appendix 22.7 (16.0-29.3; asthma 24.2 (4.6-43.8; and healthy volunteers 13.2 (8.3-18.1. In cases of acute appendicitis, there is an inverse relationship between duration of symptoms and serum ECP. However, this was not statistically significant. Significant local eosinophil activation and degranulation occurs in acute appendicitis, enough to cause a rise in serum levels of eosinophil chemotactic protein

  11. Acute and subacute idiopathic interstitial pneumonias. (United States)

    Taniguchi, Hiroyuki; Kondoh, Yasuhiro


    Idiopathic interstitial pneumonias (IIPs) may have an acute or subacute presentation, or acute exacerbation may occur in a previously subclinical or unrecognized chronic IIP. Acute or subacute IIPs include acute interstitial pneumonia (AIP), cryptogenic organizing pneumonia (COP), nonspecific interstitial pneumonia (NSIP), acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) and AE-NSIP. Interstitial lung diseases (ILDs) including connective tissue disease (CTD) associated ILD, hypersensitivity pneumonitis, acute eosinophilic pneumonia, drug-induced lung disease and diffuse alveolar haemorrhage need to be differentiated from acute and subacute IIPs. Despite the severe lack of randomized controlled trials for the treatment of acute and subacute IIPs, the mainstream treatment remains corticosteroid therapy. Other potential therapies reported in the literature include corticosteroids and immunosuppression, antibiotics, anticoagulants, neutrophil elastase inhibitor, autoantibody-targeted treatment, antifibrotics and hemoperfusion therapy. With regard to mechanical ventilation, patients in recent studies with acute and subacute IIPs have shown better survival than those in previous studies. Therefore, a careful value-laden decision about the indications for endotracheal intubation should be made for each patient. Noninvasive ventilation may be beneficial to reduce ventilator associated pneumonia.

  12. Chronic eosinophilic pneumonia with mucous plugs: case report

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    @@ Chronic eosinophilic pneumonia (CEP), a rare eosinophilic lung disease of unknown etiology, is characterized by peripheral blood eosinophilia, chest radiograph infiltrates, and prompt response to corticosteroid therapy.1 The first detailed description of CEP was described by Carrington et al 2 in 1969. The usual symptoms are cough, dyspnea, fever, and weight loss. It is most often seen in middle aged woman and has a subacute onset.1 We report a case of CEP presenting with right lower lung infiltrates and mucus plugging that causing bronchus obstruction.

  13. Chronic eosinophilic pneumonia presenting with ipsilateral pleural effusion: a case report


    Sriratanaviriyakul, Narin; La, Hanh H.; Albertson, Timothy E.


    Background Chronic eosinophilic pneumonia is a rare idiopathic interstitial lung disease. The nearly pathognomonic radiographic finding is the peripheral distribution of alveolar opacities. Pleural effusions are rarely seen. We report a case of chronic eosinophilic pneumonia with transudative eosinophilic pleural effusion. Case presentation A 57-year-old Hispanic woman, a nonsmoker with a history of controlled asthma, presented to the hospital with unresolving pneumonia despite three rounds o...

  14. Eosinophilic pneumonia due to toxocariasis: an adult case report. (United States)

    Demirci, Mustafa; Unlü, Mehmet; Fidan, Fatma; Kaya, Selçuk


    Toxocara is a roundworm, a common parasite of dogs (T. canis) and cats (T. cati). Toxocariasis or Visceral larva migrans (VLM) are diseases caused by the larvae of Toxocara sp., which may involve many organs, but pulmonary symptoms such as coughing and wheezing and allergic symptoms are seen in more than 80% of patients. It is known that, although the risk of infection is present, the worldwide diagnosis of toxocariasis is difficult since clinical and laboratory data provide insufficient evidence for the diagnosis. Nowadays, the diagnosis of toxocariasis is performed by serologic methods. We describe herein a case of toxocariasis with eosinophilic pneumonia that was diagnosed using serologic methods.

  15. Conservative management of eosinophilic enteritis presenting with acute abdominal syndrome

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    Marco Bassi


    Full Text Available Eosinophilic enteritis, an increasing recognized condition, is rare and often presents with non-specific symptoms. We report a case of a 46-year old female who presented with acute onset abdominal pain and nausea associated with ascites, small bowel thickening and peripheral eosinophilia. Diagnosis was confirmed by biopsies taken at esophagogastroduodenoscopy demonstrating diffuse infiltration by inflammatory cells, mainly eosinophils. Appropriate therapy was instituted. The patient recovered well and was symptom-free at 1-month follow up. In this report, we discuss the clinical presentation and the diagnostic criteria of the eosinophilic enteritis, and examine the pathophysiological theories and therapeutic strategies. The relevant literature on eosinophilic enteritis is summarized.

  16. Histopathologic study of eosinophilic bronchointerstitial pneumonia caused by Crenosoma striatum in the hedgehog. (United States)

    Hoseini, Seyed Mohammad; Youssefi, Mohammad Reza; Mousapour, Aliasghar; Dozouri, Rohollah; Eshkevari, Shahab Ramezanpour; Nikzad, Mohammad; Nikzad, Reza; Omidzahir, Shila


    Crenosoma striatum is a species of parasitic nematodes from the family Crenosomatidae responsible for pathologic lung lesions in the hedgehog (Erinaceus europaeus). Infection with C. striatum can cause weight loss, dry cough, and bronchitis. In the present study, hedgehogs killed by road accidents, or trapped and found dead on farms in different parts of Mazandaran province (Iran), were transferred to the laboratory. After dissection, parasite samples collected from the lung were placed into 70% alcohol. After clarification with lactophenol and subsequent staining, the nematodes were identified as C. striatum according to previously published guidelines. For histopathologic examination, lung samples were collected. The tissues were fixed and following routine processing, sections were stained with hematoxylin and eosin. Microscopic diagnoses included hyperemia, eosinophilic bronchointerstitial pneumonia, thickening of the interstitium, and eosinophilic microabscesses in bronchial airways. Eosinophilic pneumonia was characterized by eosinophil and other mononuclear leukocyte infiltration within the lung interstitium. Crenosoma striatum can lead to mortality in hedgehogs.

  17. Chronic eosinophilic pneumonia as a presenting feature of Churg-Strauss syndrome. (United States)

    Hueto-Perez-de-Heredia, J J; Dominguez-del-Valle, F J; Garcia, E; Gomez, M L; Gallego, J


    We report on a case of Churg-Strauss syndrome in a 30 year old male with a history of perennial rhinitis. The syndrome began nine months earlier with clinico-radiological features typical of chronic eosinophilic pneumonia. Diagnosis of vasculitis was made by skin biopsy, and at that time there was multisystemic involvement with pulmonary, cardiac, renal, cutaneous and muscular disease, and right vocal chord paralysis, which improved with corticosteroids and cyclophosphamide. This case report illustrates the possible overlap of chronic eosinophilic pneumonia and the Churg-Strauss syndrome.

  18. A case of eosinophilic pneumonia simultaneously diagnosed in a patient and a tame cat: a case report


    Tsuji,Takao; Kondo, Mitsuko; Kikuchi, Ryota; Tagaya, Etsuko; Tamaoki, Jun


    Introduction Chronic eosinophilic pneumonia is an idiopathic disorder of unknown etiology. Corticosteroid treatment provides a good response but recurrence frequently occurs after tapering of corticosteroid. Chronic eosinophilic pneumonia occurs predominantly in middle-aged women and non-cigarette smokers, which leads to the speculation that environmental antigens, particularly in the home, contribute to the etiology. Case presentation A 66-year-old Japanese woman was given a diagnosis of chr...

  19. Surfactant protein-A suppresses eosinophil-mediated killing of Mycoplasma pneumoniae in allergic lungs.

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    Julie G Ledford

    Full Text Available Surfactant protein-A (SP-A has well-established functions in reducing bacterial and viral infections but its role in chronic lung diseases such as asthma is unclear. Mycoplasma pneumoniae (Mp frequently colonizes the airways of chronic asthmatics and is thought to contribute to exacerbations of asthma. Our lab has previously reported that during Mp infection of non-allergic airways, SP-A aides in maintaining airway homeostasis by inhibiting an overzealous TNF-alpha mediated response and, in allergic mice, SP-A regulates eosinophilic infiltration and inflammation of the airway. In the current study, we used an in vivo model with wild type (WT and SP-A(-/- allergic mice challenged with the model antigen ovalbumin (Ova that were concurrently infected with Mp (Ova+Mp to test the hypothesis that SP-A ameliorates Mp-induced stimulation of eosinophils. Thus, SP-A could protect allergic airways from injury due to release of eosinophil inflammatory products. SP-A deficient mice exhibit significant increases in inflammatory cells, mucus production and lung damage during concurrent allergic airway disease and infection (Ova+Mp as compared to the WT mice of the same treatment group. In contrast, SP-A deficient mice have significantly decreased Mp burden compared to WT mice. The eosinophil specific factor, eosinophil peroxidase (EPO, which has been implicated in pathogen killing and also in epithelial dysfunction due to oxidative damage of resident lung proteins, is enhanced in samples from allergic/infected SP-A(-/- mice as compared to WT mice. In vitro experiments using purified eosinophils and human SP-A suggest that SP-A limits the release of EPO from Mp-stimulated eosinophils thereby reducing their killing capacity. These findings are the first to demonstrate that although SP-A interferes with eosinophil-mediated biologic clearance of Mp by mediating the interaction of Mp with eosinophils, SP-A simultaneously benefits the airway by limiting inflammation

  20. Idiopathic Chronic Eosinophilic Pneumonia: Retrospective Analysis of 17 Cases from a Single Center in Turkey

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    Sibel Arınç


    Full Text Available Objective: Idiopathic chronic eosinophilic pneumonia (ICEP is a rare eosinophilic lung disorder with an unknown etiology and is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or peripheral eosinophilia, and the accumulation of eosinophils in the lungs. We aimed to present diagnostic test results and follow-up outcomes of 17 patients who were diagnosed with ICEP in our hospital in light of literature. Methods: Between 2008 and 2013, we examined 17 cases of ICEP. We evaluated clinical and laboratory findings together with the long-term follow-up data. Results: The patients had a mean age of 40.8 years at presentation, and the female/male ratio was 0.8. The most common symptoms were cough (94%, shortness of breath (76%, and high fever (35%. Bronchoalveolar lavage eosinophil percentages of the patients ranged from 3% to 80%. Nine (53% patients experienced recurrence. Six patients were maintained on low dose steroid due to repeating relapses. Among these patients, 7 (77.7% had a total IgE level of above 500/IU/mL. Conclusion: Relapses are common in ICEP after the withdrawal of corticosteroid treatment or during dose reduction. We point out the importance of the close monitoring of patients for identifying relapse. A higher total IgE level during diagnosis may serve as a predictor of recurrence.

  1. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis. (United States)

    del-Moral-Martínez, María; Barrientos-Delgado, Andrés; Crespo-Lora, Vicente; Cervilla-Sáez-de-Tejada, María Eloísa; Salmerón-Escobar, Javier


    Eosinophilic cholecystitis (EC) is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed. Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms was found.

  2. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis

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    María del Moral-Martínez


    Full Text Available Eosinophilic cholecystitis (EC is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed. Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms was found.

  3. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis


    María del Moral-Martínez; Andrés Barrientos-Delgado; Vicente Crespo-Lora; María Eloísa Cervilla-Sáez-de-Tejada; Javier Salmerón-Escobar


    Eosinophilic cholecystitis (EC) is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. Whe...

  4. Eosinophilic pneumonia associated with daptomycin: a case report and a review of the literature

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    Fanourgiakis Panagiotis


    Full Text Available Abstract Introduction Although several studies did not demonstrate that daptomycin may cause significantly higher rates of pulmonary adverse effects when compared with vancomycin or penicillinase-resistant penicillins, there have been a few case reports of severe pulmonary complications associated with daptomycin administration. Case presentation A rare case of eosinophilic pneumonia occurring 10 days after daptomycin administration in a 78-year-old Caucasian man with possible infectious endocarditis is described. He developed new onset fever, up to 38.5°C, with bilateral pulmonary crackles on physical examination and with no signs of severe respiratory failure. A chest computed tomography-scan showed bilateral nodular consolidations with air bronchograms and pleural effusions. Immediate discontinuation of daptomycin was followed by vigorous improvement of clinical signs and symptoms with progressive resolution of pulmonary consolidations a month later. Conclusion Physicians should be aware of this rare but serious complication during daptomycin treatment, and prompt discontinuation of the offending agent, with or without additional supportive treatment, must occur immediately.

  5. Acute Eosinophilic Ascites in a Middle-Aged Man

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    Fadi Bleibel


    Full Text Available Eosinophilic gastroenteritis is a rare condition characterized by recurrent eosinophilic infiltration of portions of the GI tract and presenting with nonspecific GI symptoms in association with peripheral eosinophilia. Its etiology and pathogenesis remain unclear and its symptoms overlap with many GI and systemic diseases. Thus, both gastroenterologists and general internists need to be aware of this rare condition. We present a case of a 55-year-old male with diffuse abdominal pain and distention for two weeks. His physical examination was significant for moderate ascites. Initial work-up demonstrated severe peripheral blood eosinophilia, normal liver function tests, thickening of the stomach and small bowel wall, and elevated serum IgE. Upper endoscopy and extensive testing for malignancy and parasitic infections failed to establish a diagnosis. Ascitic fluid analysis showed significant eosinophilia. Further, a full-thickness jejunal showed marked eosinophilic infiltration of the serosa and muscularis propria. Subsequent treatment with oral prednisone resulted in normalization of laboratory and radiologic abnormalities in a few week period.

  6. Acute Eosinophilic Ascites in a Middle-Aged Man (United States)

    Bleibel, Fadi; Fragoza, Keith; Faller, Garrey T.


    Eosinophilic gastroenteritis is a rare condition characterized by recurrent eosinophilic infiltration of portions of the GI tract and presenting with nonspecific GI symptoms in association with peripheral eosinophilia. Its etiology and pathogenesis remain unclear and its symptoms overlap with many GI and systemic diseases. Thus, both gastroenterologists and general internists need to be aware of this rare condition. We present a case of a 55-year-old male with diffuse abdominal pain and distention for two weeks. His physical examination was significant for moderate ascites. Initial work-up demonstrated severe peripheral blood eosinophilia, normal liver function tests, thickening of the stomach and small bowel wall, and elevated serum IgE. Upper endoscopy and extensive testing for malignancy and parasitic infections failed to establish a diagnosis. Ascitic fluid analysis showed significant eosinophilia. Further, a full-thickness jejunal showed marked eosinophilic infiltration of the serosa and muscularis propria. Subsequent treatment with oral prednisone resulted in normalization of laboratory and radiologic abnormalities in a few week period. PMID:22649743

  7. Acute Mastoiditis Caused by Streptococcus pneumoniae. (United States)

    Obringer, Emily; Chen, Judy L


    Acute mastoiditis (AM) is a relatively rare complication of acute otitis media (AOM). The most common pathogens include Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. Pneumococcal vaccination and changes in antibiotic prescribing recommendations for AOM may change the incidence of AM in the future. Diagnosis of AM can be made based on clinical presentation, but computed tomography of the temporal bone with contrast should be considered if there is concern for complicated AM. Both extracranial and intracranial complications of AM may occur. Previously, routine cortical mastoidectomy was recommended for AM treatment, but new data suggest that a more conservative treatment approach can be considered, including intravenous (IV) antibiotics alone or IV antibiotics with myringotomy. [Pediatr Ann. 2016;45(5):e176-e179.].

  8. Chronic eosinophilic pneumonia involving with mediastinal lymph nodes: radiologic study of three cases. Neumonia eosinofila cronica asociada a adenopatias mediastinicas: estudio radiologico de tres casos

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    Calvo Garcia, A.; Gordillo Gutierrez, I.; Guembe Urtiaga, P. (Hospital Gregorio Maraon, Madrid (Spain))


    Chronic eosinophilic pneumonia (CEP) is an uncommon disorder in our setting. Chest x-ray is essential to diagnosis. To date, we have found only three reported cases in which mediastinal lymph nodes were involved. We present three additional cases with standard thoracic study. (Author)

  9. Pneumonia in acute stroke patients fed by nasogastric tube


    Dziewas, R. (Rainer); Ritter, M.; Schilling, M; Konrad, C.; Oelenberg, S; Nabavi, D; Stogbauer, F; Ringelstein, E; Ludemann, P


    Background: Aspiration pneumonia is the most important acute complication of stroke related dysphagia. Tube feeding is usually recommended as an effective and safe way to supply nutrition in dysphagic stroke patients.

  10. Clinical and pulmonary thin-section CT findings in acute Klebsiella Pneumoniae pneumonia

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    Okada, Fumito [Oita University Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Oita (Japan); Oita University Faculty of Medicine, Department of Radiology, Oita (Japan); Ando, Yumiko; Honda, Koichi; Nakayama, Tomoko; Kiyonaga, Maki; Ono, Asami; Tanoue, Shuichi; Maeda, Toru; Mori, Hiromu [Oita University Faculty of Medicine, Department of Diagnostic and Interventional Radiology, Oita (Japan)


    The aim of this study was to assess the clinical and pulmonary thin-section CT findings in patients with acute Klebsiella pneumoniae pneumonia. We retrospectively evaluated thin-section CT examinations performed between January 1991 and December 2007 from 962 patients with acute Klebsiella pneumoniae pneumonia. Seven hundred and sixty-four cases with concurrent infectious diseases were excluded. Thus, our study group comprised 198 patients (118 male, 80 female; age range 18-97 years, mean age 61.5). Underlying diseases and clinical findings were assessed. Parenchymal abnormalities were evaluated along with the presence of enlarged lymph nodes and pleural effusion. CT findings in patients with acute Klebsiella pneumoniae pneumonia consisted mainly of ground-glass attenuation (100%), consolidation (91.4%), and intralobular reticular opacity (85.9%), which were found in the periphery (96%) of both sides of the lungs (72.2%) and were often associated with pleural effusion (53%). The underlying conditions in patients with Klebsiella pneumoniae pneumonia were alcoholism or smoking habit. (orig.)

  11. Clinical and pulmonary thin-section CT findings in acute Klebsiella pneumoniae pneumonia. (United States)

    Okada, Fumito; Ando, Yumiko; Honda, Koichi; Nakayama, Tomoko; Kiyonaga, Maki; Ono, Asami; Tanoue, Shuichi; Maeda, Toru; Mori, Hiromu


    The aim of this study was to assess the clinical and pulmonary thin-section CT findings in patients with acute Klebsiella pneumoniae pneumonia. We retrospectively evaluated thin-section CT examinations performed between January 1991 and December 2007 from 962 patients with acute Klebsiella pneumoniae pneumonia. Seven hundred and sixty-four cases with concurrent infectious diseases were excluded. Thus, our study group comprised 198 patients (118 male, 80 female; age range 18-97 years, mean age 61.5). Underlying diseases and clinical findings were assessed. Parenchymal abnormalities were evaluated along with the presence of enlarged lymph nodes and pleural effusion. CT findings in patients with acute Klebsiella pneumoniae pneumonia consisted mainly of ground-glass attenuation (100%), consolidation (91.4%), and intralobular reticular opacity (85.9%), which were found in the periphery (96%) of both sides of the lungs (72.2%) and were often associated with pleural effusion (53%). The underlying conditions in patients with Klebsiella pneumoniae pneumonia were alcoholism or smoking habit.

  12. Acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections in community-acquired pneumonia and exacerbations of COPD or asthma: therapeutic considerations. (United States)

    Meloni, F; Paschetto, E; Mangiarotti, P; Crepaldi, M; Morosini, M; Bulgheroni, A; Fietta, A


    Rates of acute Chlamydia pneumoniae and Mycoplasma pneumoniae infections were determined in 115 adults hospitalized for community-acquired pneumonia (CAP), purulent exacerbations of COPD and acute exacerbations of bronchial asthma, by means of serology and molecular methods. Results were compared with those obtained in a matched control group. Common respiratory pathogens were isolated by cultures in 22.5% and 22.2% of CAP and exacerbated COPD patients, respectively. Cultures from exacerbated asthma patients were always negative. Serological and molecular evidence of current C. pneumoniae infection was obtained in 10.0%, 8.9% and 3.3% of CAP, COPD and asthma cases. The corresponding rates of acute M. pneumoniae infection were 17.5%, 6.7% and 3.3%, respectively. Finally, no difference was found between typical and atypical pathogen rates. These findings highlight the importance of taking into account C. pneumoniae and M. pneumoniae infections in guiding the choice of empirical antibacterial treatment for CAP and purulent exacerbations of COPD.

  13. Mycoplasma pneumoniae pneumonia in hospitalized children diagnosed at acute stage by paired sera

    Institute of Scientific and Technical Information of China (English)

    LIU Chun-ling; WEI Ming; LIU Zhen-ye; WANG Gui-qiang; ZHANG Bo; XU Hua; HU Liang-ping; HE Xiao-feng; WANG Jun-hua; ZHANG Jun-hong; LIU Xiao-yu


    Background Mycoplasma pneumoniae (M. pneumoniae) is a frequent cause of respiratory tract infections. However,there is deficient knowledge about the clinical manifestations of M. pneumoniae infection. We described the clinical and laboratory findings of M. pneumoniae pneumonia in hospitalized children who were all diagnosed by a ≥ fourfold increase in antibody titer.Methods M. pneumoniae antibodies were routinely detected in children admitted with acute respiratory infection during a one-year period. The medical history was re-collected from children whose M. pneumoniae antibody titer increased≥fourfold at the bedside by a single person, and their frozen paired serum samples were measured again for the M.pneumoniae antibody titer.Results Of the 635 children whose sera were detected for the M. pneumoniae antibody, paired sera were obtained from 82 and 29.3% (24/82) showed a ≥ fourfold increase in antibody titer. There were 24 cases, nine boys and 15 girls, aged from two to 14 years, whose second serum samples were taken on day 9 at the earliest after symptom onset; the shortest interval was three days. All children presented with a high fever (≥38.5℃) and coughing. Twenty-one had no nasal obstruction or a runny nose, and five had mild headaches which all were associated with the high fever. The disease was comparatively severe if the peak temperature was >39.5℃. All were diagnosed as having pneumonia through chest X-rays. Four had bilateral or multilobar involvement and their peak temperatures were all ≤ 39.5℃. None of the children had difficulty in breathing and all showed no signs of wheezing.Conclusions The second serum sample could be taken on day 9 at the earliest after symptom onset meant that paired sera could be used for the clinical diagnosis of M. pneumoniae pneumonia in children at the acute stage. M. pneumoniae is a lower respiratory tract pathogen. Extrapulmonary complications were rare and minor in our study. High peak temperature (

  14. A review of pulmonary coagulopathy in acute lung injury, acute respiratory distress syndrome and pneumonia

    NARCIS (Netherlands)

    Nieuwenhuizen, Laurens; de Groot, Philip G.; Grutters, Jan C.; Biesma, Douwe H.


    Enhanced bronchoalveolar coagulation is a hallmark of many acute inflammatory lung diseases such as acute lung injury, acute respiratory distress syndrome and pneumonia. Intervention with natural anticoagulants in these diseases has therefore become a topic of interest. Recently, new data on the rol

  15. Rapidly fatal community-acquired pneumonia due to Klebsiella pneumoniae complicated with acute myocarditis and accelerated idioventricular rhythm. (United States)

    Chuang, Tzu-Yi; Lin, Chou-Jui; Lee, Shih-Wei; Chuang, Chun-Pin; Jong, Yuh-Shiun; Chen, Wen-Jone; Hsueh, Po-Ren


    We describe a previously healthy 52-year-old man with rapidly fatal community-acquired pneumonia caused by Klebsiella pneumoniae. The patient developed acute renal dysfunction, accelerated idioventricular rhythm (acute myocarditis), lactic acidosis and septic shock. He died within 15 hours after admission despite intravenous levofloxacin (750 mg daily) and aggressive medical treatment.

  16. Eosinophilic Fasciitis and Acute Encephalopathy Toxicity from Pembrolizumab Treatment of a Patient with Metastatic Melanoma. (United States)

    Khoja, Leila; Maurice, Catherine; Chappell, MaryAnne; MacMillan, Leslie; Al-Habeeb, Ayman S; Al-Faraidy, Nada; Butler, Marcus O; Rogalla, Patrik; Mason, Warren; Joshua, Anthony M; Hogg, David


    Anti-PD-1 inhibitors have significant activity in metastatic melanoma. Responses often occur early and may be sustained. The optimal duration of treatment with these agents is unknown. Here, we report the case of a 51-year-old woman treated with pembrolizumab, as part of the Keynote-001 trial, as first-line treatment for metastatic disease. She experienced a complete response after 13.8 months of treatment with no adverse events. One month after the last drug infusion and 18 months from starting treatment, the patient presented with eosinophilic fasciitis. She then developed acute confusion and weakness, thought to be due to intracranial vasculitis. High-dose steroids were initiated with resolution of the fasciitis. Aspirin was commenced for presumed vasculitis with resolution of the neurologic symptoms. To our knowledge, there are no previous reports of eosinophilic fasciitis or cerebral vasculitis due to anti-PD-1 agents. This case demonstrates that toxicity may occur in association with pembrolizumab treatment after a prolonged period of treatment without toxicity. Future trials should explore the optimal duration of treatment with pembrolizumab.

  17. Bacteriology of aspiration pneumonia in patients with acute coma. (United States)

    Lauterbach, Enise; Voss, Frederik; Gerigk, Roland; Lauterbach, Michael


    Loss of protective airway reflexes in patients with acute coma puts these patients at risk of aspiration pneumonia complicating the course of the primary disease. Available data vary considerably with regard to bacteriology, role of anaerobic bacteria, and antibiotic treatment. Our objective was to research the bacteriology of aspiration pneumonia in acute coma patients who were not pre-treated with antibiotics or hospitalized within 30 days prior to the event. We prospectively analyzed 127 patient records from adult patients admitted, intubated and ventilated to a tertiary medical intensive care unit with acute coma. Bacteriology and antibiotic resistance testing from tracheal aspirate sampled within 24 h after admission, blood cultures, ICU scores (APACHE II, SOFA), hematology, and clinical chemistry were assessed. Patients were followed up until death or hospital discharge. The majority of patients with acute coma suffered from acute cardiovascular disorders, predominantly myocardial infarction, followed by poisonings, and coma of unknown cause. In a majority of our patients, microaspiration resulted in overt infection. Most frequently S. aureus, H. influenzae, and S. pneumoniae were isolated. Anaerobic bacteria (Bacteroides spec., Fusobacteria, Prevotella spec.) were isolated from tracheal aspirate in a minority of patients, and predominantly as part of a mixed infection. Antibiotic monotherapy with a 2nd generation cephalosporin, or a 3rd generation gyrase inhibitor, was most effective in our patients regardless of the presence of anaerobic bacteria.

  18. Eosinophilic fasciitis* (United States)

    Lamback, Elisa Baranski; Resende, Fernanda Simões Seabra; Lenzi, Thiara Cristina Rocha


    Eosinophilic fasciitis is a rare sclerodermiform syndrome of unknown etiology. It is characterized by the thickening of the muscular fascia and subcutaneous tissue, with a variable infiltration of eosinophils. Peripheral eosinophilia, poly or monoclonal hypergammaglobulinemia and increased erythrocyte sedimentation rate can be seen. Clinical features begin acutely, with local edema and a painful and symmetrical stiffening of the limbs, progressing rapidly to fibrosis, which can limit joint movements. Some cases have a history of strenuous physical exercise or trauma. The diagnosis is confirmed by a deep skin biopsy. Glucocorticoids in high doses is the treatment of choice. We report a typical eosinophilic fasciitis case with peripheral eosinophilia and dramatic response to pulse therapy with methylprednisolone.

  19. High Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in Children with Acute Respiratory Infections from Lima, Peru (United States)

    del Valle-Mendoza, Juana; Orellana-Peralta, Fiorella; Marcelo-Rodríguez, Alvaro; Verne, Eduardo; Esquivel-Vizcarra, Mónica; Silva-Caso, Wilmer; Aguilar-Luis, Miguel Angel; Weilg, Pablo; Casabona-Oré, Verónica; Ugarte, Claudia; del Valle, Luis J.


    Background Mycoplasma pneumoniae and Chlamydia pneumoniae are atypical pathogens responsible for pneumonia and a leading cause of morbidity and mortality in low income countries. The study objective is to determine the prevalence of this pathogens in Peruvian children with acute respiratory infections. Methods A consecutive cross-sectional study was conducted in Lima, Peru from May 2009 to September 2010. A total of 675 children admitted with clinical diagnoses of acute respiratory infections were tested for Mycoplasma pneumoniae and Chlamydia pneumoniae detection by polymerase chain reaction (PCR), and clinical symptoms were registered by the attending physician. Results Mycoplasma pneumonia was detected in 25.19% (170/675) of nasopharyngeal samples and Chlamydia pneumonia in 10.52% (71/675). The most common symptoms in patients with these atypical pathogens were rhinorrhea, cough and fever. A higher prevalence of Mycoplasma pneumoniae cases were registered in summer, between December 2009 and March 2010. Conclusions Mycoplasma pneumoniae and Chlamydia pneumonia are a significant cause of morbidity in Peruvian children with acute respiratory infections (ARI). Further studies should evaluate the use of reliable techniques such as PCR in Peru in order to avoid underdiagnoses of these atypical pathogens. PMID:28129377

  20. Chlamydia pneumoniae and mycoplasma pneumoniae in children with acute respiratory infection in general practices in the Netherlands.

    NARCIS (Netherlands)

    Tjhie, J.H.T.; Dorigo-Zetsma, J.W.; Roosendaal, R.; Brule, A.J.C. van den; Bestebroer, T.M.; Bartelds, A.I.M.; Vandenbroucke-Grauls, C.M.J.E.


    In this retrospective study Chlamydia pneumoniae and Mycoplasma pneumoniae infections were detected by polymerase chain reaction (PCR) in samples (n=457) from children presenting with acute respiratory infection to general practitioners during 1992-97. Samples were collected in autumn and winter, an


    Directory of Open Access Journals (Sweden)

    Michelle Prinka Adyana


    Full Text Available Near drowning is a condition in which the victim survived the first 24 hours. The WorldHealth Organization (WHO , recorded worldwide in 2000 there were 400,000 incidentdrowned accidentally . That is, this figure ranks second only to traffic accidents.Aspiration pneumonia is a complication of near drwoning which occurred in 80 % ofcases of near drowning, while 50 % of patients sink into acute respiratory distresssyndrome ( ARDS . This case report discusses the acute respiratory distress syndromeand acute pneumonia in near drowning 24 years old , who had drowned at the beach for± 15 minutes , the chest x - ray obtained pulmonary edema dd / lung pnuemonia therepneuomothorax . Examination of multislice spiral computed tomography ( MSCT bilateral pneumothorax Thorax obtained major and minor fisuura right and left majorfissure , pneumomediastinum , pulmonary pneumonia contusio / suspected aspirationpneumonia , emphysema subcutis . In intensive care patients conducted for 9 days andreturn to akitivitas everyday

  2. Association between pneumonia in acute stroke stage and 3-year mortality in patients with acute first-ever ischemic stroke. (United States)

    Yu, Yi-Jing; Weng, Wei-Chieh; Su, Feng-Chieh; Peng, Tsung-I; Chien, Yu-Yi; Wu, Chia-Lun; Lee, Kuang-Yung; Wei, Yi-Chia; Lin, Shun-Wen; Zhu, Jun-Xiao; Huang, Wen-Yi


    The influence of pneumonia in acute stroke stage on the clinical presentation and long-term outcomes of patients with acute ischemic stroke is still controversial. We investigate the influence of pneumonia in acute stroke stage on the 3-year outcomes of patients with acute first-ever ischemic stroke. Nine-hundred and thirty-four patients with acute first-ever ischemic stroke were enrolled and had been followed for 3years. Patients were divided into two groups according to whether pneumonia occurred during acute stroke stage or not. Clinical presentations, risk factors for stroke, laboratory data, co-morbidities, and outcomes were recorded. The result showed that a total of 100 patients (10.7%) had pneumonia in acute stroke stage. The prevalence of older age, atrial fibrillation was significantly higher in patients with pneumonia in acute stroke stage. Total anterior circulation syndrome and posterior circulation syndrome occurred more frequently among patients with pneumonia in acute stroke stage (Ppneumonia in acute stroke stage is a significant predictor of 3-year mortality (hazard ratio=6.39, 95% confidence interval=4.03-10.11, Ppneumonia during the acute stroke stage is associated with increased risk of 3-year mortality. Interventions to prevent pneumonia in acute stroke stage might improve ischemic stroke outcome.

  3. Idiopathic Eosinophilic Cholecystitis


    Huseyin Tas


    Eosinophilic cholecystitis is one of the rare causes of cholecystitis. Diagnosis is made by exclusion of other causes for eosinophilic cholecystitis and by pathological examination of the gallbladder wall infiltration with more than 90% of the eosinophilic leukocytes. We have aimed to present a case of 24 year old man who had Eosinophilia in blood tests, progressive complaints after medical treatment, was diagnosed with acute acalculous cholecystitis and was treated with cholecystectomy. Idio...

  4. Acute lung inflammation in Klebsiella pneumoniae B5055-induced pneumonia and sepsis in BALB/c mice: a comparative study. (United States)

    Kumar, Vijay; Chhibber, Sanjay


    Lungs play an important role in the body's defense against a variety of pathogens, but this network of immune system-mediated defense can be deregulated during acute pulmonary infections. The present study compares acute lung inflammation occurring during Klebsiella pneumoniae B5055-induced pneumonia and sepsis in BALB/c mice. Pneumonia was induced by intranasal instillation of bacteria (10(4) cfu), while sepsis was developed by placing the fibrin-thrombin clot containing known amount of bacteria (10(2) cfu) into the peritoneal cavity of animals. Mice with sepsis showed 100% mortality within five post-infection days, whereas all the animals with pneumonia survived. In animals suffering from K. pneumoniae B5055-induced pneumonia, all the inflammatory parameters (TNF-α, IL-1α, MPO, MDA, and NO) were found to be maximum till third post-infection day, after that, a decline was observed, whereas in septic animals, all the above-mentioned markers of inflammation kept on increasing. Histopathological study showed presence of alternatively activated alveolar macrophages (or foam cells) in lungs of mice with pneumonia after third post-infection day, which might have contributed to the induction of resolution of inflammation, but no such observation was made in lungs of septic mice. Hence, during pneumonia, controlled activation of macrophages may lead to resolution of inflammation.

  5. A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid


    Hideki Yasui; Koshi Yokomura; Takafumi Suda


    Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days ...

  6. Persistent pathogens as risk factors of community-acquired pneumonia and acute bronchitis in children

    Directory of Open Access Journals (Sweden)

    O. V. Zhukova


    Full Text Available The aim of this study was to determine the relationship between infection with “persistent” agents of children and the possibility of the development of inflammatory diseases of the respiratory tract such as community-acquired pneumonia and acute bronchitis on the basis of risk management concepts.Materials and methods. 701 children in age from 15 days to 16 years were examined in Nizhny Novgorod and the Nizhny Novgorod region with clinically and radiologically confirmed diagnosis: community-acquired pneumonia, acute bronchitis. This study was performed in the period from 2005 to 2014. The control group consisted of 127 healthy children of different ages. The detection of M. pneumoniae, Сytomegalovirus, Herpes simplex I/II C. pneumoniae was performed by PCR. The concept of risk determination was based on the determination of the absolute risk in the exposed and the no exposed groups, attributable risk, relative risk, the population attributable risk, as well as determining the standard errors for each type of risk and confidence interval.Results. Attributable risk, relative risk, population-attributable risk are statistically significant figures. Attributable risk of development of community-acquired pneumonia was 29,26%; 27,37%; 25,70%; 20,21% for the M. pneumoniae, C. pneumoniae, CMV, HSV I / II respectively. The relative risk was 1,43 for the M. pneumoniae; 1,38 – for C. pneumoniae and CMV; 1,28- for HSV I / II. The presence of persistent pathogens is resulting in increased incidence of communityacquired pneumonia throughout the population (population attributable risk: 4,75% for M. pneumoniae, 0,23% for C. pneumoniae, 5,59% for the CMV and 1,08% for the HSV I/II. Similar calculations were performed for patients with acute bronchitis. The statistical analysis allowed to exclude C. pneumoniae and HSV I / II of the risk factors for communityacquired pneumonia and acute bronchitis.Conclusion. The findings suggest the influence of M

  7. Acute necrotizing eosinophilic myocarditis in a patient taking Garcinia cambogia extract successfully treated with high-dose corticosteroids. (United States)

    Allen, Scott F; Godley, Robert W; Evron, Joshua M; Heider, Amer; Nicklas, John M; Thomas, Michael P


    A previously healthy 48-year-old woman was evaluated for lightheadedness and chest heaviness 2 weeks after starting the herbal supplement Garcinia cambogia. She was found to be hypotensive and had an elevated serum troponin level. The patient had a progressive clinical decline, ultimately experiencing fulminant heart failure and sustained ventricular arrhythmias, which required extracorporeal membrane oxygenation support. Endomyocardial biopsy results were consistent with acute necrotizing eosinophilic myocarditis (ANEM). High-dose corticosteroids were initiated promptly and her condition rapidly improved, with almost complete cardiac recovery 1 week later. In conclusion, we have described a case of ANEM associated with the use of Garcinia cambogia extract.

  8. Can acute interstitial pneumonia be differentiated from bronchiolitis obliterans organizing pneumonia by high-resolution CT?

    Energy Technology Data Exchange (ETDEWEB)

    Mihara, Naoki; Johkoh, Takeshi [Osaka Univ., Suita (Japan). Medical School; Ichikado, Kazuya (and others)


    In the early stages, clinical and chest radiographic findings of acute interstitial pneumonia (AIP) are often similar to those of bronchiolitis obliterans organizing pneumonia (BOOP). However, patients with AIP have a poor prognosis, while those with BOOP can achieve a complete recovery after corticosteroid therapy. The objective of this study was to identify differences in high-resolution CT (HRCT) findings between the two diseases. The study included 27 patients with AIP and 14 with BOOP who were histologically diagnosed [open-lung biopsy (n=7), autopsy (n=17), transbronchial lung biopsy (n=17)]. The frequency and distribution of various HRCT findings for each disease were retrospectively evaluated. Traction bronchiectasis, interlobular septal thickening, and intralobular reticular opacities were significantly more prevalent in AIP (92.6%, 85.2%, and 59.3%, respectively) than in BOOP (42.9%, 35.7%, and 14.3%, respectively) (p<0.01). Parenchymal nodules and peripheral distribution were more prevalent in BOOP (28.6% and 57.1%, respectively) than in AIP (7.4% and 14.8%, respectively) (p<0.01). Areas with ground-glass attenuation, air-space consolidation, and architectural distortion were common in both AIP and BOOP. For a differential diagnosis of AIP and BOOP, special attention should be given to the following HRCT findings: traction bronchiectasis, interlobular septal thickening, intralobular reticular opacities, parenchymal nodules, pleural effusion, and peripheral zone predominance. (author)

  9. Pneumonia (United States)

    ... of pneumonia. Be sure to get the following vaccines: Flu vaccine can help prevent pneumonia caused by the flu virus. Pneumococcal vaccine lowers your chances of getting pneumonia from Streptococcus ...

  10. [Emergence of new pneumonia: besides severe acute respiratory syndrome]. (United States)

    Mangiarotti, P; Pozzi, E


    Important epidemiological modifications have been registered in respiratory infections, both in immunocompetent and immunocompromised hosts. Pathogens with modified antibiotic susceptibility patterns have emerged, which display an increased antibiotic resistance, such as S. pneumoniae, S. aureus, H. influenzae. This trait has a strong impact on the therapeutic choices, particularly when an empiric antibiotic treatment is selected. The prevalence of bacterial species showing non-susceptibility to the most common prescribed antibiotics (betalactams, macrolides etc.) follows a different geographic distribution. Some pathogens have acquired a new epidemiological role in patients affected with immune deficiencies: among them P. carinii and other bacterial, fungal and viral pathogens. The emergence of new, previously unknown, species, has been registered, both bacteria (C. pneumoniae) and viruses (Metapneumovirus, Hantavirus etc.). Such aspects must be considered in the diagnosis of respiratory infections, which should include diagnostic tests for the identification of such pathogens. Among the new respiratory infections severe acute respiratory syndrome (SARS) has quickly become a health care emergency, so that efforts have been made to identify the aetiological agent as well as the main epidemiological and clinical characteristics of the disease. Avian influenza has raised great interest immediately after the first cases of human infection caused by the avian virus, especially after the outbreaks in Asian countries and in the Netherlands. A crucial step in containing infection is the prevention of the disease; efforts are directed toward this endpoint.

  11. Different cytokine profile and eosinophil activation are involved in rhinovirus- and RS virus-induced acute exacerbation of childhood wheezing. (United States)

    Kato, Masahiko; Tsukagoshi, Hiroyuki; Yoshizumi, Masakazu; Saitoh, Mika; Kozawa, Kunihisa; Yamada, Yoshiyuki; Maruyama, Kenichi; Hayashi, Yasuhide; Kimura, Hirokazu


    Because little information is available on eosinophil activation and cytokine response in virus-induced wheezing, we attempted to detect respiratory viruses and measure eosinophil cationic protein (ECP), and 27 types of cytokines/chemokines in both serum and nasal secretions from children with wheezing. This study was an observational, case-control investigation of 267 subjects, who were visited and/or hospitalized with acute respiratory symptoms (with wheezing: men, 115; women, 59; mean/median age, 3.6/3.0 years) or who were visited for regular physical examination and treatment (non-symptomatic wheezing: men, 48; women, 31; mean/median, 5.0/4.7 years), and 14 control subjects (controls: men, 9; women, 5; mean/median, 3.6/3.7 years). We detected viruses in nasal secretions from 174 patients with acute exacerbations of wheezing using antigen detection kits or reverse transcription-polymerase chain reaction, followed by direct DNA sequencing analysis. We measured peripheral eosinophil counts, and serum concentrations of ECP and 27 cytokines/chemokines using a multiplex bead-based assay in patients with wheezing or non-symptomatic wheezing. We also examined nasal ECP and 27 cytokines/chemokines in patients with wheezing. Of 174 samples from wheezing exacerbations, rhinovirus was detected in 59; respiratory syncytial (RS) virus in 44; enterovirus in 17; other viruses in 19; and no viruses in 35. Serum concentrations of ECP, IL-5, IL-6, IL-1ra, and IP-10 were significantly elevated in rhinovirus-induced wheezing compared with non-symptomatic wheezing. Similarly, serum ECP, IL-5, and IP-10 were significantly higher in rhinovirus-induced wheezing than in controls. On the other hand, IL-1ra and IP-10, but not ECP and IL-5 were significantly higher in RS virus-induced wheezing than in controls. Furthermore, only IL-5 was significantly elevated in the rhinovirus group compared with the RS virus group in both serum and nasal secretions. Different cytokine profile and

  12. Clinical Management of Acute Interstitial Pneumonia: A Case Report

    Directory of Open Access Journals (Sweden)

    Yang Xia


    Full Text Available We describe a 51-year-old woman who was admitted to hospital because of cough and expectoration accompanied with general fatigue and progressive dyspnea. Chest HRCT scan showed areas of ground glass attenuation, consolidation, and traction bronchiectasis in bilateral bases of lungs. BAL fluid test and transbronchial lung biopsy failed to offer insightful evidence for diagnosis. She was clinically diagnosed with acute interstitial pneumonia (AIP. Treatment with mechanical ventilation and intravenous application of methylprednisolone (80 mg/day showed poor clinical response and thus was followed by steroid pulse therapy (500 mg/day, 3 days. However, she died of respiratory dysfunction eventually. Autopsy showed diffuse alveolar damage associated with hyaline membrane formation, pulmonary interstitial, immature collagen edema, and focal type II pneumocyte hyperplasia.

  13. TCM Therapeutic Strategy on Acute Lung Injury Caused by Infectious Atypical Pneumonia and Acute Respiratory Distress Syndrome

    Institute of Scientific and Technical Information of China (English)



    @@ Infectious atypical pneumonia (IAP) is also called severe acute respiratory syndrome (SARS) by WHO. In its development, around 20% of SARS can develop into the stage of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), active and effective treatment of it constitutes the important basis for lowering mortality and reducing secondary pulmonary function impairment and pulmonary fibrosis.

  14. Acute interstitial pneumonia in mink kits inoculated with defined isolates of Aleutian mink disease parvovirus

    DEFF Research Database (Denmark)

    Alexandersen, Søren; Larsen, S; Aasted, B;


    The present study addressed the causal role of Aleutian mink disease parvovirus (ADV) in acute interstitial pneumonia in mink kits. All the examined isolates of ADV caused interstitial pneumonia in newborn kits, although the severity of disease and the mortality varied. These findings indicate...

  15. Acute Placental Infection Due to Klebsiella pneumoniae: Report of a Unique Case

    Directory of Open Access Journals (Sweden)

    Janice M. Lage


    Full Text Available A 40-year-old woman, gravida 9, with seven healthy children and a history of one abortion (p 7 + 1 , presented at 18 weeks of gestation with fever and malodorous vaginal discharge. Ultrasound revealed a macerated fetus. The placenta showed acute chorioamnionitis and acute villitis with microabscess formation. Blood and vaginal cultures both grew Klebsiella pneumoniae. This is the first reported case in English literature of Klebsiella pneumoniae causing suppurative placentitis leading to fetal demise.

  16. Eosinophilic oesophagitis

    DEFF Research Database (Denmark)

    Nielsen, Rasmus Gaardskjær; Husby, Steffen


    in males, and patients often belong to the paediatric or adolescence age groups. The exact prevalence of eosinophilic oesophagitis is unknown, but it has been suggested that the United States has a higher prevalence than Europe. Several treatment algorithms have been suggested, including elemental diets......Eosinophilic oesophagitis is characterised by age-dependent symptoms mimicking gastrooesophageal reflux disease, a distinct endoscopic appearance and a histological picture with extensive infiltration of eosinophils in the oesophageal mucosa. Eosinophilic oesophagitis is more frequently seen...

  17. Diagnosis of Acute Respiratory Distress Syndrome in Nosocomial Pneumonia

    Directory of Open Access Journals (Sweden)

    A. N. Kuzovlev


    Full Text Available Objective: to define the informative value of the parameters of gas exchange, lung volumetry, and central hemodynamics in the diagnosis of acute respiratory distress syndrome (ARDS in nosocomial pneumonia (NP. Subjects and methods. The study included 38 patients with cancer and severe injury who were divided into 3 groups in accordance with the diagnostic criteria of ARDS and NP: 1 patients with ARDS + NP; 2 those with NP; 3 those with non-ARDS, non-PN. ARDS was diagnosed in 2 steps. At Step 1, the investigators took into account risk factors for ARDS and used the lung injury scale developed by J. Murray et al. and the ARDS diagnostic criteria defined by the American-European Consensus Conference on ARDS. At Step 2, after obtaining the data of lung volume-try (1—2 hours after Step 1, they assessed the compliance of the above criteria for ARDS with those developed by the V. A. Negovsky Research Institute of General Reanimatology, Russian Academy of Medical Sciences, and redistributed the patients between the groups. The stage of ARDS was determined in accordance with the classification of the above Institute. All the patients underwent a comprehensive examination the key element of which was to estimate gas exchange parameters and to monitor lung volumetry and central hemodynamics by the transpulmonary thermodilution methods, by using a Pulsion PiCCO Plus monitor (Pulsion Medical Systems, Germany. The findings were statistically analyzed using a Statistica 7.0 package (arithmetic mean, error of the mean, _ Student’s test, Newman-Keuls test, correlation analysis. The difference was considered to be significant if p-value was Results. The patients with ARDS + NP were observed to have a significantly lower oxygenation index (10 ml/kg and Murray scale scores (>2 than those in patients with NP without ARDS. The reference values of the pulmonary vascular permeability index due to its inadequate informative value call for further investigation. The

  18. Dietary supplementation with omega-3 polyunsaturated fatty acids ameliorates acute pneumonia induced by Klebsiella pneumoniae in BALB/c mice. (United States)

    Sharma, Sonica; Chhibber, Sanjay; Mohan, Harsh; Sharma, Saroj


    The immune benefits associated with the optimal intake of dietary fatty acids are widely known. The objective of the present investigation was to elucidate the role of omega-3 polyunsaturated fatty acids (n-3 PUFA) food source on acute pneumonia induced by Klebsiella pneumoniae. Three different n-3 PUFA preparations (cod liver oil, Maxigard, and flaxseed oil) were orally supplemented and infection was induced in different groups of experimental mice. Mice fed olive oil and normal saline served as oil and saline controls, respectively. After 2 weeks of fatty acid feeding, no effect on the establishment of infection was observed when acute pneumonia was induced in animals. On the other hand, 6 weeks of n-3 PUFA administration was found to improve resistance in mice, as reduced lung bacterial load coupled with significant improvement in pathology was seen in infected mice. Alveolar macrophages collected from all 3 groups of mice fed n-3 PUFA exhibited a significant decrease in the level of apoptosis following infection with K. pneumoniae and an enhanced in vitro phagocytic potential for the pathogen. Lower lung levels of nitric oxide, malondialdehyde, and lactate dehydrogenase were associated with a decrease in the severity of tissue damage. There was a significant increase in the lung levels of pro-inflammatory cytokines (tumor necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β)). No significant change was observed in the levels of interleukin-10 (IL-10). This study highlights that dietary n-3 PUFA supplementation exerts an overall beneficial effect against acute experimental pneumonia. This mechanism is operative through upregulation of nonspecific and specific immune defenses of the host.

  19. Acute interstitial pneumonia (AIP): relationship to Hamman-Rich syndrome, diffuse alveolar damage (DAD), and acute respiratory distress syndrome (ARDS). (United States)

    Mukhopadhyay, Sanjay; Parambil, Joseph G


    Acute interstitial pneumonia (AIP) is a term used for an idiopathic form of acute lung injury characterized clinically by acute respiratory failure with bilateral lung infiltrates and histologically by diffuse alveolar damage (DAD), a combination of findings previously known as the Hamman-Rich syndrome. This review aims to clarify the diagnostic criteria of AIP, its relationship with DAD and acute respiratory distress syndrome (ARDS), key etiologies that need to be excluded before making the diagnosis, and the salient clinical features. Cases that meet clinical and pathologic criteria for AIP overlap substantially with those that fulfill clinical criteria for ARDS. The main differences between AIP and ARDS are that AIP requires a histologic diagnosis of DAD and exclusion of known etiologies. AIP should also be distinguished from "acute exacerbation of IPF," a condition in which acute lung injury (usually DAD) supervenes on underlying usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF).

  20. Risk factors for the development of pneumonia in acute psychotropic drugs poisoning

    Directory of Open Access Journals (Sweden)

    Vučinić Slavica


    Full Text Available Background/Aim. Pneumonia is the most frequent complication in acute psychotropic drugs poisoning, which results in substantial morbidity and mortality, but which also increases the costs of treatment. Risk factors for pneumonia are numerous: age, sex, place of the appearance of pneumonia, severity of underlying disease, airway instrumentation (intubation, reintubation, etc. The incidence of pneumonia varies in poisoning caused by the various groups of drugs. The aim of this study was to determine the incidence and risk factors for pneumonia in the patients with acute psychotropic drugs poisoning. Methods. A group of 782 patients, out of which 614 (78.5% with psychotropic and 168 (21.5% nonpsychotropic drug poisoning were analyzed prospectively during a two-year period. The diagnosis of pneumonia was made according to: clinical presentation, new and persistent pulmonary infiltrates on chest radiography, positive nonspecific parameters of inflammation, and the microbiological confirmation of causative microorganisms. To analyze predisposing risk factors for pneumonia, the following variables were recorded: sex, age, underlying diseases, endotracheal intubation, coma, severity of poisoning with different drugs, histamine H2 blockers, corticosteroids, mechanical ventilation, central venous catheter. The univariate analysis for pneumonia risk factors in all patients, and for each group separately was done. The multivariate analysis was performed using the logistic regression technique. Results. Pneumonia was found in 94 (12.02% of the patients, 86 of which (91.5% in psychotropic and 8 (8.5% in nonpsychotropic drug poisoning. In the psychotropic drug group, pneumonia was the most frequent in antidepressant (47%, and the rarest in benzodiazepine poisoning (3.8%. A statistically significant incidence of pneumonia was found in the patients with acute antidpressant poisoning (p < 0.001. Univariate analysis showed statistical significance for the

  1. Eosinophilic meningitis. (United States)

    Sawanyawisuth, Kittisak; Chotmongkol, Verajit


    Eosinophilic meningitis is defined by the presence of at least 10% eosinophils in the total cerebrospinal fluid (CSF) leukocyte count. Although there are several possible causes of eosinophils in the CSF, parasitic infection is the main cause. The three common parasites causing eosinophilic meningitis include Angiostrongylus cantonensis, Gnathostoma spinigerum, and Taenia solium. Even though these parasites are endemic in tropical countries, they are now spreading globally due to extensive traveling, and physicians worldwide should pay more attention to this condition. This chapter will review risk factors, clinical manifestations, and treatment of these three parasites.

  2. Antimicrobial susceptibilities and serotypes of Streptococcus pneumoniae isolates from elderly patients with pneumonia and acute exacerbation of chronic obstructive pulmonary disease. (United States)

    Pérez-Trallero, Emilio; Marimón, José M; Larruskain, Julián; Alonso, Marta; Ercibengoa, María


    In the elderly, Streptococcus pneumoniae is the most common cause of pneumonia and one of the most frequently isolated pathogens in cases of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study was conducted to compare the pneumococcal isolates obtained during episodes of AECOPD and pneumonia in patients of ≥65 years old and to analyze whether in patients with AECOPD and pneumonia within a short interval, the same isolate caused both episodes. This laboratory-based study was performed between 2005 and 2008. Pneumococcal isolates from episodes of pneumonia (n = 401) and AECOPD (n = 398), matched one-to-one by date of isolation, were characterized. The serotypes and genotypes of other pneumococcal isolates causing pneumonia and AECOPD in the same patient were compared. In patients with pneumonia, COPD as an underlying disease was not associated with more-drug-resistant pneumococci. In contrast, isolates causing AECOPD showed higher rates of resistance than those causing pneumonia. Serotypes 1, 3, and 7F were more frequent in pneumonia. The same pneumococcus was involved in 25.7% (9/35 patients) of patients with two consecutive AECOPD episodes but in only 6.3% (2/32 patients) of COPD patients with pneumonia and exacerbation (Fisher's exact test; P = 0.047). Less invasive serotypes were isolated more often in AECOPD and were more resistant to antimicrobials. The presence of a specific pneumococcal serotype in AECOPD does not predict the etiology of subsequent pneumonia.

  3. Chest physiotherapy in children with acute bacterial pneumonia



    Background: Pneumonia is the single leading cause of death in children younger than 5 years of age. Chest physiotherapy is often prescribed as an additional therapy in children with pneumonia. Different chest physiotherapy techniques are available that aim to improve airway clearance, gas exchange and reduce the work of breathing. However, it is unclear if these techniques are effective in this population.Objective: The present review aimed to determine the efficacy of different chest physiot...

  4. Prediction of Pneumonia in Acute Stroke Patients Using Tongue Pressure Measurements (United States)

    Nakamori, Masahiro; Hosomi, Naohisa; Ishikawa, Kenichi; Imamura, Eiji; Shishido, Takeo; Ohshita, Tomohiko; Yoshikawa, Mineka; Tsuga, Kazuhiro; Wakabayashi, Shinichi; Maruyama, Hirofumi; Matsumoto, Masayasu


    Swallowing dysfunction caused by stroke is a risk factor for aspiration pneumonia. Tongue pressure measurement is a simple and noninvasive method for evaluating swallowing dysfunction. We have hypothesized that low tongue pressure may be able to predict pneumonia occurrence in acute stroke patients. Tongue pressure was measured using balloon-type equipment in 220 acute stroke patients. The modified Mann Assessment of Swallowing Ability (MASA) score was evaluated independently on the same day. Tongue pressure was measured every week thereafter. An improvement in tongue pressure was observed within the first 2 weeks. Receiver operating curve analysis was performed to determine the ability of tongue pressure to predict modified MASA score <95, which suggests swallowing dysfunction. The optimal cutoff for tongue pressure was 21.6 kPa (χ2 = 45.82, p<0.001, sensitivity 95.9%, specificity 91.8%, area under the curve = 0.97). The tongue pressure was significantly lower in patients with pneumonia than in those without pneumonia. Using a Cox proportional hazard model for pneumonia onset with a cutoff tongue pressure value of 21.6 kPa and adjustment for age, sex, and National Institutes of Health Stroke Scale score at admission, the tongue pressure had additional predictive power for pneumonia onset (hazard ratio, 7.95; 95% confidence interval, 2.09 to 52.11; p = 0.0013). In the group with low tongue pressure, 27 of 95 patients showed improvement of tongue pressure within 2 weeks. Pneumonia occurred frequently in patients without improvement of tongue pressure, but not in patients with improvement (31/68 and 2/27, p<0.001). Tongue pressure is a sensitive indicator for predicting pneumonia occurrence in acute stroke patients. PMID:27802333

  5. Severe acute respiratory failure secondary to acute fibrinous and organizing pneumonia requiring mechanical ventilation: a case report and literature review. (United States)

    López-Cuenca, Sonia; Morales-García, Silvia; Martín-Hita, Ana; Frutos-Vivar, Fernando; Fernández-Segoviano, Pilar; Esteban, Andrés


    A 27-year-old woman was admitted to our ICU with acute hypoxemic respiratory failure and criteria for ARDS. Despite an F(IO(2)) of 1.0 and a lung protective strategy, the patient died on day 15 without any improvement. The relatives gave consent for post-mortem analysis. The histopathologic study of the lung showed findings typical of an acute fibrinous and organizing pneumonia. Apropos of this case we performed a PubMed search. We found 13 articles, including a total of 29 patients. Acute fibrinous and organizing pneumonia is an unusual cause of acute lung injury. The diagnostic criterion is histopathologic. There is little information regarding the pathophysiology of this illness. Important questions remain regarding this disease, including predisposing factors and management. Patients who require mechanical ventilation have poor outcomes.

  6. Soluble Endothelial Selectin in Acute Lung Injury Complicated by Severe Pneumonia

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    Daisuke Osaka, Yoko Shibata, Kazunori Kanouchi, Michiko Nishiwaki, Tomomi Kimura, Hiroyuki Kishi, Shuichi Abe, Sumito Inoue, Yoshikane Tokairin, Akira Igarashi, Keiko Yamauchi, Yasuko Aida, Takako Nemoto, Keiko Nunomiya, Koji Fukuzaki, Isao Kubota


    Full Text Available Background: Pneumonia is still one of the most frequent causes of death in the elderly. Complication of acute lung injury (ALI/acute respiratory distress syndrome (ARDS by pneumonia makes patients very ill due to severe respiratory failure. Biomarkers that can discriminate the presence of complicating ALI/ARDS are required for early detection. The aim of this research was to investigate whether soluble endothelial selectin (sES could be a biomarker for ALI.Methods: Serum sES levels were measured in 27 pneumonia patients, who were enrolled between April 2006 and September 2007. Among these patients, six had ALI or a condition that was clinically comparable to ALI (cALI. All patients who were enrolled were successfully treated and survived.Results: Circulating sES levels were elevated in pneumonia patients with ALI/cALI, and sES levels decreased following treatment of their pneumonia. Univariate and multivariate logistic regression analyses showed that sES was the only significant factor for identifying complicating ALI/cALI, independently of C-reactive protein (CRP and lactate dehydrogenase (LDH. By receiver operating characteristic (ROC curve analysis, the cut-off value for sES was 40.1 ng/mL, with a sensitivity of 0.8 and a specificity of 0.8.Conclusion: sES may be a useful biomarker for discriminating complicating ALI/cALI in patients with severe pneumonia.

  7. Molecular epidemiology of nonencapsulated Streptococcus pneumoniae among Japanese children with acute otitis media. (United States)

    Hotomi, Muneki; Nakajima, Kouji; Hiraoka, Masanobu; Nahm, Moon H; Yamanaka, Noboru


    The introduction of pneumococcal conjugate vaccine may change the epidemiology of Streptococcus pneumoniae. The increased prevalence of non-vaccine serotypes as the cause of pneumococcal diseases has already reported in the United States and Europe. However, little attention has been focused on the S. pneumoniae. In this study, nonencapsulated S. pneumoniae were identified in 15 isolates (6.4%) out of 236 pneumococcal strains obtained from the nasopharynges of children with acute otitis media (AOM), in 3 isolates (14.3%) out of 21 strains from acute rhinosinusitis, and in 2 isolates (12.5%) out of 16 nasopharyngeal carriage strains obtained from normal healthy children. Among the 20 nonencapsulated S. pneumoniae isolates, 15 (75.0%) isolates had the pspK gene. Seven sequence types (STs) were identified: ST7502 (5 strains), ST1106 (2 strains), ST7803 (2 strains), ST7786 (1 strain), ST6741 (1 strain), ST7496 (1 strain), and ST8642 (1 strain). Because nonencapsulated S. pneumoniae strains are not targeted by the current available pneumococcal vaccines, these strains will gradually become more common in nasopharyngeal carriage. The increase in colonization and dissemination of these strains would increase the risk of AOM and other systemic pneumococcal diseases against which current vaccines cannot provide protection. Nonencapsulated S. pneumoniae may thus become more prevalent as human pathogen.

  8. Presence of Eosinophils in Nasal Secretion during Acute Respiratory Tract Infection in Young Children Predicts Subsequent Wheezing within Two Months

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    Miwa Shinohara


    Conclusions: Our findings not only suggest that nasal eosinophil testing may serve as a convenient clinical marker for identifying young children at risk for subsequent wheezing, but also shed new light on the role of eosinophils in the onset of wheezing in young children.

  9. Pneumonia (United States)

    ... better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking. NIH: National Heart, Lung, and Blood Institute

  10. 急性间质性肺炎%Acute interstitial pneumonia

    Institute of Scientific and Technical Information of China (English)

    李辉; 谢风


    Acute interstitial pneumonia is clinically characterized by an interstitial lung disease causing rapid onset of respiratory failure, which is different from other more chronic forms of interstitial pneumonia. It is synonymous with Hamman-Rich syndrome, occurring in patients without pre-existing lung disease. Histopathological finding is diffuse alveolar damage. Acute interstitial pneumonia radiologically and physiologically resembles acute respiratory distress syndrome and is considered to represent a part of idiopathic acute respiratory distress syndrome. It is frequently confused with other clinical entities characterized by rapidly progressive interstitial pneumonia, especially secondary acute interstitial pneumonia, acute exacerbation and accelerated forms of crytogenic fibrosing alveolitis. This review aims to clarify the relative clinical and pathological issues.%急性间质性肺炎是一种临床上引起快速呼吸衰竭的间质性肺疾病,可区别于其他慢性间质性肺炎,又称为Hamman-Rich综合征,主要发生在没有肺基础疾病的患者.组织病理学表现为弥漫性肺损伤.急性间质性肺炎的放射学和生理学改变与急性呼吸窘迫综合征相似,并且被认为代表了一小部分特发性急性呼吸窘迫综合征.急性间质性肺炎经常与其他快速进展的间质性肺炎相混淆,特别是继发性急性间质性肺炎、急性加重的隐源性机化性肺炎.本文阐述了急性间质性肺炎相关的临床和病理学问题.

  11. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

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    Filippo Luca Fimognari


    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  12. Eosinophilic colitis

    Institute of Scientific and Technical Information of China (English)

    Nnenna Okpara; Bassam Aswad; Gyorgy Baffy


    Eosinophilic colitis (EC) is a rare form of primary eosinophilic gastrointestinal disease with a bimodal peak of prevalence in neonates and young adults. EC remains a little understood condition in contrast to the increasingly recognized eosinophilic esophagitis. Clinical presentation of EC is highly variable according to mucosal, transmural, or serosal predominance of inflammation. EC has a broad differential diagnosis because colon tissue eosinophilia often occurs in parasitic infection, drug-induced allergic reactions,inflammatory bowel disease, and various connective tissue disorders, which require thorough searching for secondary causes that may be specifically treated with antibiotics or dietary and drug elimination.Like eosinophilic gastrointestinal disease involving other segments of the gastrointestinal tract, EC responds very well to steroids that may be spared by using antihistamines, leukotriene inhibitors and biologics.

  13. Eosinophilic cystitis

    NARCIS (Netherlands)

    P.G. Nikkels; T.P.V.M. de Jong (Tom); P.C.M.S. Verhagen (Paul)


    textabstractWe describe four cases of eosinophilic cystitis in whom no specific cause could be found, and review the literature. Complaints at presentation included urgency, frequency, abdominal pain, and haematuria. In three patients the symptoms and ultrasound picture

  14. High seroprevalence of Mycoplasma pneumoniae IgM in acute Q fever by enzyme-linked immunosorbent assay (ELISA.

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    Chung-Hsu Lai

    Full Text Available Q fever is serologically cross-reactive with other intracellular microorganisms. However, studies of the serological status of Mycoplasma pneumoniae and Chlamydophila pneumoniae during Q fever are rare. We conducted a retrospective serological study of M. pneumoniae and C. pneumoniae by enzyme-linked immunosorbent assay (ELISA, a method widely used in clinical practice, in 102 cases of acute Q fever, 39 cases of scrub typhus, and 14 cases of murine typhus. The seropositive (57.8%, 7.7%, and 0%, p<0.001 and seroconversion rates (50.6%, 8.8%, and 0%, p<0.001 of M. pneumoniae IgM, but not M. pneumoniae IgG and C. pneumoniae IgG/IgM, in acute Q fever were significantly higher than in scrub typhus and murine typhus. Another ELISA kit also revealed a high seropositivity (49.5% and seroconversion rate (33.3% of M. pneumoniae IgM in acute Q fever. The temporal and age distributions of patients with positive M. pneumoniae IgM were not typical of M. pneumoniae pneumonia. Comparing acute Q fever patients who were positive for M. pneumoniae IgM (59 cases with those who were negative (43 cases, the demographic characteristics and underlying diseases were not different. In addition, the clinical manifestations associated with atypical pneumonia, including headache (71.2% vs. 81.4%, p=0.255, sore throat (8.5% vs. 16.3%, p=0.351, cough (35.6% vs. 23.3%, p=0.199, and chest x-ray suggesting pneumonia (19.3% vs. 9.5%, p=0.258, were unchanged between the two groups. Clinicians should be aware of the high seroprevalence of M. pneumoniae IgM in acute Q fever, particularly with ELISA kits, which can lead to misdiagnosis, overestimations of the prevalence of M. pneumoniae pneumonia, and underestimations of the true prevalence of Q fever pneumonia.

  15. Acute and subacute chemical-induced lung injuries: HRCT findings

    Energy Technology Data Exchange (ETDEWEB)

    Akira, Masanori, E-mail: [Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai City, Osaka 591-8555 (Japan); Suganuma, Narufumi [Department of Environmental Medicine, Kochi Medical School (Japan)


    Lung injury caused by chemicals includes bronchitis, bronchiolitis, chemical pneumonitis, pulmonary edema, acute respiratory distress syndrome, organizing pneumonia, hypersensitivity pneumonitis, acute eosinophilic pneumonia, and sarcoid-like granulomatous lung disease. Each chemical induces variable pathophysiology and the situation resembles to the drug induced lung disease. The HRCT features are variable and nonspecific, however HRCT may be useful in the evaluation of the lung injuries and so we should know about HRCT features of lung parenchymal abnormalities caused by chemicals.

  16. Chest physiotherapy in children with acute bacterial pneumonia

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    Lieselotte Corten


    Full Text Available Background: Pneumonia is the single leading cause of death in children younger than 5 years of age. Chest physiotherapy is often prescribed as an additional therapy in children with pneumonia. Different chest physiotherapy techniques are available that aim to improve airway clearance, gas exchange and reduce the work of breathing. However, it is unclear if these techniques are effective in this population.Objective: The present review aimed to determine the efficacy of different chest physiotherapy techniques compared with no physiotherapy or other chest physiotherapy treatments in hospitalised children with bacterial pneumonia.Method: Six electronic databases (PubMed, Medline, Cochrane Library, PEDro, CINAHL and Africa-wide information, and were searched for eligible studies.Results: Two randomised controlled trials and one ongoing study were identified. Neither completed trial reported differences between the control and intervention groups, although one study reported a longer duration of coughing (p = 0.04 and rhonchi (p = 0.03 in the intervention group.Conclusion: Because of the limited number of included articles and different presentations of outcome measures, we could not reject or accept chest physiotherapy as either an effective or harmful treatment option in this population.

  17. Video-Assisted Thoracoscopic Lung Biopsy as a Possible Cause of Acute Interstitial Pneumonia in a Patient with Nonspecific Interstitial Pneumonia

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    D Jeffrey Moore


    Full Text Available The present case report describes a 44-year-old woman who presented with dyspnea due to diffuse interstitial lung disease. High-resolution computed tomography showed features of usual interstitial pneumonia, but the lung biopsy obtained by video-assisted thoracoscopy was consistent with a histological pattern of nonspecific interstitial pneumonia. Following the procedure, the patient developed progressive respiratory distress and died on postoperative day 13 with a clinical picture of acute interstitial pneumonia. The autopsy showed evidence of diffuse alveolar damage superimposed on the background pattern of nonspecific interstitial pneumonia. The present case report supports the notion that patients with a variety of subtypes of idiopathic interstitial pneumonias may be at risk of exacerbation of their underlying disease following thoracic procedures, including video-assisted thoracoscopic lung biopsy.

  18. Sudden psychotic episode probably due to meningoencephalitis and Chlamydia pneumoniae acute infection

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    Canas Nuno


    Full Text Available Abstract Background Since 9% to 20% of all cases of acute psychosis presenting to an Emergency Department (ED are due to a general medical condition, cautious medical workup should be mandatory in such patients. Differential diagnosis must consider conditions as diverse as renal failure or CNS infection. Acute Chlamydia pneumoniae infection usually causes a self-limited respiratory syndrome. Rarely, acute neurological complications occur, with acute meningoencephalitis most frequently reported. Diagnosis requires a high level of suspicion and is difficult to confirm. Case report We describe a 22 year-old female Caucasian who, three days after a mild pharingitis, developed an acute psychosis with exuberant symptoms interspersed with periods of lucidity, in a background of normal consciousness and orientation. Initial medical and imagiological workup were inconclusive. After 20 days of unsuccessful treatment with antipsychotics she developed a high fever and was re-evaluated medically. Lumbar puncture revealed an inflammatory cerebrospinal fluid. MRI showed irregular thickening and nodularity of the lateral ventricles' lining. An anti-Chlamydia pneumoniae IgM antibody titter of 85 IU/ml was detected. All symptoms cleared after treatment with antibiotics and corticosteroids. Conclusion This is, to our knowledge, the first reported case of acute CP-associated meningoencephalitis manifesting as an acute psychotic episode. It illustrates the principle that non-organic psychiatric syndromes must remain a diagnosis of exclusion in first-time acute psychosis.

  19. Acute Fibrinous and Organizing Pneumonia Associated With Allogenic Hematopoietic Stem Cell Transplant Successfully Treated With Corticosteroids

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    Lam-Phuong Nguyen DO


    Full Text Available Acute fibrinous and organizing pneumonia (AFOP is an extremely rare, relatively new, and distinct histological pattern of acute lung injury characterized predominately by the presence of intra-alveolar fibrin and associated organizing pneumonia. AFOP may be idiopathic or associated with a wide spectrum of clinical conditions. It has a variable clinical presentation from mild respiratory symptoms to that similar to the acute respiratory distress syndrome. Currently there is no consensus on treatment, and corticosteroids previously were of unclear benefit. To date, there are less than 40 cases of AFOP reported in the literature and only one has been linked to hematopoietic stem cell transplantation. Here we report the first case series of 2 patients who developed AFOP following allogenic stem cell transplant that were successfully treated with high-dose corticosteroids.

  20. A(H1N1)Influenza Pneumonia with Acute Disseminated Encephalomyelitis: A Case Report

    Institute of Scientific and Technical Information of China (English)



    @@ INTRODUCTION A 56-year-old Chinese female patient with A (H1N1) influenza pneumonia accompanied by acute disseminated encephalomyelitis (ADEM) of the Central Nervous System (CNS) is described in this article. The patient had typical clinical manifestation,and the diagnosis was reached after MRI and other examinations. From this case, we can conclude that the virus ofA (H1N1) influenza can infect CNS, and we should pay more attention to patients of A (H1N1)influenza pneumonia with neurological complications.

  1. Acute bacterial meningitis caused by Streptococcus pneumoniae resistant to the antimicrobian agents and their serotypes Meningite bacteriana aguda por Streptococcus pneumoniae resistente aos antimicrobianos e seus sorotipos


    Andrea Maciel de Oliveira Rossoni; Libera Maria Dalla Costa; Denize Bonato Berto; Sônia Santos Farah; Marilene Gelain; Maria Cristina de Cunto Brandileone; Vitor Hugo Mariano Ramos; Sergio Monteiro de Almeida


    The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from Apri...

  2. Community acquired bilateral upper lobe Pneumonia with acute adrenal insufficiency: A new face of Achromobacter xylosoxidans

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    Suman S Karanth


    Full Text Available AbstractAchromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection.

  3. Community acquired bilateral upper lobe pneumonia with acute adrenal insufficiency: A new face of Achromobacter Xylosoxidans. (United States)

    Karanth, Suman S; Gupta, Anurag; Prabhu, Mukhyaprana


    Achromobacter xylosoxidans is an uncommon pathogen of low virulence known to cause serious nosocomial infection in the immunocompromised. Its inherent multi-drug resistance makes treatment difficult. Community-acquired infections are rare despite its ubiquitous existence. We present a 50-year-old immunocompetent woman who presented with one-month history of coughing with expectoration who was subsequently diagnosed with bilateral upper lobe pneumonia and acute adrenal insufficiency. Achromobacter xylosoxidans was isolated from sputum and bronchoalveolar lavage culture. The acute adrenal insufficiency recovered after appropriate antibiotic therapy. Amongst the myriad of presentations, we highlight the rarity of acute adrenal insufficiency triggered by the infection.

  4. Asthma and pneumonia among children less than five years with acute respiratory symptoms in Mulago Hospital, Uganda

    DEFF Research Database (Denmark)

    Nantanda, Rebecca; Tumwine, James K; Ndeezi, Grace;


    Pneumonia is considered the major cause of mortality among children with acute respiratory disease in low-income countries but may be over-diagnosed at the cost of under-diagnosing asthma. We report the magnitude of asthma and pneumonia among "under-fives" with cough and difficulty breathing, based...

  5. Eosinophilic esophagitis

    Institute of Scientific and Technical Information of China (English)

    Anand R Gupte; Peter V Draganov


    Eosinophilic esophagitis is increasingly recognized in adults. The diagnosis is based on the presence of both typical symptoms and pathologic findings on esophageal biopsy. Patients usually present with dysphagia, food impaction and/or reflux-like symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power field. In addition,it is essential to exclude the presence of known causes of tissue eosinophilia such as gastroesophageal reflux disease, infections, malignancy, collagen vascular diseases, hypersensitivity, and inflammatory bowel disease. There are no standardized protocols for the therapy of eosinophilic esophagitis. A variety of therapeutic approaches including acid suppression, dietary modi f icat ions, topical cor t icosteroids and endoscopic dilation can be used alone or in combination.

  6. The Infection of Chlamydia Pneumonia in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    李涛; 许香广; 张国良; 方卫华


    Objectives To study the association between infection with chlamydia pneumonia and acute myocardial infarction (AMI). Methods Serology of chlamydia pneumoniae specific IgG、IgM antibodies were measured by microimmunofluorescence test in groups of acute myocardial infarction (AMI) and health control(HC). Results The total infection positive rates were 30.6% in HC group and 88.1% in AMI group, including the previous infection rates which were 30.6% and 71.4%, while the acute infection rates were 0% and 16.7%. The frequency of total infection, previous infection and acute infection was significantly higher in AMI group than in the HC group. Odds Ratio for the development of AMI were 16.82, 5.68, 14.2, respectively(95% CI 5.83 to 48.54,2.46 to 13.11, 1.68 to 119.97). Geometric mean IgG titre was significantly higher in patients with AMI compared with the HC group (P< 0.01). There is no IgM positive in HC group but there were two cases in AMI group. Conclusions The presence of high titers of immmunoglobulin G in AMI. Chlamydia pneumonia infection may be a risk factor for the AMI .

  7. Diagnosis and Treatment of Acute EosinophiIic Pneumonia:One Case Report%急性嗜酸粒细胞性肺炎一例诊治分析

    Institute of Scientific and Technical Information of China (English)



    Acute eosinophilic pneumonia( AEP) is a rare type of low incidence of eosinophilic pneumonia diseases, which have various manifestations. The delayed increase of peripheral blood eosinophilic granulocytes is one of its main features and the main reason of its uneasy diagnosis. This paper analyzes the diagnostic process of an AEP patient,who failed to get a definite diagnosis after a number of examinations and was diagnosed as AEP after percutaneous lung biopsy. At this point, peripheral blood eosinophils increased significantly. Its acute onset manifests cough, sputum clinically. In patients with inconspicuous systemic symptoms, chest X - ray or lung CT presented real shadow. The peripheral blood cells should be rechecked for several times and if necessary,electronic bronchoscope combined with bronchialveolar lavage fluid can be used to carry out eosinophilic granulocyte counts in order to make a diagnosis as early as possible.%急性嗜酸粒细胞性肺炎是嗜酸粒细胞性肺疾病的一种少见类型,发病率较低,临床表现多样,外周血嗜酸粒细胞迟发性增高是其主要特点之一,也是早期不易确诊的主要原因。本文报道1例急性嗜酸粒细胞性肺炎患者,其早期经多项检查未能确诊,后行经皮肺穿刺活检术诊断为急性嗜酸粒细胞性肺炎。此时,患者外周血嗜酸粒细胞增高明显。建议对于急性发病,临床主要表现为咳嗽、咳痰,全身症状不明显,而胸片或双肺CT呈实变性阴影者,应多次复查外周血细胞,必要时可采用电子支气管镜结合支气管肺泡灌洗液行嗜酸粒细胞计数检查,以尽早确诊。

  8. A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid

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    Hideki Yasui


    Full Text Available Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days after he ingested the kerosene. After corticosteroid commencement, the patient's symptoms and hypoxia improved within a few days. Although some radiological characteristics of this disorder have been reported previously, the process of radiological improvement of exogenous lipoid pneumonia is not well known. In this case, computed tomography findings changed dramatically after corticosteroid therapy was initiated. Extensive bilateral consolidations that were observed on admission improved. Although pneumatoceles developed two weeks after corticosteroid commencement, they were nearly gone after two months of the treatment. While corticosteroid therapy is not suitable for all cases, it should be considered for severe or refractory cases.

  9. [Serotype distribution and antibiotic susceptibilities of Streptococcus pneumoniae causing acute exacerbations and pneumonia in children with chronic respiratory diseases]. (United States)

    Altınkanat Gelmez, Gülşen; Soysal, Ahmet; Kuzdan, Canan; Karadağ, Bülent; Hasdemir, Ufuk; Bakır, Mustafa; Söyletir, Güner


    This study aimed to investigate serotype distribution and antimicrobial resistance of Streptococcus pneumoniae isolates obtained from children with chronic respiratory diseases admitted to hospital with a diagnosis of acute exacerbations between 2008-2010 at Marmara University Hospital, Istanbul, Turkey. Sixty one S.pneumoniae strains isolated from the respiratory samples of patients were studied for erythromycin, clindamycin, tetracyline, trimethoprim-sulphametoxazole (TMP-SMX), vancomycin, levofloxacin susceptibilities by disk diffusion method; MIC values of penicillin and ceftriaxone were determined by E-test (AB Biodisk, Sweden). Results were evaluated according to the CLSI standards. The erythromycin-clindamycin double disc method was applied for the detection of macrolide resistance phenotypes. The presence of macrolide resistance genes, ermB, mef(A)/(E), ermTR were determined by PCR using specific primers for each gene. The serotypes were determined by multiplex PCR using specific primers for 40 different serotypes. According to CLSI criteria, penicillin resistance in S.pneumoniae isolates were found to be 8.2% (5/61) and intermediate resistance rate was 54% (33/61) for oral penicillin. Penicillin resistance were found to be only 1.6% (1/61) for parenteral penicillin. Resistance rates of erythromycin, clindamycin, tetracyline, TMP-SMX were detected as 55.8%, 46%, 47.5% and 67.2%; respectively. No resistance was detected to vancomycin and levofloxacin. Constitutive macrolide-lincosamide-streptogramin B (cMLSB) phenotype and M phenotype were observed in 82.4% (n= 28) and 17.6% (n= 6) of the macrolide resistant isolates, respectively. Inducible macrolide-lincosamide-streptogramin B (iMLSB) phenotype was not detected. The macrolid resistance genotypes, ermB, mef(A)/(E), were positive 50% and 14.7%; respectively. Both ermB and mef(A)/(E) genes were detected 35.3% of the macrolid resistant isolates. None of the isolates were positive for ermTR gene. The most

  10. Detection and significance of inflammatory factors and immunoglobulin in acute stage patients with infantile pneumonia

    Institute of Scientific and Technical Information of China (English)

    Xiao-Zheng Meng; Liang Qiao


    Objective:To investigate the detection and significance of inflammatory factors and immunoglobulin in acute stage patients with infantile pneumonia.Methods:A total of 80 cases of acute stage patients with infantile pneumonia were divided into mild group (n=33) and severe group (n=47) according to illness degrees, and 40 cases of healthy children were selected as control group. Serum CRP, Ig A, Ig G and Ig M levels were detected by nephelometry, IL-6 levels were detected by enzyme-linked immunosorbent assay. The levels of inflammatory factors (CRP, IL-6) and immunoglobulin indexes (Ig A, Ig G and Ig M) were compared among 3 groups.Results: The inflammatory factors (CRP, IL-6) in mild and severe group increased significantly compared with control group, CRP and IL-6 levels in severe group were were significantly higher than that in mild group (P<0.05). The levels of Ig A in mild and severe group decreased significantly compared with control group, Ig A level in severe group was significantly lower than that in mild group (P<0.05), the levels of Ig G and Ig M in mild and severe group increased significantly compared with control group, the levels of Ig G and Ig M in severe group were significantly higher than that in mild group (P<0.05). Conclusions:The levels of inflammatory factors are increased while immune function is decreased in acute stage patients with infantile pneumonia. Inflammation is stronger and immune function is worse with the severity of the disease. Detection of inflammatory factors and immunoglobulin levels is helpful to diagnose and treatment of acute stage patients with infantile pneumonia.

  11. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward



    Abstract Background: Our aim was to compare the accuracy of lung ultrasound (LUS) and standard chest x-ray (CXR) for diagnosing pneumonia in older patients with acute respiratory symptoms (dyspnea, cough, hemoptysis, and atypical chest pain) admitted to an acute-care geriatric ward. Methods: We enrolled 169 (80 M, 89 F) multimorbid patients aged 83.0 ± 9.2 years from January 1 to October 31, 2015. Each participant underwent CXR and bedside LUS within 6 hours from ward admission. LUS was perfo...

  12. Clinical and Radiological Profile of Acute Fibrinous and Organizing Pneumonia: A Retrospective Study

    Institute of Scientific and Technical Information of China (English)

    Jing-Hong Dai; Hui Li; Wei Shen; Li-Yun Miao; Yong-Long Xiao; Mei Huang; Meng-Shu Cao


    Background:Acute fibrinous and organizing pneumonia (AFOP) is a unique pathological entity with intra-alveolar fibrin in the form of "fibrin balls" and organizing pneumonia.It was divided into rare idiopathic interstitial pneumonia according to the classification notified by American Thoracic Society/European Respiratory Society in 2013.As a rare pathological entity,it is still not well known and recognized by clinicians.We reviewed the clinical features of 20 patients with AFOP diagnosed in a teaching hospital.Methods:The medical records of 20 patients with biopsy-proven diagnosis of AFOP were retrospectively reviewed.The patients' symptoms,duration of the disease,comorbidities,clinical laboratory data,pulmonary function testing,radiographic studies,and the response to treatment were extracted and analyzed.Results:Fever was the most common symptom and was manifested in 90% of AFOP patients.For clinical laboratory findings,systematic inflammatory indicators,including C-reactive protein and erythrocyte sedimentation rate,were significantly higher than normal in AFOP patients.In accordance with this increased indicators,injured liver functions were common in AFOP patients.Inversely,AFOP patients had worse clinical conditions including anemia and hypoalbuminemia.For pulmonary function testing,AFOP patients showed the pattern of restrictive mixed with obstructive ventilation dysfunction.For high-resolution computerized tomography (HRCT) findings,the most common pattern for AFOP patients was lobar consolidation which was very similar to pneumonia.However,unlike pneumonia,AFOP patients responded well to glucocorticoids.Conclusion:Patients with AFOP manifest as acute inflammatory-like clinical laboratory parameters and lobar consolidation on HRCT,but respond well to steroid.

  13. Effects of inhaled CO administration on acute lung injury in baboons with pneumococcal pneumonia (United States)

    Kraft, Bryan D.; Hess, Dean R.; Harris, R. Scott; Wolf, Monroe A.; Suliman, Hagir B.; Roggli, Victor L.; Davies, John D.; Winkler, Tilo; Stenzler, Alex; Baron, Rebecca M.; Thompson, B. Taylor; Choi, Augustine M.; Welty-Wolf, Karen E.; Piantadosi, Claude A.


    Inhaled carbon monoxide (CO) gas has therapeutic potential for patients with acute respiratory distress syndrome if a safe, evidence-based dosing strategy and a ventilator-compatible CO delivery system can be developed. In this study, we used a clinically relevant baboon model of Streptococcus pneumoniae pneumonia to 1) test a novel, ventilator-compatible CO delivery system; 2) establish a safe and effective CO dosing regimen; and 3) investigate the local and systemic effects of CO therapy on inflammation and acute lung injury (ALI). Animals were inoculated with S. pneumoniae (108-109 CFU) (n = 14) or saline vehicle (n = 5); in a subset with pneumonia (n = 5), we administered low-dose, inhaled CO gas (100–300 ppm × 60–90 min) at 0, 6, 24, and/or 48 h postinoculation and serially measured blood carboxyhemoglobin (COHb) levels. We found that CO inhalation at 200 ppm for 60 min is well tolerated and achieves a COHb of 6–8% with ambient CO levels ≤ 1 ppm. The COHb level measured at 20 min predicted the 60-min COHb level by the Coburn-Forster-Kane equation with high accuracy. Animals given inhaled CO + antibiotics displayed significantly less ALI at 8 days postinoculation compared with antibiotics alone. Inhaled CO was associated with activation of mitochondrial biogenesis in the lung and with augmentation of renal antioxidative programs. These data support the feasibility of safely delivering inhaled CO gas during mechanical ventilation and provide preliminary evidence that CO may accelerate the resolution of ALI in a clinically relevant nonhuman primate pneumonia model. PMID:26320156

  14. Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P). (United States)

    Marchand, E; Reynaud-Gaubert, M; Lauque, D; Durieu, J; Tonnel, A B; Cordier, J F


    Idiopathic chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown cause with nonspecific respiratory and systemic symptoms but rather characteristic peripheral alveolar infiltrates on imaging, developing mainly in women and in atopic subjects. The disorder is highly responsive to oral corticosteroid therapy, but relapses are frequent on reducing or stopping treatment. The long-term course of the disease and data regarding outcome, particularly the need for prolonged oral corticosteroid therapy and the development of severe asthma, are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features and, above all, the later course of CEP in a large homogeneous series of 62 stringently selected patients of whom 46 were followed for more than 1 year. The prevalence of smokers was low (6.5%) and about half of our patients (51.6%) had a previous, and often prolonged, history of asthma. The clinical and roentgenographic features were in keeping with previous studies, but we found that computed tomography could disclose ground glass opacities not detected by X-ray, and that migratory infiltrates before treatment were more frequent (25.5%) than reported previously. The bronchoalveolar lavage cellular count always showed a striking eosinophilic pattern, thus allowing distinction between CEP and cryptogenic organizing pneumonia, both syndromes sharing many common clinical and imaging features. About two-thirds of the patients (68%) showed a ventilatory defect in pulmonary function tests, with about one-half of these presenting with an obstructive pattern, sometimes without previous asthma. Along with the submucosal eosinophilic infiltration noted in 2 patients without ventilatory defect, this is strong evidence to confirm that CEP is not only an alveolointerstitial but also an airway disease. The dramatic response to oral corticosteroid therapy was observed in all treated patients. Although only 1

  15. Effect of nitric oxide inhalation on gas exchange in acute severe pneumonia. (United States)

    Gómez, Federico P; Amado, Veronica M; Roca, Josep; Torres, Antoni; Nicolas, Josep M; Rodriguez-Roisin, Robert; Barberà, Joan A


    Inhaled nitric oxide (NO) causes selective pulmonary vasodilatation and may improve gas exchange. The study was aimed to evaluate the acute effects of inhaled NO on pulmonary gas exchange in severe unilateral pneumonia, where hypoxemia results from increased intrapulmonary shunt. We studied 8 patients without preexisting lung disease (59±18 yr; 4M/4F) with early unilateral severe pneumonia and respiratory failure. Pulmonary and systemic hemodynamics and gas exchange, including ventilation-perfusion (V;A/Q;) distributions, were measured at baseline and while breathing 5 and 40 parts per million (ppm) of NO. Inhaled NO caused a dose-dependent fall in pulmonary vascular resistance (by 12% and 21%, with 5 and 40ppm, respectively; ppneumonia.

  16. Acute fibrinous and organising pneumonia: a rare histopathological variant of chemotherapy-induced lung injury. (United States)

    Gupta, Arjun; Sen, Shiraj; Naina, Harris


    Bleomycin-induced lung injury is the most common chemotherapy-associated lung disease, and is linked with several histopathological patterns. Acute fibrinous and organising pneumonia (AFOP) is a relatively new and rare histological pattern of diffuse lung injury. We report the first known case of bleomycin-induced AFOP. A 36-year-old man with metastatic testicular cancer received three cycles of bleomycin, etoposide and cisplatin, before being transitioned to paclitaxel, ifosfamide and cisplatin. He subsequently presented with exertional dyspnoea, cough and pleuritic chest pain. CT of the chest demonstrated bilateral ground glass opacities with peribronchovascular distribution and pulmonary function tests demonstrated a restrictive pattern of lung disease with impaired diffusion. Transbronchial biopsy revealed intra-alveolar fibrin deposits with organising pneumonia, consisting of intraluminal loose connective tissue consistent with AFOP. The patient received high-dose corticosteroids with symptomatic and radiographic improvement. AFOP should be recognised as a histopathological variant of bleomycin-induced lung injury.

  17. Allergic airway inflammation decreases lung bacterial burden following acute Klebsiella pneumoniae infection in a neutrophil- and CCL8-dependent manner. (United States)

    Dulek, Daniel E; Newcomb, Dawn C; Goleniewska, Kasia; Cephus, Jaqueline; Zhou, Weisong; Reiss, Sara; Toki, Shinji; Ye, Fei; Zaynagetdinov, Rinat; Sherrill, Taylor P; Blackwell, Timothy S; Moore, Martin L; Boyd, Kelli L; Kolls, Jay K; Peebles, R Stokes


    The Th17 cytokines interleukin-17A (IL-17A), IL-17F, and IL-22 are critical for the lung immune response to a variety of bacterial pathogens, including Klebsiella pneumoniae. Th2 cytokine expression in the airways is a characteristic feature of asthma and allergic airway inflammation. The Th2 cytokines IL-4 and IL-13 diminish ex vivo and in vivo IL-17A protein expression by Th17 cells. To determine the effect of IL-4 and IL-13 on IL-17-dependent lung immune responses to acute bacterial infection, we developed a combined model in which allergic airway inflammation and lung IL-4 and IL-13 expression were induced by ovalbumin sensitization and challenge prior to acute lung infection with K. pneumoniae. We hypothesized that preexisting allergic airway inflammation decreases lung IL-17A expression and airway neutrophil recruitment in response to acute K. pneumoniae infection and thereby increases the lung K. pneumoniae burden. As hypothesized, we found that allergic airway inflammation decreased the number of K. pneumoniae-induced airway neutrophils and lung IL-17A, IL-17F, and IL-22 expression. Despite the marked reduction in postinfection airway neutrophilia and lung expression of Th17 cytokines, allergic airway inflammation significantly decreased the lung K. pneumoniae burden and postinfection mortality. We showed that the decreased lung K. pneumoniae burden was independent of IL-4, IL-5, and IL-17A and partially dependent on IL-13 and STAT6. Additionally, we demonstrated that the decreased lung K. pneumoniae burden associated with allergic airway inflammation was both neutrophil and CCL8 dependent. These findings suggest a novel role for CCL8 in lung antibacterial immunity against K. pneumoniae and suggest new mechanisms of orchestrating lung antibacterial immunity.

  18. Journey of a survivor of near drowning, polymicrobial pneumonia, and acute respiratory distress syndrome. (United States)

    Ecklund, Margaret M; Wahl, Gary; Yamshchikov, Alexandra V; Smith, Michael S


    This article discusses a woman who collapsed and landed in a puddle of water in a park near a horse trail. Her rescue and resuscitation started an extraordinary effort by her body to heal from multiple insults. This case study highlights the diagnosis and support of polymicrobial pneumonia secondary to near drowning and the multisystem complications throughout the 3-month hospitalization. It highlights the evidence for treatment of the polymicrobial nature of submersion injury, acute lung injury, and benefits of progressive mobility. Social media as a tool for the family's communication and coping are also discussed.

  19. Treatment Failure and Mortality amongst Children with Severe Acute Malnutrition Presenting with Cough or Respiratory Difficulty and Radiological Pneumonia.

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti

    Full Text Available Appropriate intervention is critical in reducing deaths among under-five, severe acutely malnourished (SAM children with danger signs of severe pneumonia; however, there is paucity of data on outcome of World Health Organisation (WHO recommended interventions of SAM children with severe pneumonia. We sought to evaluate outcome of the interventions in such children.We prospectively enrolled SAM children aged 0-59 months, admitted to the Intensive Care Unit (ICU or Acute Respiratory Infection (ARI ward of the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b, between April 2011 and June 2012 with cough or respiratory difficulty and radiological pneumonia. All the enrolled children were treated with ampicillin and gentamicin, and micronutrients as recommended by the WHO. Comparison was made among pneumonic children with (n = 111 and without WHO defined danger signs of severe pneumonia (n = 296. The outcomes of interest were treatment failure (if a child required changing of antibiotics and deaths during hospitalization. Further comparison was also made among those who developed treatment failure and who did not and among the survivors and deaths.SAM children with danger signs of severe pneumonia more often experienced treatment failure (58% vs. 20%; p<0.001 and fatal outcome (21% vs. 4%; p<0.001 compared to those without danger signs. Only 6/111 (5.4% SAM children with danger signs of severe pneumonia and 12/296 (4.0% without danger signs had bacterial isolates from blood. In log-linear binomial regression analysis, after adjusting for potential confounders, danger signs of severe pneumonia, dehydration, hypocalcaemia, and bacteraemia were independently associated both with treatment failure and deaths in SAM children presenting with cough or respiratory difficulty and radiological pneumonia (p<0.01.The result suggests that SAM children with cough or respiratory difficulty and radiologic pneumonia who

  20. TNF-α Induces Transient Resistance to Fas-induced Apoptosis in Eosinophilic Acute Myeloid Leukemia Cells

    Institute of Scientific and Technical Information of China (English)

    Yimin Qin; Sogyong Auh; Lyubov Blokh; Catherine Long; Isabelle Gagnon; Kimm J. Hamann


    Tumor necrosis factor α (TNF-α) has been recognized as an activator of nuclear factor κB (NF-κB), a factor implicated in the protection of many cell types from apoptosis. We and others have presented evidence to suggest that Fas-induced apoptosis may be an important aspect of the resolution of inflammation, and that delayed resolution of inflammation may be directly associated with NF-κB-dependent resistance to Fas. Because TNF-α activates NF-κB in many cell types including inflammatory cells such as eosinophils, we examined effects of TNF-α signaling on the Fas-mediated killing of an eosinophilic cell line AML14. While agonist anti-Fas (CH11) treatment induced apoptosis in AML14 cells, no significant cell death occurred in response to TNF-α alone. Electrophoretic mobility shift assay (EMSA) revealed that TNF-α induced NF-κB transactivation in AML14 cells in a time- and dose-dependent fashion, and subsequent supershift assays indicated that the translocated NF-κB was the heterodimer p65 (RelA)/p50. Pre-treatment of cells with TNF-α dramatically decreased the CH11-induced cell death in a transient fashion, accompanied by suppression of activation of caspase-8 and caspase-3 activation. Inhibition of NF-κB transactivation by inhibitors, BAY 11-7085 and parthenolide, reversed the suppression of Fas-mediated apoptosis by TNF-α. Furthermore, TNF-α up-regulated X-linked inhibitor of apoptosis protein (XIAP) transiently and XIAP levels were correlated with the temporal pattern of TNF-α protection against Fas-mediated apoptosis. This finding suggested that TNF-α may contribute to the prolonged survival of inflammatory cells by suppression of Fas-mediated apoptosis, the process involved with NF-κB transactivation, anti-apoptotic XIAP up-regulation and caspase suppression.

  1. Acute bacterial meningitis caused by Streptococcus pneumoniae resistant to the antimicrobian agents and their serotypes Meningite bacteriana aguda por Streptococcus pneumoniae resistente aos antimicrobianos e seus sorotipos

    Directory of Open Access Journals (Sweden)

    Andrea Maciel de Oliveira Rossoni


    Full Text Available The main objectives of this study are to evaluate the resistance rates of Streptococcus pneumonia to penicillin G, ceftriaxone and vancomycin in patients with meningitis; to analyze possible risk factors to the antimicrobian resistance; to describe the serotypes detected and to suggest an initial empirical treatment for meningitis. The sensitiveness and serotypes of all isolated S. pneumoniae of patients with acute bacterial meningitis received by the Paraná State Central Laboratory from April 2001 to august 2002 have been evaluated. One hundred S. pneumoniae have been isolated, of which 15% were resistant to penicillin, 1% to cephalosporin and 0% to vancomycin. The serotypes most found were 14 (19%, 3 and 23F (10% each. When only the resistant serotypes were analyzed, the most prevalent was the 14 with 44%. The risk factors found in relation to the S. pneumoniae resistance were: age under one year old (p=0.01 and previous use of antibiotic (p=0.046. The resistance rates found, which were moderate to penicillin, low to cephalosporin and neutral to vancomycin, suggest the isolated use of a 3rd generation cephalosporin as an initial empirical therapy for the treatment of acute bacterial meningitis with a communitarian background.Este estudo teve como objetivo avaliar as taxas de resistência de Streptococcus pneumoniae, isolados de pacientes com meningite, à penicilina G, ceftriaxona e vancomicina; avaliar possíveis fatores de risco para resistência antimicrobiana; descrever os sorotipos encontrados e sugerir a terapêutica empírica inicial para meningite. Foram isoladas 100 amostras de S. pneumoniae, encontrando-se 15% de resistência à penicilina, 1% à cefalosporina e 0% à vancomicina. Os sorotipos mais encontrados foram 14 (19%, 3 e 23F (10% cada. Analisando-se os resistentes, o sorotipo 14 (44% também foi o mais freqüente. Os fatores de risco para resistência de S. pneumoniae encontrados foram: idade menor que um ano (p=0,01 e o uso

  2. A case of catastrophic antiphospholipid syndrome, which presented an acute interstitial pneumonia-like image on chest CT scan. (United States)

    Kameda, Tomohiro; Dobashi, Hiroaki; Susaki, Kentaro; Danjo, Junichi; Nakashima, Shusaku; Shimada, Hiromi; Izumikawa, Miharu; Takeuchi, Yohei; Mitsunaka, Hiroki; Bandoh, Shuji; Imataki, Osamu; Nose, Masato; Matsunaga, Takuya


    We report the case of catastrophic antiphospholipid syndrome (CAPS) complicated with mixed connective tissue disease (MCTD). A female patient was diagnosed with acute interstitial pneumonia (AIP) with MCTD by chest CT scan. Corticosteroid therapy was refractory for lung involvement, and she died due to acute respiratory failure. The autopsy revealed that AIP was compatible with lung involvement of CAPS. We therefore suggest that chest CT might reveal AIP-like findings in CAPS patients whose condition is complicated with pulmonary manifestations.

  3. Duration of Colonization With Klebsiella pneumoniae Carbapenemase-Producing Bacteria at Long-Term Acute Care Hospitals in Chicago, Illinois

    NARCIS (Netherlands)

    Haverkate, Manon R; Weiner, Shayna; Lolans, Karen; Moore, Nicholas M; Weinstein, Robert A; Bonten, Marc J M; Hayden, Mary K; Bootsma, Martin C J


    Background.  High prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae has been reported in long-term acute care hospitals (LTACHs), in part because of frequent readmissions of colonized patients. Knowledge of the duration of colonization with KPC is essential to iden

  4. Impact of the use of procalcitonin assay in hospitalized adult patients with pneumonia at a community acute care hospital. (United States)

    Kook, Janet L; Chao, Stephanie R; Le, Jennifer; Robinson, Philip A


    A retrospective, quasi-experimental cohort study compared antibiotic use before and after implementation of a procalcitonin assay at a community acute care hospital. This study demonstrated that the implementation of the procalcitonin assay was associated with a decrease in antibiotic days of therapy in adult patients with pneumonia.

  5. Pathophysiology of acute meningitis caused by Streptococcus pneumoniae and adjunctive therapy approaches

    Directory of Open Access Journals (Sweden)

    Tatiana Barichello


    Full Text Available Pneumococcal meningitis is a life-threatening disease characterized by an acute purulent infection affecting piamater, arachnoid and the subarachnoid space. The intense inflammatory host's response is potentially fatal and contributes to the neurological sequelae. Streptococcus pneumoniae colonizes the nasopharynx, followed by bacteremia, microbial invasion and blood-brain barrier traversal. S. pneumoniae is recognized by antigen-presenting cells through the binding of Toll-like receptors inducing the activation of factor nuclear kappa B or mitogen-activated protein kinase pathways and subsequent up-regulation of lymphocyte populations and expression of numerous proteins involved in inflammation and immune response. Many brain cells can produce cytokines, chemokines and others pro-inflammatory molecules in response to bacteria stimuli, as consequence, polymorphonuclear are attracted, activated and released in large amounts of superoxide anion and nitric oxide, leading to the peroxynitrite formation, generating oxidative stress. This cascade leads to lipid peroxidation, mitochondrial damage, blood-brain barrier breakdown contributing to cell injury during pneumococcal meningitis.

  6. Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia. (United States)

    Wollina, Uwe; Graf, Andreas; Hanisch, Volkmar


    Microcannular liposuction in tumescent anesthesia is the most effective treatment for painful lipedema. Tumescent anesthesia is an established and safe procedure in local analgesia when performed according to guidelines. Major adverse effects are rare. In patients with advanced lipedema, however, the commonly presented comorbidities bear additional risks.We report on post-surgical acute pulmonary edema after tumescent liposuction according to guidelines in a 52-year-old female patient with lipedema of the legs. We discuss in detail possible scenarios that might be involved in such emergency. In the present case the most likely was a retarded community acquired atypical pneumonia with aggravation of pre-existent comorbidities.A combined treatment with intravenous b-lactam antibiosis, positive pressure ventilation, and continuous venovenous hemodialysis and filtration resulted in complete remission in a couple of days. In conclusion, tumescent liposuction of advanced lipedema patients should only be performed in well-trained centers with sufficient infrastructure.

  7. Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia

    Directory of Open Access Journals (Sweden)

    Youjin Chang


    Full Text Available Severe acute respiratory distress syndrome (ARDS is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO made it possible to consider lung transplantation (LTPL in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.

  8. Acute Chlamydia pneumoniae infections in asthmatic and non-asthmatic military conscripts during a non-epidemic period. (United States)

    Juvonen, R; Bloigu, A; Paldanius, M; Peitso, A; Silvennoinen-Kassinen, S; Harju, T; Leinonen, M; Saikku, P


    Chlamydia pneumoniae respiratory tract infections were studied in 512 male military conscripts (123 asthmatic and 389 non-asthmatic) taking part in 180-day service between July 2004 and July 2005 in Kajaani, Finland. Respiratory tract infections requiring a medical consultation were analysed prospectively. At baseline, at end of service, and during each episode of respiratory infection, blood samples were obtained for measurement of C. pneumoniae antibodies. Data concerning the clinical features of each infection episode were collected. Serological evidence of acute C. pneumoniae infection was found in 34 of the 512 conscripts with antibody data available, including 9.8% of the asthmatic subjects and 5.7% of the non-asthmatic subjects (p 0.111). A serological diagnosis could be made for 25 clinical episodes in 24 conscripts. The spectrum of respiratory tract infections included 13 episodes of mild upper respiratory tract infection and seven episodes of sinusitis, with five episodes involving asthma exacerbation. Two of three pneumonias were primary infections. Primary infections were diagnosed in five subjects, and re-infection/reactivation in 19 subjects, with the latter comprising 12 non-asthmatic subjects and seven asthmatic subjects (p 0.180). Prolonged infections were present in six asthmatic subjects and one non-asthmatic subject (p 0.001). A wide variety of respiratory tract infections, ranging from common cold to pneumonia, were associated with serologically confirmed C. pneumoniae infections. Infections were often mild, with common cold and sinusitis being the most common manifestations. Acute, rapidly resolved C. pneumoniae infections were equally common among asthmatic subjects and non-asthmatic subjects, whereas prolonged infections were more common among subjects with asthma.

  9. Post-infective transverse myelitis following Streptococcus pneumoniae meningitis with radiological features of acute disseminated encephalomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Williams Thomas


    Full Text Available Abstract Introduction Post-infectious autoimmune demyelination of the central nervous system is a rare neurological disorder typically associated with exanthematous viral infections. We report an unusual presentation of the condition and a previously undocumented association with Streptococcus pneumonia meningitis. Case presentation A 50-year-old Caucasian woman presented to our facility with an acute myelopathy three days after discharge following acute Streptococcus pneumoniae meningitis. Imaging studies of the spine ruled out an infective focus and no other lesions were seen within the cord. Diffuse, bilateral white matter lesions were seen within the cerebral hemispheres, and our patient was diagnosed as having a post-infective demyelination syndrome that met the diagnostic criteria for an acute transverse myelitis. Our patient clinically and radiologically improved following treatment with steroids. Conclusions The novel association of a Streptococcus pneumoniae infection with post-infectious autoimmune central nervous system demyelination should alert the reader to the potentially causative role of this common organism, and gives insights into the pathogenesis. The unusual dissociation between the clinical presentation and the location of the radiological lesions should also highlight the potential for the condition to mimic the presentation of others, and stimulates debate on the definitions of acute transverse myelitis and acute disseminated encephalomyelitis, and their potential overlap.

  10. Eosinophils in asthma

    Institute of Scientific and Technical Information of China (English)



    @@ The contribution of eosinophils to host-defense and inflammatory responses has undergone periodic reevalu-ations. Thirty years ago, eosinophil was considered as a principal effector cell in host-defense against parasites.

  11. Recurrent isochromosome 21 and multiple abnormalities in a patient suspected of having acute myeloid leukemia with eosinophilic differentiation-a rare case from South India

    Institute of Scientific and Technical Information of China (English)

    Sangeetha Vijay; Santhi Sarojam; Sureshkumar Raveendran; Vani Syamala; Sreeja Leelakumari; Geetha Narayanan; Sreedharan Hariharan


    Acute myeloid leukemia (AML) is a phenotypically heterogeneous disorder.The M4 subtype of AML is frequently associated with the cytogenetic marker inversion 16 and/or the presence of eosinophilia.Blast crisis is the aggressive phase of the triphasic chronic myeloid leukemia (CML),which is a disease with Philadelphia (Ph) chromosome as the major abnormality.In the present study,we report a 76-year-old patient suspected of having AML with eosinophilic differentiation (AML-M4),which in clinical tests resembles CML blast crisis with multiple chromosomal abnormalities.Isochromosome 21 [i(21)(q10)] was the most recurrent feature noted in metaphases with 46 chromosomes.Ring chromosome,tetraploid endoreduplication,recurrent aneuploid clones with loss of X chromosome,monosomy 17,monosomy 7,and structural variation translocation (9;14) were also observed in this patient.Fluorescent in situ hybridization (FISH) confirmed the absence of Ph chromosome.This report shows how cytogenetic analyses revealed atypical structural aberrations in the M4 subtype of AML.

  12. Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure

    DEFF Research Database (Denmark)

    Møller, Tom; Moser, Claus; Adamsen, Lis


    Long-lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad-spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic...... fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient-performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness...... of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty-five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between...

  13. An outbreak of acute bovine mastitis caused by Klebsiella pneumoniae in a dairy herd

    Directory of Open Access Journals (Sweden)

    Silva N.


    Full Text Available An outbreak of coliform mastitis is described in a dairy herd from the State of Rio de Janeiro, Brazil. During a four-month period 14 fatal cases of Klebsiella pneumoniae-related mastitis were observed in a herd of 104 lactating cows. The symptoms included peracute enterotoxemia in which the cows died 6 to 12 h after the detection of mastitis by CMT. Staphylococcus aureus and Streptococcus agalactiae Streptococcus agalactiae were also isolated although could not be associated with cases of acute fatal mastitis. Milking practices were also evaluated. The milking machine was being used correctly and adequate precautions for hygiene and pre-milking and post-milking teat dipping were used. The organism was sensitive to gentamicin. Therapy for acute toxic mastitis required early action for the treatment of infections, involving corticosteroids and fluid therapy. The use of a Klebsiella vaccine produced from the microorganisms isolated from the herd, associated with hygiene measures, resulted in the control of the outbreak.

  14. Necrotizing pneumonia and acute purulent pericarditis caused by Streptococcus pneumoniae serotype 19A in a healthy 4-year-old girl after one catch-up dose of 13-valent pneumococcal conjugate vaccine. (United States)

    Lu, Shay; Tsai, Jeng-Dau; Tsao, Ten-Fu; Liao, Pei-Fen; Sheu, Ji-Nan


    Streptococcus pneumoniae is a common cause of infectious diseases in children that may lead to life-threatening complications. Acute purulent pericarditis is an uncommon complication of S. pneumoniae in the antibiotic era. A healthy 4-year-old girl was admitted with pneumonia and pleural effusion. She had received one catch-up dose of 13-valent pneumococcal conjugate vaccine at 2 years of age. She rapidly developed necrotizing pneumonia, complicated by bronchopleural fistula presenting as subcutaneous emphysema and pneumothorax and acute purulent pericarditis. S. pneumoniae serotype 19A was subsequently identified from blood, empyema and pericardial fluid cultures. After appropriate antibiotic therapy and a right lower lobectomy, her condition stabilized and she promptly recovered. This case highlights two rare potential clinical complications of pneumococcal disease in a child: necrotizing pneumonia and acute purulent pericarditis. This is the first report of a child who received just one catch-up dose of 13-valent pneumococcal conjugate vaccine at 2 years of age, as per the United States' Advisory Committee on Immunization Practice's recommendations, but who still developed severe invasive pneumococcal disease with life-threatening complications caused by S. pneumoniae serotype 19A.

  15. Concurrent acute interstitial pneumonia and pulmonary embolism during treatment with peginterferon alpha-2a and ribavirin in a patient with hepatitis C

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    Hikmet Coban


    Full Text Available The case presented is the first patient with concurrent acute interstitial pneumonia and pulmonary embolism associated with combined treatment of peginterferon and ribavirin for hepatitis C.

  16. Eosinophilic Endotype of Asthma. (United States)

    Aleman, Fernando; Lim, Hui Fang; Nair, Parameswaran


    Asthma is a heterogeneous disease that can be classified into different clinical endotypes, depending on the type of airway inflammation, clinical severity, and response to treatment. This article focuses on the eosinophilic endotype of asthma, which is defined by the central role that eosinophils play in the pathophysiology of the condition. It is characterized by elevated sputum and/or blood eosinophils on at least 2 occasions and by a significant response to treatments that suppress eosinophilia. Histopathologic demonstration of eosinophils in the airways provides the most direct diagnosis of eosinophilic asthma; but it is invasive, thus, impractical in clinical practice.

  17. Successful treatment of Chlamydophila pneumoniae acute respiratory distress syndrome with extracorporeal membrane oxygenator: a case report and diagnostic review

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    De Bels David


    Full Text Available Abstract Introduction Chlamydophila pneumoniae is a respiratory pathogen known to infect the upper and lower respiratory tracts. Infection severity can range from sub-clinical pulmonary infection to acute respiratory distress syndrome. Case presentation A previously healthy 62-year-old Caucasian man was admitted to our hospital for acute respiratory failure. Serum samples obtained every week starting from the day of admission showed clear-cut seroconversion for C. pneumoniae antibodies. All other cultures obtained during the first days of hospitalization were negative. Despite maximal ventilatory support (high positive end expiratory pressure, fraction of inspired oxygen of 1.0, nitric oxide inhalation, neuromuscular blocking agents and prone positioning, our patient remained severely hypoxemic, which led us to initiate an extracorporeal membrane oxygenation treatment. Extracorporeal membrane oxygenation and hemodiafiltration were withdrawn on day 12. Our patient was extubated on day 18 and discharged from our Intensive Care Unit on day 20. He went home a month later. Conclusion We describe the first published case of acute respiratory distress syndrome due to C. pneumoniae infection successfully treated by extracorporeal membrane oxygenation, a very useful tool in this syndrome. A quick and specific method for the definite diagnosis of Chlamydophila infection should be developed.

  18. Eosinophilic mastitis masquerading as breast carcinoma. (United States)

    Garg, M; Kumar, S; Neogi, S


    We report the sixth case of Eosinophilic Mastitis, presenting similarly enough to be confused with breast carcinoma. A 50 year old lady presented with a six month history of progressively enlarging asymptomatic breast lump, cough and breathlessness. Clinical examination, mammography and axillary lymphadenopathy suggested malignant disease. Ronchi were heard on chest auscultation. Needle cytology was twice inconclusive and Tru-cut biopsy showed acute on chronic inflammation. Blood investigations revealed significant peripheral eosinophilia. Open biopsy reported eosinophilic mastits, correlating with peripheral eosinophilia and pulmonary symptoms. The patient responded to conservative management. Eosinophilic infiltration of the breast is a rare manifestation of tissue involvement in peripheral eosinophilia. Asthma, Churgh-Strauss Syndrome and hyper-eosinophilic syndromes are associated. Importantly, if a clinically and radiologically malignant breast lump in asthmatic ladies with peripheral eosinophilia is not confirmed on cytology, this entity could be a diagnosis, potentially saving the patient from surgery.

  19. Acute myocardial infarction versus other cardiovascular events in community-acquired pneumonia

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    Stefano Aliberti


    Full Text Available The aim of the present study was to define the prevalence, characteristics, risk factors and impact on clinical outcomes of acute myocardial infarction (AMI versus other cardiovascular events (CVEs in patients with community-acquired pneumonia (CAP. This was an international, multicentre, observational, prospective study of CAP patients hospitalised in eight hospitals in Italy and Switzerland. Three groups were identified: those without CVEs, those with AMI and those with other CVEs. Among 905 patients, 21 (2.3% patients experienced at least one AMI, while 107 (11.7% patients experienced at least one other CVE. Patients with CAP and either AMI or other CVEs showed a higher severity of the disease than patients with CAP alone. Female sex, liver disease and the presence of severe sepsis were independent predictors for the occurrence of AMI, while female sex, age >65 years, neurological disease and the presence of pleural effusion predicted other CVEs. In-hospital mortality was significantly higher among those who experienced AMI in comparison to those experiencing other CVEs (43% versus 21%, p=0.039. The presence of AMI showed an adjusted odds ratio for in-hospital mortality of 3.57 (p=0.012 and for other CVEs of 2.63 (p=0.002. These findings on AMI versus other CVEs as complications of CAP may be important when planning interventional studies on cardioprotective medications.

  20. Pneumonia, Acute Respiratory Distress Syndrome, and Early Immune-Modulator Therapy

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    Kyung-Yil Lee


    Full Text Available Acute respiratory distress syndrome (ARDS is caused by infectious insults, such as pneumonia from various pathogens or related to other noninfectious events. Clinical and histopathologic characteristics are similar across severely affected patients, suggesting that a common mode of immune reaction may be involved in the immunopathogenesis of ARDS. There may be etiologic substances that have an affinity for respiratory cells and induce lung cell injury in cases of ARDS. These substances originate not only from pathogens, but also from injured host cells. At the molecular level, these substances have various sizes and biochemical characteristics, classifying them as protein substances and non-protein substances. Immune cells and immune proteins may recognize and act on these substances, including pathogenic proteins and peptides, depending upon the size and biochemical properties of the substances (this theory is known as the protein-homeostasis-system hypothesis. The severity or chronicity of ARDS depends on the amount of etiologic substances with corresponding immune reactions, the duration of the appearance of specific immune cells, or the repertoire of specific immune cells that control the substances. Therefore, treatment with early systemic immune modulators (corticosteroids and/or intravenous immunoglobulin as soon as possible may reduce aberrant immune responses in the potential stage of ARDS.

  1. [Pemphigus with eosinophilic spongiosis]. (United States)

    Pons, S; Ortíz Medina, A


    A bibliographic review of a new subject-pemphigus with eosinophilic spongiosis accomplished: Three clinical courses are recognized: a) pemphigus in its initial phase, b) pemphigus markedly seborrheic, which presents during its evolution, some morphologic anomalies, c) pemphigus that appear like an authentic Duhring in its initial phase and during part of its evolution. On studying the histopathology three aspects are observed; 1) pure eosinophilic spongiosis with two modalites: diffuse or vesiculate; 2) mixed eosinophilic spongiosis and, 3) alternate eosinophilic spongiosis. The review report the study of this new observation and discusses the nosological situation as well as its pausible causation.

  2. Effectiveness using higher inhaled corticosteroid dosage in patients with COPD by different blood eosinophilic counts

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    Cheng SL


    Full Text Available Shih-Lung Cheng,1,2 Ching-Hsiung Lin3–5 1Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, 2Department of Chemical Engineering and Materials Science, Yuan Ze University, Zhongli, Taoyuan City, 3Department of Internal Medicine, Division of Chest Medicine, Changhua Christian Hospital, Changhua, 4Department of Respiratory Care, College of Health Sciences, Chang Jung Christian University, Tainan, 5School of Medicine, Chung Shan Medical University, Taichung City, Taiwan Background: Blood eosinophil counts have been documented as a good biomarker for patients with chronic obstructive pulmonary disease (COPD using inhaled corticosteroid (ICS therapy. However, the effectiveness and safety of prescribing high or medium dose of ICS for patients with different eosinophil counts are unknown.Methods: A post hoc analysis of a previous prospective randomized study was performed for COPD patients using higher dose (HD: Fluticasone 1,000 µg/day or medium dose (MD: Fluticasone 500 µg/day of ICS combined with Salmeterol (100 µg/day. Patients were classified into two groups: those with high eosinophil counts (HE ≥3% and those with low eosinophil counts (LE <3%. Lung function was evaluated with forced expiratory volume in 1 second, forced vital capacity, and COPD assessment test. Frequencies of acute exacerbation and pneumonia were also measured.Results: Two hundred and forty-eight patients were studied and classified into higher eosinophil (HE (n=85, 34.3% and lower eosinophil (LE groups (n=163, 65.7%. The levels of forced expiratory volume in 1 second were significantly increased in patients of HE group treated with HD therapy, compared with the other groups (HE/HD: 125.9±27.2 mL vs HE/MD: 94.3±23.7 mL, vs LE/HD: 70.4±20.5 mL, vs LE/MD: 49.8±16.7 mL; P<0.05 at the end of the study. Quality of life (COPD assessment test markedly improved in HE/HD group than in MD/LE group (HE/HD: 9±5 vs LE/MD: 16±7, P=0.02. The frequency of acute

  3. Bone marrow-derived cells participate in stromal remodeling of the lung following acute bacterial pneumonia in mice. (United States)

    Serikov, Vladimir B; Mikhaylov, Viatcheslav M; Krasnodembskay, Anna D; Matthay, Michael A


    Bone marrow-derived cells (BMDC) have been shown to graft injured tissues, differentiate in specialized cells, and participate in repair. The importance of these processes in acute lung bacterial inflammation and development of fibrosis is unknown. The goal of this study was to investigate the temporal sequence and lineage commitment of BMDC in mouse lungs injured by bacterial pneumonia. We transplanted GFP-tagged BMDC into 5-Gy-irradiated C57BL/6 mice. After 3 months of recovery, mice were subjected to LD(50) intratracheal instillation of live E. coli (controls received saline) which produced pneumonia and subsequent areas of fibrosis. Lungs were investigated by immunohistology for up to 6 months. At the peak of lung inflammation, the predominant influx of BMDC were GFP(+) leukocytes. Postinflammatory foci of lung fibrosis were evident after 1-2 months. The fibrotic foci in lung stroma contained clusters of GFP(+) CD45(+) cells, GFP(+) vimentin-positive cells, and GFP(+) collagen I-positive fibroblasts. GFP(+) endothelial or epithelial cells were not identified. These data suggest that following 5-Gy irradiation and acute bacterial pneumonia, BMDC may temporarily participate in lung postinflammatory repair and stromal remodeling without long-term engraftment as specialized endothelial or epithelial cells.

  4. Mycobacterium kansasii Pneumonia with Mediastinal Lymphadenitis in a Patient with Acute Myeloid Leukemia: Successful Treatment to Stem Cell Transplantation (United States)

    Choi, Yeon-Geun; Lee, Dong-Gun; Yim, Eunjung; Joo, Hyonsoo; Ryu, Seongyul; Choi, Jae-Ki; Kim, Hee-Je


    Non-tuberculous mycobacterial (NTM) disease is a relatively rare cause of neutropenic fever in patients with hematologic malignancies. During the neutropenic period, performing invasive procedures for microbiological or pathological confirmation is difficult. In addition, the optimal treatment duration for NTM disease in patients with leukemia, especially prior to stem cell transplantation (SCT), has not been documented. Therefore, we report a case of pneumonia with necrotizing lymphadenitis caused by Mycobacterium kansasii diagnosed during chemotherapy being performed for acute myeloid leukemia. The radiologic findings were similar to those of invasive fungal pneumonia; however, a bronchoalveolar washing fluid culture confirmed that the pathogen was M. kansasii. After 70 days from starting NTM treatment, allogeneic SCT was performed without any complications. The patient fully recovered after 12 months of NTM treatment, and neither reactivation of M. kansasii infection nor related complications were reported.

  5. Immunohistochemical detection of virus through its nuclear cytopathic effect in idiopathic interstitial pneumonia other than acute exacerbation

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    G.C. dos Santos


    Full Text Available Idiopathic interstitial pneumonias include complex diseases that have a strong interaction between genetic makeup and environmental factors. However, in many cases, no infectious agent can be demonstrated, and these clinical diseases rapidly progress to death. Theoretically, idiopathic interstitial pneumonias could be caused by the Epstein-Barr virus, cytomegalovirus, adenovirus, hepatitis C virus, respiratory syncytial virus, and herpesvirus, which may be present in such small amounts or such configuration that routine histopathological analysis or viral culture techniques cannot detect them. To test the hypothesis that immunohistochemistry provides more accurate results than the mere histological demonstration of viral inclusions, this method was applied to 37 open lung biopsies obtained from patients with idiopathic interstitial pneumonias. As a result, immunohistochemistry detected measles virus and cytomegalovirus in diffuse alveolar damage-related histological patterns of acute exacerbation of idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia in 38 and 10% of the cases, respectively. Alveolar epithelium infection by cytomegalovirus was observed in 25% of organizing pneumonia patterns. These findings were coincident with nuclear cytopathic effects but without demonstration of cytomegalovirus inclusions. These data indicate that diffuse alveolar damage-related cytomegalovirus or measles virus infections enhance lung injury, and a direct involvement of these viruses in diffuse alveolar damage-related histological patterns is likely. Immunohistochemistry was more sensitive than the histological demonstration of cytomegalovirus or measles virus inclusions. We concluded that all patients with diffuse alveolar damage-related histological patterns should be investigated for cytomegalovirus and measles virus using sensitive immunohistochemistry in conjunction with routine procedures.

  6. Using decision trees to manage hospital readmission risk for acute myocardial infarction, heart failure, and pneumonia. (United States)

    Hilbert, John P; Zasadil, Scott; Keyser, Donna J; Peele, Pamela B


    To improve healthcare quality and reduce costs, the Affordable Care Act places hospitals at financial risk for excessive readmissions associated with acute myocardial infarction (AMI), heart failure (HF), and pneumonia (PN). Although predictive analytics is increasingly looked to as a means for measuring, comparing, and managing this risk, many modeling tools require data inputs that are not readily available and/or additional resources to yield actionable information. This article demonstrates how hospitals and clinicians can use their own structured discharge data to create decision trees that produce highly transparent, clinically relevant decision rules for better managing readmission risk associated with AMI, HF, and PN. For illustrative purposes, basic decision trees are trained and tested using publically available data from the California State Inpatient Databases and an open-source statistical package. As expected, these simple models perform less well than other more sophisticated tools, with areas under the receiver operating characteristic (ROC) curve (or AUC) of 0.612, 0.583, and 0.650, respectively, but achieve a lift of at least 1.5 or greater for higher-risk patients with any of the three conditions. More importantly, they are shown to offer substantial advantages in terms of transparency and interpretability, comprehensiveness, and adaptability. By enabling hospitals and clinicians to identify important factors associated with readmissions, target subgroups of patients at both high and low risk, and design and implement interventions that are appropriate to the risk levels observed, decision trees serve as an ideal application for addressing the challenge of reducing hospital readmissions.

  7. [Comparison of culture and real-time PCR methods in the detection of Streptococcus pneumoniae and Haemophilus influenzae in acute otitis media effusion specimens]. (United States)

    Eser, Ozgen Köseoğlu; Alp, Sehnaz; Ergin, Alper; Ipçi, Kaan; Alp, Alpaslan; Gür, Deniz; Hasçelik, Gülşen


    Streptococcus pneumoniae and Haemophilus influenzae are the major etiologic agents of acute otitis media. This study was aimed to compare the detection rate of S.pneumoniae and H.influenzae by culture and real-time polymerase chain reaction (Rt-PCR) in the middle ear effusions of patients diagnosed as acute otitis media. A total of 60 middle ear effusion samples collected from children with acute otitis media were included in the study. The samples were inoculated and incubated in BACTEC Ped Plus blood culture bottles and BACTEC 9120 system (BD Diagnostic Systems, MD), respectively, and the isolates were identified by conventional methods. For the molecular diagnosis of H.influenzae and S.pneumoniae, ply pneumolysin gene and HIB capsule region, respectively were amplified by Rt-PCR (LightCycler, Roche Diagnostics, Germany). H.influenzae and S.pneumoniae were isolated from 5 (8.3%) and 3 (5%) of the patient samples with conventional culture methods, respectively. In addition in 11.6% of the samples other microorganisms (Staphylococcus epidermidis, Streptococcus intermedius, Streptococcus sanguinis, Moraxella catarrhalis, Pseudomonas aeruginosa, Candida albicans) were also isolated. On the other hand H.influenzae and S.pneumoniae were detected in 38 (63.3%) and 24 (40%) of the samples with Rt-PCR, respectively. There was about eight fold increase in the detection frequency of H.influenzae and S.pneumoniae with Rt-PCR compared to culture methods. When culture was accepted as the gold standard method, the sensitivity, specificity and positive predictive value of Rt-PCR in the detection of H.influenzae and S.pneumoniae were estimated as 80%, 51% and 98.2%, respectively. As a result, Rt-PCR was shown to be a sensitive method and could be preferred for the rapid diagnosis of H.influenzae and S.pneumoniae in the etiological diagnosis of acute otitis media, especially in culture negative cases.

  8. Acute suppurative parotitis caused by Streptococcus pneumoniae in an HIV-infected man. (United States)

    Guzman Vinasco, Luis; Bares, Sara; Sandkovsky, Uriel


    We report a case of a 32-year-old man who presented with progressive unilateral parotid gland enlargement and subsequently tested positive for HIV. A CT scan of the neck performed with contrast showed a phlegmon in the region of the right parotid tail measuring approximately 2.5×2.4 cm. Cultures of the aspirated fluid grew Streptococcus pneumoniae and the S. pneumoniae urinary antigen test was also positive. The patient underwent surgical debridement and received antimicrobial therapy with complete resolution of the parotitis. Parotitis caused by S. pneumoniae is rare, and HIV infection should be suspected in any case of invasive pneumococcal disease.


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    E. V. Prutkina


    Full Text Available Abstract. Amounts of several neutrophil enzymes (elastase, myeloperoxidase (MPO, MMP-2 and their local inhibitors, i.e., Clara cell protein (CC16 and HSP-70, have been determined in blood plasma from fifty-two patients with various forms of influenza A/H1N1. Sixteen patients have developed acute respiratory distress syndrome (ARDS. In cases of uncomplicated influenza, elastase and MPO levels were shown to be increased, while MMP-2 levels did not change, along with higher contents of HSP-70 and unchanged CC16 amounts. Upon development of influenza-associated pneumonia, elastase and MPO concentrations became elevated, whereas MMP-2 levels were decreased, along with unchanged amounts of CC16 and HSP-70. In cases of ARDS development, CC16 amounts exhibited a sharp decrease. Meanwhile, contents of other proteins remained at the levels shown for pneumonia patients. It has been shown that increased concentrations of neutrophil elastase and MPO with a relative CC16 deficiency and decreased MMP-2 may represent a mechanism of pneumonia development. Decreased CC16 concentration may serve as a risk predictor of ARDS development.

  10. Klebsiella pneumoniae alleviates influenza-induced acute lung injury via limiting NK cell expansion. (United States)

    Wang, Jian; Li, Fengqi; Sun, Rui; Gao, Xiang; Wei, Haiming; Tian, Zhigang


    A protective effect induced by bacterial preinfection upon a subsequent lethal influenza virus infection has been observed, but the underlying immune mechanisms have not yet been fully elucidated. In this study, we used a mouse model of Klebsiella pneumoniae preinfection to gain insight into how bacterial preinfection influences the subsequent lethal influenza virus infection. We found that K. pneumoniae preinfection significantly attenuated lung immune injury and decreased mortality during influenza virus infection, but K. pneumoniae-specific immunity was not involved in this cross-protection against influenza virus. K. pneumoniae preinfection limited NK cell expansion, which was involved in influenza-induced immune injury and death. Furthermore, K. pneumoniae preinfection could not control NK cell expansion and death during influenza virus infection in Rag1(-/-) mice, but adoptive transfer of T cells from wild-type mice was able to restore this protective effect. Our data suggest that the adaptive immune response activated by bacterial infection limits the excessive innate immune response induced by a subsequent influenza infection, ultimately protecting mice from death.

  11. The Eosinophil in Infection. (United States)

    Ravin, Karen A; Loy, Michael


    First described by Paul Ehrlich in 1879, who noted its characteristic staining by acidophilic dyes, for many years, the eosinophil was considered to be an end-effector cell associated with helminth infections and a cause of tissue damage. Over the past 30 years, research has helped to elucidate the complexity of the eosinophil's function and establish its role in host defense and immunity. Eosinophils express an array of ligand receptors which play a role in cell growth, adhesion, chemotaxis, degranulation, and cell-to-cell interactions. They play a role in activation of complement via both classical and alternative pathways. Eosinophils synthesize, store and secrete cytokines, chemokines, and growth factors. They can process antigen, stimulate T cells, and promote humoral responses by interacting with B cells. Eosinophils can function as antigen presenting cells and can regulate processes associated with both T1 and T2 immunity. Although long known to play a role in defense against helminth organisms, the interactions of eosinophils with these parasites are now recognized to be much more complex. In addition, their interaction with other pathogens continues to be investigated. In this paper, we review the eosinophil's unique biology and structure, including its characteristic granules and the effects of its proteins, our developing understanding of its role in innate and adaptive immunity and importance in immunomodulation, and the part it plays in defense against parasitic, viral, fungal and bacterial infections. Rather than our worst enemy, the eosinophil may, in fact, be one of the most essential components in host defense and immunity.

  12. Eosinophilic cellulitis and dermographism. (United States)

    Nguyen, Nathalie Q; Ma, Linglei


    A 26-year-old man presented with a history of intermittent erythematous plaques on his hands and legs. A peripheral blood eosinophilia was noted. Histopathologic examination showed numerous eosinophils and characteristic flame figures. The clinical presentation and histopathologic alterations are consistent with the diagnosis of Wells' syndrome, which is also known as eosinophilic cellulitis. Wells' syndrome is a rare condition of unclear etiology. We discuss its diagnosis and possible association with other conditions that manifest peripheral eosinophilia.

  13. Atypical pneumonia (United States)

    Walking pneumonia; Community-acquired pneumonia - atypical ... Bacteria that cause atypical pneumonia include: Mycoplasma pneumonia is caused by the bacteria Mycoplasma pneumoniae . It often affects people younger than age 40. Pneumonia due ...

  14. Etiology of acute otitis media and serotype distribution of Streptococcus pneumoniae and Haemophilus influenzae in Chilean children <5 years of age (United States)

    Rosenblut, Andres; Napolitano, Carla; Pereira, Angelica; Moreno, Camilo; Kolhe, Devayani; Lepetic, Alejandro; Ortega-Barria, Eduardo


    Abstract The impact of bacterial conjugate vaccines on acute otitis media (AOM) is affected by several factors including population characteristics, bacterial etiology and vaccine conjugation method, carrier, and coverage. This study estimated the baseline etiology, distribution, and antibiotic susceptibility of bacterial serotypes that causes AOM in children aged Streptococcus pneumoniae (41.7% [58/139]) and Haemophilus influenzae (40.3% [56/139]) were predominant among the cultures that showed bacterial growth (85% [139/164]). All Streptococcus pneumoniae positive episodes were serotyped, 19F (21%) and 14 (17%) were the predominant serotypes; all Haemophilus influenzae strains were nontypeable. Streptococcus pneumoniae were resistant to penicillin (5%) and erythromycin (33%); Haemophilus influenzae were resistant to ampicillin (14%) and cefuroxime and cefotaxime (2% each). AOM in Chilean children is predominantly caused by Streptococcus pneumoniae and nontypeable Haemophilus influenzae. Use of a broad spectrum vaccine against these pathogens might aid the reduction of AOM in Chile. PMID:28178138

  15. Impact of oral simvastatin therapy on acute lung injury in mice during pneumococcal pneumonia

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    Boyd Angela R


    Full Text Available Abstract Background Recent studies suggest that the reported protective effects of statins (HMG-CoA reductase inhibitors against community-acquired pneumonia (CAP and sepsis in humans may be due to confounders and a healthy user-effect. To directly test whether statins are protective against Streptococcus pneumoniae, the leading cause of CAP, we examined the impact of prolonged oral simvastatin therapy at physiologically relevant doses in a mouse model of pneumococcal pneumonia. BALB/c mice were placed on rodent chow containing 0 mg/kg (control, 12 mg/kg (low simvastatin diet [LSD]; corresponds to 1.0 mg/kg/day, or 120 mg/kg (high simvastatin diet [HSD]; corresponds to 10 mg/kg/day simvastatin for four weeks, infected intratracheally with S. pneumoniae serotype 4 strain TIGR4, and sacrificed at 24, 36, or 42 h post-infection for assessment of lung histology, cytokine production, vascular leakage and edema, bacterial burden and bloodstream dissemination. Some mice received ampicillin at 12-h intervals beginning at 48 h post-infection and were monitored for survival. Immunoblots of homogenized lung samples was used to assess ICAM-1 production. Results Mice receiving HSD had reduced lung consolidation characterized by less macrophage and neutrophil infiltration and a significant reduction in the chemokines MCP-1 (P = 0.03 and KC (P = 0.02 and ICAM-1 in the lungs compared to control mice. HSD mice also had significantly lower bacterial titers in the blood at 36 (P = 0.007 and 42 (P = 0.03 hours post-infection versus controls. LSD had a more modest effect against S. pneumoniae but also resulted in reduced bacterial titers in the lungs and blood of mice after 42 h and a reduced number of infiltrated neutrophils. Neither LSD nor HSD mice had reduced mortality in a pneumonia model where mice received ampicillin 48 h after challenge. Conclusions Prolonged oral simvastatin therapy had a strong dose-dependent effect on protection

  16. [Survival by a young woman with malnutrition due to alcoholism and eating disorders and with acute respiratory distress syndrome due to severe pneumonia who showed increased serum neutrophil elastase activity]. (United States)

    Nakajima, Hirokazu; Sawaguchi, Hirochiyo; Nakajima, Shigenori


    A 30-year-old woman with malnutrition due to alcoholism and eating disorders was found to have acute respiratory distress syndrome (ARDS) and sepsis due to severe Streptococcus pneumoniae pneumonia. S. pneumoniae was detected by an in vitro rapid immunochromatographic assay for S. pneumoniae antigen in urine on the day of admission and by blood culture 2 days after admission. Symptoms and laboratory findings improved after treatment with sivelestat sodium hydrate, antibiotics, and mechanical ventilation. Treatment with sivelestat sodium hydrate also decreased serum neutrophil elastase activity. This case demonstrates the usefulness of early treatment with sivelestat sodium hydrate in ARDS due to severe pneumonia.

  17. Eosinophil levels in the acute phase of experimental chagas' disease Níveis de eosinófilos na fase aguda da doença de Chagas experimental

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    Maria Cristina Nakhle


    Full Text Available Eosinophil dynamics, in bone marrow, blood and peritoneal exudate, of resistant C57B1/6 (C57 and susceptible A/Snell (A/Sn mice was comparatively studied during the acute phase of infection by Trypanosoma cruzi Y strain. A decline was observed in bone marrow eosinophil levels in A/Sn, but not in C57 mice, soon after infection, those of the former remaining significantly below those of the latter up to the 4th day of infection. Bone marrow eosinophil levels of C57 mice declined subsequently to levels comparable to those of A/Sn mice, the number of these cells in this compartment remaining 50% those of non infected controls, in both strains, up to the end of the experiment on the 14th day of infection. The fluctuations in eosinophil levels in blood and peritoneal space were similar in both mice strains studied. Concomitantly with depletion of eosinophils in the marrow, depletion in blood and a marked rise of these cells in the peritoneal space, initial site of infection, occurred in both strains. The difference in eosinophil bone marrow levels, between C57 and A/Sn mice, observed in the first four days of infection, suggests a higher eosinopoiesis capacity of the former in this period, which might contribute to their higher resistance to T. cruzi infection.A dinâmica de eosinófilos, na medula óssea, sangue e exsudato peritoneal, de uma linhagem de camundongos resistente (C57B1/6 e de uma susceptível (A/Snell foi comparativamente estudada durante a fase aguda da infecção com a cepa Y do Trypanosoma cruzi. Foi observada uma queda nos níveis de eosinófilos da medula óssea nos camundongos A/Sn, mas não nos C57, logo após a infecção, os dos primeiros permanecendo significativamente abaixo dos níveis dos últimos até o 4? dia de infecção. Os níveis de eosinófilos da medula óssea nos camundongos C57 caíram subseqüentemente a níveis próximos aos dos camundongos A/Sn, o número destas células neste compartimento permanecendo em

  18. [Case report: Löffler's syndrome due to Ascaris lumbricoides mimicking acute bacterial community--acquired pneumonia]. (United States)

    Acar, Ali; Oncül, Oral; Cavuşlu, Saban; Okutan, Oğuzhan; Kartaloğlu, Zafer


    In this study we present a patient with Loeffler's syndrome caused by Ascaris lumbricoides who presented with the clinical findings of community-acquired pneumonia (CAP). Our patient, who was twenty-five years old, and who had had symptoms such as coughing, expectorating, dyspnea and fever for approximately ten days, was hospitalized. We auscultated polyphonic rhonchuses at the both hemithoraxes. A chest X-ray revealed bilateral lower zone patch consolidation. Acute bacterial community acquired pneumonia (CAP) was diagnosed due to these findings and empirical antibiotic treatment was begun. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. During the course of advanced investigations, we measured peripheric eosinophilia, and high levels of total Eo and total IgE, and observed Ascaris lumbricoides eggs during stool examination. The patient was given a diagnosis of Loeffler's syndrome. Thereupon the patient was treated successfully with one dose of albendazol 400 mg. In conclusion, we suggest that Loeffler's syndrome must be considered early in the differential diagnosis for CAP when peripheric eosinophilia is seen in patients if they live in an endemic area for parasitic disease.

  19. The critical role of myeloperoxidase in Streptococcus pneumoniae clearance and tissue damage during mouse acute otitis media. (United States)

    Xiang, Yun; Jin, Chunfang; Wang, Wei; Wang, Zimeng; Huang, Yifei; Fan, Fangmei; Ma, Yurong; Zhang, Xuemei; Xu, Wenchun; Yin, Yibing; He, Yujuan


    We have recently reported that neutrophils play a pivotal role in innate defense against Streptococcus pneumoniae ( Spn) during mouse acute otitis media (AOM). However, the underlying mechanism remains unclear. By constructing models of pneumococcal AOM in C57BL/6 mice and using a specific inhibitor in vivo, we investigated the role of myeloperoxidase (MPO), one of the most important protein components of neutrophils. Experiment results showed a significant increase in MPO production of the recruited neutrophils in Spn-infected mice. Neutrophils killed Spn in a MPO-dependent manner. MPO facilitated the generation of reactive oxygen species (ROS), and consequently promoted Spn clearance at an early stage and exacerbated tissue damage. Moreover, MPO induced neutrophil apoptosis and necrosis, which, in turn, worsened tissue damage. In summary, our study demonstrates that neutrophil MPO plays a paradoxical role in bacterial clearance and tissue damage in pneumococcal AOM.

  20. Advances in Treatment of Acute Interstitial Pneumonia%急性间质性肺炎的治疗进展

    Institute of Scientific and Technical Information of China (English)

    徐钦星; 王利民; 任振义


    @@ 急性间质性肺炎(acute interstitial pneumonia,AIP)是一种突发起病、快速进展为呼吸衰竭并需机械通气的间质性肺疾病,其病理特点为弥漫性肺泡损伤.最早在1944年Hamman和Rich[1]报告了一组以暴发起病、进展迅速并短时间内死亡为特点的病例,在病理上主要表现为肺泡间隔增厚水肿、通明膜形成及肺问质广泛纤维增生,此后有人称此为Hamman-Rich综合症.

  1. Non-typeable Haemophilus influenzae and Streptococcus pneumoniae as primary causes of acute otitis media in colombian children: a prospective study

    Directory of Open Access Journals (Sweden)

    Castrejon Maria M


    Full Text Available Abstract Background Acute otitis media (AOM is one of the most frequently encountered bacterial infections in children aged Streptococcus pneumoniae (S. pneumoniae and non-typeable Haemophilus influenzae (NTHi are historically identified as primary AOM causes. Nevertheless, recent data on bacterial pathogens causing AOM in Latin America are limited. This prospective study aimed to identify and characterize bacterial etiology and serotypes of AOM cases including antimicrobial susceptibility in Methods From February 2008 to January 2009, children ≥3 months and Results Of the 106 enrolled children, 99 were included in the analysis. Bacteria were cultured from 62/99 (63% of samples with S. pneumoniae, H. influenzae, or S. pyogenes. The most commonly isolated bacteria were H. influenzae in 31/99 (31% and S. pneumoniae in 30/99 (30% of samples. The majority of H. influenzae episodes were NTHi (27/31; 87%. 19F was the most frequently isolated pneumococcal serotype (10/30; 33%. Of the 30 S. pneumoniae positive samples, 8/30 (27% were resistant to tetracycline, 5/30 (17% to erythromycin and 8/30 (27% had intermediate resistance to penicillin. All H. influenzae isolates tested were negative to beta-lactamase. Conclusions NTHi and S. pneumoniae are the leading causes of AOM in Colombian children. A pneumococcal conjugate vaccine that prevents both pathogens could be useful in maximizing protection against AOM.

  2. Pore-Forming Toxins Induce Macrophage Necroptosis during Acute Bacterial Pneumonia.

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    Norberto González-Juarbe


    Full Text Available Necroptosis is a highly pro-inflammatory mode of cell death regulated by RIP (or RIPK1 and RIP3 kinases and mediated by the effector MLKL. We report that diverse bacterial pathogens that produce a pore-forming toxin (PFT induce necroptosis of macrophages and this can be blocked for protection against Serratia marcescens hemorrhagic pneumonia. Following challenge with S. marcescens, Staphylococcus aureus, Streptococcus pneumoniae, Listeria monocytogenes, uropathogenic Escherichia coli (UPEC, and purified recombinant pneumolysin, macrophages pretreated with inhibitors of RIP1, RIP3, and MLKL were protected against death. Alveolar macrophages in MLKL KO mice were also protected during S. marcescens pneumonia. Inhibition of caspases had no impact on macrophage death and caspase-1 and -3/7 were determined to be inactive following challenge despite the detection of IL-1β in supernatants. Bone marrow-derived macrophages from RIP3 KO, but not caspase-1/11 KO or caspase-3 KO mice, were resistant to PFT-induced death. We explored the mechanisms for PFT-induced necroptosis and determined that loss of ion homeostasis at the plasma membrane, mitochondrial damage, ATP depletion, and the generation of reactive oxygen species were together responsible. Treatment of mice with necrostatin-5, an inhibitor of RIP1; GW806742X, an inhibitor of MLKL; and necrostatin-5 along with co-enzyme Q10 (N5/C10, which enhances ATP production; reduced the severity of S. marcescens pneumonia in a mouse intratracheal challenge model. N5/C10 protected alveolar macrophages, reduced bacterial burden, and lessened hemorrhage in the lungs. We conclude that necroptosis is the major cell death pathway evoked by PFTs in macrophages and the necroptosis pathway can be targeted for disease intervention.

  3. Olanzapine-induced eosinophilic pleuritis

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    Matthew Evison


    Eosinophilic pleural fluid is not a marker of non-malignant aetiology and eosinophilic pleural effusions require a careful and systematic diagnostic work-up. This is the second case report to identify olanzapine as a causative agent in eosinophilic pleural effusion.

  4. Eosinophilic colitis in infants

    Directory of Open Access Journals (Sweden)

    Adriana Chebar Lozinsky


    Full Text Available OBJECTIVE: To review the literature for clinical data on infants with allergic or eosinophilic colitis. DATA SOURCE: MEDLINE search of all indexes was performed using the words ''colitis or procto-colitis and eosinophilic'' or ''colitis or proctocolitis and allergic'' between 1966 and February of 2013. All articles that described patients' characteristics were selected. DATA SYNTHESIS: A total of 770 articles were identified, of which 32 met the inclusion criteria. The 32 articles included a total of 314 infants. According to the available information, 61.6% of infants were male and 78.6% were younger than 6 months. Of the 314 patients, 49.0% were fed exclusively breast milk, 44.2% received cow's milk protein, and 6.8% received soy protein. Diarrheal stools were described in 28.3% of patients. Eosinophilia was found in 43.8% (115/263 of infants. Colonic or rectal biopsy showed infiltration by eosinophils (between 5 and 25 perhigh-power field in 89.3% (236/264 of patients. Most patients showed improvement with theremoval of the protein in cow's milk from their diet or the mother's diet. Allergy challenge tests with cow's milk protein were cited by 12 of the 32 articles (66 patients. CONCLUSIONS: Eosinophilic colitis occurs predominantly in the first six months of life and in males. Allergy to cow's milk was considered the main cause of eosinophilic colitis. Exclusion of cow'smilk from the diet of the lactating mother or from the infant's diet is generally an effective therapeutic measure.

  5. Etiology of acute otitis media and serotype distribution of Streptococcus pneumoniae and Haemophilus influenzae in Chilean children <5 years of age. (United States)

    Rosenblut, Andres; Napolitano, Carla; Pereira, Angelica; Moreno, Camilo; Kolhe, Devayani; Lepetic, Alejandro; Ortega-Barria, Eduardo


    The impact of bacterial conjugate vaccines on acute otitis media (AOM) is affected by several factors including population characteristics, bacterial etiology and vaccine conjugation method, carrier, and coverage. This study estimated the baseline etiology, distribution, and antibiotic susceptibility of bacterial serotypes that causes AOM in children aged Haemophilus influenzae (40.3% [56/139]) were predominant among the cultures that showed bacterial growth (85% [139/164]). All Streptococcus pneumoniae positive episodes were serotyped, 19F (21%) and 14 (17%) were the predominant serotypes; all Haemophilus influenzae strains were nontypeable. Streptococcus pneumoniae were resistant to penicillin (5%) and erythromycin (33%); Haemophilus influenzae were resistant to ampicillin (14%) and cefuroxime and cefotaxime (2% each).AOM in Chilean children is predominantly caused by Streptococcus pneumoniae and nontypeable Haemophilus influenzae. Use of a broad spectrum vaccine against these pathogens might aid the reduction of AOM in Chile.

  6. beta-Lactamase-producing Moraxella catarrhalis may prevent the emergence of penicillin-resistant Streptococcus pneumoniae in children with recurrent acute otitis media. (United States)

    Joki-Erkkilä, Veli-Pekka; Aittoniemi, Janne; Vuento, Risto; Puhakka, Heikki


    We studied the effect of concomitant nasopharyngeal carriage of beta-lactamase producing Moraxella catarrhalis and Haemophilus influenzae on the occurrence of penicillin resistance of Streptococcus pneumoniae. We took nasopharyngeal samples from 306 children with recurrent otitis media and a history of several antibiotic treatments. We could isolate at least one of the pathogens in 89 subjects. Of these children 13% carried more than one pathogen. Of the isolated M. catarrhalis and H. influenzae strains 93% and 43% produced beta-lactamase, respectively. Of the S. pneumoniae strains 25% were non-susceptible (I/R) to penicillin. However, in patients carrying beta-lactamase-producing M. catarrhalis together with pneumococci all strains were susceptible to penicillin (P=0.0353). This finding suggests that beta-lactamase producing M. catarrhalis may hinder the emergence of penicillin resistance of S. pneumoniae in children with recurrent acute otitis media.

  7. Acute fibrinous and organising pneumonia following lung transplantation is associated with severe allograft dysfunction and poor outcome: a case series

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    Keith Meyer


    Full Text Available   Acute fibrinous and organising pneumonia (AFOP is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561. We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.  

  8. Pulmonary alveolar proteinosis requiring "hybrid" extracorporeal life support, and complicated by acute necrotizing pneumonia. (United States)

    Moisan, M; Lafargue, M; Calderon, J; Oses, P; Ouattara, A


    Pulmonary alveolar proteinosis (PAP), which was first described by Rosen in 1958, is a rare disease characterized by impaired surfactant metabolism that provokes the accumulation of proteinaceous material in the alveoli. PAP is usually an auto-immune disease though, less commonly, may be congenital or secondary to another underlying disorder, such as infection, an immunodeficiency or a haematological disease. A positive diagnosis can be made with the appearance of "crazy-paving" on a computed tomography scan, with a milky fluid bronchial aspiration. A cytological examination will also show eosinophilic material and pink stained periodic acid-Schiff-positive material. A whole lung lavage is the most widely accepted therapy for hypoxemic PAP. Herein, we report the case of a 27-year-old woman admitted into our intensive care unit for hypoxemic PAP that was complicated by a pulmonary embolism. Because the patient presented with refractory hypoxemia associated with a brief cardiac arrest, femoral veno-arterial extracorporeal life support (ECLS) was rapidly inserted. Under ECLS, the patient subsequently developed "Harlequin syndrome", which was managed using an original and minimally invasive method. A whole lung lavage as well as prone positioning was effectively performed under ECLS, and resulted in substantial improvement in oxygenation. The patient could be discharged from the hospital 40 days later.

  9. Pneumonia por varicela associada com síndrome da angústia respiratória aguda: relato de dois casos Varicella pneumonia complicated with acute respiratory distress syndrome: two cases report

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    Marcelo Moreno


    Full Text Available JUSTIFICATIVA E OBJETIVOS: A varicela é uma doença exantemática causada pela infecção primária do vírus varicela zoster (VVZ. A pneumonia pelo VVZ complicada com a síndrome da angústia respiratória aguda (SARA é rara e associa-se a altas taxas de morbimortalidade. O objetivo deste estudo foi apresentar dois casos de pneumonia por varicela que evoluíram com SARA e outras disfunções orgânicas. RELATO DOS CASOS: Paciente de 15 anos, imunocomprometido com a síndrome da imunodeficiência adquirida (SIDA e uma paciente do sexo feminino imunocompetente, foram admitidos na UTI com quadro clínico de varicela, SARA, trombocitopenia e acidose graves. Além disso, disfunção cardiovascular e falência renal ocorreram no primeiro e segundo casos, respectivamente. Foram tratados com aciclovir além de ventilação mecânica protetora. CONCLUSÕES: Os dois casos de pneumonia por varicela, que apresentaram SARA e disfunções de múltiplos órgãos, obtiveram boa evolução clínica.BACKGROUNG AND OBJECTIVES: Varicella is an exantematic disease caused by varicella-zoster virus. Varicella pneumonia complicated with acute respiratory distress syndrome (ARDS is very rare in adults and is associated with high morbimortality. We report two cases of ARDS secondary to varicella-zoster virus pneumonia. CASES REPORT: We report two cases of ARDS and multiple organ dysfunction syndrome (MODS secondary to varicella-zoster virus pneumonia. A 15-year-old man with human immunodeficiency virus (HIV infection and a 29-year-old immunocompetent female were admitted in the ICU with primary varicella infection and pneumonia. Both cases progressed towards ARDS, severe thrombocytopenia and acidosis. In addition cardiovascular and renal failure occurred in the first and second patients, respectively. Treatment consisted of immediate administration of intravenous acyclovir and a lung-protective ventilation strategy. CONCLUSIONS: Both cases of varicella

  10. Aspiration pneumonia (United States)

    Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis ... The type of bacteria that caused the pneumonia depends on: Your ... facility, for example) Whether you were recently hospitalized ...

  11. Activity assessment of eosinophilic esophagitis. (United States)

    Schoepfer, Alain; Safroneeva, Ekaterina


    The activity of eosinophilic esophagitis (EoE) can be assessed with patient-reported outcomes and biologic measures. Patient-reported outcomes include symptoms and quality of life, whereas biologic measures refer to endoscopic, histologic, and biochemical activity (e.g. blood biomarkers). So far, a validated tool to assess EoE activity in the above-mentioned dimensions is lacking. Given the lack of a standardized way to assess EoE activity in the various dimensions, the results of different clinical trials may be difficult to compare. For symptom assessment in adult patients, the symptom 'dysphagia' should be evaluated according to different standardized food consistencies. Furthermore, symptom assessment should take into account the following items: avoidance of specific food categories, food modification, and time to eat a regular meal. A distinct symptom recall period (e.g. 2 weeks) has to be defined for symptom assessment. Performing an 'esophageal stress test' with ingestion of a standardized meal to measure symptom severity bears the potential risk of acute food bolus impaction and should therefore be avoided. The description of endoscopic findings in EoE has meanwhile been standardized. Histologic evaluation of EoE activity should report either the size of the high-power field used or count the eosinophils per mm(2). There is a current lack of blood biomarkers demonstrating a good correlation with histologic activity in esophageal biopsies. The development and validation of an adult and pediatric EoE activity index is urgently needed not only for clinical trials and observational studies, but also for daily practice.

  12. 2-Chloroadenosine (2-CADO) treatment modulates the pro-inflammatory immune response to prevent acute lung inflammation in BALB/c mice suffering from Klebsiella pneumoniae B5055-induced pneumonia. (United States)

    Kumar, Vijay; Harjai, Kusum; Chhibber, Sanjay


    Acute lung inflammation (ALI) is a life-threatening pathology and can develop during the course of several clinical conditions such as pneumonia, acid aspiration or sepsis. Adenosine plays a significant role in controlling acute inflammation via binding to A(2A) receptors on inflammatory cells, i.e. neutrophils or macrophages. The present study was designed to evaluate the anti-inflammatory and immunomodulatory effects of 2-chloroadenosine (2-CADO), alone or in combination with amoxicillin/clavulanic acid (AMC), in Klebsiella pneumoniae B5055-induced acute lung infection in mice. Acute lung infection in mice was induced by directly instilling the selected dose (10(4) colony-forming units/mL) of bacteria intranasally. Histopathological examination of the lungs was performed to reveal neutrophil infiltration into the lung alveoli. In addition to the major pro-inflammatory cytokines tumour necrosis factor-alpha (TNFalpha) and interleukin (IL)-1alpha, levels of the anti-inflammatory cytokine IL-10 were also determined. Intranasal instillation of bacteria caused profound neutrophil infiltration into the lung alveoli as well as a significant increase in the levels of pro-inflammatory mediators (i.e. TNFalpha and IL-1alpha). However, intravenous administration of 2-CADO 10 microg/kg/day, alone or in combination with an antibiotic (i.e. AMC), significantly decreased neutrophil infiltration into the lung alveoli. A significant decrease in TNFalpha and IL-1alpha along with elevation of IL-10 levels in the lung homogenate of mice with acute lung infection was observed upon treatment with 2-CADO alone, with no significant decrease in bacterial counts. Moreover, in combination with AMC, 2-CADO exhibited its immunomodulatory action in acute lung infection and prevented ALI, whilst an antibacterial action was exhibited by AMC.


    Akiyama, Norimichi; Yokomura, Koshi; Nozue, Tsuyoshi; Abe, Takefumi; Matsui, Takashi; Suda, Takafumi


    We report three cases of drug-induced pneumonia caused by mesalazine. They were all diagnosed as ulcerative colitis and treated with mesalazine orally. Our three cases and literature review revealed that mesalazine-induced pneumonia resemble like eosinophilic pneumonia or organizing pneumonia and that have good prognosis with drug cessation or administration of corticosteroid. The patient of ulcerative colitis is increasing every year and it is anticipated that the patient with mesalazine-induced pneumonia may also increase. In the treatment of ulcerative colitis with mesalazine, we should pay attention with patient's cough or fever for early detection of drug-induced pneumonia.

  14. Mycoplasma pneumonia (United States)

    Walking pneumonia; Community-acquired pneumonia - mycoplasma; Community-acquired pneumonia - atypical ... Mycoplasma pneumonia usually affects people younger than 40. People who live or work in crowded areas such as schools ...

  15. Eosinophilic meningitis caused by infection of Angiostrongylus cantonensis in a traveler

    Institute of Scientific and Technical Information of China (English)

    GUAN Hongzhi; HOI Chupeng; CUI Liying; CHEN Lin


    A 55 - year - old female traveler returning from South China with acute onset of meningitis, presenting with eosinophilic pleocytosis in the cerebrospinal fluid was reported. The etiological diagnosis of angiostrongyliasis was confirmed by detection of specific serum antibody against Angiostrongylus cantonensis. Angiostrongyliasis should be considered as a major differential diagnosis for eosinophilic meningitis in the travelers to endemic regions.

  16. Selected feline eosinophilic skin diseases. (United States)

    Power, H T; Ihrke, P J


    Eosinophilic plaque and mosquito-bite dermatitis are recognized hypersensitivity reactions. The pathogenesis of eosinophilic granuloma and indolent ulcer are not as clearly understood. Each of these syndromes is distinctive from a clinical and histopathologic view point. Accurate diagnosis depends on history, physical findings, and histopathologic evaluation. Understanding of feline dermatology will be furthered by including these syndromes in a broader grouping that encompasses all the feline eosinophilic dermatoses.

  17. The analysis of IgE and eosinophil determinations in acute and chronic urticaria children%儿童急、慢性荨麻疹 IgE 及嗜酸性粒细胞检测分析

    Institute of Scientific and Technical Information of China (English)

    蔡德丰; 陆元善; 袁艳; 杨晓林; 吴跃平; 马东礼


    Objective To investigate IgE levels,eosinophil change and their clinical significance in acute and chronic urticaria children.Methods Respectively by chemiluminescence,enzyme-linked immunofluorescence and volume,conductivity and scattering (VCS)principle,serum total IgE levels,food,mites and plant-specific IgE levels and eosinophil percentages were determined,and the samples were collected from 77 acute and 46 chronic urticaria children.The differences between acute and chronic urticaria children were analyzed comparatively.Results There was no statistical significance in total IgE levels and positive rates to food,mites and plant-specific IgE levels between acute and chronic urticaria children with other allergic diseases(P >0.05),but there was a significantly higher total IgE level in chronic group than that in acute group in acute and chronic urticaria children without other allergic diseases (P 0.05).Conclusions Eosinophil percentage is not a good index for differential diagnosis in acute and chronic urticaria children.IgE has a certain significance for diagnosing acute and chronic urticaria without other allergic diseases.However,in other cases,serum level of total IgE is not a good index for differential diagnosis in acute and chronic urticaria children.Integrating case history,course of disease and clinical symptom can help with making a correct diagnosis.%目的:探讨儿童急、慢性荨麻疹 IgE 水平和嗜酸性粒细胞变化及其临床意义。方法分别用化学发光法、酶免荧光法和 VCS(体积、电导性和散射)原理检测77例急性和46例慢性荨麻疹患儿血清总 IgE 水平,食物、螨虫及植物类特异性 IgE 和嗜酸性粒细胞比例,比较急、慢性荨麻疹患儿间上述指标的差异。结果伴有其它过敏性疾病的急、慢性荨麻疹患儿间血清总 IgE 水平,食物、螨虫及植物类特异性 IgE 阳性率差异无统计学意义(P >0.05),但不伴有其它过敏性疾

  18. Use of procalcitonin for the diagnosis of pneumonia in patients presenting with a chief complaint of dyspnoea: results from the BACH (Biomarkers in Acute Heart Failure) trial (United States)

    Maisel, Alan; Neath, Sean-Xavier; Landsberg, Judd; Mueller, Christian; Nowak, Richard M.; Peacock, W. Frank; Ponikowski, Piotr; Möckel, Martin; Hogan, Christopher; Wu, Alan H.B.; Richards, Mark; Clopton, Paul; Filippatos, Gerasimos S.; Di Somma, Salvatore; Anand, Inder; Ng, Leong L.; Daniels, Lori B.; Christenson, Robert H.; Potocki, Mihael; McCord, James; Terracciano, Garret; Hartmann, Oliver; Bergmann, Andreas; Morgenthaler, Nils G.; Anker, Stefan D.


    Aims Biomarkers have proven their ability in the evaluation of cardiopulmonary diseases. We investigated the utility of concentrations of the biomarker procalcitonin (PCT) alone and with clinical variables for the diagnosis of pneumonia in patients presenting to emergency departments (EDs) with a chief complaint of shortness of breath. Methods and results The BACH trial was a prospective, international, study of 1641 patients presenting to EDs with dyspnoea. Blood samples were analysed for PCT and other biomarkers. Relevant clinical data were also captured. Patient outcomes were assessed at 90 days. The diagnosis of pneumonia was made using strictly validated guidelines. A model using PCT was more accurate [area under the curve (AUC) 72.3%] than any other individual clinical variable for the diagnosis of pneumonia in all patients, in those with obstructive lung disease, and in those with acute heart failure (AHF). Combining physician estimates of the probability of pneumonia with PCT values increased the accuracy to >86% for the diagnosis of pneumonia in all patients. Patients with a diagnosis of AHF and an elevated PCT concentration (>0.21 ng/mL) had a worse outcome if not treated with antibiotics (P = 0.046), while patients with low PCT values (<0.05 ng/mL) had a better outcome if they did not receive antibiotic therapy (P = 0.049). Conclusion Procalcitonin may aid in the diagnosis of pneumonia, particularly in cases with high diagnostic uncertainty. Importantly, PCT may aid in the decision to administer antibiotic therapy to patients presenting with AHF in which clinical uncertainty exists regarding a superimposed bacterial infection. Trial registration: NCT00537628 PMID:22302662

  19. Total artificial heart implantation for biventricular failure due to eosinophilic myocarditis. (United States)

    Kawabori, Masashi; Kurihara, Chitaru; Miller, Yair; Heck, Kent A; Bogaev, Roberta C; Civitello, Andrew B; Cohn, William E; Frazier, O H; Morgan, Jeffrey A


    Idiopathic hypereosinophilic syndrome is a condition of unknown etiology characterized by proliferation of eosinophils and their infiltration into tissues. Although cardiac involvement is rare, eosinophilic myocarditis can lead to life-threating fulminant congestive heart failure. Treatment of patients with eosinophilic myocarditis is challenging as heart failure can be caused by biventricular dysfunction. To our knowledge, this is the first case reported in the literature describing a patient with acute severe biventricular heart failure caused by eosinophilic myocarditis with mural left ventricular apical thrombus who was successfully treated with implantation of a total artificial heart as a bridge to heart transplant.

  20. Population pharmacokinetics of ceftaroline in patients with acute bacterial skin and skin structure infections or community-acquired bacterial pneumonia. (United States)

    Van Wart, Scott A; Forrest, Alan; Khariton, Tatiana; Rubino, Christopher M; Bhavnani, Sujata M; Reynolds, Daniel K; Riccobene, Todd; Ambrose, Paul G


    Ceftaroline, the active form of ceftaroline fosamil, is a broad-spectrum cephalosporin antibiotic. A population pharmacokinetic (PPK) model for ceftaroline was developed in NONMEM® using data from 185 healthy subjects and 92 patients with acute bacterial skin and skin structure infection (ABSSSI). Data from 128 patients with community-acquired bacterial pneumonia (CABP) were used for external model validation. Healthy subjects received 50-2,000 mg ceftaroline fosamil via intravenous (IV) infusion over 1 hour or intramuscular (IM) injection q12h or q24h. ABSSSI and CABP patients received 600 mg of ceftaroline fosamil IV over 1 hour q12h. A three-compartment model with zero-order IV or parallel first-order IM input and first-order elimination described ceftaroline fosamil PK. A two-compartment model with first-order conversion of prodrug to ceftaroline and parallel linear and saturable elimination described ceftaroline PK. Creatinine clearance was the primary determinant of ceftaroline exposure. Good agreement between the observed data and both population (r(2)  = 0.93) and individual post-hoc (r(2)  = 0.98) predictions suggests the PPK model can adequately approximate ceftaroline PK using covariate information. Such a PPK model can evaluate dose adjustments for patients with renal impairment and generate ceftaroline exposures for use in pharmacokinetic-pharmacodynamic assessments of efficacy in patients with ABSSSI or CABP.

  1. Community-acquired pneumonia and survival of critically ill acute exacerbation of COPD patients in respiratory intensive care units (United States)

    Lu, Zhiwei; Cheng, Yusheng; Tu, Xiongwen; Chen, Liang; Chen, Hu; Yang, Jian; Wang, Jinyan; Zhang, Liqin


    Purpose The aim of this study was to appraise the effect of community-acquired pneumonia (CAP) on inhospital mortality in critically ill acute exacerbation of COPD (AECOPD) patients admitted to a respiratory intensive care unit. Patients and methods A retrospective observational study was performed. Consecutive critically ill AECOPD patients receiving treatment in a respiratory intensive care unit were reviewed from September 1, 2012, to August 31, 2015. Categorical variables were analyzed using chi-square tests, and continuous variables were analyzed by Mann–Whitney U-test. Kaplan–Meier analysis was used to assess the association of CAP with survival of critically ill AECOPD patients for univariate analysis. Cox’s proportional hazards regression model was performed to identify risk factors for multivariate analysis. Results A total of 80 consecutive eligible individuals were reviewed. These included 38 patients with CAP and 42 patients without CAP. Patients with CAP had a higher inhospital rate of mortality than patients without CAP (42% vs 33.3%, Pcritically ill AECOPD patients (CAP: hazard ratio, 5.29; 95% CI, 1.50–18.47, Pcritically ill AECOPD patients. PMID:27563239

  2. Psychosis following mycoplasma pneumonia. (United States)

    Banerjee, Bonita; Petersen, Kyle


    Extrapulmonary manifestations of Mycoplasma pneumoniae are well described, including a subset of central nervous system (CNS)-associated syndromes. In pediatric populations, frequencies of CNS sequelae occur in 0.1% to 7% of patients. Neurologic illness associated with M. pneumoniae, such as meningitis, encephalitis, polyradiculitis, Guillain-Barre, and stroke have been reported; however, the incidence of M. pneumoniae-associated organic brain syndrome is rare. We present the case of a 20-year-old midshipman with acute psychosis following resolution of M. pneumoniae pneumonia and review 6 other adult cases found in the literature. M. pneumoniae remains one of the most common causes of respiratory illnesses in the military recruit setting and therefore should always be suspected as an organic cause of mental status changes in young persons such as recruits, cadets, and midshipmen particularly with antecedent respiratory illnesses.

  3. Genetics Home Reference: eosinophil peroxidase deficiency (United States)

    ... Genetics Home Health Conditions eosinophil peroxidase deficiency eosinophil peroxidase deficiency Enable Javascript to view the expand/collapse ... Download PDF Open All Close All Description Eosinophil peroxidase deficiency is a condition that affects certain white ...

  4. Early warning and prevention of pneumonia in acute leukemia by patient education, spirometry, and positive expiratory pressure: A randomized controlled trial. (United States)

    Møller, Tom; Moser, Claus; Adamsen, Lis; Rugaard, Grith; Jarden, Mary; Bøtcher, Tina S; Wiedenbein, Liza; Kjeldsen, Lars


    Long-lasting neutropenia associated with acute myeloid leukemia (AML) and its treatment gives rise to a high risk of pneumonia. The use of broad-spectrum antibiotic prophylaxis during outpatient management has not completely protected patients against admission due to infections and neutropenic fever, emphasizing the need to approach infection protection with complementary efforts. In a randomized controlled design, we examined the applicability of patient-performed daily spirometry [forced expiratory volume in one second (FEV1)] as an early warning tool and explored the effectiveness of positive expiratory pressure (PEP) in preventing pneumonia among 80 AML patients. Twenty-five incidences of pneumonia were detected among 23 patients (6 interventions, 17 controls), giving a prevalence of 28.75% during 5420 days of observation. We found a significant difference in incidence between intervention versus control group (2.17 per 1000 days vs. 6.52 per 1000 days, P = 0.021, respectively). A cross point at 80-76% of the personal FEV1 reference value showed high sensitivity and specificity on pneumonia development. Our data demonstrate the feasibility of educating AML patients in their continuous daily measurement of FEV1 and use of PEP. Daily measures of FEV1 may be an important early warning tool for assessment of pulmonary deterioration during critical phases of neutropenia. We suggest that strategic patient education in the use of spirometry and PEP should be part of standard of care for AML patients undergoing induction chemotherapy.

  5. Pathogenic Approaches To The Treatment Of Patients With Acute Pneumonia Progressing With Bronchial Obstruction

    Directory of Open Access Journals (Sweden)

    M Khaidarova


    Full Text Available At the analysis of clinical efficiency of differential therapy inthe  patients  with  AP  with  BO  the  type  vegetative  nervous system is defined. In the patients with hypersympathicotonic VR  (group  II  and  asympathycotonic  VR  (III  group.during differential treatment there was noted reduction in duration of dyspnea, pulmonary cyanosis,  moist pulmonary rales . In  the  patients  with  AP  with  BO  alongside  with  changes biochemical, immune and vegetative status there was found wrong  attitude    of  the  family  to  the  child,  and  also the psychological behavioral deviations in the child as increasd anxiety,  aggression;  on  a  background  of  complex  therapywere  performed  psychological  correctional  methods  oftreatment:  musictherapy,  psychogymnastics,  gameexercises. At  catamnestic  observation  within  one  year  of  40  childrenwho  have  received  on  a  background  of  other  methods  of treatment psychocorrection, repeated bronchial obstructionwas  observed  only  at  15  %  observable  children.  In  control group  already  through  3  months  45  %  of  children  have addressed  with  repeated  episodes  BO  at  pneumonia  and

  6. Characteristics and outcomes of acute otitis media in children carrying streptococcus pneumoniae or haemophilus influenzae in their nasopharynx as a single otopathogen after introduction of the heptavalent pneumococcal conjugate vaccine. (United States)

    Caeymaex, Laurence; Varon, Emmanuelle; Levy, Corinne; Béchet, Stéphane; Derkx, Véronique; Desvignes, Véronique; Doit, Catherine; Cohen, Robert


    After PCV7 implementation, clinical characteristics were investigated in 832 young children with acute otitis media, carrying a single S. pneumoniae or H. influenzae in their nasopharynx. As compared with H. influenzae, S. pneumoniae-associated acute otitis media was less frequently associated with treatment failure (odds ratio = 0.5; 95% confidence interval: 0.36-0.83) and recurrence (odds ratio = 0.4; 95% confidence interval: 0.22-0.75). Post-PCV7 serotype replacement seemed not to affect the acute otitis media characteristics in these children.

  7. Eosinophils, probiotics, and the microbiome. (United States)

    Rosenberg, Helene F; Masterson, Joanne C; Furuta, Glenn T


    There is currently substantial interest in the therapeutic properties of probiotic microorganisms as recent research suggests that oral administration of specific bacterial strains may reduce inflammation and alter the nature of endogenous microflora in the gastrointestinal tract. Eosinophils are multifunctional tissue leukocytes, prominent among the resident cells of the gastrointestinal mucosa that promote local immunity. Recent studies with genetically altered mice indicate that eosinophils not only participate in maintaining gut homeostasis, but that the absence of eosinophils may have significant impact on the nature of the endogenous gut microflora and responses to gut pathogens, notably Clostridium difficile Furthermore, in human subjects, there is an intriguing relationship between eosinophils, allergic inflammation, and the nature of the lung microflora, notably a distinct association between eosinophil infiltration and detection of bacteria of the phylum Actinobacteria. Among topics for future research, it will be important to determine whether homeostatic mechanisms involve direct interactions between eosinophils and bacteria or whether they involve primarily eosinophil-mediated responses to cytokine signaling in the local microenvironment. Likewise, although is it clear that eosinophils can and do interact with bacteria in vivo, their ability to discern between pathogenic and probiotic species in various settings remains to be explored.

  8. Amount of Pneumocystis carinii and degree of acute lung inflammation in HIV-associated P carinii pneumonia

    DEFF Research Database (Denmark)

    Vestbo, Jørgen; Nielsen, T L; Junge, Jette


    Correlations between semiquantitative amounts of Pneumocystis carinii (PC), the degree of inflammation, and the severity of pneumonia were analyzed in 58 patients with PC pneumonia (PCP). Material from both transbronchial biopsies (TBBs; n = 39) and bronchoalveolar lavage fluid (BALF; n = 57...

  9. Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome following HAART Initiation in an HIV-infected Patient Being Treated for Severe Pneumonia: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Dong Won Park


    Full Text Available Pnuemocystis jirovecii pneumonia (PJP is one of leading causes of acute respiratory failure in patients infected with human immunodeficiency virus (HIV, and the mortality rate remains high in mechanically ventilated HIV patients with PJP. There are several reported cases who received extracorporeal membrane oxygenation (ECMO treatment for respiratory failure associated with severe PJP in HIV-infected patients. We report a patient who was newly diagnosed with HIV and PJP whose condition worsened after highly active antiretroviral therapy (HAART initiation and progressed to acute respiratory distress syndrome requiring veno-venous ECMO. The patient recovered from PJP and is undergoing treatment with HAART. ECMO support can be an effective life-saving salvage therapy for acute respiratory failure refractory to mechanical ventilation following HAART in HIV-infected patients with severe PJP.

  10. Natural antioxidant betanin protects rats from paraquat-induced acute lung injury interstitial pneumonia. (United States)

    Han, Junyan; Ma, Deshun; Zhang, Miao; Yang, Xuelian; Tan, Dehong


    The effect of betanin on a rat paraquat-induced acute lung injury (ALI) model was investigated. Paraquat was injected intraperitoneally at a single dose of 20 mg/kg body weight, and betanin (25 and 100 mg/kg/d) was orally administered 3 days before and 2 days after paraquat administration. Rats were sacrificed 24 hours after the last betanin dosage, and lung tissue and bronchoalveolar lavage fluid (BALF) were collected. In rats treated only with paraquat, extensive lung injury characteristic of ALI was observed, including histological changes, elevation of lung : body weight ratio, increased lung permeability, increased lung neutrophilia infiltration, increased malondialdehyde (MDA) and myeloperoxidase (MPO) activity, reduced superoxide dismutase (SOD) activity, reduced claudin-4 and zonula occluden-1 protein levels, increased BALF interleukin (IL-1) and tumor necrosis factor (TNF)-α levels, reduced BALF IL-10 levels, and increased lung nuclear factor kappa (NF-κB) activity. In rats treated with betanin, paraquat-induced ALI was attenuated in a dose-dependent manner. In conclusion, our results indicate that betanin attenuates paraquat-induced ALI possibly via antioxidant and anti-inflammatory mechanisms. Thus, the potential for using betanin as an auxilliary therapy for ALI should be explored further.

  11. Mucosal immunization with PsaA protein, using chitosan as a delivery system, increases protection against acute otitis media and invasive infection by Streptococcus pneumoniae. (United States)

    Xu, J-H; Dai, W-J; Chen, B; Fan, X-Y


    As infection with Streptococcus pneumoniae (mainly via the mucosal route) is a leading cause of acute otitis media, sinus and bacterial pneumonia, the mucosal immunity plays an important role in the prevention of pneumococcal diseases. Therefore, intranasal vaccination may be an effective immunization strategy, but requires appropriate mucosal vaccine delivery systems. In this work, chitosan was used as a mucosal delivery system to form chitosan-PsaA nanoparticles based on ionotropic gelation methods and used to immunize BALB/c mice intranasally. Compared to mice immunized with naked PsaA, levels of IFN-γ, IL-17A and IL-4 in spleen lymphocytes, the systemic (IgG in serum) and mucosal (IgA in mucosal lavage) specific antibodies were enhanced significantly in mice inoculated with chitosan-PsaA. Furthermore, increased protection against acute otitis media following middle ear challenge with pneumococcus serotype 14, and improved survival following intraperitoneal challenge with pneumococcus serotype 3 or serotype 14, was found in the mice immunized with chitosan-PsaA nanoparticles. Thus, intranasal immunization with chitosan-PsaA can successfully induce mucosal and systemic immune responses and increase protection against pneumococcal acute otitis media and invasive infections. Hence, intranasal immunization with PsaA protein, based on chitosan as a delivery system, is an efficient immunization strategy for preventing pneumococcal infections.

  12. Genetic alteration of penicillin non-susceptible Streptococcus pneumoniae observed throughout recurrence of acute otitis media detected by amplified fragment length polymorphism analysis.

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    Sugata K


    Full Text Available The prevalence of penicillin non-susceptible Streptococcus pneumoniae (PNSSP is increasing among isolates from acute otitis media (AOM. Repeated episodes of antibiotic exposure are a well-known risk factor for the isolation of PNSSP although otitis-prone or recurrent AOM cases frequently require repeated courses of antibiotic treatment. In order to evaluate the chronological alteration of S. pneumoniae during recurrences of AOM, strains of S. pneumoniae were isolated from 11 patients, each of whom had experienced 2-4 episodes of AOM, were examined. Every bacterial specimen obtained from a single episode of recurrent AOM was examined by PCR-based penicillin-binding protein (PBP assay, serotyping, and amplified fragment length polymorphism (AFLP, then compared to other samples from the same case. Two cases (18.2% showed strain diversity during repeated antibiotic treatments by serotyping or PBP-assay. By AFLP analysis, 6 cases (54.5% demonstrated heterogeneous strains during recurrent AOM. Clonal survivors of previous episodes of AOM were not always the cause of subsequent episodes of AOM, even in otitis-prone cases.

  13. Eosinophilic Fasciitis Associated with Myositis

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    Yuko Adachi


    Full Text Available Eosinophilic fasciitis is clinically characterized by symmetrical scleroderma-like indurations of the skin with pain. The histological features are fascial inflammation with lymphocytes and eosinophils as well as thickened and fibrotic fascia. Lymphocytic infiltration and degeneration of the underlying muscle are rarely observed. We report a 69-year-old Japanese woman who presented with multiple areas of glossy induration and painful peau d'orange-like lesions on the chest and four extremities. T2-weighted magnetic resonance imaging showed significant hyperintense thickening of the fascia of the lower extremities. Histopathological examination of a biopsy specimen from the induration showed marked fibrinoid degeneration of the fascia and the neighboring muscle with mixed cellular infiltration of lymphocytes and eosinophils. The predominant CD8+ lymphocytic infiltrates were observed by immunohistological study. A diagnosis of eosinophilic fasciitis with myositis was made. Oral administration of prednisolone and discontinuation of exercise significantly improved the lesions and pain.

  14. A Case of Eosinophilic Esophagitis Accompanying Familial Mediterranean Fever (United States)

    Rohani, Pejman; Najafi Sani, Mehri; Ahmadi, Mitra


    Background. Eosinophilic esophagitis is an inflammatory condition where there is a dense infiltration of eosinophils typically exceeding fifteen cells per high power field. Familial Mediterranean fever is an autosomal recessive disorder characterized by brief, acute, and self-limited episodes of fever and polyserositis that recur at irregular intervals. Case Presentation. A three-year-and-nine-month-old Iranian girl was admitted to our center. The patient's parents complained of a history of abdominal pain, poor appetite, and poor weight gain from 1.5 years ago and episodes of food impaction after starting solid foods. Eosinophilic esophagitis was diagnosed based on histology. Because of continuing abdominal pain after treatment of eosinophilic esophagitis, the episodic nature of disease, and the presence of fever with pain, screening for familial Mediterranean fever mutation was performed and the patient was found to be heterozygote for Mediterranean fever. Conclusion. We have reported a case of eosinophilic esophagitis coexisting with familial Mediterranean fever which has not been described previously. PMID:28255474

  15. The Analysis of Average Diameter of Erythrocytes in Children of Early Age with Pneumonia and Acute Respiratory Viral Infections

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    S. S. Shevchenko,


    Full Text Available Development of inflammatory bronkholegochny process in children is followed by the permanent changes in system of an eritron aggravating finally the phenomena of a hypoxia of bodies and fabrics. Work purpose: studying of average diameter of erythrocytes at children of early age, patients with pneumonia and ARVI. Determination of average diameter of erythrocytes was carried out by a diffraction method on identical structure of chaotic objects at 36 children with pneumonia and at 41 children with a ARVI aged from 4 months till 3 years. The control group was made by 20 almost healthy children of the same age. During the sharp period of a disease the average diameter of erythrocytes was authentically increased both at pneumonia, and at a ARVI. Reliable difference of these indicators when comparing a toxic syndrome at pneumonia and a ARVI is revealed. Thus, at children of early age, patients with pneumonia and ARVI, in dynamics of a disease the natural changes of average diameter of erythrocytes having differential and diagnostic and predictive value are revealed.

  16. Improving Physical Activity Ensures the Long-Term Survival of Pneumonia Patients in a Super-Aged Society: A Retrospective Study in an Acute-Care Hospital in Japan. (United States)

    Sato, Kei; Okada, Shinji; Sugawara, Ayumi; Tode, Naoki; Watanuki, Zenta; Suzuki, Kumiko; Ichinose, Masakazu


    Pneumonia is the third largest cause of death in Japan. Chest physicians have been struggling to improve the outcome of pneumonia treatment in acute care settings. However, a poor long-term prognosis after pneumonia has not been well recognized. Furthermore, the factors related to the poor prognosis, especially the possible involvement of senescence-related disability, have not been identified. In this study, long-term outcomes after discharge from hospital were retrospectively analyzed to identify factors related to the poor long-term prognosis. Outcomes of 958 pneumonia patients who were discharged from South Miyagi Medical Center (Miyagi, Japan) from June 1, 2008 to March 31, 2014 were determined through patient surveys or medical record reviews on September 26, 2014. Survival curves were constructed and compared according to various factors. Multivariate analysis revealed that all levels of decrease in physical activity, an age of 80 years old or more, the most severe status in Japanese Respiratory Society pneumonia severity grading system, the presence of antibiotic-resistant bacteria, and comorbid malignancy significantly reduced long-term survival. The effects of dementia, neuromuscular disease, heart disease, and nursing care residency on long-term survival were detected only with univariate analysis. Physical activity influenced the acute-phase and the long-term prognosis of pneumonia. This report provides information to assist physicians in giving better suggestions to disabled older patients when choosing pneumonia treatment options. In conclusion, we propose that death related to pneumonia can be prevented in the same way as non-communicable diseases by improving physical activity.

  17. CNS Complications of Mycoplasma Pneumoniae

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap


    Full Text Available Three cases of acute central nervous system disease occurring subsequent to infection with M pneumoniae are reported from University College, Institute of Child Health, and Great Ormond Street Hospital, London, UK.

  18. Eosinophilic meningitis caused by Angiostrongylus cantonensis in an adolescent with mental retardation and pica disorder. (United States)

    Hsueh, Chang-Wei; Chen, Huan-Sheng; Li, Chen-Hua; Chen, Yu-Wei


    Eosinophilic meningitis or encephalitis is a rare disorder and is most commonly caused by Angiostrongylus cantonensis. Humans are accidentally infected when they ingest raw snails or vegetables contaminated with the parasite larvae. Because of the improvement in sanitary food handling practices, the occurrence of A. cantonensis eosinophilic meningitis has been decreasing in Taiwan in recent decades. The common symptoms and signs of eosinophilic meningitis are severe headache, neck stiffness, paresthesia, vomiting, nausea, and fever. Acute urinary retention is a rare presentation. We report a case of A. cantonensis eosinophilic meningitis in an intellectually disabled patient who presented with acute urinary retention without any other meningeal signs. The patient received supportive treatment with corticosteroid therapy and was discharged and received urinary rehabilitation at home.

  19. Hematopoietic Processes in Eosinophilic Asthma. (United States)

    Salter, Brittany M; Sehmi, Roma


    Airway eosinophilia is a hallmark of allergic asthma and understanding mechanisms that promote increases in lung eosinophil numbers is important for effective pharmaco-therapeutic development. It has become evident that expansion of hemopoietic compartments in the bone marrow promotes differentiation and trafficking of mature eosinophils to the airways. Hematopoietic progenitor cells egress the bone marrow and home to the lungs, where in-situ differentiative processes within the tissue provide an ongoing source of pro-inflammatory cells. In addition, hematopoietic progenitor cells in the airways can respond to locally-derived alarmins, to produce a panoply of cytokines thereby themselves acting as effector pro-inflammatory cells that potentiate type 2 responses in eosinophilic asthma. In this review, we will provide evidence for these findings and discuss novel targets for modulating eosinophilopoietic processes, migration and effector function of precursor cells.

  20. The application of strong ion gap and other indicators in acute pneumonia%强离子隙等指标在重症肺炎中的应用价值分析

    Institute of Scientific and Technical Information of China (English)

    张忠源; 胡望平; 池细弟; 叶桂云; 徐尚华; 张永平; 叶龙飞


    目的 探讨强离子隙(SIG)、乳酸和阴离子隙(AG)等指标在重症肺炎中的应用价值.方法 在测定血气、血pH、电解质结果基础上,应用Stewart-Figge方法学的方程式计算SIG.结果 223例重症肺炎患者与71例非重症肺炎患者进行比较,钠、钾、SIG、AG、清蛋白(ALB)、pH、磷酸盐及乳酸水平差异均有统计学意义(P<0.05),重症肺炎患者中217例存活患者与6例死亡患者比较,SIG、AG及ALB水平差异有统计学意义(P<0.05).结论 SIG、乳酸和AG等指标对重症肺炎的诊断、治疗、病情监测具有指导意义;SIG值在重症肺炎患者预后评估中有较大的应用价值.%Objective To investigate the application value of strong ion gap(SIG) ,lactic acid,anionic gap(AG) and other indicators in acute pneumonia. Methods SIG was calculated with Stewart-Figge model,based on the results of blood gas,blood pH,and serum electrolytes. Results Comparing 223 acute pneumonia patients and 71 non-acute pneumonia patients, there were significant difference in the results of sodium, potassium,SIG, AG,albumin, pH , phosphate and lactic acid(P<0. 05). The results of AG,albumin, and SIG of 217 alive acute pneumonia patients were also significantly different from those of 6 death acute pneumonia patients (P<0. 05). Conclusion It might be important of SIG,lactate, AG and other indicators for the diagnosis,treatment,and monitoring of acute pneumonia. The application value of SIG in prognosis of acute pneumonia could be significant.

  1. Eosinophilic cholecystitis with common bile duct stricture: a rare disease. (United States)

    Mehanna, Daniel; Naseem, Zainab; Mustaev, Muslim


    Although the most common cause of cholecystitis is gallstones, other conditions may present as acute cholecystitis. We describe a case of eosinophilic cholecystitis with common bile duct stricture. A 36-year-old woman initially had generalised abdominal pain and peripheral eosinophilia. Diagnostic laparoscopy showed eosinophilic ascites and necrotic nodules on the posterior abdominal wall. She was treated with anthelminthics on presumption of toxacara infection based on borderline positivity of serological tests. She later presented with acute cholecystitis and had a cholecystectomy and choledocotomy. Day 9 T-tube cholangiogram showed irregular narrowing of the distal common bile duct. The patient's symptoms were improved with steroids and the T-tube was subsequently removed.

  2. Focus on JNJ-Q2, a novel fluoroquinolone, for the management of community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections

    Directory of Open Access Journals (Sweden)

    Jones TM


    Full Text Available Travis M Jones,1,2 Steven W Johnson,1,3 V Paul DiMondi,1,4 Dustin T Wilson,1,2 1Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, 2Department of Pharmacy, Duke University Hospital, Durham, 3Department of Pharmacy, Forsyth Medical Center, Novant Health, Winston-Salem, 4Department of Pharmacy, Durham VA Medical Center, Durham, NC, USA Abstract: JNJ-Q2 is a novel, fifth-generation fluoroquinolone that has excellent in vitro and in vivo activity against a variety of Gram-positive and Gram-negative organisms. In vitro studies indicate that JNJ-Q2 has potent activity against pathogens responsible for acute bacterial skin and skin structure infections (ABSSSI and community-acquired bacterial pneumonia (CABP, such as Staphylococcus aureus and Streptococcus pneumoniae. JNJ-Q2 also has been shown to have a higher barrier to resistance compared to other agents in the class and it remains highly active against drug-resistant organisms, including methicillin-resistant S. aureus, ciprofloxacin-resistant methicillin-resistant S. aureus, and drug-resistant S. pneumoniae. In two Phase II studies, the efficacy of JNJ-Q2 was comparable to linezolid for ABSSSI and moxifloxacin for CABP. Furthermore, JNJ-Q2 was well tolerated, with adverse event rates similar to or less than other fluoroquinolones. With an expanded spectrum of activity and low potential for resistance, JNJ-Q2 shows promise as an effective treatment option for ABSSSI and CABP. Considering its early stage of development, the definitive role of JNJ-Q2 against these infections and its safety profile will be determined in future Phase III studies. Keywords: JNJ-Q2, fluoroquinolone, ABSSSI, CABP, MRSA

  3. Does eosinophilic COPD exacerbation have a better patient outcome than non-eosinophilic in the intensive care unit? (United States)

    Saltürk, Cüneyt; Karakurt, Zuhal; Adiguzel, Nalan; Kargin, Feyza; Sari, Rabia; Celik, M Emin; Takir, Huriye Berk; Tuncay, Eylem; Sogukpinar, Ozlem; Ciftaslan, Nezihe; Mocin, Ozlem; Gungor, Gokay; Oztas, Selahattin


    Background COPD exacerbations requiring intensive care unit (ICU) admission have a major impact on morbidity and mortality. Only 10%–25% of COPD exacerbations are eosinophilic. Aim To assess whether eosinophilic COPD exacerbations have better outcomes than non-eosinophilic COPD exacerbations in the ICU. Methods This retrospective observational cohort study was conducted in a thoracic, surgery-level III respiratory ICU of a tertiary teaching hospital for chest diseases from 2013 to 2014. Subjects previously diagnosed with COPD and who were admitted to the ICU with acute respiratory failure were included. Data were collected electronically from the hospital database. Subjects’ characteristics, complete blood count parameters, neutrophil to lymphocyte ratio (NLR), delta NLR (admission minus discharge), C-reactive protein (CRP) on admission to and discharge from ICU, length of ICU stay, and mortality were recorded. COPD subjects were grouped according to eosinophil levels (>2% or ≤2%) (group 1, eosinophilic; group 2, non-eosinophilic). These groups were compared with the recorded data. Results Over the study period, 647 eligible COPD subjects were enrolled (62 [40.3% female] in group 1 and 585 [33.5% female] in group 2). Group 2 had significantly higher C-reactive protein, neutrophils, NLR, delta NLR, and hemoglobin, but a lower lymphocyte, monocyte, and platelet count than group 1, on admission to and discharge from the ICU. Median (interquartile range) length of ICU stay and mortality in the ICU in groups 1 and 2 were 4 days (2–7 days) vs 6 days (3–9 days) (P2%. NLR and peripheral eosinophilia may be helpful indicators for steroid and antibiotic management. PMID:26392758

  4. Eosinophilic meningitis secondary to intravenous vancomycin. (United States)

    Kazi, Ruchika; Kazi, Haseeb A; Ruggeri, Cara; Ender, Peter T


    Eosinophilic meningitis may be due to infectious or noninfectious etiologies. Parasitic infections cause this entity most frequently and of the noninfectious causes, medications play an important role. We describe a 32-year-old male who developed eosinophilic meningitis while receiving intravenous vancomycin. No other apparent cause of the eosinophilic meningitis was appreciated. This case represents the first description of eosinophilic meningitis due to systemic vancomycin.

  5. Eosinophilic annular erythema in childhood - Case report* (United States)

    Abarzúa, Alvaro; Giesen, Laura; Silva, Sergio; González, Sergio


    Eosinophilic annular erythema is a rare, benign, recurrent disease, clinically characterized by persistent, annular, erythematous lesions, revealing histopathologically perivascular infiltrates with abundant eosinophils. This report describes an unusual case of eosinophilic annular erythema in a 3-year-old female, requiring sustained doses of hydroxychloroquine to be adequately controlled. PMID:27579748

  6. Eosinophilic cholecystitis caused by Ascaris lumbricoides


    Montiel-Jarquín, Alvaro


    Eosinophilic cholecystitis is caused by the accumulation of eosinophils in the gallbladder wall and diagnosis is usually made based on histopathologic studies. The purpose of this paper is to comment on a case report published in World J Gastroenterol 2007 July; 13 (27): 3760-3762, about eosinophilic cholecystitis along with pericarditis without histopathological studies, which are considered necessary for its diagnosis.

  7. Eosinophilic cholecystitis caused by Ascaris lumbricoides

    Institute of Scientific and Technical Information of China (English)

    Montiel-Jarquín Alvaro


    Eosinophilic cholecystitis is caused by the accumulation of eosinophils in the gallbladder wall and diagnosis is usually made based on histopahologic studies.The purpose of this paper is to comment on a case report published in Wodd J Gastroenterol 2007 luly;13 (27):3760-3762,about eosinophilic cholecystitis along with pericarditis without histopathological studies,which are considered necessary for its diagnosis.

  8. Fasciola hepatica induces eosinophil apoptosis in the migratory and biliary stages of infection in sheep. (United States)

    Escamilla, A; Bautista, M J; Zafra, R; Pacheco, I L; Ruiz, M T; Martínez-Cruz, S; Méndez, A; Martínez-Moreno, A; Molina-Hernández, V; Pérez, J


    The aim of the present work was to evaluate the number of apoptotic eosinophils in the livers of sheep experimentally infected with Fasciola hepatica during the migratory and biliary stages of infection. Four groups (n=5) of sheep were used; groups 1-3 were orally infected with 200 metacercariae (mc) and sacrificed at 8 and 28 days post-infection (dpi), and 17 weeks post-infection (wpi), respectively. Group 4 was used as an uninfected control. Apoptosis was detected using immunohistochemistry with a polyclonal antibody against anti-active caspase-3, and transmission electron microscopy (TEM). Eosinophils were identified using the Hansel stain in serial sections for caspase-3, and by ultrastructural features using TEM. At 8 and 28 dpi, numerous caspase-3(+) eosinophils were mainly found at the periphery of acute hepatic necrotic foci. The percentage of caspase -3(+) apoptotic eosinophils in the periphery of necrotic foci was high (46.1-53.9) at 8 and 28 dpi, respectively, and decreased in granulomas found at 28 dpi (6%). Transmission electron microscopy confirmed the presence of apoptotic eosinophils in hepatic lesions at 8 and 28 dpi. At 17 wpi, apoptotic eosinophils were detected in the infiltrate surrounding some enlarged bile ducts containing adult flukes. This is the first report of apoptosis induced by F. hepatica in sheep and the first study reporting apoptosis in eosinophils in hepatic inflammatory infiltrates in vivo. The high number of apoptotic eosinophils in acute necrotic tracts during the migratory and biliary stages of infection suggests that eosinophil apoptosis may play a role in F. hepatica survival during different stages of infection.

  9. Eosinophilic Endomyocarditis: A Rare Case of Neonatal Mortality

    Directory of Open Access Journals (Sweden)

    Allison J. Pollock


    Full Text Available Background - Eosinophilic endomyocarditis (EEM is a rare diagnosis that is extremely uncommon in newborns. This case report aimed to present a case of neonatal mortality from acute cardiac failure due to EEM. Case - Our report presents a term male neonate with minor complications in the immediate postnatal course, who was discharged at 48 hours of life, but who developed unexpected respiratory distress, followed by cardiac arrest and death at 3 days of life. One day after discharge, the infant developed respiratory distress and cool skin, and then developed cardiac arrest at the pediatrician's office, undergoing resuscitation with intravenous fluid, cardiopulmonary resuscitation, epinephrine, atropine, and failed intubation. Autopsy revealed EEM, an inflammatory infiltrative process involving the endomyocardium. Pathology - Pathogenesis involves three stages: (1 myocarditis with an acute eosinophilic inflammatory infiltrate followed by (2 myocyte necrosis and eventually (3 fibrosis in the final stage of the disease. Discussion - The cause of death was acute cardiac failure due to intense eosinophilic infiltration and degranulation with early subendocardial myocyte necrosis but before development of extensive myocyte necrosis. This case appears to be the youngest patient reported with EEM.

  10. Pneumocystis jiroveci pneumonia prophylaxis during maintenance therapy influences methotrexate/6-mercaptopurine dosing but not event-free survival for childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Levinsen, Mette; Shabaneh, Diana; Bohnstedt, Cathrine


    Trimethoprim-sulfamethoxazole (TMP/SMX) is used in children with acute lymphoblastic leukemia (ALL) to prevent Pneumocystis pneumonia (PCP). We explored to which extent TMP/SMX influenced methotrexate (MTX)/6-mercaptopurine (6MP) dosage, myelosuppression, and event-free survival (EFS) during.......06) were related to reduced EFS. ANC had no effect on EFS among TMP/SMX2–7 patients (P = 0.40) but did for TMP/SMXnever patients (P = 0.02). The difference in the effect on EFS between TMP/SMX2–7 and TMP/SMXnever patients was not significant (P = 0.46). EFS did not differ between TMP/SMX2–7 and TMP....../SMXnever patients (0.83 vs. 0.83; P = 0.82). These results suggest that TMP/SMX is effective in preventing PCP and may have an antileukemic effect. TMP/SMX should be given the entire duration of maintenance therapy...

  11. Use of an oscillatory PEP device to enhance bronchial hygiene in a patient of post-H1NI pneumonia and acute respiratory distress syndrome with pneumothorax. (United States)

    Narula, Deepali; Nangia, Vivek


    A 26-year-old, 14 week pregnant woman was admitted to our hospital with pneumonia with acute respiratory distress syndrome in an intubated and mechanically ventilated state. She was diagnosed to have polymicrobial infection and left-sided pneumothorax and was put on a ventilator for 2 weeks. Postextubation, she found it difficult to clear her respiratory secretions despite aggressive routine chest physiotherapy. She was planned to undergo a mini-tracheostomy for tracheobronchial toileting. However, before that, she was given a trial of Acapella, a hand-held oscillatory positive expiratory pressure (OPEP) therapy device, for facilitating airway clearance, with the aim to speed up the recovery. The patient found it easy to use and clear the secretions optimally, thus averting a mini-tracheostomy. This case report highlights the advantages of the OPEP therapy device in effective management of bronchial hygiene in patients with poor respiratory effort.

  12. Pneumonia (image) (United States)

    Pneumonia is an inflammation of the lungs caused by an infection. Many different organisms can cause it, including bacteria, viruses, and fungi. Pneumonia is a common illness that affects millions of ...

  13. Influence of HIV infection on the clinical presentation and outcome of adults with acute community-acquired pneumonia in Yaounde, Cameroon: a retrospective hospital-based study

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    Yone Eric Walter


    Full Text Available Abstract Background The impact of HIV infection on the evolution of acute community-acquired pneumonia (CAP is still controversial. The aim of this study was to investigate possible differences in the clinical presentation and in-hospital outcomes of patients with CAP with and without HIV infection in a specialised service in Yaounde. Methods Medical files of 106 patients (51 men aged 15 years and above, admitted to the Pneumology service of the Yaounde Jamot Hospital between January 2008 and May 2012, were retrospectively studied. Results Sixty-two (58.5% patients were HIV infected. The median age of all patients was 40 years (interquartile range: 31.75-53 and there was no difference in the clinical and radiological profile of patients with and without HIV infection. The median leukocyte count (interquartile range was 14,600/mm3 (10,900-20,600 and 10,450/mm3 (6,400-16,850 respectively in HIV negative and HIV positive patients (p = 0.002. Median haemoglobin level (interquartile range was 10.8 g/dl (8.9-12 in HIV negative and 9.7 g/dl (8–11.6 in HIV positive patients (p = 0.025. In-hospital treatment failure on third day (39.5% vs. 25.5.1%, p = 0.137 and mortality rates (9% vs. 14.5%, p = 0.401 were similar between HIV negative and HIV positive patients. Conclusion Clinical and radiological features as well as response to treatment and in hospital fatal outcomes are similar in adult patients hospitalised with acute community-acquired pneumonia in Yaounde. In contrast, HIV infected patients tend to be more anaemic and have lower white cell counts than HIV negative patients. Larger prospective studies are needed to consolidate these findings.

  14. Eosinophilic vasculitis in an isolated central nervous system distribution (United States)

    Sommerville, R Brian; Noble, James M; Vonsattel, Jean Paul; Delapaz, Robert; Wright, Clinton B


    Eosinophilic vasculitis has been described as part of the Churg–Strauss syndrome, but affects the central nervous system (CNS) in <10% of cases. A 39-year-old woman with a history of migraine without aura presented to an institution in an acute confusional state with concurrent headache and left-sided weakness. Laboratory evaluation showed an increased cerebrospinal fluid (CSF) protein level, but otherwise unremarkable serologies. Magnetic resonance imaging showed bifrontal polar gyral-enhancing brain lesions. Her symptoms resolved over two weeks without residual deficits. Eighteen months later the patient presented with similar symptoms and neuroradiological findings showed involvement of territories different from those in her first episode. Brain biopsy showed transmural, predominantly eosinophilic, inflammatory infiltrates and fibrinoid necrosis without granulomas. She improved when treated with corticosteroids. To our knowledge, this is the first case of non-granulomatous eosinophilic vasculitis isolated to the CNS. No aetiology for this patient’s primary CNS eosinophilic vasculitis has yet been identified. PMID:21686608


    Institute of Scientific and Technical Information of China (English)

    Zhang Jizeng; Chen Jumei; Zhang Chenguang


    Objective: To research the formative mechanism of eosinophilic lymphogranuloma (ELG), investigate its essence, provide morphologic base for treatment.Methods: The biopsies and surgical specimens of 41 cases were studied with the light microscope, fluorescein microscope, electron microscope and immunohistochemical methods. In these cases, 10 cases levels of serum IgE were measured, it was high level, and 11 cases cured with radiotherapy. Results: The lesions mainly included proliferation of both lymph tissues and post-capillary venues and formed many new scattered lymph follicles.Marked hyperplasia of plasmocytes and mast cells and diffusible infiltration of eosinophilic granulocytes were observed in tissues. The eosinophilic granulocytes were obviously degranulated. When stained with fluorescein isothiocyanate (FITC) labeled antiserum IgE, the cells showed yellow-green fluorescence, which showed reticular shape in the germinal center of lymph follicles. The swollen tumor-like masses could disappear with radiotherapy, and the eosinophilic granulocytes count in circulation and level of serum IgE reduced to normal.Conclusion: The serum IgE is high lever and it is positive reaction in the tissues strongly. It is accord with allergic granuloma. The lymphocytes are allergenic ambocepotor cells, the x-ray can kill them and stop allergenic agent, the illness was recovered.

  16. Mycoplasma pneumoniae associated organising pneumonia in a 10 year old boy. (United States)

    Wachowski, O; Demirakça, S; Müller, K-M; Scheurlen, W


    We describe a 10 year old boy with organising pneumonia associated with acute Mycoplasma pneumoniae infection. The diagnosis of organising pneumonia was made by open lung biopsy and the M pneumoniae infection was proven serologically. Antibiotic and long term corticosteroid treatment resulted in steadily improving pulmonary function monitored by spirometry. The introduction of anti-inflammatory treatment with NSAIDs/immunosuppressive agents in order to spare steroids was well tolerated and resulted in further improvement of the pulmonary function. To our knowledge this is the first documented case of Mycoplasma pneumoniae associated organising pneumonia to be reported in a child.

  17. Impaired acquired resistance of mice to Klebsiella pneumoniae infection induced by acute NO/sub 2/ exposure

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    Bouley, G.; Azoulay-Dupuis, E.; Gaudebout, C.


    The natural resistance of nonimmunized C57B1/6 mice to an intraperitoneal Klebsiella pneumoniae challenge was not significantly affected by prior continuous exposure to 20 ppm NO/sub 2/ for 4 days. In contrast, the acquired resistance of mice immunized just before and infected just after NO/sub 2/ exposure was seriously impaired. This could not be explained by the loss of appetite (about 30%) observed in NO/sub 2/ treated mice, for neither the natural nor acquired resistance of control air exposure mice given approximately 70% ad libitum food and water were significantly modified.

  18. Colonização e resistência antimicrobiana de Streptococcus pneumoniae isolado em nasofaringe de crianças com rinofaringite aguda Nasopharyngeal colonization and antimicrobial resistance of Streptococcus pneumoniae isolated in children with acute rinofaringitis

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    Lêda Lúcia M. Ferreira


    ças com infecção respiratória alta podem ser usados na vigilância da resistência antimicrobiana numa determinada comunidade.OBJECTIVE: to determine the prevalence and risk factors for nasopharyngeal colonization by, and to evaluate antimicrobial susceptibility of Streptococcus pneumoniae strains in children with acute rhinopharyngitis. METHODS: we collected nasopharyngeal swab specimens from 400 children aged 3 months to 5 years and with clinical status of acute rhinopharyngitis from June 16, 1997 to May 20, 1998 at the outpatient clinics of two hospitals in the city of São Paulo. Nasopharyngeal specimens were collected pernasally using a calcium alginate swab and plated immediately after collection onto trypticose soy agar with 5% sheep blood and garamicin 5 mcg/ml. Penicillin susceptibility was determined by oxacillin 1 mcg disk screening test and the minimal inhibitory concentration by the E-test. RESULTS: Pneumococci were recovered from 139 children, indicating a colonization prevalence of 35%. The risk factors analyzed indicated that the colonization was more prevalent in children attending day-care centers, children with siblings younger than 5 years, and children with recent use of antimicrobial agents. The prevalence of penicillin non-susceptible strains was of 16 % (20 strains. All strains were intermediately resistant (0.1mcg/ ml < MIC < 1.0 mcg/ ml. Out of the penicillin intermediately resistant strains, 7 (37% showed intermediate resistance to cotrimoxazol and 2 (11% full resistance to trimethoprim-sulfamethoxazole. No strains were resistant to ceftriaxone, amoxicillin, clarithromicin, or chloramphenicol. CONCLUSIONS: our findings indicate that the prevalence of nasopharyngeal colonization by Streptococcus pneumoniae in children with upper respiratory infections was of 34.8%. Children attending day-care centers and children with younger siblings showed higher levels of colonization The results of prevalence of bacterial resistance were similar to those

  19. Decitabine, Cytarabine, and Daunorubicin Hydrochloride in Treating Patients With Acute Myeloid Leukemia (United States)


    Adult Acute Basophilic Leukemia; Adult Acute Eosinophilic Leukemia; Adult Acute Monoblastic Leukemia; Adult Acute Monocytic Leukemia; Adult Acute Myeloid Leukemia With Maturation; Adult Acute Myeloid Leukemia With t(9;11)(p22;q23); MLLT3-MLL; Adult Acute Myeloid Leukemia Without Maturation; Adult Acute Myelomonocytic Leukemia; Alkylating Agent-Related Acute Myeloid Leukemia; Secondary Acute Myeloid Leukemia; Untreated Adult Acute Myeloid Leukemia

  20. Eosinophilic leukaemia in a cat. (United States)

    Sharifi, Hassan; Nassiri, Seyed Mahdi; Esmaelli, Hossein; Khoshnegah, Javad


    A 14-year-old female domestic shorthair cat was presented to Tehran University Veterinary Teaching Hospital for a persistent fever, anorexia, intermittent vomiting, weight loss and weakness. The main clinical signs were pale mucous membranes, dehydration and splenomegaly. The complete blood count and serum biochemistry tests revealed non-regenerative anaemia, thrombocytopenia and increased alkaline phosphatase (ALP) activity. An enzyme-linked immunosorbent assay (ELISA) test for feline leukaemia virus was negative. Blood film and bone marrow examination revealed a large number of immature eosinophils with variable sizes and numbers of faintly azurophilic granules. Cytochemical staining of blood film demonstrated 70% positive cells for ALP activity. Four percent CD34 positive cells were detected by flow cytometry. As eosinophilic leukaemia is difficult to identify by light microscopy, well-defined diagnostic criteria and the use of flow cytometry and cytochemical staining can improve the ability to correctly diagnose this type of leukaemia in cats.

  1. Association of the blood eosinophil count with hematological malignancies and mortality. (United States)

    Andersen, Christen L; Siersma, Volkert D; Hasselbalch, Hans C; Vestergaard, Hanne; Mesa, Ruben; Felding, Peter; Olivarius, Niels D F; Bjerrum, Ole W


    Blood eosinophilia (≥0.5 × 10(9) /l) may be an early sign of hematological malignancy. We investigated associations between levels of blood eosinophils and risks of hematological malignancies and mortality in order to provide clinically derived cut-offs for referral to specialist hematology care. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count encompassing the eosinophil count during 2000-2007 and matched these laboratory data with Danish nationwide health registers. We used multivariable logistic regression to calculate odds ratios (ORs) for the 4-year incidences of hematological malignancies and mortality between the eosinophil counts and a reference count of 0.16 × 10(9) /l which was the median eosinophil count in our data. Risks of hematological malignancies and mortality increased above the median eosinophil count. At the 99th percentile, corresponding to an eosinophil count of 0.75 × 10(9) /l, risks of hematological malignancies were increased more than twofold with OR (95% C.I.) of 2.39 (1.91-2.99). Interestingly, risks reached a plateau around an eosinophil count of 1.0 × 10(9) /l. Risks also increased when the eosinophil count approached zero. Here, counts associated relatively more with acute myeloid leukemia and myelodysplastic syndromes whereas counts above 0.16 × 10(9) /l associated more with myeloproliferative neoplasms. Eosinophil counts associate with hematological malignancies and mortality even below the definition of eosinophilia. The observed plateau of risks around 1.0 × 10(9) /l is important for physicians encountering patients with eosinophilia since even mild-to-moderate eosinophilia according to traditional definitions confers maximally increased risks of subsequent/subclinical hematological malignancy.

  2. Eosinophilic fasciitis after parasite infection. (United States)

    Oliveira, Marta; Patinha, Fabia; Marinho, Antonio


    Eosinophilic fasciitis is a systemic inflammatory disease characterized by symmetrical swelling and skin induration of the distal portions of the arms and/or legs, evolving into a scleroderma-like appearance, accompanied by peripheral blood eosinophilia. It is a rare disease with a poorly understood etiology. Corticosteroid treatment remains the standard therapy, either taken alone or in association with an immunosuppressive drug. This paper presents a case of a male patient with palpebral edema and marked eosinophilia, diagnosed with intestinal parasitic infection in October 2006. He was treated with an antiparasitic drug, but both the swelling and the analytical changes remained. This was followed by a skin and muscle biopsy, which turned out to be compatible with eosinophilic fasciitis. There was progressive worsening of the clinical state, with stiffness of the abdominal wall and elevated inflammatory parameters, and the patient was referred to the Immunology Department, medicated with corticosteroids and methotrexate. Over the years there were therapeutic adjustments and other causes were excluded. Currently the patient continues to be monitored, and there is no evidence of active disease. The case described in this article is interesting because of the diagnosis of eosinophilic fasciitis probably associated/coexisting with a parasite infection. This case report differs from others in that there is an uncommon cause associated with the onset of the disease, instead of the common causes such as trauma, medication, non-parasitic infections or cancer.

  3. Effect of Prior Atorvastatin Treatment on the Frequency of Hospital Acquired Pneumonia and Evolution of Biomarkers in Patients with Acute Ischemic Stroke: A Multicenter Prospective Study (United States)

    Yu, Yuetian


    Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP). Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n = 268, PG) and no prior treatment group (n = 224, NG). All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC), procalcitonin (PCT), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6)] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p > 0.05) and 28-day mortality (50.72% versus 58.18%, p > 0.05). However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP) (36.54% versus 58.14%, p = 0.041) and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p = 0.038). Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p < 0.01). Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry. PMID:28357403

  4. Effect of Prior Atorvastatin Treatment on the Frequency of Hospital Acquired Pneumonia and Evolution of Biomarkers in Patients with Acute Ischemic Stroke: A Multicenter Prospective Study

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    Yuetian Yu


    Full Text Available Objective. To investigate whether prior treatment of atorvastatin reduces the frequency of hospital acquired pneumonia (HAP. Methods. Totally, 492 patients with acute ischemic stroke and Glasgow Coma Scale ≤ 8 were enrolled in this study. Subjects were assigned to prior atorvastatin treatment group (n=268, PG and no prior treatment group (n=224, NG. All the patients were given 20 mg atorvastatin every night during their hospital stay. HAP frequency and 28-day mortality were measured. Levels of inflammatory biomarkers [white blood cell (WBC, procalcitonin (PCT, tumor necrosis factor-alpha (TNF-α, and interleukin-6 (IL-6] were tested. Results. There was no significant difference in the incidence of HAP between PG and NG (25.74% versus. 24.55%, p>0.05 and 28-day mortality (50.72% versus 58.18%, p>0.05. However, prior statin treatment did modify the mortality of ventilator associated pneumonia (VAP (36.54% versus 58.14%, p=0.041 and proved to be a protective factor (HR, 0.564; 95% CI, 0.310~0.825, p=0.038. Concentrations of TNF-α and IL-6 in PG VAP cases were lower than those in NG VAP cases (p<0.01. Conclusions. Prior atorvastatin treatment in patients with ischemic stroke was associated with a lower concentration of IL-6 and TNF-α and improved the outcome of VAP. This clinical study has been registered with ChiCTR-ROC-17010633 in Chinese Clinical Trial Registry.

  5. Insuficiência respiratória aguda causada por pneumonia em organização secundária à terapia antineoplásica para linfoma não Hodgkin Acute respiratory failure caused by organizing pneumonia secondary to antineoplastic therapy for non-Hodgkin's lymphoma

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    Adriell Ramalho Santana


    Full Text Available Doenças difusas do parênquima pulmonar pertencem a um grupo de doenças de evolução geralmente subaguda ou crônica, mas que podem determinar insuficiência respiratória aguda. Paciente masculino, 37 anos, em terapia para linfoma não Hodgkin, admitido com tosse seca, febre, dispneia e insuficiência respiratória aguda hipoxêmica. Iniciadas ventilação mecânica e antibioticoterapia, porém houve evolução desfavorável. Tomografia computadorizada de tórax mostrava opacidades pulmonares em "vidro fosco" bilaterais. Devido ao paciente ter feito uso de três drogas relacionadas à pneumonia em organização (ciclofosfamida, doxorrubicina e rituximabe e quadros clínico e radiológico serem sugestivos, iniciou-se pulsoterapia com metilprednisolona com boa resposta. Pneumonia em organização pode ser idiopática ou associada a colagenoses, drogas e neoplasias, e geralmente responde bem a corticoterapia. O diagnóstico é anatomopatológico, mas condições clínicas do paciente não permitiam a realização de biópsia pulmonar. Pneumonia em organização deve ser diagnóstico diferencial em pacientes com aparente pneumonia de evolução desfavorável ao tratamento antimicrobiano.Interstitial lung diseases belong to a group of diseases that typically exhibit a subacute or chronic progression but that may cause acute respiratory failure. The male patient, who was 37 years of age and undergoing therapy for non-Hodgkin's lymphoma, was admitted with cough, fever, dyspnea and acute hypoxemic respiratory failure. Mechanical ventilation and antibiotic therapy were initiated but were associated with unfavorable progression. Thoracic computed tomography showed bilateral pulmonary "ground glass" opacities. Methylprednisolone pulse therapy was initiated with satisfactory response because the patient had used three drugs related to organizing pneumonia (cyclophosphamide, doxorubicin and rituximab, and the clinical and radiological symptoms were

  6. Eosinophilic gastroenteritis with ascites and hepatic dysfunction

    Institute of Scientific and Technical Information of China (English)

    Hai-Bo Zhou; Jin-Ming Chen; Qin Du


    Eosinophilic gastroenteritis is a rare gastrointestinal disorder with eosinophilic infiltration of the gastrointestinal wall and various gastrointestinal dysfunctions. Diagnosis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia.We report a case of eosinophilic gastroenteritis, which had features of the predominant subserosal type presenting with ascites and hepatic dysfunction, and which responded to a course of low-dose steroid.

  7. Eosinophil secretion of granule-derived cytokines

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    Lisa A Spencer


    Full Text Available Eosinophils are tissue-dwelling leukocytes, present in the thymus, and gastrointestinal and genitourinary tracts of healthy individuals at baseline, and recruited, often in large numbers, to allergic inflammatory foci and sites of active tissue repair. The biological significance of eosinophils is vast and varied. In health, eosinophils support uterine and mammary gland development, and maintain bone marrow plasma cells and adipose tissue alternatively activated macrophages, while in response to tissue insult eosinophils function as inflammatory effector cells, and, in the wake of an inflammatory response, promote tissue regeneration and wound healing. One common mechanism driving many of the diverse eosinophil functions is the regulated and differential secretion of a vast array of eosinophil-derived cytokines. Eosinophils are distinguished from most other leukocytes in that many, if not all, of the over three dozen eosinophil-derived cytokines are pre-synthesized and stored within intracellular granules, poised for very rapid, stimulus-induced secretion. Eosinophils engaged in cytokine secretion in situ utilize distinct pathways of cytokine release that include: classical exocytosis, whereby granules themselves fuse with the plasma membrane and release their entire contents extracellularly; piecemeal degranulation, whereby granule-derived cytokines are selectively mobilized into vesicles that emerge from granules, traverse the cytoplasm and fuse with the plasma membrane to release discrete packets of cytokines; and eosinophil cytolysis, whereby intact granules are extruded from eosinophils, and deposited within tissues. In this latter scenario, extracellular granules can themselves function as stimulus-responsive secretory-competent organelles within the tissue. Here we review the distinctive processes of differential secretion of eosinophil granule-derived cytokines.

  8. Eosinophilic Fasciitis: A Rare Skin Sclerosis

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    Amandine Servy


    Full Text Available Eosinophilic fasciitis (Schulman's syndrome is a rare disease with specific clinical symptoms such as the groove sign which facilitate diagnosis. We report a typical case of eosinophilic fasciitis in an otherwise healthy 49-year-old man who presented with “prayer and groove signs”. Histological analysis showed sclerosis and eosinophilic infiltration of the fascia. The patient was successfully treated with systemic corticotherapy and Cyclosporine. A short review of the clinicopathological features of the lesions is presented.

  9. Effect of the Diagnosis of Inflammatory Bowel Disease on Risk-Adjusted Mortality in Hospitalized Patients with Acute Myocardial Infarction, Congestive Heart Failure and Pneumonia (United States)

    Ehrenpreis, Eli D.; Zhou, Ying; Alexoff, Aimee; Melitas, Constantine


    Introduction Measurement of mortality in patients with acute myocardial infarction (AMI), congestive heart failure (CHF) and pneumonia (PN) is a high priority since these are common reasons for hospitalization. However, mortality in patients with inflammatory bowel disease (IBD) that are hospitalized for these common medical conditions is unknown. Methods A retrospective review of the 2005–2011 National Inpatient Sample (NIS), (approximately a 20% sample of discharges from community hospitals) was performed. A dataset for all patients with ICD-9-CM codes for primary diagnosis of acute myocardial infarction, pneumonia or congestive heart failure with a co-diagnosis of IBD, Crohn’s disease (CD) or ulcerative colitis (UC). 1:3 propensity score matching between patients with co-diagnosed disease vs. controls was performed. Continuous variables were compared between IBD and controls. Categorical variables were reported as frequency (percentage) and analyzed by Chi-square tests or Fisher’s exact test for co-diagnosed disease vs. control comparisons. Propensity scores were computed through multivariable logistic regression accounting for demographic and hospital factors. In-hospital mortality between the groups was compared. Results Patients with IBD, CD and UC had improved survival after AMI compared to controls. 94/2280 (4.1%) of patients with IBD and AMI died, compared to 251/5460 (5.5%) of controls, p = 0.01. This represents a 25% improved survival in IBD patients that were hospitalized with AMI. There was a 34% improved survival in patients with CD and AMI. There was a trend toward worsening survival in patients with IBD and CHF. Patients with CD and PN had improved survival compared to controls. 87/3362 (2.59%) patients with CD and PN died, compared to 428/10076 (4.25%) of controls, p < .0001. This represents a 39% improved survival in patients with CD that are hospitalized for PN. Conclusion IBD confers a survival benefit for patients hospitalized with AMI. A

  10. Tropical Pulmonary Eosinophilia with Eosinophilic Leukemoid Reaction

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    Manish Kumar


    Full Text Available A 7 year-old male presented with recurrent fever, cough and respiratory distress for over last 2 years. Based on extremely high eosinophil count, high Immunoglobulin E, increase in eosinophilic precursors in bone marrow, and positive antigen test for Wuchereria bancrofti, a diagnosis of Tropical Pulmonary Eosinophilia with Eosinophilic Leukemoid Reaction was made. Complete recovery was achieved with Diethylcarbamazine for 3 weeks. We are reporting this case as the first case of Tropical pulmonary eosinophilia with eosinophilic leukemoid reaction in a child.

  11. Eosinophilic granuloma of the capital femoral epiphysis. (United States)

    Goto, Takahiro; Nemoto, Tetsuo; Ogura, Koichi; Imanishi, Jungo; Hozumi, Takahiro; Funata, Nobuaki


    Eosinophilic granuloma occurs almost exclusively in the diaphysis or metaphysis, when tubular bones are affected. The investigators present an extremely rare case of eosinophilic granuloma arising at the epiphysis of the femoral head in an 8-year-old boy. Plain radiographs and computed tomography showed a well-circumscribed radiolucent lesion, suggesting chondroblastoma or Brodie's abscess. However, the findings on magnetic resonance images were different from typical features of chondroblastoma or Brodie's abscess. The lesion was curetted. Histological diagnosis was eosinophilic granuloma. Differential diagnoses of a radiolucent lesion at the epiphysis in a child should include, though quite rare, eosinophilic granuloma.

  12. Nursing of severe pneumonia with suspected acute respiratory distress syndrome%重症肺炎疑似急性呼吸窘迫综合征护理探讨

    Institute of Scientific and Technical Information of China (English)



    目的:探讨重症肺炎疑似急性呼吸窘迫综合征的护理效果。方法:收治重症肺炎疑似急性呼吸窘迫综合征患者50例,回顾性分析临床资料。结果:治疗后,50例患者的治疗有效率90%,死亡率10%。结论:重症肺炎疑似急性呼吸窘迫综合征的护理极为重要,严重影响患者预后。%Objective:To explore the nursing of severe pneumonia with suspected acute respiratory distress syndrome.Methods:50 patients with severe pneumonia with suspected acute respiratory distress syndrome were selected,and clinical data were retrospectively analyzed.Results:After treatment,in 50 patients,the effective rate was 90% ,and the mortality rate was 10% . Conclusion:Nursing for severe pneumonia with suspected acute respiratory distress syndrome was important.It was serious impact on the prognosis of patients.

  13. Upregulation of CD19⁺CD24(hi)CD38(hi) regulatory B cells is associated with a reduced risk of acute lung injury in elderly pneumonia patients. (United States)

    Song, Haihan; Xi, Jianjun; Li, Guang-Gang; Xu, Shumin; Wang, Chunmei; Cheng, Tingting; Li, Hongqiang; Zhang, Ying; Liu, Xiandong; Bai, Jianwen


    Acute lung injury (ALI) is a common complication in elderly pneumonia patients who have a rapid progression, and is accompanied by a high mortality rate. Because the treatment options of ALI are limited to supportive care, identifying pneumonia patients who are at higher risk of ALI development is the emphasis of many studies. Here, we approach this problem from an immunological perspective by examining CD19(+)CD24(hi)CD38(hi) B cells, an important participant in acute and chronic inflammation. We find that elderly pneumonia patients have elevated CD19(+)CD24(hi)CD38(hi) B cell frequency compared to healthy individuals. This B cell population may express a higher level of IL-10, which has been was shown to suppress CD4(+) T cell-mediated proinflammatory cytokine interferon gamma (IFNg) and tumor necrosis factor alpha (TNFa) production, through an IL-10-dependent mechanism. We also observe that the frequency of CD19(+)CD24(hi)CD38(hi) B cell is positively correlated with the frequency of CD4(+)CD25(+)Foxp3(+)Tregs in peripheral blood. Moreover, consistent with CD19(+)CD24(hi)CD38(hi) B cell's anti-inflammatory role, we find that pneumonia patients who later developed ALI have reduced level of CD19(+)CD24(hi)CD38(hi) B cells. Together, our results demonstrated that CD19(+)CD24(hi)CD38(hi) B cells in pneumonia patients possess regulatory function in vivo, and are associated with a reduced ALI risk.

  14. Childhood pneumonia and vitamin A

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    Farhad Heidarian


    Full Text Available One of the major causes of mortality in children younger than 5 years old is acute lower respiratory tract infections (ALRI. ALRI clinical features are cough, tachypnea, fever, coryza, chest retraction, crackles and wheeze. Increased white blood cell count with left shift might happen in pneumonia. C-reactive protein (CRP and erythrocyte sedimentation rate (ESR might rise in children with respiratory tract infections. Vitamin A deficiency is associated with severe childhood infections. The effect of vitamin A supplementation in childhood pneumonia depends on the prevalence and the level of vitamin A deficiency in the population. Some studies confirmed that retinol levels were significantly higher after recovery from acute pneumonia compared to acute phase. But there were no significant association between serum retinol level and the clinical manifestation.

  15. Immunization Str.pneumonia vaccine reduces the incidence orphanage children’s acute otitis media (preliminary results

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    A. A. Dzhumagaziev


    Full Text Available In order to assess the impact of pneumococcal vaccine on the incidence of ear infections in children in the first four years of life, the comparative analysis of monthly incidence of the disease in 18 months in previously vaccinated children, and for the first six months after the catch-up immunization of 7- (PCV7 or 23 – valent (PPV23 pneumococcal vaccine . Traced threefold reduction in the incidence of hospitalization 114 children being raised in orphanages for acute otitis after a single use of pneumococcal vaccine. Early immunization of 101 children against pneumococcus contributes monthly prevent 1 case of hospitalization for acute otitis media.

  16. Higher levels of mucosal antibody to pneumococcal vaccine candidate proteins are associated with reduced acute otitis media caused by Streptococcus pneumoniae in young children. (United States)

    Xu, Q; Casey, J R; Pichichero, M E


    Mucosal immunity has a crucial role in controlling human respiratory tract infections. This study characterizes the naturally acquired mucosal antibody levels to three Streptococcus pneumoniae (Spn) protein antigens, pneumococcal histidine triad protein D (PhtD), pneumococcal choline binding protein A (PcpA), and pneumolysin (Ply), and assesses the association of the mucosal antibody levels with occurrence of acute otitis media (AOM) caused by Spn. Both nasopharyngeal (NP) immunoglobulin G (IgG) and IgA levels to all three proteins slightly decreased in children from 6 to 9 months of age and then gradually increased through 24 months of age. Spn NP colonization was associated with higher mucosal antibody levels to all three proteins. However, children with Spn AOM had 5-8-fold lower IgG and 3-6-fold lower IgA levels to the three proteins than children without AOM but asymptomatically colonized with Spn. Antigen-specific antibody levels in the middle ear fluid (MEF) were correlated with antibody levels in the NP. Children with AOM caused by Spn had lower antibody levels in both the MEF and NP than children with AOM caused by other pathogens. These results indicate that higher naturally acquired mucosal antibody levels to PhtD, PcpA and Ply are associated with reduced AOM caused by Spn.


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    Balasubramanian Thiagarajan


    Full Text Available Eosinophilic otitis media is actually a recent introduction. These patients may manifest with sudden hearing loss. There may be associated bronchial asthma and allergic rhinitis. Diagnostic criteria of this condition are rather vague. A review of literature shows that demonstration of eosinophils in the middle ear secretion of these patients could be considered to be pathognomonic of this condition

  18. Pattern-recognition receptors in human eosinophils. (United States)

    Kvarnhammar, Anne Månsson; Cardell, Lars Olaf


    The pattern-recognition receptor (PRR) family includes Toll-like receptors (TLRs), nucleotide-binding oligomerization domain (NOD) -like receptors (NLRs), RIG-I-like receptors (RLRs), C-type lectin receptors (CLRs) and the receptor for advanced glycation end products (RAGE). They recognize various microbial signatures or host-derived danger signals and trigger an immune response. Eosinophils are multifunctional leucocytes involved in the pathogenesis of several inflammatory processes, including parasitic helminth infection, allergic diseases, tissue injury and tumour immunity. Human eosinophils express several PRRs, including TLR1-5, TLR7, TLR9, NOD1, NOD2, Dectin-1 and RAGE. Receptor stimulation induces survival, oxidative burst, activation of the adhesion system and release of cytokines (interleukin-1β, interleukin-6, tumour necrosis factor-α and granulocyte-macrophage colony-stimulating factor), chemokines (interleukin-8 and growth-related oncogene-α) and cytotoxic granule proteins (eosinophil cationic protein, eosinophil-derived neurotoxin, eosinophil peroxidase and major basic protein). It is also evident that eosinophils play an immunomodulatory role by interacting with surrounding cells. The presence of a broad range of PRRs in eosinophils indicates that they are not only involved in defence against parasitic helminths, but also against bacteria, viruses and fungi. From a clinical perspective, eosinophilic PRRs seem to be involved in both allergic and malignant diseases by causing exacerbations and affecting tumour growth, respectively.

  19. Feline gastrointestinal eosinophilic sclerosing fibroplasia. (United States)

    Craig, L E; Hardam, E E; Hertzke, D M; Flatland, B; Rohrbach, B W; Moore, R R


    A retrospective study of cases of a unique intramural inflammatory mass within the feline gastrointestinal tract was performed in order to describe and characterize the lesion. Twenty-five cases were identified from archival surgical and postmortem tissues. The lesion most often occurred as an ulcerated intramural mass at the pyloric sphincter (n = 12) or the ileocecocolic junction or colon (n = 9); the remaining cases were in the small intestine. Seven cases also had lymph node involvement. The lesions were characterized by eosinophilic inflammation, large reactive fibroblasts, and trabeculae of dense collagen. Intralesional bacteria were identified in 56% of the cases overall and all of the ileocecocolic junction and colon lesions. Fifty-eight percent of cats tested had peripheral eosinophilia. Cats treated with prednisone had a significantly longer survival time than those receiving other treatments. We propose that this is a unique fibroblastic response of the feline gastrointestinal tract to eosinophilic inflammation that in some cases is associated with bacteria. The lesion is often grossly and sometimes histologically mistaken for neoplasia.

  20. Histopathological study of feline eosinophilic dermatoses. (United States)

    Fondati, A; Fondevila, D; Ferrer, L


    A retrospective study was conducted on skin specimens from 24 cats with eosinophilic granuloma complex. The specimens were stained with haematoxylin and eosin and Gallego's trichrome stain. In all specimens, flame figures and/or large foci of so-called "collagen degeneration" were detected and histopathological features were not predictive of the clinical picture. Use of the term eosinophilic dermatosis was advocated in diagnostic dermatopathology. On trichrome-stained sections, normally stained collagen fibres were identified in the middle of both flame figures and large foci of "collagen degeneration" and the debris surrounding collagen bundles showed the same tinctorial properties as eosinophil granules. Eosinophil degranulation around collagen bundles seemed to represent the major pathogenetic event in these lesions, analogous with human flame figures. The term flame figures might therefore be more accurately used to designate those foci of eosinophilic to partly basophilic debris commonly referred to as "collagen degeneration".




    Abstract. Amounts of several neutrophil enzymes (elastase, myeloperoxidase (MPO), MMP-2) and their local inhibitors, i.e., Clara cell protein (CC16) and HSP-70, have been determined in blood plasma from fifty-two patients with various forms of influenza A/H1N1. Sixteen patients have developed acute respiratory distress syndrome (ARDS). In cases of uncomplicated influenza, elastase and MPO levels were shown to be increased, while MMP-2 levels did not change, along with higher contents of HSP-7...

  2. Role of Adhesion Molecules in Eosinophil Activation: A Comparative Study on the Effect of Adhesion Molecules on Eosinophil Survival

    Directory of Open Access Journals (Sweden)

    Kazutoshi Yamaguchi


    Conclusions: The regulation of adhesion molecules, by not only preventing eosinophil adhesion but also eosinophil activation, may be a potential target in the treatment of allergic inflammatory disorders.

  3. The Pneumonia Severity Index as a Predictor of In-Hospital Mortality in Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

    Directory of Open Access Journals (Sweden)

    Guoping Hu

    Full Text Available To determine whether the pneumonia severity index (PSI can predict in-hospital mortality for AECOPD patients and compare its usefulness with the CURB65 and BAP65 indexes to predict mortality.Demographics, clinical signs and symptoms, comorbidities, and laboratory and radiographic findings of hospitalized AECOPD patients were obtained. Univariate and multiple logistic regression analyses were used to identify the risk factors for in-hospital mortality. The PSI, CURB65 and BAP65 scores were calculated. Receiver operating characteristic (ROC curve analysis was used to identify the PSI, CURB65 and BAP65 scores that could discriminate between non-survivors and survivors. To control for the confounding factor of invasive mechanical ventilation (IMV regarding the mortality of AECOPD, subgroup analysis was performed when excluded patients who had met the criteria of IMV but who had not received the cure of IMV according to their wishes.During the in-hospital period, 73 patients died and 679 patients recovered. Age, PaO2<60 mmHg, pH < 7.35, PaCO2≥50 mmHg, nursing home residency, congestive heart failure, liver disease, sodium<130 mmol/L, lower FEV1% and altered mental status were risk factors for in-hospital mortality. The areas under the ROC curves (AUCs of the PSI for death were 0.847 (95% CI: 0.799-0.895. The cut-off value was 116.5 with a sensitivity of 82.2% and a specificity of 77.6%. However, the AUCs of the CURB65 and BAP65 for death were only 0.744 (95% CI: 0.680-0.809 and 0.665 (95% CI: 0.594-0.736, respectively. Subgroup analysis also showed that the PSI score could predict the mortality of AECOPD patients with an AUC = 0.857 (95% CI: 0.802-0.913, with exclusion of the patients who met the criteria of IMV but who did not receive the cure of IMV.The PSI score may be used to predict in-hospital mortality for hospitalized AECOPD patients, with a prognostic capacity superior to CURB65 and BAP65.

  4. Hydrocarbon pneumonia (United States)

    Pneumonia - hydrocarbon ... Coughing Fever Shortness of breath Smell of a hydrocarbon product on the breath Stupor (decreased level of ... Most children who drink or inhale hydrocarbon products and develop ... hydrocarbons may lead to rapid respiratory failure and death.

  5. Use of AN Eosinophil Specific Monoclonal Antibody in Assessing Eosinophil Function. (United States)

    Minkoff, Marjorie Sue

    A monoclonal antibody to an eosinophil specific determinant is very important in assessing eosinophil function during helminthic infection. Eosinophils induced by Schistosoma mansoni infection in BALB/c mice were used to induce C57B1/6 immunocytes for production of hybridomas secreting eosinophil monoclonal antibodies. These antibodies were shown to react with an eosinophil surface epitope but not with neutrophils or macrophages as determined by ELISA, immunodiffusion, immunofluorescence, and immunoblot assay. Affinity chromatography with eosinophil chemotactic factor-sepharose consistently selected out a { rm M_ R} 67,000 protein from solubilized eosinophil membrane antigens but not from neutrophil and macrophage antigens. In vitro studies showed that the eosinophil-specific monoclonal antibodies abrogated antibody-dependent eosinophil -mediated killing of S. mansoni schistosomula using mouse, rat or human eosinophils. Neutrophil and macrophage killing activities were unaffected. The monoclonal antibodies effected complement-dependent lysis of mouse and rat eosinophils but not of human eosinophils. ECF-treated eosinophils showed enhanced killing of schistosomula which was blocked by the monoclonal antibody. Murine and human eosinophils preincubated with monoclonal antibody exhibited decreased chemotaxis to ECF at optimal chemotactic concentrations. The monoclonal antibody also blocked eosinophil binding to ECF- sepharose beads. In vivo induction of peripheral blood eosinophilia by injection of S. mansoni eggs was suppressed by injections of monoclonal antibodies 2CD13 and 2QD45 in mouse and rat experimental models. Eosinophilia induced by keyhole limpet hemocyanin- cyclophosphamide treatment was also suppressed by monoclonal antibody in both murine and rat systems. Pulmonary granulomas in mice given egg injection and monoclonal antibody were smaller and contained fewer eosinophils than those granulomas from mice given eggs only. In immuno-biochemical studies, the

  6. Gemifloxacin for the treatment of community-acquired pneumonia and acute exacerbation of chronic bronchitis: a meta-analysis of randomized controlled trials

    Institute of Scientific and Technical Information of China (English)

    ZHANG Lei; WANG Rui; Falagas E. Matthew; CHEN Liang-an; LIU You-ning


    Background Gemifloxacin is a fluoroquinolone antibiotic with broad spectrum of antibacterial activity.The aim of the study was to evaluate the comparative effectiveness and safety of gemifloxacin for the treatment of patients with community-acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB).Methods We performed a meta-analysis of randomized controlled trials (RCTs) comparing gemifloxacin with other approved antibiotics.The PubMed,EMBASE,Chinese Biomedical Literature Database and the Cochrane Central Register of Controlled Trials were searched,with no language restrictions.Results Ten RCTs,comparing gemifloxacin with other quinolones (in 5 RCTs) and β-lactams and/or macrolides (in 5 RCTs),involving 3940 patients,were included in this meta-analysis.Overall,the treatment success was higher for gemifloxacin when compared with other antibiotics (odds ratio 1.39,95% confidence interval 1.15-1.68 in intention-to-treat patients,and 1.33,1.02-1.73 in clinically evaluable patients).There was no significant difference between the compared antibiotics regarding microbiological success (1.19,0.84-1.68) or all-cause mortality (0.82,0.41-1.63).The total drug related adverse events were similar for gemifloxacin when compared with other quinolones (0.89,0.56-1.41),while lower when compared with β-lactams and/or macrolides (0.71,0.57-0.89).In subgroup analyses,administration of gemifloxacin was associated with fewer cases of diarrhoea and more rashes compared with other antibiotics (0.66,0.48-0.91,and 2.36,1.18-4.74,respectively).Conclusions The available evidence suggests that gemifloxacin 320 mg oral daily is equivalent or superior to other approved antibiotics in effectiveness and safety for CAP and AECB.The development of rash represents potential limitation of gemifloxacin.

  7. Novel targeted therapies for eosinophilic disorders (United States)

    Wechsler, Michael E.; Fulkerson, Patricia C.; Bochner, Bruce S.; Gauvreau, Gail M.; Gleich, Gerald J.; Henkel, Tim; Kolbeck, Roland; Mathur, Sameer K.; Ortega, Hector; Patel, Jatin; Prussin, Calman; Renzi, Paolo; Rothenberg, Marc E.; Roufosse, Florence; Simon, Dagmar; Simon, Hans-Uwe; Wardlaw, Andrew; Weller, Peter F.; Klion, Amy D.


    Hypereosinophilic syndromes (HESs) are a diverse group of conditions characterized by clinical manifestations attributable to eosinophilia and eosinophilic infiltration of tissues. HESs are chronic disorders with significant morbidity and mortality. Although the availability of targeted chemotherapeutic agents, including imatinib, has improved quality of life and survival in some patients with HESs, additional agents with increased efficacy and decreased toxicity are sorely needed. The purpose of this review is to provide an overview of eosinophil biology with an emphasis on potential targets of pharmacotherapy and to provide a summary of potential eosinophil-targeting agents, including those in development, in clinical trials, or approved for other disorders. PMID:22935585

  8. Eosinophilic follicular reaction induced by Demodex folliculorum mite: a different disease from eosinophilic folliculitis. (United States)

    Sabater-Marco, V; Escutia-Muñoz, B; Botella-Estrada, R


    Eosinophilic folliculitis (EF) is an idiopathic dermatitis included in the spectrum of eosinophilic pustular follicular reactions. Demodex folliculorum has been implicated as contributing to the pathogenesis of human immunodeficiency virus-associated EF, but it has not been described outside this context. We present an immunocompetent 65-year-old white man with a 5-year history of recurrent pruritic erythematous and oedematous lesions on his face, neck and scalp. Histopathologically, an eosinophilic microabcess with Demodex folliculorum mite within a pilosebaceous follicle was seen, and considered the causal agent. There were also accumulations of eosinophil granules on collagen bundles, and flame figure formations in the dermis. We believe that 'eosinophilic follicular reaction' is an appropriate term to describe this case of EF induced by D. folliculorum and thus distinguish it from the idiopathic form of EF. Moreover, this case suggests that D. folliculorum can sometimes induce an eosinophilic immune reaction.

  9. 3 Tesla proton MRI for the diagnosis of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia: Initial results in comparison to HRCT

    Energy Technology Data Exchange (ETDEWEB)

    Attenberger, U.I., E-mail: [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany); Morelli, J.N. [Scott and White Hospital, Texas A and M Health Sciences Center, Temple (United States); Henzler, T. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany); Buchheidt, D. [Department of Hematology and Oncology, University Medical Center Mannheim (Germany); Fink, C. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany); Department of Radiology, AKH Celle, Celle (Germany); Schoenberg, S.O.; Reichert, M. [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim (Germany)


    Purpose: To evaluate the diagnostic accuracy of 3 Tesla proton MRI for the assessment of pneumonia/lung infiltrates in neutropenic patients with acute myeloid leukemia. Material and methods: In a prospective study, 3 Tesla MRI was performed in 19 febrile neutropenic patients (5 women, 14 men; mean age 61 years ± 14.2; range 23–77 years). All patients underwent high-resolution CT less than 24 h prior to MRI. The MRI protocol (Magnetom Tim Trio, Siemens) included a T2-weighted HASTE sequence (TE/TR: 49 ms/∞, slice thickness 6 mm) and a high-resolution 3D VIBE sequence with an ultra-short TE < 1 ms (TE/TR 0.8/2.9 ms, slice thickness 2 mm). The VIBE sequence was examined before and after intravenous injection of 0.1 mmol/kg gadoterate meglumine (Dotarem, Guerbet). The presence of pulmonary abnormalities, their location within the lung, and lesion type (nodules, consolidations, glass opacity areas) were analyzed by one reader and compared to the findings of HRCT, which was evaluated by a second independent radiologist who served as the reference standard. The findings were compared per lobe in each patient and rated as true positive (TP) findings if all three characteristics (presence, location, and lesion type) listed above were concordant to HRCT. Results: Pulmonary abnormalities were characterized by 3 Tesla MRI with a sensitivity of 82.3% and a specificity of 78.6%, resulting in an overall accuracy of 88% (NPV/PPV 66.7%/89.5%). In 51 lobes (19 of 19 patients), pulmonary abnormalities visualized by MR were judged to be concordant in their location and in the lesion type identified by both readers. In 22 lobes (11 of 19 patients), no abnormalities were present on either MR or HRCT (true negative). In 6 lobes (5 of 19 patients), ground glass opacity areas were detected on MRI but were not visible on HRCT (false positives). In 11 lobes (7 of 19 patients), MRI failed to detect ground glass opacity areas identified by HRCT. However, since the abnormalities were

  10. Eosinophilic diseases in two Cavalier King Charles spaniels. (United States)

    German, A J; Holden, D J; Hall, E J; Day, M J


    This report describes the clinical presentation of two Cavalier King Charles spaniels with different eosinophilic diseases. The first case presented with dyspnoea and a non-productive cough, and investigations demonstrated eosinophilic bronchopneumonopathy. The second dog was referred for the investigation of haemorrhagic vomiting and diarrhoea and was eventually diagnosed with eosinophilic enteritis. Both dogs had concurrent eosinophilic stomatitis, and both responded completely to immunosuppressive glucocorticoid therapy. This report is the first to describe the concurrence of eosinophilic stomatitis and systemic eosinophilic disease in Cavalier King Charles spaniels, and suggest that this breed may be predisposed to eosinophilic syndromes.

  11. Treatments and the choice of opportunity in treating pedo-pneumonia with acute pyothorax%小儿肺炎合并急性脓胸治疗方法及时机的选择

    Institute of Scientific and Technical Information of China (English)

    王永连; 王忠民; 王毅; 陈志军; 赵宝生; 李汉臣


    Objective To explore the different treatments and the choice of opportunity in treating pedo-pneumonia with acute pyothorax.Methods Forty-eight cases of pedo-pneumonia with acute pyothorax from Sep.2003 to Oct.2007 were selected in our study.We analysed the dates of their diagnoses,treatment and therapeutic effect retrospectively.Results Forty-seven cases were healed,1 case was dead.There were 6 eases treated with antibiotics,supportive treatment and thoracentesis,19 cases treated with antibiotics,supportive treatment and closed drainage,23 cases treated with antibiotic,supportive treatment and operation in the cured cases.Conclusions Suitable therapy and opportunity of chose are important to treat pedo-pneumonia with acute pyothorax.%目的 探讨小儿肺炎合并急性脓胸不同的治疗方法及时机的选择.方法 回顾性分析我科自2003年9月至2007年10月收治的48例小儿肺炎合并急性脓胸的诊断、治疗及疗效.结果 48例小儿肺炎合并急性脓胸治愈47例,死亡1例.抗生素治疗+支持治疗+胸腔穿刺治愈6例,抗生素+支持治疗+胸腔闭式引流治愈19例,抗生素+支持治疗+开胸手术治愈23例.结论 对小儿肺炎合并急性脓胸的治疗要选择合适的方法,并且运用时机要恰当.

  12. 重症肺炎合并急性心力衰竭的临床护理措施分析%Severe Pneumonia with Acute heart failure Clinical Nursing Measures

    Institute of Scientific and Technical Information of China (English)



    目的:剖析重症肺炎合并急性心力衰竭的护理方法及效果。方法将该院2013年5月一2015年4月接收的重症肺炎合并急性心力衰竭者110例随机分成实验组与对照组,每组55例。前者行全面护理干预,后者行常规护理。观察两组病情变化,比较住院时间和总有效率。结果实验组总有效率与住院时间明显优于对照组,差异有统计学意义(P〈0.05)。结论全面护理干预用于重症肺炎合并急性心力衰竭中,可取得较好的成果。%Objective To analyze the effect of nursing severe pneumonia and acute heart failure. Methods Will be from May 2013 to April 2015 received severe pneumonia with acute heart failure in 110 cases randomly divided into experi-mental group and control group,each group of 55 cases. the comprehensive nursing intervention,the routine nursing care. Observe two groups condition change, more time and total effective rate in hospital. Results Experimental group total effective rate and the length of hospital stay was better than control groupthe difference was statistically significant (P<0.05). Conclusion Comprehensive nursing intervention for acute heart failure,severe pneumonia with good results can be obtained.

  13. Infección por Mycoplasma pneumoniae: tres casos con complicaciones neurológicas


    Cunha, J; Madalena, C.; Guimarães, P.; Sousa, A; Temudo, T


    Summary. Introduction. Mycoplasma pneumoniae infection has been associated with severe central nervous system diseases. The pathogenesis of these disorders is unknown and the treatment uncertain. Case reports. The authors present three cases of central nervous system diseases: acute transverse myelitis, cerebellitis and encephalomyelitis associated with M. pneumoniae infection. Conclusions. M. pneumoniae infection should be considered in all cases of severe acute central nervous s...

  14. Eosinophilic granuloma of the mandibular condyle

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Kyung Hoe; Yi, Won Jin; Oh, Sung Won; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Mun Kyung [Department of Oral and Maxillofacial Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Seoul (Korea, Republic of)


    The present study reports a case of eosinophilic granuloma of the mandibular condyle. Eosinophilic granulomas on the mandibular condyle are very rare, but there are several common clinical and radiographic presentations. The clinical presentations involve swelling on preauricular area, limitation of opening, TMJ pain, etc. The radiographic presentations involve radiolucent lytic condylar lesion with or without pathologic fracture. Sometimes new bone formations are observed. The purpose of the article is to add new cases to the literatures.

  15. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report

    Institute of Scientific and Technical Information of China (English)

    Kosuke Kaji; Mitsuteru Kitade; Hideto Kawaratani; Masahito Uemura; Junichi Yamao; Masao Fujimoto; Akira Mitoro; Masahisa Toyohara; Motoyuki Yoshida; Hiroshi Fukui; Hitoshi Yoshiji; Masahide Yoshikawa; Masaharu Yamazaki; Yasuhide Ikenaka; Ryuichi Noguchi; Masayoshi Sawai; Masatoshi Ishikawa; Tsuyoshi Mashitani


    Although the etiology of eosinophilic cholecystitis is still obscure, the postulated causes include allergies,parasites, hypereosinophilic syndrome, and eosinophilic gastroenteritis. It is sometimes accompanied by several complications, but a simultaneous onset with pericarditis is very rares. A 28-year-old woman complained of acute right hypocondrial pain and dyspnea associated with systemic eruption. Several imaging modalities revealed acute cholecystitis and pericarditis with massive pericardial effusion. A marked peripheral blood eosinophilia was observed, and the eruption was diagnosed as urticaria. Her serum had a high titer of antibody against Ascaris lumbricoides. Treatment with albendazole drastically improved all clinical manifestations along with normalization of the imaging features and eosinophilia. We report herein a rare case of simultaneous onset of acute cholecystitis and pericarditis associated with a marked eosinophilia caused by parasitic infection.

  16. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes

    Institute of Scientific and Technical Information of China (English)

    Hugh James Freeman


    Eosinophilic gastroenteritJs (EGE) in the adult is a distinctive pathologically-based disorder characterized by an eosinophil-predominant mucosal inflammatory process. Most often, the disorder is detected during endoscopic investigation for abdominal pain or diarrhea. Other causes of gastric and intestinal mucosal eosinophilia require exclusion, including parasitic infections and drug-induced causes. Occasionally, the muscle wall or serosal surface may be involved. EGE appears to be more readily recognized, in large part, due to an evolution in the imaging methods used to evaluate abdominal pain and diarrhea, in particular, endoscopic imaging and mucosal biopsies. Definition of EGE, however, may be difficult, as the normal ranges of eosinophil numbers in normal and abnormal gastric and intestinal mucosa are not well standardized. Also, the eosinophilic inflammatory process may be either patchy or diffuse and the detection of the eosinophilic infiltrates may vary depending on the method of biopsy fixation. Treatment has traditionally focused on resolution of symptoms, and, in some instances, eosinophil quantification in pre-treatment and post-treatment biopsies. Future evaluation and treatment of EGE may depend on precise serological biomarkers to aid in definition of the long-term natural history of the disorder and its response to pharmacological or biological forms of therapy.

  17. Characterisation of a collection of Streptococcus pneumoniae isolates from patients suffering from acute exacerbations of chronic bronchitis: in vitro susceptibility to antibiotics and biofilm formation in relation to antibiotic efflux and serotypes/serogroups. (United States)

    Vandevelde, Nathalie M; Tulkens, Paul M; Diaz Iglesias, Yvan; Verhaegen, Jan; Rodriguez-Villalobos, Hector; Philippart, Ivan; Cadrobbi, Julie; Coppens, Nathalie; Boel, An; Van Vaerenbergh, Kristien; Francart, Hugo; Vanhoof, Raymond; Liistro, Giuseppe; Jordens, Paul; d'Odemont, Jean-Paul; Valcke, Yvan; Verschuren, Franck; Van Bambeke, Françoise


    The correlation between Streptococcus pneumoniae serotypes, biofilm production, antibiotic susceptibility and drug efflux in isolates from patients suffering from acute exacerbations of chronic bronchitis (AECB) remains largely unexplored. Using 101 isolates collected from AECB patients for whom partial (n=51) or full (n=50) medical details were available, we determined serotypes (ST)/serogroups (SG) (Quellung reaction), antibiotic susceptibility patterns [MIC (microdilution) using EUCAST and CLSI criteria] and ability to produce biofilm in vitro (10-day model; crystal violet staining). The majority of patients were 55-75 years old and pneumoniae. Moreover, 54% showed high severity scores (GOLD 3-4), and comorbidities were frequent including hypertension (60%), cancer (24%) and diabetes (20%). Alcohol and/or tobacco dependence was >30%. Isolates of SG6-11-15-23, known for large biofilm production and causing chronic infections, were the most prevalent (>15% each), but other isolates also produced biofilm (SG9-18-22-27 and ST8-20 being most productive), except SG7, SG29 and ST5 (fluoroquinolones and 2% for telithromycin. ST19A isolates showed resistance to all antibiotics, ST14 to all except moxifloxacin, and SG9 and SG19 to all except telithromycin, moxifloxacin and ceftriaxone (SG19 only). Solithromycin and telithromycin MICs were similar. No correlation was observed between biofilm production and MIC or efflux (macrolides, fluoroquinolones). S. pneumoniae serotyping may improve AECB treatment by avoiding antibiotics with predictable low activity, but it is not predictive of biofilm production.

  18. 异丙托溴铵、布地奈德雾化吸入加用口服急支糖浆辅助治疗小儿肺炎支原体肺炎的临床观察%Ipratropium Bromide Nebulized Budesonide Inhalation Plus Oral Acute Bronchitis Syrup Auxiliary Treatment of Mycoplasma Pneumoniae Pneumonia Clinical Observation

    Institute of Scientific and Technical Information of China (English)

    王丽珍; 李飞平; 罗芳; 张梅娟


    Objective; To study the budesonide, ipratropium bromide Stock aerosol inhalation plus oral acute bronchitis syrup efficacy of mycoplasma pneumonia in children. Method; from May 2011 to May 2012 in our hospital diagnosed with pneumonia, mycoplasma pneumonia, aged 3 to 14 years old, 69 cases of hospitalized children, 35 cases were randomly divided into a control group and a test group of 34 patients. Test group application budesonide, ipratropium bromide atomizing inhalation plus oral acute bronchitis syrup, observation and comparison of the two groups on the basis of given antibiotics. Experimental group, children with cough disappeared time, of pulmonary rales disappear and hospitalization time there was significantly shorter (P<0.01) than the control group, the total effective rate in the test group than the control group (P<0. 01). Conclusion:Budesonide, ipratropium bromide oxygen drive to the aerosol inhalation plus oral acute bronchitis syrup can be used as auxiliary treatment of mycoplasma pneumonia treatment.%目的:研究布地奈德、异丙托溴铵联合雾化吸入加用口服急支糖浆对小儿支原体肺炎的疗效.方法:将2011年5月-2012年5月在我院诊断为肺炎支原体肺炎,年龄3~14岁的69例住院患儿,随机分为对照组35例与试验组34例.在给予抗感染的基础上试验组应用布地奈德、异丙托溴铵氧气驱动雾化吸入加用口服急支糖浆,观察比较两组疗效.结果:试验组患儿咳嗽消失时间、肺部罗音消失时间及住院时间均比对照组有极显著缩短(P<0.01),试验组总有效率比对照组高(P<0.01).结论:布地奈德、异丙托溴铵氧气驱动雾化吸入加用口服急支糖浆可以作为治疗小儿支原体肺炎的辅助治疗方式.

  19. Analysing the eosinophil cationic protein - a clue to the function of the eosinophil granulocyte

    Directory of Open Access Journals (Sweden)

    Bishop-Bailey David


    Full Text Available Abstract Eosinophil granulocytes reside in respiratory mucosa including lungs, in the gastro-intestinal tract, and in lymphocyte associated organs, the thymus, lymph nodes and the spleen. In parasitic infections, atopic diseases such as atopic dermatitis and asthma, the numbers of the circulating eosinophils are frequently elevated. In conditions such as Hypereosinophilic Syndrome (HES circulating eosinophil levels are even further raised. Although, eosinophils were identified more than hundred years ago, their roles in homeostasis and in disease still remain unclear. The most prominent feature of the eosinophils are their large secondary granules, each containing four basic proteins, the best known being the eosinophil cationic protein (ECP. This protein has been developed as a marker for eosinophilic disease and quantified in biological fluids including serum, bronchoalveolar lavage and nasal secretions. Elevated ECP levels are found in T helper lymphocyte type 2 (atopic diseases such as allergic asthma and allergic rhinitis but also occasionally in other diseases such as bacterial sinusitis. ECP is a ribonuclease which has been attributed with cytotoxic, neurotoxic, fibrosis promoting and immune-regulatory functions. ECP regulates mucosal and immune cells and may directly act against helminth, bacterial and viral infections. The levels of ECP measured in disease in combination with the catalogue of known functions of the protein and its polymorphisms presented here will build a foundation for further speculations of the role of ECP, and ultimately the role of the eosinophil.

  20. Chlamydia Pneumoniae Pneumonia: An Evolving Clinical Spectrum

    Directory of Open Access Journals (Sweden)

    David Megran


    Full Text Available Chlamydia pneumoniae is a recently recognized respiratory tract pathogen. It accounts for 6 to 10% of all cases of community acquired pneumonia requiring admission to hospital. Two patients hospitalized with C pneumoniae pneumonia are presented to illustrate its range of severity and the extrapulmonary manifestations.

  1. Chlamydia pneumoniae pneumonia: An evolving clinical spectrum (United States)

    Megran, David; Peeling, Rosanna W; Marrie, Thomas J


    Chlamydia pneumoniae is a recently recognized respiratory tract pathogen. It accounts for 6 to 10% of all cases of community acquired pneumonia requiring admission to hospital. Two patients hospitalized with C pneumoniae pneumonia are presented to illustrate its range of severity and the extrapulmonary manifestations. PMID:22514396

  2. 小儿呼吸道感染肺炎链球菌耐药性分析%Analysis on drug-resistance of streptococcus pneumoniae for children's acute upper respiratory tract infection

    Institute of Scientific and Technical Information of China (English)



    OBJECTIVE To know about the detachment and drug- resistance of streptococcus pneumoniae on children's acute upper respiratory tract infection to provide basis for applying antibiotics properly. METHODS Go respiratory specimens of sick children from 2008 to 2010 and conducted germiculture and drug-resistance experiment. RESULTS 196 strains of streptococcus pneumoniae were separated from 3 132 samples. The separation rate was 6.26%. 40 strains of streptococcus pneumoniae had drug-resistance over penicillin. The drug-resistance rate was 20.41%. It was most sensitive to cefotaxime and vancomycin. CONCLUSION It is of great importance to reinforce the analysis of drug-resistance of streptococcus pneumoniae. It is helpful to doctors ' clinic drug application and decrease the drug-resistance of bacteria.%目的 了解某院患儿呼吸道感染肺炎链球菌的分离和耐药情况,以指导临床合理使用抗生素.方法 对该院2008~2010年患儿呼吸道标本进行细菌培养及药敏分析.结果 3 132份呼吸道标本中培养出肺炎链球菌196株,分离率为6.26%,对青霉素耐药菌40株,耐药率为20.41%,对头孢噻肟、万古霉素仍保持很好的敏感性.结论 加强肺炎链球菌耐药性检测,对临床诊疗及降低选择性耐药菌株增多具有重要意义.

  3. Prevent Pneumonia

    Centers for Disease Control (CDC) Podcasts


    CDC’s Matthew Westercamp explains what pneumonia is, its symptoms, and how to prevent it.  Created: 8/6/2015 by National Center for Immunization and Respiratory Diseases (NCIRD), Division of Bacterial Diseases (DBD), Respiratory Diseases Branch (RDB).   Date Released: 8/6/2015.

  4. Nursing care of patients with severe pneumonia complicated with acute heart failure%重症肺炎合并急性心力衰竭的护理措施研究

    Institute of Scientific and Technical Information of China (English)



    目的:重症肺炎合并急性心力衰竭的护理措施。方法对我院从2012年3月至2015年1月收治的31例重症肺炎合并心衰患儿的护理资料进行分析。结果31例患儿经过积极治疗及护理以后,均痊愈。住院时间6至21d,平均(13.01±2.54)d。经对患儿家长进行问卷调查,护理满意度为97%。结论对重症肺炎合并急性心力衰竭患儿合理有效的护理可以明显改善病情,提高治疗效果。%Objective:the nursing measures of severe pneumonia complicated with acute heart failure.Methods:the nursing data of 31 cases of severe pneumonia complicated with heart failure in our hospital from january 2015 to March 2012 were analyzed. Results:31 cases were cured by active treatment and nursing.Hospitalization time of 6 to 21d,average(13.01+2.54)d.The parents of the children with the questionnaire survey,nursing satisfaction was 97%.Conclusion:the severe pneumonia complicated with acute heart failure in childrenreasonable and effective nursing can improve the condition and improve the treatment effect.

  5. Systemic corticosteroids and early administration of antiviral agents for pneumonia with acute wheezing due to influenza A(H1N1pdm09 in Japan.

    Directory of Open Access Journals (Sweden)

    Koichiro Kudo

    Full Text Available BACKGROUND: Pneumonia patients with wheezing due to influenza A(H1N1pdm09 were frequently treated with systemic corticosteroids in Japan although systemic corticosteroid for critically ill patients with pneumonia caused by influenza A(H1N1pdm09 has been controversial. Applicability of systemic corticosteroid treatment needs to be evaluated. METHODS/PRINCIPAL FINDINGS: We retrospectively reviewed 89 subjects who were diagnosed with influenza A(H1N1pdm09 and admitted to a national hospital, Tokyo during the pandemic period. The median age of subjects (45 males was 8 years (range, 0-71. All subjects were treated with antiviral agents and the median time from symptom onset to initiation of antiviral agents was 2 days (range, 0-7. Subjects were classified into four groups: upper respiratory tract infection, wheezing illness, pneumonia with wheezing, and pneumonia without wheezing. The characteristics of each group was evaluated. A history of asthma was found more frequently in the wheezing illness (55.6% and pneumonia with wheezing (43.3% groups than in the other two groups (p = 0.017. Corticosteroid treatment was assessed among subjects with pneumonia. Oxygen saturation was lower in subjects receiving corticosteroids (steroid group than in subjects not receiving corticosteroids (no-steroid group (p<0.001. The steroid group required greater oxygen supply than the no-steroid group (p<0.001. No significant difference was found by the Kaplan-Meier method between the steroid and the no-steroid groups in hours to fever alleviation from the initiation of antiviral agents and hospitalization days. In logistic regression analysis, wheezing, pneumonia and oxygen saturation were independent factors associated with using systemic corticosteroids. CONCLUSION: Patients with wheezing and a history of asthma were frequently found in the study subjects. Systemic corticosteroids together with early administration of antiviral agents to pneumonia with wheezing and

  6. New Insights into Eosinophilic Otitis Media. (United States)

    Kanazawa, Hiromi; Yoshida, Naohiro; Iino, Yukiko


    Eosinophilic otitis media (EOM) is a type of intractable otitis media that occurs mainly in patients with bronchial asthma (BA). In 2011, the diagnostic criteria for EOM were established. EOM is characterized by the presence of a highly viscous yellowish effusion containing eosinophils and immunoglobulin E (IgE), eosinophil chemoattractants, such as eosinophil cationic protein, interleukin-5, and eotaxin. Local sensitization against foreign agents such as fungi or bacteria (e.g., Staphylococcus aureus) may result in local IgE production in the middle ear and may be responsible for the severity of EOM. The clinical features of EOM closely resemble localized eosinophilic granulomatosis polyangiitis, therefore it is necessary to be vigilant to the symptoms of mononeuritis, polyneuritis, and skin purpura during diagnosis. Standard treatment for EOM is the instillation of triamcinolone acetonide into the mesotympanum. However, severe cases exhibiting strong inflammation and otorrhea are not easily controlled with antibiotics and/or corticosteroids. We proposed the introduction of a severity score to evaluate the severity of EOM. This score correlated with local IgE levels in middle ear effusion. Clinically, the risk factors associated with this severity score were body mass index, and the duration of bronchial asthma (from the onset of BA to the age of the first consultation of otitis media to our hospital). We emphasize that early diagnosis and adequate treatment are vital in preventing progressive and sudden hearing loss resulting from EOM.

  7. Does bee pollen cause to eosinophilic gastroenteropathy? (United States)

    Güç, Belgin Usta; Asilsoy, Suna; Canan, Oğuz; Kayaselçuk, Fazilet


    Bee pollen is given to children by mothers in order to strengthen their immune systems. There are no studies related with the side effects of bee polen in the literature. In this article, the literature was reviewed by presenting a case of allergic eosinophilic gastropathy related with bee polen. A 5-year old child was admitted due to abdominal pain. Edema was detected on the eyelids and pretibial region. In laboratory investigations, pathology was not detected in terms of hepatic and renal causes that would explain the protein loss of the patient diagnosed with hypoproteinemia and hypoalbuminemia. Urticaria was detected during the follow-up visit. When the history of the patient was deepened, it was learned that bee pollen was given to the patient every day. The total eosinophil count was found to be 1 800/mm(3). Allergic gastroenteropathy was considered because of hypereosinophilia and severe abdominal pain and endoscopy was performed. Biopsy revealed abundant eosinophils in the whole gastric mucosa. A diagnosis of allergic eosinophilic gastropathy was made. Bee polen was discontinued. Abdominal pain and edema disappeared in five days. Four weeks later, the levels of serum albumin and total eosinophil returned to normal.

  8. [Eosinophilic gastroenteritis caused by bee pollen sensitization]. (United States)

    Puente, S; Iñíguez, A; Subirats, M; Alonso, M J; Polo, F; Moneo, I


    A 34-year-old Spanish woman with a lifelong history of seasonal rhinoconjunctivitis and honey intolerance (pyrosis and abdominal pain) developed, 3 weeks after starting ingestion of bee pollen, astenia, anorexia, abdominal pain, diarrhoea, peripheral blood hypereosinophilia and elevated serum total IgE levels. A duodenal biopsy showed eosinophilic infiltration of the mucosal layer. Other causes of hypereosinophilia were not found. Repeated parasitological stool studies, as well as a duodenal aspirate showed negative results. Symptoms, hypereosinophilia and elevated IgE levels resolved after bee pollen ingestion was stopped. This is a typical case of eosinophilic gastroenteritis by ingestion of bee pollen in a woman with intolerance to honey bee, because the patient fulfilled the usual diagnostic criteria: gastrointestinal symptoms were present, eosinophilic infiltration of the digestive tract was demonstrated by biopsy, no eosinophilic infiltration of other organs was found and the presence of parasites was excluded. Honey intolerance and/or bee pollen administration should be considered as a cause of eosinophilic gastroenteritis.

  9. Nursing home-acquired pneumonia. (United States)

    El Solh, Ali A


    Nursing home-acquired pneumonia (NHAP) was first described in 1978. Since then there has been much written regarding NHAP and its management despite the lack of well-designed studies in this patient population. The most characteristic features of patients with NHAP are the atypical presentation, which may lead to delay in diagnosis and therapy. The microbial etiology of pneumonia encompasses a wide spectrum that spans microbes recovered from patients with community-acquired pneumonia to organisms considered specific only to nosocomial settings. Decision to transfer a nursing home patient to an acute care facility depends on a host of factors, which include the level of staffing available at the nursing home, patients' advance directives, and complexity of treatment. The presence of risk factors for multidrug-resistant pathogens dictates approach to therapy. Prevention remains the cornerstone of reducing the incidence of disease. Despite the advance in medical services, mortality from NHAP remains high.

  10. Clinical features of pneumonia in extreme old age



    The clinical features of 70 people over the age of 85 with radiologically positive pneumonia were studied. It was shown that the classical presenting symptoms of pneumonia were often absent and 81 % had one or more acute ’geriatric’ features such as acute confusion, recent onset of falls, recent worsening immobility or recent onset of incontinence, at the time of presentation. An increased risk of mortality was associated with acute confusion, dementia, central cyanosis and long term immobili...

  11. Ultrasound in Rheumatologic Interstitial Lung Disease: A Case Report of Nonspecific Interstitial Pneumonia in Rheumatoid Arthritis

    Directory of Open Access Journals (Sweden)

    A. Laria


    Full Text Available According to the American Thoracic Society (ATS/European Respiratory Society consensus classification, idiopathic interstitial pneumonias (IIPs include several clinic-radiologic-pathologic entities: idiopathic pulmonary fibrosis (IPF, usual interstitial pneumonia (UIP, nonspecific interstitial pneumonia (NSIP, cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, and lymphoid interstitial pneumonia. Ultrasound Lung Comets (ULCs are an echographic chest-sonography hallmark of pulmonary interstitial fibrosis. We describe the ultrasound (US findings in the follow-up of a NSIP’s case in rheumatoid arthritis (RA.

  12. Seropositivity for Chlamydia Pneumoniae and Mycoplasma Pneumoniae in Asthmatic Children

    Directory of Open Access Journals (Sweden)

    Murat Tutanc


    Full Text Available Acute respiratory tract infections may trigger acute asthma attacks and may be held responsible for etiopathogenesis in children with asthma. Although bacterial infections attract a limited amount of attention, recently Chlamydia pneumoniae (CP and Mycoplasma pneumoniae (MP, in particular, are reported to be the possible factors. IgM and IgG seroprevalence was investigated in 66 children patients with bronchial asthma (between the ages of 3 and 14 for CP and Mycoplasma pneumoniae. In a total of 66 cases, 18 (27.2% patients were detected with IgG positivity for CP whereas 27 of them (40.9% were detected with IgG positivity for MP. IgG positivity was determined in 6 patients (13.0% in the control group for CP, and in 6 patients (10.8% in the control group for MP. The rate of the asthma patients with IgG seropositivity for MP was 4 times higher than that of the control group. It was seen that IgG antibody seropositivity for CP was higher in those with more frequent attacks. No such difference was observed in terms of IgG antibody seropositivity for M. pneumoniae. There are many studies indicating that CP and MP infections take an importance place in the etiology of bronchial asthma and asthma attacks in children. The results obtained reveal the effect of both microorganisms on the etiopathogenesis of the bronchial asthma and the increased number of asthma attacks.

  13. Eosinophilic gastroenteritis associated with multiple gastric cancer. (United States)

    Otowa, Yasunori; Mitsutsuji, Masaaki; Urade, Takeshi; Chono, Teruhiro; Morimoto, Haruki; Yokoyama, Kunio; Hirata, Kenro; Kawamura, Shiro; Shimada, Etsuji; Fujita, Masayuki


    Eosinophilic gastroenteritis (EG) is an inflammation of the digestive tract that is characterized by eosinophilic infiltration. There are no specific symptoms, and are related to the layer in which eosinophilic infiltration is observed. A 69-year-old Japanese man presented to our hospital with a history of general malaise, diarrhea, and dysgeusia. Esophagogastroduodenoscopy showed reddish elevated lesions that were edematous all over the gastric mucosa. In addition, three tumors were also observed. The biopsies of the reddish elevated mucosa revealed eosinophilic infiltration and tubular adenocarcinoma from the tumors. Colonoscopy showed abnormal reddish elevated mucosa. The biopsies from the reddish elevated mucosa showed eosinophilic infiltration. From the abdominal contrast computed tomography scan, tumor stain was seen in the anterior wall of the gastric body. No ascites, intestinal wall thickening, or lymph node swelling were found. A slight elevation in the serum immunoglobulin E (IgE), 480 IU/ml, was found from the laboratory test results; other laboratory results were within normal limits including the number of peripheral eosinophils. No specific allergen was found from the multiple antigen simultaneous test and from the skin patch test. The parasitic immunodiagnosis was negative. He was diagnosed with EG associated with gastric cancer and underwent total gastrectomy, regional lymph node dissection with reconstruction by a Roux-en-Y method. He was prescribed prednisolone after the operation and showed a good clinical response. There are many case reports on EG, but none of them were associated with cancer. We encountered a case of EG associated with multiple gastric cancer; the patient underwent total gastrectomy.

  14. A review of Chlamydia pneumoniae and atherosclerosis

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Fasting, H; Henneberg, E W;


    Chlamydia pneumoniae is a Gram-negative obligate intracellular bacterium that causes acute upper and lower respiratory infections. Its distribution is worldwide. Seroepidemiological studies have shown an association between C. pneumoniae and atherosclerosis, and the risk of acute myocardial infar...... individuals who are or are not infected with C. pneumoniae. The latter are needed in order to clarify the impact of the presence of C. pneumoniae and to avoid indiscriminate use of antimicrobials....... of viable organisms. However, the pathogenicity is unknown, and the significance of detecting the organism is unresolved. In two minor controlled clinical trials, patients with ischaemic heart disease were randomised into antibiotic-treated and placebo groups. Both trials showed a significant reduction...

  15. Mycoplasma pneumoniae meningoencephalitis: a case report

    Directory of Open Access Journals (Sweden)

    Mehmet Selçuk Bektaş


    Full Text Available Nervous system is the most affected area in mycoplasma pneumoniae infections with exception of respiratory system. It is an important agent of childhood acute encephalitis and respiratory system infections in school-age children and young adults. Routine clinical and laboratory findings to identify spesific diagnosis is limited. Twelve-year-old female patient was admitted with fever, fatigue, sore throat, slipping the right eye, withdrawal of the mouth from the right and right hemiclonic seizures. Test of anti-Mycoplasma pneumoniae (M. pneumoniae IgM was positive and IgG antibodies were found to be 4-fold increase in the sera of follow-up. This article was presented with the aim of remembering M. pneumoniae to be an differential diagnosis in children with acute encephalitis.

  16. How Is Pneumonia Treated? (United States)

    ... to cure the infection and prevent complications. Bacterial pneumonia Bacterial pneumonia is treated with medicines called antibiotics. ... fewer symptoms such as cough and fever. Viral pneumonia Antibiotics don't work when the cause of ...

  17. What Is Pneumonia? (United States)

    ... Share this page from the NHLBI on Twitter. Pneumonia Pneumonia is a bacterial, viral, or fungal infection of ... and trouble breathing. Many factors affect how serious pneumonia is, such as the type of germ causing ...

  18. Pneumocystis Pneumonia (For Parents) (United States)

    ... Feeding Your 1- to 2-Year-Old Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia A A A What's in this article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  19. Pneumonia in Immunocompromised People (United States)

    ... Alternative preventive drug treatments are dapsone , atovaquone , and pentamidine (which can be taken as an aerosol, inhaled ... ACZONE trimethoprim No US brand name atovaquone MEPRON pentamidine NEBUPENT Pneumonia Overview of Pneumonia Aspiration Pneumonia and ...

  20. Comparison of histological lesions in acute hemorrhagic pneumonia in mink associated with Pseudomonas aeruginosa or Escherichia coli

    DEFF Research Database (Denmark)

    Salomonsen, Charlotte Mark; Boye, Mette; Høiby, N.;


    culture of E. coli were examined. Formalin-fixed paraffin-embedded lung tissue obtained from the mink was examined by histology and fluorescence in-situ hybridization (FISH). It was possible to detect a slight histological difference between hemorrhagic pneumonia caused by P. aeruginosa and by E. coli...

  1. A case of feline gastrointestinal eosinophilic sclerosing fibroplasia associated with phycomycetes


    Grau-Roma, Llorenc; Galindo-Cardiel, I.; Isidoro-Ayza, M.; Fernández, M; Majó, N.


    Feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) is a recently described inflammatory condition of domestic cats with unknown aetiology. A proportion of cases of FGESF are associated with bacteria, but antibiotic treatment is ineffective. It has been hypothesized that genetically predisposed cats may develop FGESF in response to the introduction of bacteria or other antigens into the intestinal wall. A 9- month-old male Persian cat presented with a history of marked acute h...

  2. Antiepithelial autoantibodies associated with the feline eosinophilic granuloma complex. (United States)

    Gelberg, H B; Lewis, R M; Felsburg, P J; Smith, C A


    A retrospective study of banked sera from 19 cats with the eosinophilic granuloma complex revealed that 68% of affected cats had circulating antibodies to components of normal cat epithelium. Seemingly, the eosinophilic granuloma complex of cats may be an autoimmune disease; however, epidermal damage caused by the eosinophilic granuloma complex may release altered self-antigens to which the cat's immune system responds.

  3. Eosinophilic esophagitis: A newly established cause of dysphagia


    Yan, Brian M; Shaffer, Eldon A.


    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also atta...

  4. Idiopathic eosinophilic parotitis in an eight-year-old boy: a case report

    Directory of Open Access Journals (Sweden)

    Gelardi Matteo


    Full Text Available Abstract Introduction A number of medical conditions, some of them recently reported, are associated with an increased production of eosinophils. We report the first case of eosinophilic parotitis in the literature. Case presentation The patient was an eight-year-old Caucasian boy who presented with a two-year history of recurring acute parotitis with no fever. He had had a total of five episodes with no response to antibiotics, but remission had been achieved with oral corticosteroid therapy. We performed allergy tests for inhalant and food allergens and for haptens, but the results were all negative. The results of echography ruled out sialodochitis. Instead, a swab from the parotid duct led to the detection of a high number of eosinophils. Conclusions This report is first in the literature to describe a case of eosinophilic parotitis, and we suggest that a cytological assessment, which is quite simple yet rarely used by physicians, be performed when patients with parotitis of uncertain origin are under evaluation.

  5. Eosinophil: central mediator of allergic asthma?

    Institute of Scientific and Technical Information of China (English)

    SHEN Hua-hao


    @@ Allergic asthma is a chronic disorder characterized by chronic airway inflammation, airway hyperresponsiveness, reversible airway obstruction, airway remodelling and mucus hypersecretion. It has been widely recognized that the infiltration of the lung with increased number of eosinophils is a hallmark of this disease.1

  6. Eosinophilic granulomatosis with polyangiitis: an overview

    Directory of Open Access Journals (Sweden)

    Andrea eGioffredi


    Full Text Available Eosinophilic granulomatosis with polyangiitis (EGPA is a multisystemic disorder, belonging to the small vessel ANCA-associated vasculitis, defined as a eosinophil-rich and necrotizing granulomatous inflammation often involving the respiratory tract, and necrotizing vasculitis predominantly affecting small to medium-sized vessels, associated with asthma and eosinophilia. EGPA pathogenesis is not well known: HLA-DRB1*04 and *07, HLA-DRB4 and IL10.2 haplotype of the IL-10 promoter gene are the most studied genetic determinants. Among the acquired pathogenetic factors, the exposure to different allergens, infections, vaccinations, drugs and silica exposure have been involved.Eosinophils are the most characteristic cells in EGPA and different studies have demonstrated their role as effector and immunoregulatory cells.EGPA is considered a disease with a prevalent activation of the Th2 cellular-mediated inflammatory response but also humoral immunity plays an important role. A link between B and T inflammatory responses may explain different disease features. EGPA typically develops into three sequential phases: the allergic phase, distinguished by the occurrence of asthma, allergic rhinitis and sinusitis, the eosinophilic phase, in which the main pathological finding is the eosinophilic organ infiltrations (e.g. lungs, heart and gastrointestinal system and the vasculitic phase, characterized by purpura, peripheral neuropathy and constitutional symptoms.ANCA (especially pANCA anti-MPO are present in 40-60% of the patients. An elevation of IgG4 is frequently found. Corticosteroids and cyclophosphamide are classically used for remission induction, while azathioprine and methotrexate are the therapeutic options for remission maintenance. B-cell depletion with rituximab has shown promising results for remission induction.

  7. Association of Mycoplasma pneumoniae infection and childhood asthma

    Institute of Scientific and Technical Information of China (English)

    YADAV Shakti Nrisingh; GAUTAM Mahesh Kumar; JIANG Li


    Mycoplasma pneumoniae is a frequent cause of acute respiratory infections in both children and adults.It can cause pharyngitis, otitis, tracheobronchitis, or community-acquired pneumonia, but may also remain totally asymptomatic.Mycoplasma pneumoniae is an organism that reportedly has a strong relationship to asthma.The role of atypical bacterial infection in the pathogenesis of asthma is a subject of continuing debate. There is an increasing body of literature concerning the association between Mycoplasma pneumoniae ( M. pneumoniae) and asthma pathogenesis.Moreover, many studies investigating such a link have been uncontrolled and have provided conflicting evidence, in part due to the difficulty in accurately diagnosing infection with these atypical pathogens. Large, general population-based prospective studies are necessary to investigate the development of asthma induced by M. pneumoniae infection in humans. This manuscript will review the relationship between M.pneumoniae infection and childhood asthma.

  8. Mitochondria in the Center of Human Eosinophil Apoptosis and Survival

    Directory of Open Access Journals (Sweden)

    Pinja Ilmarinen


    Full Text Available Eosinophils are abundantly present in most phenotypes of asthma and they contribute to the maintenance and exacerbations of the disease. Regulators of eosinophil longevity play critical roles in determining whether eosinophils accumulate into the airways of asthmatics. Several cytokines enhance eosinophil survival promoting eosinophilic airway inflammation while for example glucocorticoids, the most important anti-inflammatory drugs used to treat asthma, promote the intrinsic pathway of eosinophil apoptosis and by this mechanism contribute to the resolution of eosinophilic airway inflammation. Mitochondria seem to play central roles in both intrinsic mitochondrion-centered and extrinsic receptor-mediated pathways of apoptosis in eosinophils. Mitochondria may also be important for survival signalling. In addition to glucocorticoids, another important agent that regulates human eosinophil longevity via mitochondrial route is nitric oxide, which is present in increased amounts in the airways of asthmatics. Nitric oxide seems to be able to trigger both survival and apoptosis in eosinophils. This review discusses the current evidence of the mechanisms of induced eosinophil apoptosis and survival focusing on the role of mitochondria and clinically relevant stimulants, such as glucocorticoids and nitric oxide.

  9. Ultrastructural study of cutaneous lesions in feline eosinophilic granuloma complex. (United States)

    Bardagí, Mar; Fondati, Alessandra; Fondevila, Dolors; Ferrer, Lluís


    The purpose of this study was to investigate the ultrastructural appearance of flame figures, reported to comprise a mixture of degenerate collagen and degranulated eosinophils, in feline eosinophilic granuloma complex (EGC). Skin specimens from eight cats with EGC and from two clinically healthy cats were examined by transmission electron microscopy. Flame figures appeared to comprise ultrastructurally normal collagen fibrils separated by oedema and surrounded by large numbers of degranulating eosinophils. Longitudinal sections of collagen fibrils displayed the characteristic cross-striation of normal dermal collagen. Feline eosinophils, analogous to human eosinophils, degranulated both by cytolysis and piecemeal degranulation. The results of this study suggest that flame figures form in feline EGC due to eosinophil recruitment and degranulation, and that collagen fibres are partially disrupted but collagen fibrils are not damaged. These findings suggest that eosinophil accumulation and the release of granule contents represent the primary events in feline EGC.

  10. Cystatin F Ensures Eosinophil Survival by Regulating Granule Biogenesis. (United States)

    Matthews, Stephen P; McMillan, Sarah J; Colbert, Jeff D; Lawrence, Rachel A; Watts, Colin


    Eosinophils are now recognized as multifunctional leukocytes that provide critical homeostatic signals to maintain other immune cells and aid tissue repair. Paradoxically, eosinophils also express an armory of granule-localized toxins and hydrolases believed to contribute to pathology in inflammatory disease. How eosinophils deliver their supporting functions while avoiding self-inflicted injury is poorly understood. We have demonstrated that cystatin F (CF) is a critical survival factor for eosinophils. Eosinophils from CF null mice had reduced lifespan, reduced granularity, and disturbed granule morphology. In vitro, cysteine protease inhibitors restored granularity, demonstrating that control of cysteine protease activity by CF is critical for normal eosinophil development. CF null mice showed reduced pulmonary pathology in a model of allergic lung inflammation but also reduced ability to combat infection by the nematode Brugia malayi. These data identify CF as a "cytoprotectant" that promotes eosinophil survival and function by ensuring granule integrity. VIDEO ABSTRACT.

  11. Ultrasonic atomizing inhalation nursing effect evaluation oftreatment of children with acute pneumonia%超声雾化吸入治疗小儿急性肺炎的护理效果评价

    Institute of Scientific and Technical Information of China (English)

    徐瑞霞; 王琰琰; 陈维秀


    Objective To evaluate the nursing effect of ultrasonic atomizing inhalation therapy in children with acute pneumonia.Methods the ultra-sonic aerosol inhalation in treatment of 25 cases of pediatric patients as the research object,given nursing measures,effect of nursing.Results 25 cases after ul-trasonic atomization inhalation treatment and careful nursing,15 cases were cured,9 cases effective,1 cases ineffective,the total effective rate of the treatment was 96%.Conclusion in children with acute pneumonia inhalation therapy to give effective nursing measures can effectively improve the therapeutic effect.%目的:评价超声雾化吸入治疗小儿急性肺炎的护理效果。方法以行超声雾化吸入治疗的小儿患儿25例为研究对象,给予护理措施,研究护理效果。结果本组25例患儿经过超声雾化吸入治疗和精心的护理后,治愈15例,有效9例,无效1例,总的治疗有效率为96.0%。结论在小儿急性肺炎超声雾化吸入治疗中给予有效的护理措施能有效提高治疗效果。

  12. Eosinophil cationic protein mRNA expression in children with bronchial asthma. (United States)

    Yu, H Y; Li, X Y; Cai, Z F; Li, L; Shi, X Z; Song, H X; Liu, X J


    Studies have shown that eosinophils are closely related to pathogenesis of bronchial asthma. Eosinophils release eosinophil cationic protein (ECP), which plays an important role in infection and allergic reactions. Serum ECP mRNA expression in children with bronchial asthma has not been adequately investigated. We analyzed serum ECP mRNA expression in 63 children with bronchial asthma and 21 healthy children by using reverse-transcriptase polymerase chain reaction to understand the role of ECP in children with bronchial asthma. The children with bronchial asthma were segregated into acute-phase and stable-phase groups, based on the severity of the illness. Serum ECP mRNA expression in children with bronchial asthma (0.375 ± 0.04) was significantly higher than that in healthy controls (0.20 ± 0.02; P children in the acute-phase group showed higher ECP mRNA expression level (0.44 ± 0.06) than those in the stable-phase (0.31 ± 0.03) and healthy control groups (0.20 ± 0.02; P children with bronchial asthma.

  13. [The idiopathic hypereosinophilic syndrome and chronic eosinophilic leukemia]. (United States)

    Chrobák, L; Voglová, J


    Idiopathic hypereosinophilic syndrome is a heterogenous group of hematological disorders characterized by eosinophilia (> 1.5 x 10(9)/l) persistent for more than 6 months, exclusion of reactive eosinophilia from other causes, such as parasitic infections or allergy, and evidence of end-organ damage. According to World Health Organization the exclusion includes all neoplastic disorders in which eosinophils are part of the neoplastic clone. Excluded should be also T cell population with aberant phenotype and abnormal cytokine production, recently considert also as "lymphocytic" variants of the HES [42]. HES has to be reclassified as chronic eosinophilic leukemia (CEL) when there is evidence for clonality based on the presence of chromosomal abnormalities or inactivation of X-chromosome in female patients. The successful empiric treatment of patients with tyrosine kinase inhibitor imatinib (Glivec) suggested the presence of an imatinib-sensitive tyrosine kinase inhibitor. The identification of a specific intersticial chromosome deletion del(4)(q12;q12) creating the FIP1L1-PDGFRA fusion gene confirmed this hypothesis. Patients carrying this gene should be reclassified as CEL and detection of this gene is a positive predictor for response to imatinib therapy. Effective doses of imatinib are 100 mg/day. The side effects are minimal. The only exception is an acute left ventricular dysfunction which has been reported in three patients within the first week of treatment with imatinib. Imatinib has been successfully used also in some patients with the constitutively activated thyrosine kinase ETV6-PDGFRbeta [1] and in systemic mast cell disease associated with eosinophilia. Other therapeutical options for HES/CEL have been mentioned. The resistence to imatinib and the possibilities how to overcome it are discussed.

  14. Eosinophilic esophagitis-endoscopic distinguishing findings

    Institute of Scientific and Technical Information of China (English)

    Ana Célia Caetano; Raquel Gon(c)alves; Carla Rolanda


    Eosinophilic esophagitis (EE) is the most frequent condition found in a group of gastrointestinal disorders called eosinophilic gastrointestinal diseases.The hypothetical pathophysiological mechanism is related to a hypersensitivity reaction.Gastroesophageal reflux disease-like complaints not ameliorated by acid blockade or occasional symptoms of dysphagia or food impaction are likely presentations of EE.Due to its unclear pathogenesis and unspecific symptoms,it is difficult to diagnose EE without a strong suspicion.Although histological criteria are necessary to diagnosis EE,there are some characteristic endoscopic features.We present the case of a healthy 55-year-old woman with dysphagia and several episodes of esophageal food impaction over the last six months.This case report stresses the most distinguishing endoscopic findings-mucosa rings,white exudative plaques and linear furrows-that can help in the prompt recognition of this condition.

  15. Eosinophilic Esophagitis in Brazilian Pediatric Patients (United States)

    Pinheiro, Mayra Isabel Correia; de Góes Cavalcanti, Luciano Pamplona; Honório, Rodrigo Schuler; de Alencar Moreno, Luís Hélder; Fortes, Mayara Carvalho; da Silva, Carlos Antônio Bruno


    We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils. PMID:24106430

  16. Eosinophilic myocarditis during treatment with olanzapine

    DEFF Research Database (Denmark)

    Vang, Torkel; Rosenzweig, Mary; Bruhn, Christina Hedegaard;


    BACKGROUND: Drug-induced eosinophilic myocarditis is a life-threatening and frequently overlooked condition. The prevalence of myocarditis in clozapine-treated patients may be as high as 3 %. An association between olanzapine and myocarditis has not previously been described, but given the chemical...... fatal cases of eosinophilic myocarditis associated with the use of olanzapine. CASE PRESENTATION: Case 1 was a 39-year-old Caucasian man with known substance abuse and schizophrenia. He was found dead in his home. Olanzapine was prescribed at day -54, and dose at time of death was 40 mg/day. Post......-mortem toxicological examination demonstrated presence of olanzapine, morphine, venlafaxine and oxazepam. Syringes indicating substance abuse were found in his home. Case 2 was a 36-year-old Caucasian man diagnosed with schizophrenia was found dead unexpectedly. There was no history of substance abuse. Current...

  17. Strongyloides stercoralis hyperinfection causing eosinophilic ascites. (United States)

    Shukla, Shailaja; Chauhan, Richa; Wadhwa, Shveta; Sehgal, Shivali; Singh, Smita


    Strongyloidiasis is associated with Strongyloides stercoralis, an intestinal nematode with greater prevalence in tropical and subtropical regions. Hyperinfection syndrome with dissemination may occur in immunosuppressed individuals. However, invasion of peritoneal cavity with peritoneal effusion is rarely reported in the literature. We report a case of S. stercoralis hyperinfection in a young alcoholic patient with Diabetes mellitus, liver disease and ascites. Diagnostic paracentesis showed numerous filariform larvae of S. stercoralis against a background of eosinophils.

  18. Eosinophilic gastroenteritis: Clinical experience with 15 patients

    Institute of Scientific and Technical Information of China (English)

    Ming-Jen Chen; Cheng-Hsin Chu; Shee-Chan Lin; Shou-Chuan Shih; Tsang-En Wang


    AIM: To evaluate the clinic features of eosinophilicgastroenteritis and to examine the diagnosis, treatment,long-term outcome of this disease.METHODS: Charts with a diagnosis of eosinophilicgastroenteritis from 1984 to 2002 at Mackay Memorial Hospital were reviewed retrospectively. There were 15 patients diagnosed with eosinophilic gastroenteritis. The diagnosis was established in 13 by histologic evaluation of endoscopic biopsy or operative specimen and in 2 by radiologic imaging and the presence of eosinophilic ascites.RESULTS: All the patients had gastrointestinal symptoms and 12 (80 %) had hypereosinophilia (absolute eosinophil count 1 008 to 31 360/cm3). The most common symptoms were abdominal pain and diarrhea. Five of the 15 patients had a history of allergy. Seven patients had involvement of the mucosa, 2 of muscularis, and 6 of subserosa. One with a history of seafood allergy was successfully treated with an elimination diet. Another patient improved spontaneously after fasted for several days. The remaining 13 patients were treated with oral prednisolone, 10 to 40 mg/day initially,which was then tapered. The symptoms in all the patients subsided within two weeks. Eleven of the 15 patients were followed up for more than 12 months (12 to 104 months,mean 48.7), of whom 5 had relapses after discontinuing steroids (13 episodes). Two of these patients required longterm maintenance oral prednisolone (5 to 10 mg/day).CONCLUSION: Eosinophilic gastroenteritis is a rare condition of unclear etiology characterized by relapses and remissions. Short courses of corticosteroids are the mainstay of treatment, although some patients with relapsing disease require long-term low-dose steroids.

  19. Eosinophilic gastroenteritis with ascites and colon involvement. (United States)

    Levinson, J D; Ramanathan, V R; Nozick, J H


    The case of a 39-year old white man with eosinophilic gastroenteritis is presented. The major clinical features were gastric outlet obstruction, diarrhea and massive ascites. At surgery, significant involvement of the entire gastrointestinal tract from the gastric antrum to the sigmoid colon was found. Histologic documentation of colon involvement was obtained. The response to corticosteroids was prompt and sustained. At present, he is maintained on an alternating day schedule of steroid administration.

  20. Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

    Institute of Scientific and Technical Information of China (English)

    Gennaro Liguori; Maurizio Cortale; Fabrizio Cimino; Michele Sozzi


    A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia.The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-de-sac in the lower part of the esophagus.Soon after the procedure,the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus,and a mediastinal emphysema.An emergency right thoracotomy was performed,followed by a total esophagectomy with esophagogastroplasty and jejunostomy.The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal,submucosal and muscular layers.The diagnosis was esophageal perforation in eosinophilic esophagitis.

  1. Combined pericarditis and pneumonia caused by Legionella infection

    DEFF Research Database (Denmark)

    Svendsen, Jesper Hastrup; Jønsson, V; Niebuhr, U


    During a one year period acute pericarditis was diagnosed in 16 consecutive patients without acute infarction or malignancy. In two of these patients with both pericarditis and pneumonia Legionella infection was present. One case was caused by Legionella longbeachae and the other by both Legionella...... longbeachae and Legionella jordanis. When pericarditis is associated with pneumonia Legionella infection should be sought so that effective treatment with erythromycin may be started early....

  2. Oral and airway microbiota in HIV-infected pneumonia patients


    Iwai, S.; Fei, M; Huang, D.; Fong, S.; Subramanian, A.; Grieco, K; Lynch, SV; Huang, L


    Despite the increased frequency of recurrent pneumonia in HIV-infected patients and recent studies linking the airway bacterial community (microbiota) to acute and chronic respiratory infection, little is known of the oral and airway microbiota that exist in these individuals and their propensity to harbor pathogens despite antimicrobial treatment for acute pneumonia. This pilot study compared paired samples of the oral and airway microbiota from 15 hospitalized HIV-infected patients receivin...

  3. Canine Oral Eosinophilic Granuloma Treated with Electrochemotherapy

    Directory of Open Access Journals (Sweden)

    Matías Nicolás Tellado


    Full Text Available A case of a canine oral eosinophilic granuloma in a 14-year-old female crossbred is described. The dog was presented with a history of ptyalism, halitosis, local pain, decreased appetite, and blood staining noted on food and water bowls. Clinical, hematologic, and biochemical examinations, abdominal ultrasonography, and 3-view chest radiographs were performed, and no metastases were found. Histopathologic examination of two 6 mm punch biopsies from the oral lesion revealed the presence of eosinophilic granulomatous lesions in the submucosa. After treatment with corticosteroids and wide spectrum antibiotics no significant changes in clinical signs and lesion size were observed. Electrochemotherapy (ECT, a novel tumor treatment routinely used for cutaneous and subcutaneous tumors in human patients in the European Union since 2006, was used to treat the eosinophilic granuloma. The procedure was performed under general anesthesia, followed by intravenous administration of bleomycin. Six weeks after treatment a complete response with disappearance of the mass and improvement of clinical signs were observed.

  4. Application of microimmunofluorescence test and PCR in the diagnosis of acute Chlamydia pneumoniae infections%微量免疫荧光试验和PCR在诊断肺炎衣原体急性感染中的应用

    Institute of Scientific and Technical Information of China (English)

    李建标; 蔡庆; 王颖; 赵建中; 端青; 纪树国; 朱美财


    Objective To explore the role of acute infection of Chlamydia pneumoniae (Cpn) in respiratory diseases. Methods Microimmunofluorescence test was used to detect IgG antibodies for Cpn in serum obtained from 93 inpatients and PCR was used to test Cpn in detection of Cpn DNA in throat specimens from 55 of the 99 patients. Results Acute Cpn infection was diagnosed in 35.5% of the respiratory diseases. Antibodies for Cpn (titer of ≥512) were present in 47.6% of the pneumonia group, which may suggest that during 1998 to 1999, Cpn caused an epidemic in Beijing. They were also present in 50% of asthma group, 50.0% of pulmonary heart disease group and 26.3% of lung cancer group. Only five patients (9.1%) were positive by PCR. There exists discrepancy between serological and PCR results. Conclusion Detection of IgG antibodies for Cpn conduces to diagnosis of acute Cpn infection and give advice for appropriate therapy.%目的 探讨肺炎衣原体(Cpn)急性感染在呼吸道疾病中的重要性。方法 用微量免疫荧光(MIF)试验检测了93例住院病人血清中Cpn抗体IgG,同时用PCR测定了其中55例病人咽试子标本中Cpn DNA。结果 35.5%呼吸道疾病存在Cpn急性感染。在肺炎组抗体(效价≥512)阳性率为47.6%,提示1998~1999年可能处在北京市Cpn流行期;在哮喘组的阳性率达到50%;在肺心病组和肺癌组的阳性率分别为50.0%和26.3%。PCR检测Cpn的阳性率仅为9.1%,MIF和PCR的检测结果存在差别。结论 检测Cpn抗体IgG有助于对Cpn急性感染进行诊断,从而指导临床用药。

  5. Preliminary investigation of a mice model of Klebsiella pneumoniae subsp. ozaenae induced pneumonia. (United States)

    Renois, Fanny; Jacques, Jérôme; Guillard, Thomas; Moret, Hélène; Pluot, Michel; Andreoletti, Laurent; de Champs, Christophe


    In the present study, we comparatively assessed the pathophysiological mechanisms developed during lung infection of BALB/C female mice infected by an original wild type Klebsiella pneumoniae subsp. ozaenae strain (CH137) or by a referent subspecies K. pneumoniae. subsp. pneumoniae strain (ATCC10031). The mice infected with 2.10⁶ CFU K. p. subsp. pneumoniae (n = 10) showed transient signs of infection and all of them recovered. All of those infected with 1.10⁶ CFU K. p. subsp. ozaenae (n = 10) developed pneumonia within 24 h and died between 48 and 72 h. Few macrophages, numerous polymorphonuclear cells and lymphocytes were observed in their lungs in opposite to K. p. subsp. pneumoniae. In bronchoalveolar lavage, a significant increase in MIP-2, IL-6, KC and MCP-1 levels was only observed in K. p. subsp. ozaenae infected mice whereas high levels of TNF-α were evidenced with the two subspecies. Our findings indicated a lethal effect of a wild type K. p. subsp. ozaenae strain by acute pneumonia reflecting an insufficient alveolar macrophage response. This model might be of a major interest to comparatively explore the pathogenicity of K. p. subsp ozaenae strains and to further explore the physiopathological mechanisms of gram-negative bacteria induced human pneumonia.

  6. Mycoplasma pneumoniae meningoencephalitis:a case report

    Institute of Scientific and Technical Information of China (English)

    Mehmet Selçuk Bektaş; Fesih Aktar; Mehmet Açıkgöz; Ertan Sal; HüseyinÇaksen


    Nervous system is the most affected area inmycoplasma pneumoniaeinfections with exception of respiratory system.It is an important agent of childhood acute encephalitis and respiratory system infections in school-age children and young adults.Routine clinical and laboratory findings to identify spesific diagnosis is limited.Twelve-year-old female patient was admitted with fever, fatigue, sore throat, slipping the right eye, withdrawal of the mouth from the right and right hemiclonic seizures.Test of anti-Mycoplasma pneumoniae(M. pneumoniae)IgM was positive andIgG antibodies were found to be4-fold increase in the sera of follow-up.This article was presented with the aim of rememberingM. pneumoniae to be an differential diagnosis in children with acute encephalitis.

  7. Experimentally produced calf pneumonia. (United States)

    Gourlay, R N; Howard, C J; Thomas, L H; Stott, E J


    Experimental pneumonia was produced in calves by the endobronchial inoculation of pneumonic lung homogenates. Irradiated homogenates produced minimal pneumonia. Ampicillin treatment of the homogenates and the experimental calves reduced the extent of pneumonia. Treatment with tylosin tartrate prevented experimental pneumonia. These results suggest that the total pneumonia was due to organisms susceptible to tylosin tartrate and that the residual pneumonia remaining after ampicillin treatment was due to organisms susceptible to tylosin tartrate but not to ampicillin. Of the organisms isolated from the lungs, the ones in this latter category most likely to be responsible are Mycoplasma dispar and ureaplasmas (T-mycoplasmas).

  8. Desquamative interstitial pneumonia: A case report

    Directory of Open Access Journals (Sweden)

    Lovrenski Aleksandra


    Full Text Available Introduction. Desquamative interstitial pneumonia is one of the rarest idiopathic interstitial pneumonias and the rarest form of smoking-related interstitial lung diseases. It was first described by Liebow in 1965. Histologically, it is characterized by the presence of eosinophilic macrophages uniformly filling airspaces which often contain a finely granular light-brown pigment that does not stain for hemosiderin. The alveolar walls are usually mildly thickened by fibrous tissue and infiltrated by a moderate number of lymphocytes. Case Outline. Our patient was a 56-year-old male, heavy smoker, with bilateral lung infiltrations of unknown etiology and several months of discomfort in the form of dry cough and shortness of breath. Lung function tests showed a moderate restrictive ventilation disorder and a severe reduction of diffusing capacity. Since bronchoscopic specimens did not reveal lung lesion etiology, an open lung biopsy of the lower left pulmonary lobe was performed, and based on the obtained surgical material the pathohistologically diagnosis of desquamative interstitial pneumonia was established. The patient was started on corticosteroid and immunosuppressive therapy, and he ceased smoking. At the last control examination, two years after the onset of symptoms, the patient was feeling well, and high-resolution computed tomography (HRCT scan of the thorax showed regression of pathological changes. Conclusion. Although, as in our case, the majority of DIP patients improve on treatment, some patients still develop progressive irreversible fibrosis despite therapy.

  9. Feline familial pedal eosinophilic dermatosis in two littermates


    Charline Pressanti; Marie-Christine Cadiergues


    In cats, the most common eosinophilic dermatoses are feline miliary dermatitis and eosinophilic granuloma complex. The most commonly identified underlying cause is a hypersensitivity reaction. Few cases of familial forms of eosinophilic dermatoses are reported in the literature. Two young adult cats from the same litter presented 2 years apart with a severe and chronic fluid or tissue infiltration of the distal part of several limbs. Lesions started on the forelegs and developed on the other ...

  10. Nonpathogenic, environmental fungi induce activation and degranulation of human eosinophils. (United States)

    Inoue, Yoshinari; Matsuwaki, Yoshinori; Shin, Seung-Heon; Ponikau, Jens U; Kita, Hirohito


    Eosinophils and their products are probably important in the pathophysiology of allergic diseases, such as bronchial asthma, and in host immunity to certain organisms. An association between environmental fungal exposure and asthma has been long recognized clinically. Although products of microorganisms (e.g., lipopolysaccharides) directly activate certain inflammatory cells (e.g., macrophages), the mechanism(s) that triggers eosinophil degranulation is unknown. In this study we investigated whether human eosinophils have an innate immune response to certain fungal organisms. We incubated human eosinophils with extracts from seven environmental airborne fungi (Alternaria alternata, Aspergillus versicolor, Bipolaris sorokiniana, Candida albicans, Cladosporium herbarum, Curvularia spicifera, and Penicillium notatum). Alternaria and Penicillium induced calcium-dependent exocytosis (e.g., eosinophil-derived neurotoxin release) in eosinophils from normal individuals. Alternaria also strongly induced other activation events in eosinophils, including increases in intracellular calcium concentration, cell surface expression of CD63 and CD11b, and production of IL-8. Other fungi did not induce eosinophil degranulation, and Alternaria did not induce neutrophil activation, suggesting specificity for fungal species and cell type. The Alternaria-induced eosinophil degranulation was pertussis toxin sensitive and desensitized by preincubating cells with G protein-coupled receptor agonists, platelet-activating factor, or FMLP. The eosinophil-stimulating activity in Alternaria extract was highly heat labile and had an M(r) of approximately 60 kDa. Thus, eosinophils, but not neutrophils, possess G protein-dependent cellular activation machinery that directly responds to an Alternaria protein product(s). This innate response by eosinophils to certain environmental fungi may be important in host defense and in the exacerbation of inflammation in asthma and allergic diseases.

  11. Pathogenic role of mast cells in experimental eosinophilic esophagitis


    Niranjan, Rituraj; Mavi, Parm; Rayapudi, Madhavi; Dynda, Scott; Mishra, Anil


    Eosinophilic esophagitis (EoE) is a chronic allergic disease characterized by esophageal intraepithelial eosinophils, extracellular eosinophil granule deposition, induced mast cell accumulation, and epithelial cell hyperplasia. However, the processes involved in the development of a number of these characteristics are largely unknown. Herein, we tested the hypothesis whether induced mast cell accumulation in the esophagus has a role in promoting EoE pathogenesis. Accordingly, we induced exper...

  12. Decline in antibiotic resistance and changes in the serotype distribution of Streptococcus pneumoniae isolates from children with acute otitis media; a 2001-2011 survey by the French Pneumococcal Network. (United States)

    Kempf, M; Varon, E; Lepoutre, A; Gravet, A; Baraduc, R; Brun, M; Chardon, H; Cremniter, J; Croizé, J; Dalmay, F; Demachy, M-C; Fosse, T; Grelaud, C; Hadou, T; Hamdad, F; Koeck, J-L; Luce, S; Mermond, S; Patry, I; Péchinot, A; Raymond, J; Ros, A; Segonds, C; Soullié, B; Tandé, D; Vergnaud, M; Vernet-Garnier, V; Wallet, F; Gutmann, L; Ploy, M-C; Lanotte, P


    Streptococcus pneumoniae is an important cause of acute otitis media (AOM). The aim of this study was to evaluate trends in antibiotic resistance and circulating serotypes of pneumococci isolated from middle ear fluid of French children with AOM during the period 2001-2011, before and after the introduction of the PCV-7 (2003) and PCV-13 (2010) vaccines. Between 2001 and 2011 the French pneumococcal surveillance network analysed the antibiotic susceptibility of 6683 S. pneumoniae isolated from children with AOM, of which 1569 were serotyped. We observed a significant overall increase in antibiotic susceptibility. Respective resistance (I+R) rates in 2001 and 2011 were 76.9% and 57.3% for penicillin, 43.0% and 29.8% for amoxicillin, and 28.6% and 13.0% for cefotaxime. We also found a marked reduction in vaccine serotypes after PCV-7 implementation, from 63.0% in 2001 to 13.2% in 2011, while the incidence of the additional six serotypes included in PCV-13 increased during the same period, with a particularly high proportion of 19A isolates. The proportion of some non-PCV-13 serotypes also increased between 2001 and 2011, especially 15A and 23A. Before PCV-7 implementation, most (70.8%) penicillin non-susceptible pneumococci belonged to PCV-7 serotypes, whereas in 2011, 56.8% of penicillin non-susceptible pneumococci belonged to serotype 19A. Between 2001 and 2011, antibiotic resistance among pneumococci responsible for AOM in France fell markedly, and PCV-7 serotypes were replaced by non-PCV-7 serotypes, especially 19A. We are continuing to assess the impact of PCV-13, introduced in France in 2010, on pneumococcal serotype circulation and antibiotic resistance.

  13. Resected case of eosinophilic cholangiopathy presenting with secondary sclerosing cholangitis

    Institute of Scientific and Technical Information of China (English)

    Fumihiko Miura; Takehide Asano; Hodaka Amano; Masahiro Yoshida; Naoyuki Toyota; Keita Wada; Kenichiro Kato; Tadahiro Takada; Junichi Fukushima; Fukuo Kondo; Hajime Takikawa


    Eosinophilic cholangiopathy is a rare condition characterized by eosinophilic infiltration of the biliary tract and causes sclerosing cholangitis. We report a patient with secondary sclerosing cholangitis with eosinophilic cholecystitis. A 46-year-old Japanese man was admitted to our hospital with jaundice.Computed tomography revealed dilatation of both the intrahepatic and extrahepatic bile ducts, diffuse thickening of the wall of the extrahepatic bile duct, and thickening of the gallbladder wall. Under the diagnosis of lower bile duct carcinoma, he underwent pyloruspreserving pancreatoduodenectomy and liver biopsy.On histopathological examination, conspicuous fibrosis was seen in the lower bile duct wall. In the gallbladder wall, marked eosinophilic infiltration was seen. Liver biopsy revealed mild portal fibrosis. He was diagnosed as definite eosinophilic cholecystitis with sclerosing cholangitis with unknown etiology. The possible etiology of sclerosing cholangitis was consequent fibrosis from previous eosinophilic infiltration in the bile duct. The clinicopathological findings of our case and a literature review indicated that eosinophilic cholangiopathy could cause a condition mimicking primary sclerosing cholangitis (PSC). Bile duct wall thickening in patients (PSC). Bile duct wall thickening in patients with eosinophilic cholangitis might be due to fibrosis of the bile duct wall. Eosinophilic cholangiopathy might be confused as PSC with eosinophilia.

  14. Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract. (United States)

    Hurrell, Jennifer M; Genta, Robert M; Melton, Shelby D


    Eosinophils, a constitutive component of the columnar-lined gastrointestinal tract, play an essential role in allergic responses and parasitic infections. The tissue density of these cells also increases in a variety of conditions of uncertain etiology. With the exception of the esophageal squamous epithelium, in which no eosinophils are normally present, the population of normal eosinophils in the remainder of the luminal gut is poorly defined. Therefore, histopathologists must rely on their subjective judgment to determine when a diagnosis of eosinophilic gastritis, enteritis, or colitis should be rendered. Eosinophilic esophagitis is currently the best defined and most studied eosinophilic condition of the digestive tract; therefore, the confidence in accurate diagnosis is increasing. In contrast, the characteristic clinicopathologic features of eosinophilic conditions affecting other parts of the digestive tract remain somewhat elusive. This review was designed to present pathologists with simple and practical information for the biopsy-based histopathologic diagnosis of eosinophilic esophagitis, gastritis, enteritis, and colitis. It was prepared by critically reviewing more than 200 articles on the topic, along with incorporating evidence accumulated through our own collective experience. We anticipate that by increasing pathologists' confidence in reporting these abnormal but often nameless eosinophilic infiltrates, we can help better define and characterize their significance.

  15. Mechanisms of interferon-γ production by neutrophils and its function during Streptococcus pneumoniae pneumonia. (United States)

    Gomez, John C; Yamada, Mitsuhiro; Martin, Jessica R; Dang, Hong; Brickey, W June; Bergmeier, Wolfgang; Dinauer, Mary C; Doerschuk, Claire M


    Bacterial pneumonia is a common public health problem associated with significant mortality, morbidity, and cost. Neutrophils are usually the earliest leukocytes to respond to bacteria in the lungs. Neutrophils rapidly sequester in the pulmonary microvasculature and migrate into the lung parenchyma and alveolar spaces, where they perform numerous effector functions for host defense. Previous studies showed that migrated neutrophils produce IFN-γ early during pneumonia induced by Streptococcus pneumoniae and that early production of IFN-γ regulates bacterial clearance. IFN-γ production by neutrophils requires Rac2, Hck/Lyn/Fgr Src family tyrosine kinases, and NADPH oxidase. Our current studies examined the mechanisms that regulate IFN-γ production by lung neutrophils during acute S. pneumoniae pneumonia in mice and its function. We demonstrate that IFN-γ production by neutrophils is a tightly regulated process that does not require IL-12. The adaptor molecule MyD88 is critical for IFN-γ production by neutrophils. The guanine nucleotide exchange factor CalDAG-GEFI modulates IFN-γ production. The CD11/CD18 complex, CD44, Toll-like receptors 2 and 4, TRIF, and Nrf2 are not required for IFN-γ production by neutrophils. The recently described neutrophil-dendritic cell hybrid cell, identified by its expression of Ly6G and CD11c, is present at low numbers in pneumonic lungs and is not a source of IFN-γ. IFN-γ produced by neutrophils early during acute S. pneumoniae pneumonia induces transcription of target genes in the lungs, which are critical for host defense. These studies underline the complexity of the neutrophil responses during pneumonia in the acute inflammatory response and in subsequent resolution or initiation of immune responses.

  16. Pneumonia - children - discharge (United States)

    ... this page: // Pneumonia in children - discharge To use the sharing features ... this page, please enable JavaScript. Your child has pneumonia, which is an infection in the lungs. In ...

  17. Pneumonia - adults - discharge (United States)

    ... this page: // Pneumonia in adults - discharge To use the sharing features on this page, please enable JavaScript. You have pneumonia, which is an infection in your lungs. In ...

  18. Pneumocystis jiroveci pneumonia (United States)

    ... Pneumocystis jiroveci pneumonia To use the sharing features on this page, please enable JavaScript. Pneumocystis jiroveci pneumonia is a fungal infection of the lungs. The ...

  19. FastStats: Pneumonia (United States)

    ... this? Submit What's this? Submit Button NCHS Home Pneumonia Recommend on Facebook Tweet Share Compartir Data are ... visits Number of visits to emergency departments with pneumonia as the primary hospital discharge diagnosis: 674,000 ...

  20. Relationship between Chlamydia pneumoniae infection and occurrence of bronchial asthma

    Institute of Scientific and Technical Information of China (English)

    SHI Yi; ZHENG Wen; XIA Xi-rong; ZHANG Xi-long; TONG Mao-rong; FENG Gen-bao; ZHAO Bei-lei; HU Lan-ping


    Objective: To study the relationship between Chlamydia pneumoniae (C. Pneumoniae) infection and asthma exacerbation. Methods: A prospective study of C. Pneumoniae infection was conducted in 75 patients with asthma and 63 patients with respiratory tract infection, and 100 blood donors served as controls.The presence of infection was convinced by the polymerase chain reaction and direct immunofluorescence assay for C. Pneumoniae DNA from throat swab specimens and micro-immunofluorescence testing for C. Pneumoniae-specific IgG, IgM and IgA antibodies. Results: Prevalence of specific IgG in asthma patients (81.3%) was higher than that of the blood donors (68. 0%, P<0. 05) and was not significantly different from respiratory tract infection patients (68. 0%, P>0. 05). The acute C. Pneumoniae infection rate of symptomatic asthma patients (59.4%) was markedly higher than that of respiratory tract infection patients (34.9%, P<0. 05). The average titer of C. Pneumoniae IgG instead of IgA in asthma patients (48. 38±6. 94)was significantly higher than respiratory tract infection patients (24. 70±8. 77, P<0. 05). Other pathogens were identified in 12 of 21 (57. 1%) asthma patients with C. Pneumoniae. The symptoms of 7 asthma patients with C. Pneumoniae infection were improved through antibiotic treatment. Conclusion: The findings suggest a possible role of C. Pneumoniae infection in asthma.

  1. Pneumocystis Pneumonia (For Parents) (United States)

    ... Feeding Your 1- to 2-Year-Old Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia Print A A A What's in this article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  2. Pneumonia (For Parents) (United States)

    ... Old Feeding Your 1- to 2-Year-Old Pneumonia KidsHealth > For Parents > Pneumonia A A A What's in this article? Signs ... Doctor Professional Treatment Home Care en español Neumonía Pneumonia is a general term for lung infections that ...

  3. Establishment of a GM-CSF-dependent megakaryoblastic cell line with the potential to differentiate into an eosinophilic lineage in response to retinoic acids. (United States)

    Ma, F; Koike, K; Higuchi, T; Kinoshita, T; Takeuchi, K; Mwamtemi, H H; Sawai, N; Kamijo, T; Shiohara, M; Horie, S; Kawa, S; Sasaki, Y; Hidaka, E; Yamagami, O; Yamashita, T; Koike, T; Ishii, E; Komiyama, A


    We recently established a human granulocyte-macrophage colony-stimulating factor (GM-CSF)-dependent cell line (HML) from colony-constituent cells grown by peripheral blood cells of a patient with acute megakaryoblastic leukaemia. The HML cells possessed megakaryocytic features, as determined by cytochemical, electron microscopic and flow cytometric analysis. In the present study we examined the effects of retinoic acid (RA) on the development of HML cells. All-trans-RA, 13-cis-RA and 9-cis-RA at 10(-8) mol/l to 10(-5) mol/l inhibited the GM-CSF-dependent cell growth. Some of the RA-treated cells contained prominent azurophilic granules and were positive for peroxidase. They also reacted with Biebrich scarlet, Luxol fast blue and a monoclonal antibody against eosinophil peroxidase. In addition, exposure to RA increased the frequency and the intensity of major basic protein-positive cells. However, eosinophil-derived neurotoxin and eosinophil cationic protein were not detected or were only detected at a low level in the lysates of the HML cells treated with RA. Although IL-5 alone could not stimulate cell growth, the addition of IL-5 to the cultures containing stem cell factor + all-trans-RA was required for the expression of the eosinophilic phenotype. These results suggest that the HML cell line is a megakaryoblastic cell line with the potential to differentiate into the eosinophilic lineage. HML cells may be a useful model for elucidating the eosinophilic differentiation programme.

  4. [Acute abdomen caused by eosinophilic enteritis: six observations]. (United States)

    Martínez-Ubieto, Fernando; Bueno-Delgado, Alvaro; Jiménez-Bernadó, Teresa; Santero Ramírez, María Pilar; Arribas-Del Amo, Dolores; Martínez-Ubieto, Javier


    Antecedentes: la enteritis eosinofílica es un padecimiento raro y los casos de abdomen agudo que origina suponen un mínimo porcentaje. Su etiología aún no está aclarada pero se asocia con enfermedades del colágeno, intolerancias alimentarias e infestaciones por parásitos, como anisakis, descubierto en una de las histologías de nuestros casos. Casos clínicos: de 1997 a 2011 se diagnosticaron seis casos de abdomen agudo; en tres de ellos la enteritis eosinofílica causó necrosis irreversible de un segmento intestinal y hubo que practicar una resección intestinal segmentaria. En dos de ellos había un segmento intestinal con aspecto inflamatorio, que fue el único hallazgo causante del cuadro agudo y en los que sólo se practicó biopsia y otro caso donde fue un hallazgo sin relación con el proceso agudo. Conclusiones: la enteritis eosinofílica puede ocasionar cuadros de abdomen agudo que requieren intervención quirúrgica urgente. El aspecto intraoperatorio es el de un segmento con aspecto inflamatorio que puede llegar a ser macroscópicamente irreversible y donde sólo la resección parcial es el tratamiento correcto, que puede hacerse por vía laparoscópica.

  5. Eosinophilic esophagitis in adults: An update

    Institute of Scientific and Technical Information of China (English)

    Monjur Ahmed


    Eosinophilic esophagitis is a worldwide chronic allergic disease of the esophagus.In the last decade,there is an epidemic of this entity in the western world.Mostly seen in children and young adults,patients present with dysphagia or food impaction in the emergency room.Characteristic endoscopic findings,esophageal eosinophilia and non-responsiveness to proton pump inhibitors help make the diagnosis.Avoidance of foodallergens,administration of steroidal anti-inflammatory medications and dilation of the esophagus are the mainstays of treatment.Investigations are ongoing for mucosal healing and optimum maintenance treatment.

  6. 51例不明原因重症肺炎导致急性肺损伤的临床分析%Acute lung injury resulted from severe pneumonia of unknown origin: report of 51 cases

    Institute of Scientific and Technical Information of China (English)

    江平; 史宏彰; 马俭; 张黎; 刘锦铭


    Objective To further increase the awareness of the acute lung injury resulted from severe pneumonia of unknown origin. Methods The medical data of 51 cases with acute lung injury following severe pneumonia treated in our emergency department during epidemic of influenza A HINlwere reviewed retrospectively. Results The clinical symptoms included cough in 51 cases, productive cough (31), fever (45), breathlessness (51), and myalgia (13). The oxygenation index showed 200-300 in 22 cases, and <200 in the other 29 cases. Chest X-ray showed mainly signs of exudate with patchy, ground glass, reticular and nodular changes in bilateral lungs. The lesions became worse and fused rapidly. Bilateral disease was identified in 94. 1 % of the 51 patients. Fifteen patients died. The mortality rate was 29. 4% (15/51). All death cases had acute respiratory distress syndrome (ARDS). About 51. 7% of ARDS patients died. Underlying disease was found in 10 cases, about 66. 7% of the death cases. Forty-one patients (41/51) received treatment with methylprednisolone, 28 survived. The diagnosis was confirmed in 6 cases, including invasive pulmonary aspergillosis (3), and influenza A H1N1 (3). The serum antibody assay was positive for human immunodeficiency virus in 6 cases. The serum antibody test was negative for Chlamydia, Mycoplasma or Legionella in all cases. Of the 6 cases positive for fungal culture, G-test was positive in 2 cases, but GM test was negative in all cases. Serology test for viral infection (cytomegalovirus, adenovirus, and respiratory syncytial virus) was carried out in 32 cases. IgG antibody against cytomegalovirus was positive in 9 cases. Conclusions It is a tough challenge to reveal the etiology of acute lung injury resulted from severe pneumonia. Underlying diseases may be associated with the prognosis of severe pneumonia. Early use of corticosteroids is helpful for favorable outcome of acute lung injury.%目的 提高对不明原因重症肺炎导致

  7. A case of feline gastrointestinal eosinophilic sclerosing fibroplasia associated with phycomycetes. (United States)

    Grau-Roma, L; Galindo-Cardiel, I; Isidoro-Ayza, M; Fernandez, M; Majó, N


    Feline gastrointestinal eosinophilic sclerosing fibroplasia (FGESF) is a recently described inflammatory condition of domestic cats with unknown aetiology. A proportion of cases of FGESF are associated with bacteria, but antibiotic treatment is ineffective. It has been hypothesized that genetically predisposed cats may develop FGESF in response to the introduction of bacteria or other antigens into the intestinal wall. A 9- month-old male Persian cat presented with a history of marked acute haematemesis. A mass (10 cm diameter) was detected within the pylorus and proximal duodenum and this was not surgically accessible. On necropsy examination the duodenal wall was seen to be markedly thickened with extensive mucosal ulceration. Microscopically, there were haphazardly oriented trabecular bands of dense eosinophilic collagen, separated by wide, clear areas containing variable numbers of fibroblasts, eosinophils, mast cells, neutrophils, macrophages, lymphocytes and plasma cells. Numerous pleomorphic, non-parallel walled, sparsely septate hyphae, characteristic of phycomycetes, were present within the collagen matrix. Colonies of gram-positive and gram-negative rods were also present within the lesion. This is the first description of FGESF with intralesional fungi.

  8. Antibody to eosinophil cationic protein suppresses dextran sulfate sodium-induced colitis in rats

    Institute of Scientific and Technical Information of China (English)

    Kazuko Shichijo; Kazuya Makiyama; Chun-Yang Wen; Mutsumi Matsuu; Toshiyuki Nakayama; Masahiro Nakashima; Makoto Ihara; Ichiro Sekine


    AIM: To produce an antibody against rat eosinophil cationic protein (ECP) and to examine the effects of the antibody in rats with dextran sulfate sodium (DSS)-induced colitis.METHODS: An antibody was raised against rat ECP. Rats were treated with 3% DSS in drinking water for 7 d and received the antibody or normal serum. The colons were exarmined histologically and correlated with clinical symptoms.Immunohistochemistry and Western blot analysis were estimated as a grade of inflammation.RESULTS: The ECP antibody stained the activated eosinophils around the injured crypts in the colonic mucosa.Antibody treatment reduced the severity of colonic ulceration and acute clinical symptoms (diarrhea and/or blood-stained stool). Body weight gain was significantly greater and the colon length was significantly longer in anti-ECP-treated rats than in normal serum-treated rats. Expression of ECP in activated eosinophils was associated with the presence of erosions and inflammation. The number of Ki-67-positive cells in the regenerated surface epithelium increased in anti-ECP-treated rats compared with normal serum-treated rats. Western blot analysis revealed reduced expression of macrophage migration inhibitory factor (MIF) in anti-ECP-treated rats.CONCLUSION: Our results indicate that treatment with ECP antibody, improved DSS-induced colitis in rats, possibly by increasing the regenerative activity of the colonic epithelium and downregulation of the immune response,and suggest that anti-ECP may promote intestinal wound healing in patients with ulcerative colitis (UC).

  9. Visual loss secondary to eosinophilic mucin rhinosinusitis in a woman: a case report

    Directory of Open Access Journals (Sweden)

    Joshi Naresh


    Full Text Available Abstract Introduction Eosinophilic mucin rhinosinusitis is an inflammatory pathological condition of the nose and paranasal sinuses. It is rare, occurs in immunocompetent patients and is characterised by peripheral eosinophilia and extensive bilateral sinus disease. To the best of our knowledge, visual loss with this condition has not been previously reported. Case presentation We present the case of a 26-year-old Asian woman with a background history of chronic sinusitis who presented with acute left-sided visual loss. Imaging showed significant opacification in the frontal, ethmoidal and sphenoidal sinuses as well as evidence of a unilateral optic neuritis. Histological analysis of sinus mucin revealed dense eosinophilic infiltrate and, despite medical and surgical intervention, vision was not restored in her left eye. Conclusion We introduce visual loss as a complication of eosinophilic mucin rhinosinusitis. This adds further evidence to previous reports in the literature that optic neuropathy in sinusitis can occur secondary to non-compressive mechanisms. We also describe a rare finding: the vision in this patient did not improve following steroid therapy, antifungal therapy or surgical intervention. There are very few such cases described in the literature. We conclude that chronic sinusitis is an indolent inflammatory process which can cause visual loss and we reiterate the importance of recognizing and considering sinusitis as a cause of visual loss in patients in order that prompt medical and surgical treatment of the underlying disease can be initiated.

  10. Acute purulent pericarditis caused by Streptococcus pneumoniae: a case report and literature review%肺炎链球菌致急性化脓性心包炎1例并文献复习

    Institute of Scientific and Technical Information of China (English)

    刘金荣; 姚开虎; 高路; 徐保平


    Objective To improve the understanding to acute purulent pericarditis caused by Streptococcus Pneumoniae ( PPSP ) ,to report a case of acute PPSP serotype 6A in a Chinese child and 16 reported cases by English literature on this topic up to now. Methods Clinical manifestation and prognosis of 17 patients ( including our reported case in this article ) with acute purulent pericarditis caused by Streptococcus Pneumoniae were retrospectively analyzed. Results A 14-month-old previously healthy boy had a history with 7-day-tachypnea and 3-day-cough. The levels of white blood cell ( WBC ) and C-reactive protein ( CRP ) were significantly high. A computed tomographic imaging of the chest and echocardiographic stud)' showed massive pericardial fluid. Streptococcus Pneumoniae serotype 6A was recovered from pericardial fluid and was found to be sensitive to penicillin. The patient was diagnosed as PPSP and treated with intravenous infusion of cefamandole and linezolid successively. On the 19th day of hospitalization the patient was discharged in good general condition and with hemodynamically stable. Over 6 months follow-up, ultrasound cardiography only revealed a little thickening cardiac pericardium. Since 1990, only 16 cases of PPSP have been reported in children in the PubMed databases. 17 cases ( 9 males,7 females, 1 unknown ) aged from 4 months to 17 years, 10 cases were younger than 2 years old. Children were healthy without previous medical conditions and only 3cases had underlying diseases. Its clinical recognition was difficult due to insidiously subtle and varied presentations,but most of cases had fever, dyspnea and cough. The levels of WBC, neutrophil and C-reactive protein were very high. Pericardial fluid was often yellowish-brown and revealed typical manifestation of purulent pericarditis. Echocardiogram and chest CT/X ray showed a large amount of pericardial effusion, man)' cases showed pneumonia pleural effussion. 8 cases were with penicillin susceptible

  11. Diffuse eosinophilic gastroenteritis with antral obstruction: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Moon, Sung Hee; Kim, Young Bok; Lee, Koung Hee [National Police Hospital, Seoul (Korea, Republic of)


    Eosinophilic gastroenteritis is a rare disease characterized by tissue eosinophilia that can involve different layers of the gut wall and cause various gastrointestinal symptoms. We describe the UGI and CT findings of a case of diffuse eosinophilic gastroenteritis with tumor-like antral obstruction due to thickening of the submucosa and muscle layer in a 21-year-old male. (author)

  12. Eosinophil chemotactic factors from cysticercoids of Hymenolepis nana. (United States)

    Niwa, A; Asano, K; Ito, A


    A comparative study of eosinophil chemotactic factors was carried out using cysticercoids and oncospheres of Hymenolepis nana. Cysticercoids showed twice the chemotactic activity for eosinophils than the oncospheres. Eosinophilia induced by oncospheres and cysticercoids observed in secondary and primary infections, respectively, were discussed from the view point of the immunobiology of this parasite.

  13. Steroid responsive eosinophilic gastric outlet obstruction in a child

    Institute of Scientific and Technical Information of China (English)

    Richard Kellermayer; Nina Tatevian; William Klish; Robert J Shulman


    Gastric outlet obstruction is a rare complication of eosinophilic gastroenteritis, most commonly treated surgically. We report a case of eosinophilic gastric outlet obstruction in a child that responded to conservative medical management. A brief review of this clinical entity is also provided.

  14. Eosinophilic esophagitis: From pathophysiology to treatment. (United States)

    D'Alessandro, Alessandra; Esposito, Dario; Pesce, Marcella; Cuomo, Rosario; De Palma, Giovanni Domenico; Sarnelli, Giovanni


    Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often require steroids; despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis, that require additional endoscopic treatments. This review summarizes the evidence on EoE pathophysiology and illustrates the safety and efficacy of the most recent medical and endoscopic treatments.

  15. Bone marrow contribution to eosinophilic inflammation

    Directory of Open Access Journals (Sweden)

    Denburg Judah A


    Full Text Available Allergen-induced bone marrow responses are observable in human allergic asthmatics, involving specific increases in eosinophil-basophil progenitors (Eo/B-CFU, measured either by hemopoietic assays or by flow cytometric analyses of CD34-positive, IL-3Ralpha-positive, and/or IL-5-responsive cell populations. The results are consistent with the upregulation of an IL-5-sensitive population of progenitors in allergen-induced late phase asthmatic responses. Studies in vitro on the phenotype of developing eosinophils and basophils suggest that the early acquisition of IL-5Ralpha, as well as the capacity to produce cytokines such as GM-CSF and IL-5, are features of the differentiation process. These observations are consistent with findings in animal models, indicating that allergen-induced increases in bone marrow progenitor formation depend on hemopoietic factor(s released post-allergen. The possibility that there is constitutive marrow upregulation of eosinophilopoiesis in allergic airways disease is also an area for future investigation.

  16. The human eosinophil proteome. Changes induced by birch pollen allergy. (United States)

    Woschnagg, Charlotte; Forsberg, Jens; Engström, Ake; Odreman, Federico; Venge, Per; Garcia, Rodolfo C


    Proteins from human eosinophils were separated bidimensionally and identified by mass spectrometry (336 spots/bands, 98 different proteins). Of these, 24.7% belonged to the cytoskeleton/migration group. Highly basic proteins (11.3%) were concentrated in the granule-containing cell fraction. We detected novel hyperacidic forms of cofilin-1, profilin-1 and adenylyl cyclase-associated protein, and hyperbasic forms of eosinophil-derived neurotoxin/eosinophil protein X and major basic protein homologue. We also found evidence of the triglycosylation of the heavy chain of eosinophil peroxidase. In addition, through comparative 2D image analysis, spot quantification and MS, it was found that hsc70, actin-capping protein and hyperacidic forms of eosinophil peroxidase heavy chain are overexpressed in cells from birch pollen allergic subjects, at the peak of a season. The link between these findings and an increased cellular antigen-presenting capacity and motility are discussed.

  17. Eosinophilic Pleural Effusion: A Rare Manifestation of Hypereosinophilic Syndrome

    Directory of Open Access Journals (Sweden)

    Ndubuisi C. Okafor


    Full Text Available Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Hypereosinophilic syndrome (HES is a rare disease and very few cases have been reported of HES presenting as eosinophilic pleural effusion (EPE. We report a case of a 26-year-old male who presented with shortness of breath. He had bilateral pleural effusions, generalized lymphadenopathy, splenomegaly, and leukocytosis with marked peripheral blood eosinophilia. The pleural fluid was exudative, with 25%–30% eosinophilis, and absence of neoplastic cells. Hypereosinophilic syndrome was diagnosed after other causes of eosinophilia were excluded. He continued to be dyspneic with persistent accumulation of eosinophilic pleural fluid, even after his peripheral eosinophil count had normalized in response to treatment. This patient represents a very unusual presentation of HES with dyspnea and pleural effusions and demonstrates that treatment based on response of peripheral eosinophil counts, as is currently recommended, may not always be clinically adequate.

  18. 2013 Update on Celiac Disease and Eosinophilic Esophagitis

    Directory of Open Access Journals (Sweden)

    Marco Astegiano


    Full Text Available Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease.

  19. An Atypical Case of Eosinophilic Gastroenteritis Presenting as Hypovolemic Shock

    Directory of Open Access Journals (Sweden)

    Miguel Martillo


    Full Text Available Eosinophilic gastroenteritis is an uncommon condition characterized by focal or diffuse infiltration of eosinophils in the gastrointestinal tract in the absence of secondary causes. The pathogenesis of this condition is not well understood and its clinical presentation depends on the segment and layer of the gastrointestinal tract affected. The definition of eosinophilic gastroenteritis may be difficult, as the normal ranges of eosinophil numbers in normal and abnormal gastric and intestinal mucosa are not standardized. We present the case of a 59-year-old male who came to the hospital with hypovolemic shock and lethargy secondary to severe diarrhea. Laboratory analysis was significant for peripheral eosinophilia, and pathology from both the duodenum and colon showed marked eosinophilic infiltration.

  20. Immunomodulatory therapy of cytomegalovirus pneumonia after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    WANG Gen-shu; CHEN Gui-hua; LU Min-qiang; YANG Yang; CAI Chang-jie; YI Hui-min; LI Hua; XU Chi; YI Shu-hong


    Background There has been increasing interest in the research into cytomegalovirus (CMV) pneumonia after liver transplantation (LT). This study was undertaken to investigate the immunomodulatory therapy of CMV pneumonia after LT.Methods Six patients with CMV pneumonia after LT from October 2003 to November 2005 were analyzed retrospectively. They were diagnosed according to clinical manifestations, chest X-ray findings and pathogenic changes and given comprehensive therapy including mainly immunomodulation therapy and anti-viral medication. At the early stage of CMV pneumonia, the dose of immunosuppressive agents was decreased or ceased, instead replaced by immunoenhancement therapy. During recovery period from CMV pneumonia, the dose of immunosuppressive agents was given again or enhanced, and immunoenhancement therapy was ceased.The liver function of the patients was monitored closely during the treatment.Results In this series, five patients were survived and one died. The liver function of the six patients remained normal during the treatment, and no episode of acute rejection took place.Conclusions Poor immunity is the pathogenic basis of CMV pneumonia after LT. At early stage of CMV pneumonia, the immunity of the patients should be enhanced, and during the recovery period from CMV pneumonia, immunosuppresants shoud be given again but immunoenhancement therapy ceased. Individualized immunomodulatory therapy is essential to the treatment of CMV pneumonia after LT.

  1. Streptococcus pneumoniae serotypes isolated from the middle ear of Mexican children diagnosed with acute otitis media Serotipificación de Streptococcus pneumoniae aislados de líquido de oído medio en niños mexicanos con diagnóstico de otitis media aguda

    Directory of Open Access Journals (Sweden)

    Demóstenes Gómez-Barreto


    Full Text Available OBJECTIVE: The aim of this study was to identify the etiology and the serotypes of S. pneumoniae (Sp in Mexican children with acute otitis media (AOM. MATERIALS AND METHODS: The study includessamples frompatientsdiagnosed with AOM at the Federico Gomez Children's Hospital of Mexico (2002-2003,with positive culture for Sp bacteriologically confirmed in middle ear fluid obtained by tympanocentesis. All Sp were serotyped. A total of 138 samples from 135 children with AOM were included. RESULTS: Sp was isolated in 72 samples from 70 children. Sixty (85.7% were previously healthy and 10 (14.3% were immunocompromised. The most common serotypes were 6B and 19F (16.67%, and 6 A, 14 and 23F (15.27%. CONCLUSION: The distribution of serotypes among the children with AOM in the study is similar to that reported in developing cities, and 63.9% of the isolated serotypes are found to be included in the 7-Valent Pneumococcal Conjugate Vaccine (PCV, 68.1% in the 10-Valent PCV and 83.3% in 13-Valent PCV.OBJETIVO: Conocer la etiología y serotipos de S. pneumoniae (Sp en niños mexicanos, con otitis media aguda (OMA. MATERIAL Y MÉTODOS: Se incluyeron las muestras de pacientes con OMA del Hospital Infantil de México Federico Gómez (2002-2003, con cultivo positivo para Sp, (bacteriológicamente confirmados en el líquido del oído medio obtenido por timpanocentesis. Todos los Sp. fueron serotipificados. Se incluyeron 138 muestras de 135 niños con OMA. RESULTADOS: Sp. se aisló en 72 muestras de 70 niños: 60 (85.7% eran previamente sanos y 10 (14.3% eran inmunocomprometidos. Los serotipos más frecuentes fueron 6B y 19F (16.67%, y 6 A, 14 y 23F (15.27%. CONCLUSIONES: La distribución de los serotipos en niños con otitis media aguda fue similar a la reportada en ciudades en desarrollo y se observó que 63.9% de los serotipos aislados están incluidos en la vacuna conjugada 7-valente, 68.1% en la 10-valente y 83.3% en la 13-valente.

  2. Rare idiopathic intestinal pneumonias (IIPs) and histologic patterns in new ATS/ERS multidisciplinary classification of the IIPs

    Energy Technology Data Exchange (ETDEWEB)

    Johkoh, Takeshi, E-mail: [Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers (Japan); Fukuoka, Junya, E-mail: [Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences (Japan); Tanaka, Tomonori, E-mail: [Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences (Japan)


    Highlights: •The new (ATS/ERS) update to the multidisciplinary classification of idiopathic interstitial pneumonias (IIPs) defines both rare IIPs and rare histologic patterns of IIPs. •Rare IIPs; lymphoid interstitial pneumonia, pleuroparenchymal fibroelastosis. •Rare histologic pattern, acute fibrionous organizing pneumonia, bronchocentric pattern of interstitial pneumonia. -- Abstract: The new American Thoracic Society/European Respiratory Society (ATS/ERS) update to the multidisciplinary classification of idiopathic interstitial pneumonias (IIPs) defines both rare IIPs and rare histologic patterns of IIPs. Although these diseases are rare, each has some distinguishing imaging and pathologic characteristics. Common findings for IIPs in computed tomography (CT) include cysts in lymphoid interstitial pneumonia (LIP), upper lobe subpleural consolidation in pleuropulmonary fibroelastosis (PPFE), symmetrical consolidation in acute fibrinous organizing pneumonia (AFOP), and peribronchovascular consolidation or centrilobular nodules in bronchiolocentric pattern of interstitial pneumonia.

  3. Performance of three microimmunofluorescence assays for detection of Chlamydia pneumoniae immunoglobulin M, G, and A antibodies

    DEFF Research Database (Denmark)

    Bennedsen, Mette; Berthelsen, Lene; Lind, Inga


    Labsystems (LAB) and MRL Diagnostics (MRL) by investigation of sera from three groups of patients: group I, 83 sera from 28 patients with atypical pneumonia; group II, 37 sera from 16 patients with acute C. pneumoniae or Chlamydia psittaci respiratory tract infection confirmed by PCR or culture; group III......The microimmunofluorescence (MIF) test is considered the "gold standard" for laboratory diagnosis of acute and chronic Chlamydia pneumoniae infection. The performance of a MIF test based on C. pneumoniae antigen from Washington Research Foundation (WRF) was compared with those of assays from...

  4. 无创机械通气在重症肺炎合并急性呼吸衰竭中的应用%Noninvasive mechanical ventilation in severe pneumonia an acute respiratory failure

    Institute of Scientific and Technical Information of China (English)



    目的 探讨无创机械通气(NIV)在救治重症肺炎合并急性呼吸衰竭中的价值.方法 收集24例重症肺炎合并急性呼吸衰竭患者进行NIV的临床资料,回顾性分析NIV前后缺氧的改善情况、并发症及转归等.结果 24例患者使用了机械通气,14例仅采用NIV,气体交换获得持久性改善,避免了气管插管,并最终存活出院.另10例先采用NIV,后改用有创机械通气.所有患者均能较好耐受.NIV使用1h后,PaO2和平均氧合指数较治疗前有明最提高(P<0.05).结论 NIV可用于重症肺炎合并急性呼吸衰竭的早期呼吸支持治疗,能有效改善缺氧,耐受性和安全性好.%Objective To evaluate the clinical value of noninvasive mechanical ventilation(NIV) in the patients with severe pneumonia and acute respiratory failure(ARF).Methods All clinical data(24cases)were analyzed retrospectively.The main analyzed parameters included improvement of hypoxemia before and after NIV,complications and prognosis.Results Mechanical ventilation was applied in 24 cases in which 14 cases received NIV only.Sustianed improvement in gas exchanges was observed in 14 patients who avoided endotracheal intuhation and survived and 10 cases received sequential invasive and noninvasive ventilation.The NIV was well tolerated by all patients,within first hour of NIV,the PaO2 and the ratio of the PaO2 to the fraction of inspired oxygen(FiO2) were improved in all patients(P<0.05).Conclusion As an early approach of respiratory support is effective in some cases with severe pneumonia and ARF with well tolerance and safety.

  5. [Interstitial Pneumonia and Emphysema]. (United States)

    Sawa, Teiji; Kato, Yuko; Ishii, Sachiyo


    Interstitial pneumonia (IP) and chronic obstructive pulmonary disease (COPD) are representative diseases of restrictive pulmonary dysfunction and obstructive pulmonary dysfunction, respectively. In the preoperative anesthesia clinic, anesthesiologists are frequently asked to assess the anesthesia management of patients with these diseases. In respiratory function tests, IP is detected as a decrease in % vital capacity (< 80%), and COPD as a decrease in % FEV1.0 (< 70%). Other key factors which affect the assessment are; 1) severity assessment that affects the safety of anesthesia management, 2) prognostic evaluation including the acute exacerbation in the postoperative period, and 3) patient-related factors (age, life degree of autonomy, other comorbidities, surgery-related factors, and anesthesia method). In the patients in the disease stage I or II, anesthesia management is relatively safe. On the other hand, the patients in the disease stage IV have no surgical indication except life-saving emergent situation. In another words, anesthesiologists are required to make the judgment for the anesthesia management of the patient in the disease stage III, based on the assessment of patient-related factors, surgery-related factors, and prognosis.

  6. Therapeutic targeting of eosinophil adhesion and accumulation in allergic conjunctivitis

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    Monica eBaiula


    Full Text Available Considerable evidence indicates that eosinophils are important effectors of ocular allergy. Increased worldwide prevalence of allergic eye pathologies has stimulated the identification of novel drug targets, including eosinophils and adhesion molecules.Accumulation of eosinophils in the eye is a key event in the onset and maintenance of allergic inflammation and is mediated by different adhesion molecules. Antihistamines with multiple mechanisms of action can be effective during the early and late phases of allergic conjunctivitis by blocking the interaction between β1 integrins and vascular cell adhesion molecule (VCAM-1. Small molecule antagonists that target key elements in the process of eosinophil recruitment have been identified and reinforce the validity of α4β1 integrin as a therapeutic target.Glucocorticoids are among the most effective drugs for ocular allergy, but their use is limited by adverse effects. Novel dissociated glucocorticoids can prevent eosinophil accumulation and induce apoptosis of eosinophils, making them promising candidates for ophthalmic drugs.This article reviews recent understanding of the role of adhesion molecules in eosinophil recruitment in the inflamed conjunctiva along with effective treatments for allergic conjunctivitis.

  7. Plasminogen activator inhibitor-2 (PAI-2) in eosinophilic leukocytes. (United States)

    Swartz, Jonathan M; Byström, Jonas; Dyer, Kimberly D; Nitto, Takeaki; Wynn, Thomas A; Rosenberg, Helene F


    Plasminogen activator inhibitor-2 (PAI-2) as a potential eosinophil protein was inferred from our gene microarray study of mouse eosinophilopoiesis. Here, we detect 47 kDa intracellular and approximately 60 kDa secretory forms of PAI-2 in purified human eosinophil extracts. PAI-2 is present at variable concentrations in eosinophil lysates, ranging from 30 to 444 ng/10(6) cells, with a mean of 182 ng/10(6) cells from 10 normal donors, which is the highest per-cell concentration among all leukocyte subtypes evaluated. Enzymatic assay confirmed that eosinophil-derived PAI-2 is biologically active and inhibits activation of its preferred substrate, urokinase. Immunohistochemical and immunogold staining demonstrated PAI-2 localization in eosinophil-specific granules. Immunoreactive PAI-2 was detected in extracellular deposits in and around the eosinophil-enriched granuloma tissue encapsulating the parasitic egg in livers of wild-type mice infected with the helminthic parasite Schistosoma mansoni. Among the possibilities, we consider a role for eosinophil-derived PAI-2 in inflammation and remodeling associated with parasitic infection as well as allergic airways disease, respiratory virus infection, and host responses to tumors and metastasis in vivo.

  8. Clinical characteristics of eosinophilic asthma exacerbations

    DEFF Research Database (Denmark)

    Bjerregaard, Asger; Laing, Ingrid A; Backer, Vibeke;


    BACKGROUND AND OBJECTIVE: Airway eosinophilia is associated with an increased risk of asthma exacerbations; however, the impact on the severity of exacerbations is largely unknown. We describe the sputum inflammatory phenotype during asthma exacerbation and correlate it with severity and treatment...... response. METHODS: Patients presenting to hospital with an asthma exacerbation were recruited during a 12-month period and followed up after 4 weeks. Induced sputum was collected at both visits. Patients underwent spirometry, arterial blood gas analysis, fractional exhaled nitric oxide analysis, white...... with a sensitivity of 86% and a specificity of 70%. CONCLUSION: Our findings suggest that eosinophilic asthma exacerbations may be clinically more severe than NEEs, supporting the identification of these higher risk patients for specific interventions....

  9. Cardiac tamponade leading to the diagnosis of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome): a case report and review of the literature. (United States)

    Yano, Toshiyuki; Ishimura, Shutaro; Furukawa, Tetsuaki; Koyama, Masayuki; Tanaka, Marenao; Shimoshige, Shinya; Hashimoto, Akiyoshi; Miura, Tetsuji


    Eosinophilic granulomatosis with polyangiitis (EGPA), which was previously called Churg-Strauss syndrome, is a necrotizing systemic vasculitis of unknown cause accompanied by prominent eosinophilia. Cardiovascular complications, including eosinophilic myocarditis, are a major cause of mortality in this disorder. Acute pericarditis with slight pericardial effusion is a typical manifestation in EGPA, though hemodynamically significant pericardial effusion has been reported in a few cases. We report a case that initially presented with isolated cardiac tamponade, which was followed by systemic manifestations of EGPA over 3 weeks. Including the present case, previous EGPA cases with cardiac tamponade are reviewed to delineate its clinical characteristics.

  10. Acute exacerbations of fibrotic interstitial lung disease. (United States)

    Churg, Andrew; Wright, Joanne L; Tazelaar, Henry D


    An acute exacerbation is the development of acute lung injury, usually resulting in acute respiratory distress syndrome, in a patient with a pre-existing fibrosing interstitial pneumonia. By definition, acute exacerbations are not caused by infection, heart failure, aspiration or drug reaction. Most patients with acute exacerbations have underlying usual interstitial pneumonia, either idiopathic or in association with a connective tissue disease, but the same process has been reported in patients with fibrotic non-specific interstitial pneumonia, fibrotic hypersensitivity pneumonitis, desquamative interstitial pneumonia and asbestosis. Occasionally an acute exacerbation is the initial manifestation of underlying interstitial lung disease. On biopsy, acute exacerbations appear as diffuse alveolar damage or bronchiolitis obliterans organizing pneumonia (BOOP) superimposed upon the fibrosing interstitial pneumonia. Biopsies may be extremely confusing, because the acute injury pattern can completely obscure the underlying disease; a useful clue is that diffuse alveolar damage and organizing pneumonia should not be associated with old dense fibrosis and peripheral honeycomb change. Consultation with radiology can also be extremely helpful, because the fibrosing disease may be evident on old or concurrent computed tomography scans. The aetiology of acute exacerbations is unknown, and the prognosis is poor; however, some patients survive with high-dose steroid therapy.

  11. STAT3 activation and infiltration of eosinophil granulocytes in mycosis fungoides

    DEFF Research Database (Denmark)

    Fredholm, Simon Mayland; Gjerdrum, Lise Mette; Willerslev-Olsen, Andreas;


    Eosinophil granulocytes have been implicated in anticancer immunity but recent data indicate that eosinophils can also promote cancer. Herein, we studied eosinophils in skin lesions from 43 patients with mycosis fungoides (MF). The presence of eosinophils correlated with disease stage: 78...

  12. Development of Eosinophilic Fasciitis during Infliximab Therapy for Psoriatic Arthritis

    Directory of Open Access Journals (Sweden)

    Richard Hariman


    Full Text Available Eosinophilic fasciitis (EF is a rare disorder involving chronic inflammation of the fascia and connective tissue surrounding muscles, nerves, and blood vessels. While its pathogenesis is not entirely understood, this disorder is thought to be autoimmune or allergic in nature. We present here a case of a 59-year-old male who developed peripheral eosinophilia and subsequent eosinophilic fasciitis during treatment with infliximab. To our knowledge, eosinophilic fasciitis has not been previously described in patients during treatment with an inhibitor of tumor necrosis factor α.

  13. A case of feline gastrointestinal eosinophilic sclerosing fibroplasia. (United States)

    Suzuki, Manabu; Onchi, Miyako; Ozaki, Masakazu


    Feline gastrointestinal eosinophilic sclerosing fibroplasia was diagnosed in an 8-month-old Scottish fold that had a primary gastrointestinal mass involving the stomach, duodenum and mesenteric lymph nodes. Histopathologically, the most characteristic feature of this mass was granulation tissue with eosinophil infiltration and hyperplasia of sclerosing collagen fiber. Immunohistochemically, large spindle-shaped cells were positive for smooth muscle actin and vimentin. This case emphasizes the importance of feline gastrointestinal eosinophilic sclerosing fibroplasia as a differential diagnosis of gastrointestinal neoplastic lesions such as osteosarcoma and mast cell tumor in cats.

  14. Eosinophilic cholecystitis as a rare manifestation of visceral larva migrans

    Institute of Scientific and Technical Information of China (English)


    Eosinophilic cholecystitis is an infrequent form of cholecystitis. The etiology of eosinophilic cholecystitis is still obscure, and it is sometimes accompanied with several complications, but a simultaneous onset with pericarditis is very rare. We would like to make an alternative interpretation of our recent report "Kaji K, Yoshiji H, Yoshikawa M, Yamazaki M, Ikenaka Y,Noguchi R, Sawai M, Ishikawa M, Mashitani T, Kitade M, Kawaratani H, Uemura M, Yamao J, Fujimoto M,Mitoro A,Toyohara M, Yoshida M, Fukui H. Eosinophilic cholecystitis along with pericarditis caused by Ascaris lumbricoides: A case report.World J Gastroenterol 2007;13: 3760-3762."

  15. Symptoms, Diagnosis and Treatment of Pneumonia (United States)

    ... Lung Health and Diseases > Lung Disease Lookup > Pneumonia Pneumonia Symptoms, Causes, and Risk Factors Anyone can get ... risk for pneumonia. What Are the Symptoms of Pneumonia? Pneumonia symptoms can vary from mild to severe, ...

  16. A Case of Bipolar Affective Disorder and Aspiration Pneumonia

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    Alessandro Gerada


    Full Text Available Adults with mental illness are at a higher risk of aspiration pneumonia than the general population. We describe the case of a patient with bipolar affective disorder and two separate episodes of aspiration pneumonia associated with acute mania. We propose that he had multiple predisposing factors, including hyperverbosity, sedative medications, polydipsia (psychogenic and secondary to a comorbidity of diabetes insipidus, and neuroleptic side effects.

  17. 0~1岁儿童急性肺炎病原学研究及用药合理性分析%Etiological research and medication rationality analysis of acute pneumonia in 0~1 years old

    Institute of Scientific and Technical Information of China (English)

    王晓晖; 张楠; 黄芳


    目的 分析住院的0~1岁急性肺炎儿童呼吸道病原学结果、临床特征,评价抗菌药物使用的合理性.方法 2010年12月至2012年11月我院收治34例肺炎患儿,咽拭子送北京市疾病预防控制中心进行流感病毒核酸等快速检测,痰液送院内细菌室进行细菌培养.儿童药物利用指数(children drug utilization index,cDUI)评价抗菌药物用药剂量合理性,cDUI接近1.0时用药剂量合理.药物的用药频度(defined daily dose statistic,DDDs)数值大即临床对此药选择倾向性大.结果 34例急性肺炎患儿中,病毒感染21例,细菌感染9例,混合感染4例.存在基础疾病发生细菌性肺炎(4/9)的机会高于病毒感染(5/21)(P<0.001),有呼吸道感染患者接触史患儿病毒检出率(12/21)高于细菌检出率(4/9)(P=0.01),无交叉感染危险时,婴儿更易出现细菌感染(P=0.006).25例病毒检测阳性患儿痰培养见条件致病菌定植13例,致病菌4例.细菌感染时抗菌药物联用比例(4/9)高于混合感染(1/4)(P =0.001),各组抗菌药物使用天数差异无统计学意义(P=0.29).本研究共涉及7种抗菌药物,头孢曲松(DDDs=1813.45、总用药187 d)和头孢呋新(DDDs=1513.73、总用药162 d)用药频度、总用药天数高于其余5种抗菌药物.所有剂型抗菌药物cDUI均≤1.0,由高到低分别是:阿莫西林克拉维酸钾(cDUI=1.0)、头孢呋辛(cDUI =0.89)、头孢曲松(cDUI=0.87)、阿奇霉素口服剂和头孢吡肟(cDUI=0.80)、麦迪霉素口服剂(cDUI=0.75)、青霉素注射剂(cDUI=0.50).结论 病毒是本次婴儿急性肺炎的主要病原,病毒为细菌定植提供条件,头孢曲松的过多使用加剧条件致病菌致病风险.部分患儿抗菌药物疗程长或联合使用属于不合理用药.%Objective To analyze the etiological results and clinical characteristics in infants with acute pneumonia at the age of 0 ~ 1 years and to evaluate the rationality of the use of antibiotics.Methods Thirty

  18. Mycoplasma Pneumoniae and Chlamydophila pneumoniae in hospitalized children with bronchiolitis. (United States)

    Zirakishvili, D; Chkhaidze, I; Barnabishvili, N


    Bronchiolitis is an acute lower respiratory tract infection in early childhood caused mainly by different viruses. Etiology of bronchiolitis have been studied in different environments and populations. Respiratory syncytial virus (RSV), human Metapneumovirus (hMPV), human Bocavirus (hBoV), human Rhinoviruses (hRV) have consistently been shown to predominate. Few studies however have attempted to determine whether other pathogens, particularly Mycoplasma Pneumoniae (MP) and Chlamydophila pneumoniae (CP), are associated with bronchiolitis in children under 2 years of age. The aim of this study was to determine the prevalence and clinical features of MP and CP in children under the age of 2 years presenting to the Iashvili Central Children Hospital in Tbilisi with various severities and clinical manifestations of bronchiolitis. Acute and convalescent serum samples were tested by ELISA for IgM and IgG antibodies to RSV, CP and MP.37 children under two years of age were studied. In 19 patients out of 37 (51.35%) etiological diagnosis were established and in 18 patients (48.65%) no pathogens were found. 11 patients (29.72%) had either CP or MP and 8 patients (21.62%) had RSV. Children infected with CP and MP had less severe bronchiolitis than those infected with RSV. Co-infection was not associated with disease severity. There were no statistically significant differences between groups with respect to length of hospital stay. Our study underlines the importance of atypical bacterial pathogens in acute bronchiolitis in children under 2 years and highlights the complex epidemiology and clinical features of these pathogens in this age group.

  19. Dysphagia screening and intensified oral hygiene reduce pneumonia after stroke

    DEFF Research Database (Denmark)

    Sørensen, Rikke Terp; Rasmussen, Rune Skovgaard; Overgaard, Karsten


    pneumonia could be reduced in such patients by an early screening for dysphagia and intensified oral hygiene. MATERIAL AND METHODS: In this controlled trial, 146 hospitalized acute stroke patients with moderate or severe dysphagia were included in three groups: an intervention group (n = 58), one internal...... oral hygiene. RESULTS: The incidence of x-ray verified pneumonia was 4 of 58 (7%) in the intervention group compared with 16 of 58 (28%) in the internal control group (p ... by the Gugging Swallowing Screen method and intensified oral hygiene reduced the incidence of x-ray verified pneumonia....

  20. Eosinophilic meningitis: a case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum. (United States)

    Shah, I; Barot, S; Madvariya, M


    Eosinophilic meningitis is defined as the presence of >10 eosinophils/μL in cerebrospinal fluid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.

  1. 内生场热疗联合糖皮质激素治疗急性放射性肺炎的疗效观察%Efficacy of local endogenefic thermotherapy combined with glucocorticoid for acute radiation pneumonia

    Institute of Scientific and Technical Information of China (English)

    黄建国; 卢宁; 王勇强; 赵晓伟


    目的:观察内生场热疗联合糖皮质激素治疗放射性肺炎的临床疗效.方法:86例放射性肺炎患者随机分为4组,分别给予对应治疗后,根据治疗后的症状、体征和影像学检查结果判定疗效.结果:内生场热疗和地塞米松联合治疗组患者,咳嗽、咳痰、胸闷气促症状以及呼吸困难症状有明显改善或消失,胸部CT提示肺部炎症消失或减轻,显效10例,有效10例,有效率90.9%,与治疗前相比均具有显著统计学差异(P<0.01).糖皮质激素组及热疗组患者经治疗后症状均有一定改善,其中糖皮质激素组显效5例,有效10例,有效率68.2%;热疗组显效6例,有效8例,有效率63.6%.对照组患者显效1例,有效3例,有效率25%.3个治疗组有效率均显著高于对照组(P<0.01),联合治疗组有效率显著高于糖皮质激素组(P<0.05)及热疗组(P<0.05).结论:内生场热疗联合糖皮质激素治疗放射性肺炎,疗效显著,值得临床推广应用.%Objective: To observe the clinical efficacy of local endogenefic thermotherapy combined with glucocor-ticoids for acute radiation pneumonia. Methods: All 86 cases of radiation pneumonitis were randomly divided into four groups and given the corresponding treatment. After treatment, the efficacy was determined according the symptoms, signs and imaging findings. Results: The patients treated with local endogenefic thermotherapy combined with glucocorticoids,symptoms including cough,sputum,chest tightness,shortness of breath and dyspnea were significantly improved or disappeared and lung inflammation was disappeared or reduced shown by chest CT. The excellent effective and effective cases both were 10 respectively and the effective rate was 90.9% (P<0.01,compared with before treatment). Patients'symptoms treated with glucocorticoid and hyperthermia have improved to some extent. The excellent effective and effective cases were 5 and 10 respectively and the effective rate was 68. 2

  2. Sudden death due to eosinophilic endomyocardial diseases: three case reports. (United States)

    Turan, Arzu Akcay; Karayel, Ferah; Akyildiz, Elif U; Ozdes, Taskin; Yilmaz, Eyyup; Pakis, Isil


    Eosinophils are associated with various disorders, such as allergic or hypersensitivity reactions, parasitic diseases, connective tissue diseases, certain neoplastic diseases (Hodgkin's disease, lymphomas, and carcinomas), and various immune deficiency states. Eosinophils can infiltrate any tissue and can cause tissue damage. Heart, has been demonstrated to be the most extensively involved and toxicity of eosinophils is well-established on cardiac tissue. We describe 3 cases with extensive eosinophilic infiltration without endomyocardial fibrosis. All patients died after a short clinical course with rapidly progressive heart failure. Bronchial asthma, hydatid disease and drug reaction were considered as possible etiologies of eosinophilia in case 1 and case 2. Case 3 was considered to fall into the "idiopathic hypereosinophilic syndrome" in which no underlying causes for eosinophilia could be identified.

  3. Eosinophilic granuloma in the anterior mandible mimicking radicular cyst

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    Lee, Byung Do; Lee, Wan; Lee, Jun [College of Dentistry, Wonkwang University, Iksan (Korea, Republic of); Son, Hyun Jin [Dept. of Pathology, School of Medicine, Eulji University, Daejeon (Korea, Republic of)


    Eosinophilic granuloma is a common expression of Langerhans cell histiocytosis and corresponds with typical bone lesions. The radiographic appearance of eosinophilic granuloma in the jaw is variable and not specific. It may resemble periodontitis, radicular cyst, or malignancies. The purpose of this report is to describe the characteristic radiographic features of eosinophilic granuloma of a 39-year-old male. The lesion in the anterior mandible was first diagnosed as radicular cyst because the radiographic findings were ovoid radiolucent lesion with well-defined border. However, careful interpretation revealed a non-corticated border and floating tooth appearance that were the characteristic radiographic features for the differential diagnosis. Early clinical signs of eosinophilic granuloma can occur in the jaw and a bony destructive lesion might be mistaken for periodontitis or an odontogenic cystic lesion; therefore, careful interpretation of radiographs should be emphasized.

  4. Eosinophilic venulitis of colon presenting as ileocecal mass. (United States)

    Forouhar, Faripour; Rustagi, Tarun; Lamea, Leela


    Reports of eosinophilic infiltration of the colon causing obstruction are few. It is even less common to find associated extensive intestinal venulitis, which is similar to and lumped together with so called Mesenteric Inflammatory Veno-Occlusive Disease (MIVOD) or Self-Limited Intestinal Venulitis. Eosinophilic necrotizing lymphadenitis, such as what we report here, has never been reported in association with this disease. A 41-year-old female presented with cramping lower abdominal pain, hematochezia, nausea, and vomiting. Computed tomography revealed the presence of the mass and thickening of the illeocecal wall. Endoscopy confirmed a cecal mass with surface ulceration suggestive of cecal adenocarcinoma. Patient underwent right hemicolectomy with the clinical and radiologic diagnosis of adenocarcinoma. Microscopic examination of the resected bowel showed an ulcerated mass in the cecum composed of markedly edematous tissue showing transmural eosinophilic infiltration and extensive eosinophilic and lymphocytic venulitis with and without thrombosis. This was associated with a necrotizing lymphadenitis.

  5. Pre-treatment ferritin level and alveolar-arterial oxygen gradient can predict mortality rate due to acute/subacute interstitial pneumonia in dermatomyositis treated by cyclosporine a/glucocorticosteroid combination therapy: a case control study [corrected].

    Directory of Open Access Journals (Sweden)

    Kentaro Isoda

    Full Text Available BACKGROUND: Acute/subacute interstitial pneumonia in dermatomyositis (DM-A/SIP is a disease associated with a poor prognosis that resists treatment with glucocorticosteroids (GC and progresses rapidly in a period of weeks to months to death. We retrospectively studied outcomes, prognostic factors, and their relations with survival rate in patients with DM-A/SIP treated with early cyclosporine A (CSA/GC combination therapy and 2-hour postdose blood concentration monitoring. METHODS: This study comprised 32 DM-A/SIP patients who were simultaneously treated with CSA and prednisolone. Clinical and laboratory findings were compared between those who died due to DM-A/SIP and those surviving 24 weeks after beginning of therapy. Prognostic factors were extracted, and their relations with the survival rate were evaluated. RESULTS: Of the 32 DM-A/SIP patients, 25 survived, 5 died of DM-A/SIP, and 2 died of infections. In those who died due to DM-A/SIP, ferritin level and the alveolar-arterial oxygen gradient were significantly increased compared with the survivors (P<0.001 and P = 0.002, respectively. Multivariate analyses showed that ferritin and alveolar-arterial oxygen gradient were independent prognostic factors of poor outcome. The survival rate 24 weeks after beginning of treatment was significantly lower in those with a ferritin level of ≥ 600 ng/ml and alveolar-arterial oxygen gradient of ≥ 45 Torr (P<0.001 and P<0.001, respectively. All patients with both prognostic factors died, and the outcome was significantly poorer in these patients than in those with one or neither of the prognostic factors (P<0.001. CONCLUSIONS: We identified pre-treatment high serum ferritin level and high alveolar-arterial oxygen gradient as poor prognostic factors in DM-A/SIP patients undergoing early CSA/GC combination therapy and showed that the outcomes were poor in patients with both factors.

  6. Identification of mouse acute pneumonia model induced by influenza virus using gene clone and sequence analysis%克隆测序鉴定流感病毒诱导小鼠急性肺炎模型

    Institute of Scientific and Technical Information of China (English)

    谢彬; 王雪峰; 岳志军; 南春红


    Objective To identify mouse acute pneumonia model induced by influenza virus adapted strains ( FM1 strain) using RT-PCR, gene clone and sequence analysis and pathological examination of lung tissues. Methods Acute pneumonia was induced by intranasal drip of FM1 strain. The lungs were collected after 3, 5 and 7 days. RT-PCR was used to detect the viral load. Amplified PCR products were cloned and sequenced. Pathological and histological changes to the lungs were observed. Results There were no abnormalities in the alveoli, alveolar sacs and alveolar septa and no inflammatory cell infiltration was found in normal mice. In the model group, we found disappearance of alveoli, alveolar sacs, alveolar ducts and alveolar septa, thickening of the alveolar septal and bronchiolar walls, and infiltration of inflammatory cells after 3, 5 and 7 days of influenza virus (Ⅳ) infection. Compared with the normal group, pathological changes at various time points were significantly increased (P < 0. 01). Viral nucleic acid can be detected in the lung tissue of the model group at various time points, and the pathological changes of the lung tissue were positively correlated with viral load. Sequence analysis demonstrated that there was 99. 1% consistency between RT-PCR products of lung tissues in the model group and the known IV cDNA sequence (P < 0. 01). Conclusions Gene clone and sequence analysis may be used to identify acute mouse pneumonia model induced by FM1 strain.%目的 结合RT-PCR病毒载量检测、克隆测序基因比对以及病理改变鉴定甲型流感病毒(influenza virus,IV)鼠肺适应株(FM1株)诱导的小鼠急性肺炎模型,为急性肺炎模型提供科学的鉴定方案.方法 以FM1株滴鼻诱导昆明小鼠急性肺炎,分别于第3、5、7天取小鼠肺脏,以RT-PCR法检测IV病毒载量,并通过质粒克隆测定cDNA序列;同时观察小鼠肺脏病理改变.结果 正常组小鼠肺组织的肺泡、肺泡囊和肺泡隔形态完整,周围

  7. Eosinophilic Gastroenteritis as a Rare Cause of Recurrent Epigastric Pain

    Directory of Open Access Journals (Sweden)

    Mohammad Taghi Safari


    Full Text Available Eosinophilic gastroenteritis (EGE is a rare inflammatory disorder of gastrointestinal tract characterized by eosinophilic infiltration of the bowel wall. It can mimic many gastrointestinal disorders due to its wide spectrum of presentations. Diagnose is mostly based on excluding other disorders and a high suspicion. Here we report a case of 26 year old man with a history of sever epigastric pain followed by nausea, vomiting since a few days before admission with final diagnosis of EGE.

  8. A Case of Feline Gastrointestinal Eosinophilic Sclerosing Fibroplasia


    SUZUKI, manabu; Onchi, Miyako; Ozaki, Masakazu


    Feline gastrointestinal eosinophilic sclerosing fibroplasia was diagnosed in an 8-month-old Scottish fold that had a primary gastrointestinal mass involving the stomach, duodenum and mesenteric lymph nodes. Histopathologically, the most characteristic feature of this mass was granulation tissue with eosinophil infiltration and hyperplasia of sclerosing collagen fiber. Immunohistochemically, large spindle-shaped cells were positive for smooth muscle actin and vimentin. This case emphasizes the...

  9. Eosinophilic Endomyocarditis Combined With Pericardial and Pleural Effusion


    You, Sung-Hye; Hong, Soon Jun; Ahn, Chul Min; Lim, Do-Sun


    Eosinophilic endomyocarditis is a manifestation of hypereosinophilic syndrome, characterized by prolonged (>6 months), unexplained peripheral blood eosinophilia (>1,500 cells/mm3) with end-organ damage in unknown causes. We report a case of a 42-year-old patient who developed eosinophilic endomyocarditis following upper respiratory tract symptoms for 2 months. Additionally, endomyocarditis was combined with massive pleural effusion and pericardial effusion, which have not been reported in Korea.

  10. Bronchitis and Pneumonia (United States)

    ... by a health care provider. How serious are bronchitis and pneumonia? Both conditions are more serious if a child has a chronic health condition or if the condition is caused by a bacteria, in which case antibiotics are the treatment of choice. When pneumonia is caused by bacteria, ...

  11. Pneumocystis jirovecii pneumonia

    DEFF Research Database (Denmark)

    Cordonnier, Catherine; Cesaro, Simone; Maschmeyer, Georg


    Pneumocystis jirovecii can cause life-threatening pneumonia following treatment for haematological malignancies or after HSCT. The mortality rate of P. jirovecii pneumonia (PCP) in these patients is 30%-60%, especially after HSCT. The clinical presentation of PCP in haematology differs from that ...

  12. When is pneumonia not pneumonia: a clinicopathologic study of the utility of lung tissue biopsies in determining the suitability of cadaveric tissue for donation. (United States)

    Kubilay, Zeynep; Layon, A Joseph; Baer, Herman; Archibald, Lennox K


    Healthcare-associated pneumonia (HCAP) represents a major diagnostic challenge because of the relatively low sensitivity and specificity of clinical criteria, radiological findings, and microbiologic culture results. It is often difficult to distinguish between pneumonia, underlying pulmonary disease, or conditions with pulmonary complications; this is compounded by the often-subjective clinical diagnosis of pneumonia. We conducted this study to determine the utility of post-mortem lung biopsies for diagnosing pneumonia in tissue donors diagnosed with pneumonia prior to death. Subjects were deceased patients who had been hospitalized at death and diagnosed with pneumonia. Post-mortem lung biopsies were obtained from the anatomic portion of the cadaveric lung corresponding to chest radiograph abnormalities. Specimens were fixed, stained with hematoxylin and eosin, and read by a single board-certified pathologist. Histological criteria for acute pneumonia included intense neutrophilic infiltration, fibrinous exudates, cellular debris, necrosis, or bacteria in the interstitium and intra-alveolar spaces. Of 143 subjects with a diagnosis of pneumonia at time of death, 14 (9.8 %) had histological evidence consistent with acute pneumonia. The most common histological diagnoses were emphysema (53 %), interstitial fibrosis (40 %), chronic atelectasis (36 %), acute and chronic passive congestion consistent with underlying cardiomyopathy (25 %), fibro-bullous disease (12 %), and acute bronchitis (11 %). HCAP represents a major diagnostic challenge because of the relatively low sensitivity and specificity of clinical criteria, radiological findings, and microbiologic testing. We found that attending physician-diagnosed pneumonia did not correlate with post-mortem pathological diagnosis. We conclude that histological examination of cadaveric lung tissue biopsies enables ascertainment or rule out of underlying pneumonia and prevents erroneous donor deferrals.

  13. Eosinophils increase in animals that received biotherapic

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    Pedro Gilberto Silva Morais


    morphological changes in juveniles and adults ticks parasitizing animals which consumed the biotherapic. This observation suggests a negative interference of the biotherapic in the biological cycle of the tick, decreasing its population and consequently his control’s necessity. Comparing the blood cells counts of the first and the twelfth month, a raise of 23% (P> 0.05 in the eosinophils and 8% (P< 0.05 in the platelets was observed in the T1 animals. No changes in liver enzymes were observed. The increase in eosinophils and platelets found in this experiment suggests that biotherapic ingested by the animals strengthens the defense system and the clotting cascade.Key words: bovinos

  14. A Non-Frequently Considered Diagnosis of Dysphagia; Eosinophilic Esophagitis

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    Mehmet Ağın


    Full Text Available Eosinophilic Esophagitis is infiltration of esophagus mucosa by eosinophil leucocyte. It is rarely observed in children and the symptoms are similar to gastroesophageal reflux. This case, which was applied esophagus balloon dilatation in the pediatric surgery due to dysphagia and diagnosed eosinophilic esophagitis, was presented in order to attract attention to the approach to the child with dysphagia. Total IgE=834 IU/mL and specific IgE (-, Fx5 (- was found negative. In the upper GIS endoscopy, it was observed that esophagus mucosa was pale, its structure was hard and its motility was disordered and a couple milimetric white lesions were observed as well. In the esophagus biopsy materials, it was observed that the eosinophil infiltration in the mucosa was 60%. With the diagnosis of Eosinophilic Esophagitis, the case was started on oral prednisolone 1 mg/kg/day. In the polyclinic control of the case after a week, it was observed that there was a significant decrease in the complaints about dysphagia and in the one-month control the complaints were all gone. In the symptoms similar to dysphagia and reflux, especially if the case is not responding to gastroesophageal reflux treatment, the diagnosis of Eosinophilic Esophagitis should absolutely be considered

  15. Eosinophilic ascites: A case report and literature review

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    Raed M Alsulaiman


    Full Text Available Eosinophilic gastroenteritis is a rare gastrointestinal (GI disorder characterized by nonspecific GI symptoms, peripheral eosinophilia, and eosinophilic infiltration of the intestinal wall. The disorder is classified into mucosal, muscular, and sub-serosal types, depending on the clinical picture and the depth of eosinophilic infiltration within the GI wall. Sub-serosal disease, which is complicated by ascites, usually results in the most severe clinical form of eosinophilic gastroenteritis and requires early corticosteroid therapy. In such cases, a favorable outcome can be achieved after a short course of corticosteroids. We present the case of a 28-year-old female with diffuse abdominal pain and distention for 2 weeks. Her physical examination was significant for moderate ascites. Initial work-up demonstrated severe peripheral blood eosinophilia, normal liver function tests, and elevated serum immunoglobulin E (IgE. Upper endoscopy, colonoscopy showed a thickening of the stomach and colon, and biopsies showed marked eosinophilic infiltration of the mucosa. Ascitic fluid analysis showed significant eosinophilia. Subsequent treatment with oral prednisone resulted in the normalization of laboratory and radiologic abnormalities 45 days after the start of the treatment. Despite its rarity, eosinophilic gastroenteritis needs to be recognized by the clinician because the disease is treatable, and timely diagnosis and initiation of treatment could be of major importance.

  16. Does the eosinophil have a protective role in amebiasis?

    Directory of Open Access Journals (Sweden)

    López-Osuna Martha


    Full Text Available While normal human eosinophils are destroyed in vitro by virulent Entamoeba histolytica, notwhistanding the presence of antibodies and complement, activated eosinophils promptly destroy the parasite although dying also at the end of the process. To study the possible in vivo participation of eosinophils in invasive amebiasis, we compared the induction of experimental amebic abscess of the liver (AAL in gerbils (Meriones unguiculatus previously made eosinophilic through Toxocara canis antigen injection and in normal control gerbils. After intraportal inoculation of 10(5 ameba trophozoites (6 and 24 hr, the ratio of gerbils with AAL, as well as the number and size of the microabscesses was comparable in eosinophilic and control gerbils. However, at 96 hr the number and size of the microabscesses were significanly smaller (p<0.05 in eosinophilic gerbils. On the other hand the actuarial AAL survival curve up to 45 days post-amebic inoculation was signficantly (p<0.05 shifted to the right in controls. These results suggest that antigen-induced eosinophilia may exert a protective effect against AAL in gerbils.

  17. Combination Chemotherapy in Treating Young Patients With Down Syndrome and Acute Myeloid Leukemia or Myelodysplastic Syndromes (United States)


    Childhood Acute Basophilic Leukemia; Childhood Acute Eosinophilic Leukemia; Childhood Acute Erythroleukemia (M6); Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Minimally Differentiated Myeloid Leukemia (M0); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myelomonocytic Leukemia (M4); Childhood Myelodysplastic Syndromes; de Novo Myelodysplastic Syndromes; Secondary Acute Myeloid Leukemia; Secondary Myelodysplastic Syndromes; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies

  18. Emergence of a Streptococcus pneumoniae clinical isolate highly resistant to telithromycin and fluoroquinolones. (United States)

    Faccone, Diego; Andres, Patricia; Galas, Marcelo; Tokumoto, Marta; Rosato, Adriana; Corso, Alejandra


    Streptococcus pneumoniae is a major pathogen causing community-acquired pneumonia and acute bronchitis. Macrolides, fluoroquinolones (FQs), and, recently, telithromycin (TEL) constitute primary therapeutic options, and rare cases of resistance have been reported. In this report, we describe the emergence of an S. pneumoniae clinical isolate with high-level TEL resistance (MIC, 256 microg/ml) and simultaneous resistance to FQs. Ongoing studies are oriented to elucidate the precise mechanism of resistance to TEL.

  19. Emergence of a Streptococcus pneumoniae Clinical Isolate Highly Resistant to Telithromycin and Fluoroquinolones


    Faccone, Diego; Andres, Patricia; Galas, Marcelo; Tokumoto, Marta; Rosato, Adriana; Corso, Alejandra


    Streptococcus pneumoniae is a major pathogen causing community-acquired pneumonia and acute bronchitis. Macrolides, fluoroquinolones (FQs), and, recently, telithromycin (TEL) constitute primary therapeutic options, and rare cases of resistance have been reported. In this report, we describe the emergence of an S. pneumoniae clinical isolate with high-level TEL resistance (MIC, 256 μg/ml) and simultaneous resistance to FQs. Ongoing studies are oriented to elucidate the precise mechanism of res...

  20. Redox thermodynamics of lactoperoxidase and eosinophil peroxidase. (United States)

    Battistuzzi, Gianantonio; Bellei, Marzia; Vlasits, Jutta; Banerjee, Srijib; Furtmüller, Paul G; Sola, Marco; Obinger, Christian


    Eosinophil peroxidase (EPO) and lactoperoxidase (LPO) are important constituents of the innate immune system of mammals. These heme enzymes belong to the peroxidase-cyclooxygenase superfamily and catalyze the oxidation of thiocyanate, bromide and nitrite to hypothiocyanate, hypobromous acid and nitrogen dioxide that are toxic for invading pathogens. In order to gain a better understanding of the observed differences in substrate specificity and oxidation capacity in relation to heme and protein structure, a comprehensive spectro-electrochemical investigation was performed. The reduction potential (E degrees ') of the Fe(III)/Fe(II) couple of EPO and LPO was determined to be -126mV and -176mV, respectively (25 degrees C, pH 7.0). Variable temperature experiments show that EPO and LPO feature different reduction thermodynamics. In particular, reduction of ferric EPO is enthalpically and entropically disfavored, whereas in LPO the entropic term, which selectively stabilizes the oxidized form, prevails on the enthalpic term that favors reduction of Fe(III). The data are discussed with respect to the architecture of the heme cavity and the substrate channel. Comparison with published data for myeloperoxidase demonstrates the effect of heme to protein linkages and heme distortion on the redox chemistry of mammalian peroxidases and in consequence on the enzymatic properties of these physiologically important oxidoreductases.

  1. Clinical efficacy of ambroxol treatment on acute stroke-associated pneumonia%盐酸氨溴索治疗脑卒中相关性肺炎的疗效评价

    Institute of Scientific and Technical Information of China (English)

    张媛; 何静春; 邢爱民; 李立宇


    Objective To observe the clinical effects of ambroxol on acute stroke-associated pneumonia (SAP).Methods From July 2011 to December 2012,a total of 82 patients with strokeassociated pneumonia (SAP) admitted to our hospital were selected and randomly divided into ambroxol group (n=43,treated with ambroxol in combination with antibiotic therapy) and control group (n =39,treated with antibiotic therapy).The defervescence time,hospitalization time,antibiotic use time,C-reactive protein level,blood oxygen partial pressure,bacterial clearance rate and the total effective rate were compared between the two groups.Results The defervescence time,hospitalization time,antibiotic use time were shorter in ambroxol group than in control group [(3.1 ± 0.8)d vs.(3.8±1.1)d,(11.7±3.7)d vs.(13.6±4.9)d,(5.4±1.7)dvs.(6.6±2.1)d,t=18.60,22.80,23.50,P=0.014,0.008,0.011,repectively].Bacterial clearance rate and the total effective rate were higher in ambroxol group than in control group [90.7% vs.74.4%,93.0% vs.74.4%,x2 =3.86,5.34,P=0.05,0.02].There were no significant differences in changes of C-reactive protein level and blood oxygen partial pressure between two groups before and after treatment (all P>0.05).Conclusions Ambroxol is an effective treatment for acute stroke associated pneumonia,which can shorten antibiotic use time and duration of symptoms and remove bacteria effectively.%目的 观察盐酸氨溴索静脉滴注治疗急性脑卒中相关性肺炎(SAP)的效果. 方法 选取2011年7月至2012年12月我院收治的诊断为SAP的82例老年急性脑卒中患者,随机分为盐酸氨溴索组43例和对照组39例,盐酸氨溴索组进行盐酸氨溴索并联合抗生素治疗,对照组则仅给予相应抗生素治疗,比较两组患者的退热时间、住院时间、抗生素使用时间、C反应蛋白、动脉血氧分压,以及细菌清除率、治疗有效率等. 结果 盐酸氨溴索组患者的退热时间、住院时间、抗

  2. Klebsiella pneumoniae pharyngitis mimicking malignancy: a diagnostic dilemma. (United States)

    Yeh, C-F; Li, W-Y; Hsu, Y-B


    Acute pharyngitis is a common disease. However, acute pharyngitis caused by Klebsiella pneumoniae with a gross appearance mimicking hypopharyngeal malignancy has never previously been reported. We report the case of a 57-year-old man with a right hypopharyngeal tumor which was disclosed by fiberoptic laryngoscopy and computed tomography scan. However, both the frozen and final pathologies showed no evidence of malignant cells, and a bacterial culture revealed the growth of K. pneumoniae. The hypopharyngeal lesion completely regressed after 2 weeks of antibiotic treatment. Clinicians should perform biopsy along with tissue culture for tumor-like lesions because infectious agents can lead to lesions with malignancy-like appearance.

  3. Communicating hydrocephalus following eosinophilic meningitis is pathogenic for chronic Viliuisk encephalomyelitis in Northeastern Siberia.

    Directory of Open Access Journals (Sweden)

    Alexander Storch

    Full Text Available BACKGROUND: Viliuisk encephalomyelitis (VE is an endemic neurological disease in Northeast Siberia and generally considered to be a chronic encephalomyelitis of unknown origin actually spreading in the Sakha (Yakutian Republic. METHODOLOGY AND PRINCIPLE FINDINGS: In search for the pathophysiology and causative agent of VE, we performed a cross-sectional study on clinical, serological and neuroimaging data on chronic VE patients during two medical expeditions to three villages within the Viliuiski river basin in the Republic of Sakha in 2000 and to the capital Yakutsk in 2006. The severity of the core clinical picture with predominant sensory ataxia, gait apraxia, lower limb spasticity, cognitive impairment and bladder dysfunction correlated with the degree of MRI findings showing enlargement of inner ventricular spaces as in communicating hydrocephalus. Laboratory studies revealed transient eosinophilia during the preceding acute meningitis-like phase, but no ongoing inflammatory process in the CSF. We found immune reactions against Toxocara canis in the majority of chronic VE patients but rarely in controls (P = 0.025; Fisher's exact test. Histological analysis of subacute to subchronic VE brain samples showed eosinophilic infiltrations with no signs of persistent Toxocara canis infection. CONCLUSIONS AND SIGNIFICANCE: Our data showed that pressure by the communicating hydrocephalus as a mechanical factor is the major pathogenic mechanism in chronic VE, most likely triggered by eosinophilic meningitis. There are no signs for an ongoing inflammatory process in chronic VE. The past eosinophilic reaction in VE might be caused by Toxocara ssp. infection and might therefore represent the first hint for an initial cause leading to the development of chronic VE. Our data provide a framework for future studies and potential therapeutic interventions for this enigmatic epidemic neurological disease potentially spreading in Sakha Republic.

  4. Prior cardiovascular disease increases long-term mortality in COPD patients with pneumonia


    Sibila, Oriol; Mortensen, Eric M.; Anzueto, Antonio; Laserna, Elena; Restrepo, Marcos I.


    There is controversy regarding the impact of chronic obstructive pulmonary disease (COPD) in clinical outcomes in elderly patients with pneumonia. Comorbidities such as cardiovascular disease have been reported to play an important role in patients with acute exacerbations of COPD. However, limited data are available regarding the impact of cardiovascular disease in elderly COPD patients who require hospitalisation for pneumonia.

  5. Primary Colonic Eosinophilia and Eosinophilic Colitis in Adults. (United States)

    Turner, Kevin O; Sinkre, Richa A; Neumann, William L; Genta, Robert M


    The normal content of eosinophils in the adult colon and the criteria for the histopathologic diagnosis of eosinophilic colitis remain undefined. This study aimed at: (1) establishing the numbers of eosinophils in the normal adult colon; and (2) proposing a clinicopathologic framework for the diagnosis of primary colonic eosinophilia and eosinophilic colitis. To accomplish these goals, we counted the eosinophils in the right, transverse, and left colon of 159 adults with normal colonic histology. Using a database of 1.2 million patients with colonic biopsies, we extracted all adults with a diagnosis of colonic eosinophilia. We reviewed the slides from all cases and captured demographic, clinical, and pathologic data, including information about eosinophilia in other organs. We then compared the clinical manifestations of the study patients (those with no identifiable cause of eosinophilia) to those of patients with other types of colitis. The normal eosinophil counts (per mm) were 55.7±23.4 in the right, 41.0±18.6 in the transverse, and 28.6±17.2 in the left colon. Of the 194 study patients (eosinophil counts 166-5050/mm), 63 were asymptomatic and had a normal colonoscopy. Diarrhea and abdominal pain were the commonest indications for colonoscopy (38% and 27%, respectively) among the 131 patients who had symptoms, endoscopic abnormalities, or both. Neither clinical manifestations nor endoscopic appearance were sufficiently characteristic to elicit the suspicion of colonic eosinophilia. In conclusion, primary colonic eosinophilia was extremely rare in this series (reporting high colonic eosinophilia may result in increased opportunities for clinicopathologic studies that might lead to a better definition of this still elusive entity.

  6. STAT3 activation and infiltration of eosinophil granulocytes in mycosis fungoides. (United States)

    Fredholm, Simon; Gjerdrum, Lise Mette R; Willerslev-Olsen, Andreas; Petersen, David L; Nielsen, Inger Ø; Kauczok, Claudia-S; Wobser, Marion; Ralfkiaer, Ulrik; Bonefeld, Charlotte M; Wasik, Mariusz A; Krejsgaard, Thorbjørn; Geisler, Carsten; Ralfkiaer, Elisabeth; Gniadecki, Robert; Woetmann, Anders; Odum, Niels


    Eosinophil granulocytes have been implicated in anticancer immunity but recent data indicate that eosinophils can also promote cancer. Herein, we studied eosinophils in skin lesions from 43 patients with mycosis fungoides (MF). The presence of eosinophils correlated with disease stage: 78% of patients with advanced disease displayed eosinophil infiltration, whereas this was only seen in 11% of patients with patches (pIL5). STAT3 siRNA profoundly inhibited IL5 but not HMGB1 expression. In conclusion, these data suggest that malignant T-cells orchestrate accumulation and activation of eosinophils supporting the notion of STAT3 being a putative target for therapy.

  7. Pneumonia caused by Aeromonas species in Taiwan, 2004-2011. (United States)

    Chao, C M; Lai, C C; Tsai, H Y; Wu, C J; Tang, H J; Ko, W C; Hsueh, P-R


    We investigated the clinical characteristics of patients with pneumonia caused by Aeromonas species. Patients with pneumonia caused by Aeromonas species during the period 2004 to 2011 were identified from a computerized database of a regional hospital in southern Taiwan. The medical records of these patients were retrospectively reviewed. Of the 84 patients with pneumonia due to Aeromonas species, possible Aeromonas pneumonia was diagnosed in 58 patients, probable Aeromonas pneumonia was diagnosed in 18 patients, and pneumonia due to Aeromonas was conclusively diagnosed in 8 patients. Most of the cases of Aeromonas pneumonia developed in men and in patients of advanced age. A. hydrophila (n = 50, 59.5 %) was the most common pathogen, followed by A. caviae (n = 24, 28.6 %), A. veronii biovar sobria (n = 7, 8.3 %), and A. veronii biovar veronii (n = 3, 3.6 %). Cancer (n = 37, 44.0 %) was the most common underlying disease, followed by diabetes mellitus (n = 27, 32.1 %). Drowning-associated pneumonia developed in 6 (7.1 %) patients. Of 47 patients who were admitted to the intensive care ward, 42 patients developed acute respiratory failure and 24 of those patients died. The overall in-hospital mortality rate was significantly associated with liver cirrhosis, cancer, initial presentation of shock, and usage of mechanical ventilation. In conclusion, Aeromonas species should be considered as one of the causative pathogens of severe pneumonia, especially in immunocompromised patients, and should be recognized as a cause of drowning-associated pneumonia. Cirrhosis, cancer, and shock as the initial presenting symptom are associated with poor outcome.

  8. Pneumonia in severe acute stroke patients fed by nasojejunal versus nasogastric tube%鼻空肠与鼻胃管管饲的急性重症卒中患者的肺炎

    Institute of Scientific and Technical Information of China (English)

    陈国强; 李最娥; 王宝军; 梁芙茹; 孙凯; 刘国荣


    目的 探讨鼻空肠管与鼻胃管肠内营养支持对重症急性卒中患者卒中相关性肺炎(stroke associated pneumonia,SAP)以及其他并发症的影响.方法 共纳入60例需要管饲的重症急性卒中患者,随机分为鼻空肠管组和鼻胃管组进行肠内营养支持,观察2周内SAP、腹泻、呕吐、消化道出血和低钠血症的发生,记录置管前以及置管后7d和14 d时的营养指标(总蛋白、前白蛋白、血红蛋白)并进行比较.结果 鼻空肠管组和鼻胃管组各30例,2组人口统计学和基线临床资料均无显著差异.鼻空肠管组SAP(43.3%对70.0%;x2=4.340,P=0.037)、呕吐(13.3%对43.3%x2 =6.648,P=0.010)和低钠血症(16.7%对40.0%;x2 =4.022,P=0.045)发生率显著低于鼻胃管组,但腹泻和消化道出血发生率无显著差异.鼻空肠管组置管后14 d时的血浆总蛋白和前白蛋白浓度与置管前无显著差异,但血红蛋白浓度显著降低(P=0.001);相比之下,鼻胃管组置管后14 d时血浆总蛋白(P=0.001)、前白蛋白(P=0.036)和血红蛋白(P=0.001)浓度与置管前相比均显著降低.结论 重症急性卒中患者鼻空肠肠内营养能有效预防SAP以及呕吐和低钠血症的发生,并且有助于维持患者的营养状况.%Objective To investigate the effects of enteral nutrition via the nasojejunal and nasogastric feeding on stroke-associated pneumonia (SAP) and other complications in patients with severe acute stroke.Methods A total of 60 patients with severe acute stroke who needed tube feeding were randomized to either a nasojejunal tube group or a nasaogastric tube group for enteral nutrition support.The occurrence of SAP,diarrhea,vomiting,and gastrointestinal bleeding within 2 weeks were observed.The nutrition indices (total protein,prealbumin,and hemoglobin) before and at day 7 and 14 after the tube placement were documented and compared.Results There were 30 patients in the nasojejunal tube group and the nasaogastric rube group

  9. Eosinophilic Colitis: University of Minnesota Experience and Literature Review

    Directory of Open Access Journals (Sweden)

    Wolfgang B. Gaertner


    Full Text Available Eosinophilic colitis is a rare form of primary eosinophilic gastrointestinal disease that is poorly understood. Neonates and young adults are more frequently affected. Clinical presentation is highly variable depending on the depth of inflammatory response (mucosal, transmural, or serosal. The pathophysiology of eosinophilic colitis is unclear but is suspected to be related to a hypersensitivity reaction given its correlation with other atopic disorders and clinical response to corticosteroid therapy. Diagnosis is that of exclusion and differential diagnoses are many because colonic tissue eosinophilia may occur with other colitides (parasitic, drug-induced, inflammatory bowel disease, and various connective tissue disorders. Similar to other eosinophilic gastrointestinal disorders, steroid-based therapy and diet modification achieve very good and durable responses. In this paper, we present our experience with this rare pathology. Five patients (3 pediatric and 2 adults presented with diarrhea and hematochezia. Mean age at presentation was 26 years. Mean duration of symptoms before pathologic diagnosis was 8 months. Mean eosinophil count per patient was 31 per high-power field. The pediatric patients responded very well to dietary modifications, with no recurrences. The adult patients were treated with steroids and did not respond. Overall mean followup was 22 (range, 2–48 months.

  10. Feline familial pedal eosinophilic dermatosis in two littermates

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    Charline Pressanti


    Full Text Available In cats, the most common eosinophilic dermatoses are feline miliary dermatitis and eosinophilic granuloma complex. The most commonly identified underlying cause is a hypersensitivity reaction. Few cases of familial forms of eosinophilic dermatoses are reported in the literature. Two young adult cats from the same litter presented 2 years apart with a severe and chronic fluid or tissue infiltration of the distal part of several limbs. Lesions started on the forelegs and developed on the other limbs. Cytological and histopathological examinations showed lesions consistent with an atypical form of feline eosinophilic dermatosis associated with secondary bacterial infection. In both cats, antibiotics combined with immunosuppressive treatment partially improved the lesions, which continued to progress on a waxing and waning course, even in the absence of treatment. Allergy work-up did not permit the identification of an underlying allergic triggering factor. The severity of the lesions, the unusual presentation and the unsatisfactory response to immunosuppressive therapy in two feline littermates suggested a genetic form of eosinophilic dermatosis.

  11. Eosinophilic esophagitis: A newly established cause of dysphagia

    Institute of Scientific and Technical Information of China (English)

    Brian M Yan; Eldon A Shaffer


    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment,and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/105 in children and 2.5/105 in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline"or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimai contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (>20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors,or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign,albeit inconvenient, course. With increasing recognition,this entity is taking its place as an established cause of solid food dysphagia.

  12. Eosinophilic esophagitis: a newly established cause of dysphagia. (United States)

    Yan, Brian-M; Shaffer, Eldon-A


    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/10(5) in children and 2.5/10(5) in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline" or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimal contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (>20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors, or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign, albeit inconvenient, course. With increasing recognition, this entity is taking its place as an established cause of solid food dysphagia.

  13. Computed tomographic characteristics of eosinophilic pulmonary granulomatosis in five dogs. (United States)

    Fina, Caroline; Vignoli, Massimo; Terragni, Rossella; Rossi, Federica; Wisner, Erik; Saunders, Jimmy H


    Canine pulmonary eosinophilic granulomatosis is a rare inflammatory pulmonary disease characterized by formation of eosinophilic granulomas that tend to obliterate the normal pulmonary architecture. The purpose of this retrospective study was to describe the CT characteristics of confirmed idiopathic pulmonary eosinophilic granulomatosis in a group of dogs. Five dogs met inclusion criteria. All patients were young adult dogs of variable breeds. No dog had concurrent occult heartworm disease. Computed tomographic characteristics most commonly included pulmonary masses and nodules of variable size, and lesions were most commonly located in the caudal lung lobes. Four dogs had large pulmonary masses with or without additional nodules and one dog had nodular lesions disseminated throughout the entire lung parenchyma. All large eosinophilic granulomas were smoothly margined, heterogeneous pulmonary masses displaying heterogeneous contrast enhancement. A honeycomb-like enhancement pattern was observed in all but one mass and consisted of multiple hyperattenuating rims delineating central hypoattenuating areas, suggestive of bronchiectatic lung with peripheral enhancing airway walls and fluid-filled, necrotic bronchial lumen. One dog had evidence of tracheobronchial lymphadenopathy. Findings indicated that canine eosinophilic pulmonary granulomatosis should be included as a differential diagnosis for dogs with CT characteristics of multiple pulmonary masses and/or nodules in caudal lung lobes, and a honeycomb-like enhancement pattern in masses after intravenous administration of iodinated contrast medium.

  14. Eosinophilic esophagitis: New insights in pathogenesis and therapy

    Institute of Scientific and Technical Information of China (English)

    Michele Pier Luca Guarino; Michele Cicala; Jose Behar


    Eosinophilic esophagitis(Eo E) is a clinico-pathological entity with esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus that may persist despite treatment with proton pump inhibitors. This eosinophilic infiltration is usually absent in the stomach, small intestine and colon, although there are a number of reports of patients with a multiorgan involvement. EoE is associated with abnormalities involving TH2-dependent immunity, with multiple environmental factors strongly contributing to disease expression. The layer of the esophagus affected by the eosinophilic infiltration causes the specific symptoms. Esophageal involvement results mostly in dysphagia for solids that can be severe enough to cause recurrent esophageal obstruction with typical endoscopic features suggesting esophageal remodeling and pathological changes of eosinophilic infiltration of the mucosa, sub-epithelial fibrosis and muscle hypertrophy. This disease is frequently associated with other allergic conditions such as allergic asthma, allergic dermatitis and eosinophilia. The treatment of patients with Eo E depends on the severity of the symptoms and of the inflammatory process as well as to their response to a gradual step-up treatment. The first line of treatment consists of steroid containing local inhalers. If unresponsive they are then treated with oral steroids. Intravenous interleukin blockers seem to have a consistent positive therapeutic effect.

  15. Disruption of Fas Receptor Signaling by Nitric Oxide in Eosinophils (United States)

    Hebestreit, Holger; Dibbert, Birgit; Balatti, Ivo; Braun, Doris; Schapowal, Andreas; Blaser, Kurt; Simon, Hans-Uwe


    It has been suggested that Fas ligand–Fas receptor interactions are involved in the regulation of eosinophil apoptosis and that dysfunctions in this system could contribute to the accumulation of these cells in allergic and asthmatic diseases. Here, we demonstrate that nitric oxide (NO) specifically prevents Fas receptor–mediated apoptosis in freshly isolated human eosinophils. In contrast, rapid acceleration of eosinophil apoptosis by activation of the Fas receptor occurs in the presence of eosinophil hematopoietins. Analysis of the intracellular mechanisms revealed that NO disrupts Fas receptor–mediated signaling events at the level of, or proximal to, Jun kinase (JNK), but distal to sphingomyelinase (SMase) activation and ceramide generation. In addition, activation of SMase occurs downstream of an interleukin 1 converting enzyme–like (ICE-like) protease(s) that is not blocked by NO. However, NO prevents activation of a protease that targets lamin B1. These findings suggest a role for an additional NO-sensitive apoptotic signaling pathway that amplifies the proteolytic cascade initialized by activation of the Fas receptor. Therefore, NO concentrations within allergic inflammatory sites may be important in determining whether an eosinophil survives or undergoes apoptosis upon Fas ligand stimulation. PMID:9449721

  16. Eosinophilic esophagitis: manometric and pHmetric findings

    Directory of Open Access Journals (Sweden)

    Monica Maria Cardoso Monnerat


    Full Text Available CONTEXT: Eosinophilic esophagitis is an entity characterized by an esophageal inflammatory infiltrate of eosinophils, manifested by dysphagia, intermittent food impactions and symptoms similar to gastroesophageal reflux disease (GERD, that predominantly affects young adults. There may be association of eosinophilic esophagitis with GERD, and motor abnormalities have been described. OBJECTIVE: The main objectives of this study are to describe the findings at esophageal manometry and pH monitoring in patients with eosinophilic esophagitis. METHODS: Cross-sectional study of 20 patients with a diagnosis of eosinophilic esophagitis, submitted to esophageal manometry and 24h pH monitoring. Were analysed the manometric changes and the presence of abnormal reflux on pH monitoring. RESULTS: Twenty patients (15 men, 5 women had a mean age of 29 years. Motility disorders were found in 25% (5/20 patients with ineffective esophageal motility being the most common finding. pH monitoring revealed abnormal reflux on 25%, without any relationship with manometric findings. CONCLUSIONS: Manometric abnormalities were observed in 25% of patients and abnormal reflux on pH monitoring also in 25%. This study showed no relationship between abnormal reflux and the presence of manometric changes.

  17. Lung VITAL: Rationale, design, and baseline characteristics of an ancillary study evaluating the effects of vitamin D and/or marine omega-3 fatty acid supplements on acute exacerbations of chronic respiratory disease, asthma control, pneumonia and lung function in adults. (United States)

    Gold, Diane R; Litonjua, Augusto A; Carey, Vincent J; Manson, JoAnn E; Buring, Julie E; Lee, I-Min; Gordon, David; Walter, Joseph; Friedenberg, Georgina; Hankinson, John L; Copeland, Trisha; Luttmann-Gibson, Heike


    Laboratory and observational research studies suggest that vitamin D and marine omega-3 fatty acids may reduce risk for pneumonia, acute exacerbations of respiratory diseases including chronic obstructive lung disease (COPD) or asthma, and decline of lung function, but prevention trials with adequate dosing, adequate power, and adequate time to follow-up are lacking. The ongoing Lung VITAL study is taking advantage of a large clinical trial-the VITamin D and OmegA-3 TriaL (VITAL)--to conduct the first major evaluation of the influences of vitamin D and marine omega-3 fatty acid supplementation on pneumonia risk, respiratory exacerbation episodes, asthma control and lung function in adults. VITAL is a 5-year U.S.-wide randomized, double-blind, placebo-controlled, 2 × 2 factorial trial of supplementation with vitamin D3 ([cholecalciferol], 2000 IU/day) and marine omega-3 FA (Omacor® fish oil, eicosapentaenoic acid [EPA]+docosahexaenoic acid [DHA], 1g/day) for primary prevention of CVD and cancer among men and women, at baseline aged ≥50 and ≥55, respectively, with 5107 African Americans. In a subset of 1973 participants from 11 urban U.S. centers, lung function is measured before and two years after randomization. Yearly follow-up questionnaires assess incident pneumonia in the entire randomized population, and exacerbations of respiratory disease, asthma control and dyspnea in a subpopulation of 4314 randomized participants enriched, as shown in presentation of baseline characteristics, for respiratory disease, respiratory symptoms, and history of cigarette smoking. Self-reported pneumonia hospitalization will be confirmed by medical record review, and exacerbations will be confirmed by Center for Medicare and Medicaid Services data review.

  18. Helminth infections predispose mice to pneumococcal pneumonia but not to other pneumonic pathogens. (United States)

    Apiwattanakul, Nopporn; Thomas, Paul G; Kuhn, Raymond E; Herbert, De'Broski R; McCullers, Jonathan A


    Pneumonia is the leading killer of children worldwide. Here, we report that helminth-infected mice develop fatal pneumonia when challenged with Streptococcus pneumoniae. Mice were chronically infected with either the flatworm Taenia crassiceps or the roundworm Heligmosomoides polygyrus. Upon challenge with a pneumonic type 3 strain of S. pneumoniae (A66.1), the worm-infected mice developed pneumonia at a rate and to a degree higher than age-matched control mice as measured by bioluminescent imaging and lung titers. This predisposition to pneumonia appears to be specific to S. pneumoniae, as worm-infected mice did not show evidence of increased morbidity when challenged with a lethal dose of influenza virus or sublethal doses of Staphylococcus aureus or Listeria monocytogenes. The defect was also present when worm-infected mice were challenged with a type 2 sepsis-causing strain (D39); an increased rate of pneumonia, decreased survival, and increased lung and blood titers were found. Pneumococcal colonization and immunity against acute otitis media were unaffected. Anti-helminthic treatment in the H. polygyrus model reversed this susceptibility. We conclude that helminth coinfection predisposes mice to fatal pneumococcal pneumonia by promoting increased outgrowth of bacteria in the lungs and blood. These data have broad implications for the prevention and treatment for pneumonia in the developing world, where helminth infections are endemic and pneumococcal pneumonia is common.

  19. Pneumonia (For Parents) (United States)

    ... Development Infections Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & ... to dehydration in extreme cases, bluish or gray color of the lips and fingernails If the pneumonia ...

  20. Hospital-acquired pneumonia (United States)

    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  1. Unusual presentations of eosinophilic gastroenteritis: Case series and review of literature

    Institute of Scientific and Technical Information of China (English)

    Rafiq A Sheikh; Thomas P Prindiville; R Erick Pecha; Boris H Ruebner


    Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.

  2. Biochemical characterization of reactive nitrogen species by eosinophil peroxidase in tyrosine nitration

    Directory of Open Access Journals (Sweden)



    Full Text Available It is well known that eosinophils are involved in tyrosine nitration. In this study, we evaluated tyrosine nitration by rat eosinophils isolated from peritoneal fl uid and constituent eosinophils in the stomach. Rat peritoneal eosinophils activated with 1 μM phorbol myristate acetate (PMA and 50 μM NO2 ン showed immunostaining for nitrotyrosine only in smaller cells, despite the fact that eosinophils are capable of producing superoxide (O2·ン. Free tyrosine nitrating capacity after incubation with PMA and NO2 ン was 4-fold higher in eosinophils than in neutrophils. Catalase and ク- and コ -tocopherol inhibited free tyrosine nitration by reactive nitrogen species from eosinophils but not that by peroxynitrite. Superoxide dismutase augmented free tyrosine nitration by activated eosinophils and peroxynitrite. The concentration of nitric oxide released from eosinophils was relatively low (0.32 μM/106 cells/h and did not contribute to the formation of nitrotyrosine. On the other hand, most constituent eosinophils constituent in the rat stomach stimulated by PMA and NO2 ン showed tyrosine nitration capacity. These results suggest that intact cells other than apoptotic-like eosinophils eluted in the intraperitoneal cavity could not generate reactive species responsible for nitration by a peroxidase-dependent mechanism. In contrast, normal eosinophils in the stomach were capable of nitration, suggesting that the characteristics of eosinophils in gastric mucosa are diff erent from those eluted in the peritoneal cavity.

  3. Outbreak of Group A Streptococcal Pneumonia among Marine Corps Recruits - California, November 1-December 20, 2002 (United States)


    military train- ing facility since the 1987 outbreak of rheumatic fever (1) and the largest outbreak of GAS pneumonia in the United States since 1968 (2...outbreaks of GAS pharyngitis, acute rheumatic fever , and pneumonia (3). This outbreak involved the circulation of a single GAS serotype and probably...Infectious Diseases, CDC. References 1. Wallace MR, Garst PD, Papadimos TJ, Oldfield EC III. The return of acute rheumatic fever in young adults. JAMA

  4. Chronic pneumonia due to Klebsiella oxytoca mimicking pulmonary tuberculosis. (United States)

    Gera, Kamal; Roshan, Rahul; Varma-Basil, Mandira; Shah, Ashok


    Klebsiella species infrequently cause acute community acquired pneumonia (CAP). The chronic form of the disease caused by K. pneumoniae (Friedlander's bacillus) was occasionally seen in the pre-antibiotic era. K. oxytoca is a singularly uncommon cause of CAP. The chronic form of the disease caused by K. oxytoca has been documented only once before. A 50-year-old immunocompetent male smoker presented with haemoptysis for 12 months. Imaging demonstrated a cavitary lesion in the right upper lobe with emphysematous changes. Sputum stains and cultures for Mycobacterium tuberculosis were negative. However, three sputum samples for aerobic culture as well as bronchial aspirate cultured pure growth of K. oxytoca. A diagnosis of chronic pneumonia due to K. oxytoca was established and with appropriate therapy, the patient was largely asymptomatic. The remarkable clinical and radiological similarity to pulmonary tuberculosis can result in patients with chronic Klebsiella pneumonia erroneously receiving anti-tuberculous therapy.

  5. Case Report of Necrotizing Fasciitis Associated with Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    Lei Jiao


    Full Text Available Necrotizing fasciitis, caused by Streptococcus pneumoniae, is an extremely rare and life-threatening bacterial soft tissue infection. We report a case of early necrotizing fasciitis associated with Streptococcus pneumoniae infection in a 26-year-old man who was immunocompromised with mixed connective tissue disease. The patient presented with acute, painful, erythematous, and edematous skin lesions of his right lower back, which rapidly progressed to the right knee. The patient underwent surgical exploration, and a diagnosis of necrotizing fasciitis was confirmed by pathological evidence of necrosis of the fascia and neutrophil infiltration in tissue biopsies. Cultures of fascial tissue biopsies and blood samples were positive for Streptococcus pneumoniae. To our knowledge, this is the first report of necrotizing fasciitis resulting from Streptococcus pneumoniae diagnosed at early phase; the patient recovered well without surgical debridement.

  6. Hemorrhagic pneumonia in mink caused by Pseudomonas aeruginosa

    DEFF Research Database (Denmark)

    Salomonsen, Charlotte Mark

    Hemorrhagic pneumonia in mink is an acute and fatal disease caused by Pseudomonas aeruginosa. The mink are typically found dead without prior clinical symptoms. The disease can be highly contagious and varying mortalities on the farm level has been reported. Hemorrhagic pneumonia in mink...... in hemorrhagic pneumonia caused by P. aeruginosa and E. coli in diagnostic material. The distribution of the two pathogens is visualized using fluorescence in situ hybridization (FISH). Two histological patterns were observed in the work presented in Article II; one was very hemorrhagic with few bacteria while...... is seasonal with outbreaks almost exclusively occurring from September to November in Denmark. In human medicine, P. aeruginosa is regarded as a pathogen for immune compromised individuals but no underlying disease or immune defect has been identified in mink dying of hemorrhagic pneumonia. In fact, little...

  7. Clarithromycin-induced acute interstitial nephritis and minimal change disease


    Russell, Wendy; Smith, William


    Drug associated acute interstitial nephritis and minimal change disease has been well documented but the simultaneous presentation of both is rare and has not been reported with clarithromycin. We describe a case of simultaneous acute tubulointerstitial nephritis and minimal change disease induced by clarithromycin. The patient had acute kidney injury, nephrotic syndrome, eosinophilic pneumonitis and a maculopapular skin rash. The role of steroid therapy in acute interstitial nephritis is con...


    Directory of Open Access Journals (Sweden)

    Osama Mohammed Saed Abdul-Wahab


    Full Text Available Mycoplasma pneumoniae is one of four most common species of organisms that are responsible for most clinically significant infections in humans. It is a frequent cause of acute respiratory infections in both children and adults. The organism can cause pharyngitis, otitis, tracheobronchitis, or community-acquired pneumonia, but patients may also remain totally asymptomatic. Aim of this prospective study for children, was to investigate the association of M. pneumoniae with respiratory tract infections in a Saudi population. This study was designed as a case-control study in which 90 patients (Mean age of the patients in case group was 5.94±2.73 and in control group was 6.51±2.26 of either sexes were included. These patients were classified into two groups: first group (case group, included 45 patients who had been admitted in hospital with diagnosis of respiratory tract infections and the second group (control group, included 45 healthy patients who had no history of respiratory tract infections. Both the groups were age and sex matched. Presence of IgM antibodies to Mycoplasma pneumoniae was assessed by ELISA technique in both groups. In the case group, 4 (9% cases out of 45 children were positive for anti-mycoplasma antibody whereas in the control group, all children were negative. All positive case group patients had symptoms of acute pneumonia. 18 (40% of the patients were diagnosed with bronchial asthma (40% inclusive of all the four cases diagnosed with Mycoplasma pneumoniae infection. The relative risk for the occurrence of mycoplasma infection was estimated to be 9 (95%C.I = 0.49-162.43. However, on comparing the case and control groups, the result was not found to be statistically significant. (Fischer Exact Test p = 0.0583. Children in Saudi Arabia are at a relatively higher risk of developing Mycoplasma pneumoniae infection especially those predisposed with underlying chronic respiratory illnesses such as asthma. This is a first

  9. Early Mycoplasma pneumoniae infection presenting as multiple pulmonary masses: an unusual presentation in a child

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Edward; Altes, Talissa; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)


    Mycoplasma pneumoniae is a major cause of community-acquired pneumonia. Because most children are not imaged prior to onset of clinical symptoms, the appearance of early Mycoplasma infection has not been extensively studied. We present the case of an 11-year-old boy with large pulmonary masses incidentally detected during spine MRI evaluation for scoliosis. Eight days later, the patient developed acute respiratory symptoms, and the masses seen previously had evolved into a diffuse bronchiolitis. Diagnostic testing identified Mycoplasma pneumoniae as the likely etiology. We briefly review chest CT findings of infection by Mycoplasma and compare them to this unusual presentation of Mycoplasma pneumonia with subclinical imaging findings. (orig.)

  10. Eosinophilic Gastroenteritis Presenting as Intestinal Obstruction - A Case Series

    Directory of Open Access Journals (Sweden)

    Amita Krishnappa


    Full Text Available Eosinophilic Gastroenteritis is a rare disease characterized by infiltration of the gastrointestinal tract by an increased number of eosinophils as compared to the normal. The anatomic location and intensity of the infiltrate decides the varied clinical symptomatology with which these patients present. The present report deals with four cases, all presenting with clinical signs of intestinal obstruction A laparotomy performed revealed a stricture in the first case, superficial ulcers and adhesions in the second case, an ileocaecal mass in the third case and volvulus formation in the fourth case. Eosinophilic gastroenteritis was confirmed on histopathology in all the four cases. All the four patients experienced relief of symptoms after resection. It is essential to diagnose the disease to differentiate it from other conditions presenting as intestinal obstruction. The cases are presented because of the rarity of occurrence and presentation. Relevant literature has been reviewed.

  11. Eosinophilic granuloma of bone in children; Le granulome eosinophile des os chez l`enfant

    Energy Technology Data Exchange (ETDEWEB)

    Leblan, I.; Gaucher, H.; Hoeffel, J.C.; Arnould, V.; Galloy, M.A.; Mainard, L. [Hopital d`Enfants, 54 - Vandoeuvre-les-Nancy (France)


    Eosinophilic granuloma of bone or Langerhans cell histiocytosis is mostly unifocal. It appears on plain X Ray as a solitary destructive lesion of long bones or flat bones. Computerized tomography (CT) is useful to define the extension to the cortical bone and also to precisely localize the lesion when the anatomy is complex (hip, spine, base of the skull). Magnetic resonance (MR) is very useful in case of more aggressive lesions when there is extension to soft tissues. Differential diagnosis includes circumscribed osteitis and tumors in the case of extensive destruction. The natural course of solitary lesions is favorable, spontaneously or with therapy. The prognosis is more serious in the case of multiple lesions. (authors).

  12. No prognostic significance of chronic infection with Chlamydia pneumoniae in acute coronary syndromes: insights from the Global Utilization of Strategies to Open Occluded Arteries IV Acute Coronary Syndromes trial

    DEFF Research Database (Denmark)

    Westerhout, Cynthia M; Gnarpe, Judy; Chang, Wei-Ching


    was used to quantify the prognostic relevance seropositivity (IgG > or = 1:32; IgA > or = 1:16) and elevated titer levels. RESULTS: The prevalence of Cpn IgG and IgA was similar between cases and controls (30-day death/MI: IgG, 80% vs 85%, P = .126; IgA, 45% vs 37%, P = .079), and were not statistically...... significant predictors of 30-day death/MI after baseline adjustment. Likewise, the 1-year death cohort had comparable proportions of Cpn IgG and IgA among cases and controls (86% vs 91% [P = .265] and 49% vs 43% [P = .334], respectively), and did not add prognostic value. CONCLUSIONS: These findings...... case-control substudy of the Global Utilization of Strategies to Open Occluded Arteries IV Acute Coronary Syndromes trial, 295 cases (30-day death/myocardial infarction [MI]) were matched by age, sex, baseline creatine kinase-myocardial kinase, and smoking status with 295 control subjects. To test...

  13. Clinicopathological and ultrasonographic features of cats with eosinophilic enteritis. (United States)

    Tucker, Samuel; Penninck, Dominique G; Keating, John H; Webster, Cynthia R L


    Eosinophilic enteritis (EE) in cats is poorly characterized. The aim of the current study was to retrospectively evaluate the clinical and ultrasonographic findings in cats with histologic evidence of eosinophilic inflammation on gastrointestinal biopsy. Twenty-five cats with tissue eosinophilia on surgical (10) or endoscopic (15) biopsy of the gastrointestinal tract, having an abdominal ultrasound performed within 48 h of biopsy acquisition, were enrolled. History, clinical presentation, clinical pathology and abdominal ultrasound findings were reviewed. Intestinal biopsies were evaluated by a single pathologist and separated into two groups based on the degree of eosinophilic infiltrate: mild (eosinophils/high-power field [HPF], 11/25 cats), or moderate/marked (>10 eosinophils/HPF, 14/25 cats). The former were considered primary lymphoplasmacytic or lymphocytic inflammatory bowel disease (LPE) with subtle eosinophilic infiltrates, and the latter to have EE. Signalment, history and clinical signs were similar in all cats. Only cats with EE (6/14) had palpably thickened intestines. The only distinguishing clinicopathological feature of cats with EE was the presence of peripheral eosinophilia (6/14). On ultrasound, when compared with cats with LPE, cats with EE had a greater mean jejunal wall thickness (3.34 mm ± 0.72 mm vs 4.07 mm ± 0.58 mm, respectively) and an increased incidence of thickening of the muscularis layer (1/11 and 11/14, respectively). In conclusion, ultrasonographic evidence of a prominent intestinal muscularis layer, palpably thickened intestines and peripheral eosinophilia can serve as biomarkers for the presence of EE in cats with chronic intestinal signs.

  14. Chronic eosinophilic leukemia in a cat: cytochemical and immunophenotypical features. (United States)

    Gelain, Maria Elena; Antoniazzi, Elisa; Bertazzolo, Walter; Zaccolo, Maurizia; Comazzi, Stefano


    A 3-year-old, male, domestic shorthaired cat was presented with a 3-day history of anorexia and depression. The cat was moderately dehydrated, had pale, slightly icteric, mucous membranes, oral ulcerations, and mild hepatosplenomegaly. A feline leukemia virus (FeLV) antigen test was positive. CBC results obtained at initial presentation included severe normocytic, normochromic, nonregenerative anemia, severe thrombocytopenia, and marked leukocytosis (>100,000/microL) with 77% eosinophils. After 15 days of treatment with prednisone and doxycycline, the cat had persistent severe nonregenerative anemia (HCT 3.4%), thrombocytopenia (28,000/microL), and extreme eosinophilia (total eosinophils, 123.1 x 10(3)/microL; segmented 103.0 x 10(3)/microL; immature 20.1 X 10(3)/microL). Cytologic examination of aspirates from bone marrow, liver, lymph nodes, and spleen revealed a predominance of mature and immature eosinophils, many with dysplastic changes. The M:E ratio was 96.4. On histopathologic examination, multiple organs were infiltrated by eosinophilic granulocytes. Neoplastic cells in blood and bone marrow stained positive for alkaline phosphatase and were negative for myeloperoxidase, chloroacetate esterase, and alpha-naphthyl acetate esterase. On flow cytometric analysis of peripheral blood, the neoplastic cells were positive for CD11b and CD14. These findings were consistent with chronic eosinophilic leukemia. To our knowledge, this is the first report of chronic eosinophilic leukemia in a cat associated with naturally acquired FeLV infection, in which flow cytometry was used to characterize the neoplastic cells.

  15. Sequence variants affecting eosinophil numbers associate with asthma and myocardial infarction

    DEFF Research Database (Denmark)

    Gudbjartsson, Daniel F; Bjornsdottir, Unnur S; Halapi, Eva


    Eosinophils are pleiotropic multifunctional leukocytes involved in initiation and propagation of inflammatory responses and thus have important roles in the pathogenesis of inflammatory diseases. Here we describe a genome-wide association scan for sequence variants affecting eosinophil counts in ...

  16. Optic Neuritis Associated with Myelodysplastic Syndrome Accompanied by Eosinophilic Crisis. (United States)

    Nagasaki, Joji; Nishimoto, Mitsutaka; Nakamae, Hirohisa; Nakane, Takahiko; Koh, Hideo; Yoshimoto, Kumiko; Shiraki, Kunihiko; Hino, Masayuki


    Myelodysplastic syndrome (MDS) was diagnosed in a 64-year-old man. Three months later, he presented with right-sided visual loss. A diagnosis of optic neuritis caused by both ischemic and non-ischemic changes was established. Concurrently, prominent eosinophilia was seen in both the peripheral blood and bone marrow. A partial improvement of visual loss was obtained concomitant with a rapid decrease of the eosinophils after treatment with corticosteroids. Optic neuritis related to MDS is a rare condition and its etiology has not yet been identified. We herein report a case of optic neuritis associated with MDS and accompanied by an eosinophilic crisis.

  17. A Case Report of Eosinophilic Esophagitis Accompanying Hypereosinophilic Syndrome

    Directory of Open Access Journals (Sweden)

    Mahreema Jawairia


    Full Text Available Hypereosinophilic syndrome is a blood disorder characterized by the overproduction of eosinophils in the bone marrow with persistent peripheral eosinophilia, associated with organ damage by the release of eosinophilic mediators. Although HES can involve multiple organ systems, GI tract involvement is very rare. Few cases of HES presenting with gastritis or enteritis have been reported worldwide. To date, HES presenting with esophagus involvement has only been reported once. Here, we present a 39-year-old Hispanic female patient with history of HES presenting with complaints of dysphagia and generalized pruritus.

  18. Enterobiliary Fistula as a Complication of Eosinophilic Gastroenteritis: a Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Han Myun; Woo, Ji Young [Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of)


    Eosinophilic gastroenteritis is an uncommon disease with variable clinical features characterized by eosinophilic infiltration. Clinical manifestations range from non-specific gastrointestinal complaints such as nausea, vomiting, crampy abdominal pain, and diarrhea to specific findings such as malabsorption, protein loosing enteropathy, luminal obstruction, eosinophilic ascites and effusion. We report here on a case of eosinophilic gastroenteritis causing enterobiliary fistula which is an extremely unusual complication


    NARCIS (Netherlands)



    The effects of the inhaled corticosteroid budesonide and the oral long-acting beta-agonist bambuterol on circadian variation of blood eosinophil numbers, serum levels of eosinophil cationic protein (ECP), serum eosinophil chemotactic activity (ECA), and serum neutrophil chemotactic activity (NCA) we

  20. IL-33 activates eosinophils of visceral adipose tissue both directly and via innate lymphoid cells. (United States)

    Hashiguchi, Masaaki; Kashiwakura, Yuji; Kojima, Hidefumi; Kobayashi, Ayano; Kanno, Yumiko; Kobata, Tetsuji


    Eosinophils are multifunctional leukocytes involved in allergic reactions as well as adipose tissue regulation. IL-5 is required for eosinophil survival; however, the in vivo mechanisms of eosinophil regulation are not fully understood. A tg mouse model with il5 promoter-driven EGFP expression was established for detecting the IL-5-producing cells in vivo. Il5-egfp tg mice expressed high levels of EGFP in gonadal adipose tissue (GAT) cells. EGFP(+) cells in GAT were mainly group 2 innate lymphoid cells (ILCs). IL-33 preferentially expanded EGFP(+) cells and eosinophils in GAT in vivo. EGFP(+) ILCs were found to upregulate prg2 mRNA expression in GAT eosinophils. These results demonstrate that ILCs activate eosinophils in GAT. The blockage of IL-33Rα, on the other hand, did not impair EGFP(+) ILC numbers but did impair eosinophil numbers in vivo. GAT eosinophils expressed IL-33Rα and IL-33 expanded eosinophil numbers in CD90(+) cell-depleted mice. IL-33 was further observed to induce the expression of retnla and epx mRNA in eosinophils. These findings demonstrate that IL-33 directly activates eosinophils in GAT, and together with our other findings described above, our findings show that IL-33 has dual pathways via which it activates eosinophils in vivo: a direct activation pathway and a group 2 ILC-mediated pathway.

  1. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care

    DEFF Research Database (Denmark)

    Holm, Anette; Nexoe, Joergen; Bistrup, Lene A


    of pneumonia was low (0.23), but the vital signs, CRP, and leukocyte count had comparably low positive predictive values (0.23-0.30). CONCLUSION: Streptococcus pneumoniae was the most common bacterial pathogen. The risk of hospitalisation was highest among patients with pneumonia or pneumococcal infection......BACKGROUND: Knowledge of predominant pathogens and their association with outcome are of importance for the management of lower respiratory tract infection (LRTI). As antibiotic therapy is indicated in pneumonia and not in acute bronchitis, a predictor of pneumonia is needed. AIM: To describe...... the aetiology and outcome of LRTI in adults with pneumonic and adults with non-pneumonic LRTI treated in general practice and to identify predictors of radiographic pneumonia. DESIGN OF STUDY: Prospective, observational study. SETTING: Forty-two general practices and an outpatient clinic at the Department...

  2. How Can Pneumonia Be Prevented? (United States)

    ... t last as long Fewer serious complications Pneumococcal pneumonia vaccines Two vaccines are available to prevent pneumococcal ... Vaccination Web page. Other ways to help prevent pneumonia You also can take the following steps to ...

  3. A compendium for Mycoplasma pneumoniae

    Directory of Open Access Journals (Sweden)

    Gretchen Lynn Parrott


    Full Text Available Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, walking pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction (PCR or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review.

  4. Lack of autologous tissue transmission of eosinophilic plaques in cats. (United States)

    Moriello, K A; Kunkle, G; Miller, L M; Crowley, A


    Autologous tissue transmission of spontaneously developing feline eosinophilic plaques was attempted in 5 cats. Macerated tissue from the plaque was vigorously rubbed onto 2 scarified skin sites in each cat. The inoculated areas were observed daily for 30 days. During that time, no clinical or histologic evidence of transmission was found.

  5. Characterization and antagonism of cytokine-induced eosinophil priming

    NARCIS (Netherlands)

    Rosas Rosas, Ana Marcela


    Allergic asthma is an inflammatory disease characterized by bronchial hyper-responsiveness, airway inflammation, and reversible obstruction of the airways. In humans, cytokine activated eosinophils are thought to be important players in this process since they can release inflammatory mediators afte

  6. Eosinophilic tracheobronchitis with cough hypersensitivity caused by Streptomyces albus antigen

    Directory of Open Access Journals (Sweden)

    Haruhiko Ogawa


    Full Text Available A 52-year-old woman is reported with atopic cough, in whom bronchoprovocation with Streptomyces albus antigen induced cough and bronchoscopic biopsy revealed eosinophilic tracheobronchitis. She was admitted for the diagnosis and treatment of severe non-productive cough. Although her induced sputum contained 8% eosinophils of nucleated cells and bronchoscopic biopsy specimens revealed eosinophil infiltration in both tracheal and bronchial wall, she did not have bronchial hyperresponsiveness to methacholine or heightened bronchomotor tone. Bronchodilator therapy was not effective for her coughing. Her symptoms worsened on returning home, suggesting the existence of some etiologic agents in her house. Streptomyces albus was isolated from her house. A high titer of anti-S. albus antibody was detected in her serum and the bronchoprovocation test with S. albus antigen was positive: development of coughing 15 min later and decrease in cough threshold to inhaled capsaicin 24 h later (3.9 μmol/L from 31.3 μmol/L prechallenge. This is the first report on eosinophilic tracheobronchitis with cough hypersensitivity caused by allergic reaction to S. albus antigen.

  7. Unraveling the complexity of lipid body organelles in human eosinophils. (United States)

    Melo, Rossana C N; Weller, Peter F


    Lipid-rich organelles are common in many cell types. In cells, such as adipocytes, these organelles are termed LDs, whereas in other cells, such as leukocytes, they are called LBs. The study of leukocyte LBs has attracted attention as a result of their association with human diseases. In leukocytes, such as eosinophils, LB accumulation has been documented extensively during inflammatory conditions. In these cells, LBs are linked to the regulation of immune responses by compartmentalization of several proteins and lipids involved in the control and biosynthesis of inflammatory mediators (eicosanoids). However, it has been unclear how diverse proteins, including membrane-associated enzymes involved in eicosanoid formation, incorporate into LBs, especially if the internal content of LBs is assumed to consist solely of stores of neutral lipids, as present within adipocyte LDs. Studies of the formation, function, and ultrastructure of LBs in eosinophils have been providing insights pertinent to LBs in other leukocytes. Here, we review current knowledge of the composition and function of leukocyte LBs as provided by studies of human eosinophil LBs, including recognitions of the internal architecture of eosinophil LBs based on 3D electron tomographic analyses.

  8. Eosinophils are important for protection, immunoregulation and pathology during infection with nematode microfilariae.

    Directory of Open Access Journals (Sweden)

    Emma T Cadman


    Full Text Available Eosinophil responses typify both allergic and parasitic helminth disease. In helminthic disease, the role of eosinophils can be both protective in immune responses and destructive in pathological responses. To investigate whether eosinophils are involved in both protection and pathology during filarial nematode infection, we explored the role of eosinophils and their granule proteins, eosinophil peroxidase (EPO and major basic protein-1 (MBP-1, during infection with Brugia malayi microfilariae. Using eosinophil-deficient mice (PHIL, we further clarify the role of eosinophils in clearance of microfilariae during primary, but not challenge infection in vivo. Deletion of EPO or MBP-1 alone was insufficient to abrogate parasite clearance suggesting that either these molecules are redundant or eosinophils act indirectly in parasite clearance via augmentation of other protective responses. Absence of eosinophils increased mast cell recruitment, but not other cell types, into the broncho-alveolar lavage fluid during challenge infection. In addition absence of eosinophils or EPO alone, augmented parasite-induced IgE responses, as measured by ELISA, demonstrating that eosinophils are involved in regulation of IgE. Whole body plethysmography indicated that nematode-induced changes in airway physiology were reduced in challenge infection in the absence of eosinophils and also during primary infection in the absence of EPO alone. However lack of eosinophils or MBP-1 actually increased goblet cell mucus production. We did not find any major differences in cytokine responses in the absence of eosinophils, EPO or MBP-1. These results reveal that eosinophils actively participate in regulation of IgE and goblet cell mucus production via granule secretion during nematode-induced pathology and highlight their importance both as effector cells, as damage-inducing cells and as supervisory cells that shape both innate and adaptive immunity.

  9. Combination Chemotherapy With or Without PSC 833, Peripheral Stem Cell Transplantation, and/or Interleukin-2 in Treating Patients With Acute Myeloid Leukemia (United States)


    Adult Acute Basophilic Leukemia; Adult Acute Eosinophilic Leukemia; Adult Acute Erythroid Leukemia (M6); Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monoblastic Leukemia and Acute Monocytic Leukemia (M5); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Childhood Acute Basophilic Leukemia; Childhood Acute Eosinophilic Leukemia; Childhood Acute Erythroleukemia (M6); Childhood Acute Megakaryocytic Leukemia (M7); Childhood Acute Minimally Differentiated Myeloid Leukemia (M0); Childhood Acute Monoblastic Leukemia (M5a); Childhood Acute Monoblastic Leukemia and Acute Monocytic Leukemia (M5); Childhood Acute Monocytic Leukemia (M5b); Childhood Acute Myeloblastic Leukemia With Maturation (M2); Childhood Acute Myeloblastic Leukemia Without Maturation (M1); Childhood Acute Myelomonocytic Leukemia (M4); Childhood Myelodysplastic Syndromes; de Novo Myelodysplastic Syndromes; Untreated Adult Acute Myeloid Leukemia; Untreated Childhood Acute Myeloid Leukemia and Other Myeloid Malignancies

  10. Eosinophilic esophagitis in Saudi children: Symptoms, histology and endoscopy results

    Directory of Open Access Journals (Sweden)

    Mohammed Y Hasosah


    Full Text Available Background/Aim: Eosinophilic esophagitis (EE is a clinicopathologic entity characterized by esophageal symptoms in association with a dense eosinophilic infiltrate currently defined as >15 eosinophils per high power field in the appropriate clinical context. This is the first pediatric study in Saudi Arabia to give the experience with EE and examine its symptom, histology and endoscopy results. Materials and Methods: Retrospective chart review of all patients diagnosed with EE at National Guard Hospital, Jeddah Between 2007 and 2009. The authors identified EE on histologic criteria (≥15 eosinophils per high-power field together with their clinical context. The authors reviewed medical records for details of clinical presentation, laboratory data, radiologic, endoscopic, and histologic findings, and the results of treatment. Results: We identified 15 patients in our database in the last three years. 100% of the patients were males. The median age at presentation was 10 years (range, 3-17 years. The commonly reported symptoms were failure to thrive (86%, epigastric abdominal pain (53%, poor eating (40%, dysphagia with solid food (26%, food impaction (13%, and vomiting (20%. Asthma was reported in 46% and allergic rhinitis in 40%. Peripheral eosinophilia (>0.7 Χ 10/l was found in 66%. High serum IgE Level (>60 IU/ml was found in 60%. Upper endoscopic analysis revealed esophageal trachealization in 46%, esophageal erythema in 46%, white specks on the esophageal mucosa in 33%, esophageal narrowing in 13%, and normal endoscopy in 13%. The mean eosinophils per high-power field was 30.4 (range, 20-71. Histologic characteristics included degranulated eosinophils (86%, basal cell hyperplasia (93% and eosinophils clusters (micro-abscess in 73%. The treatment of EE revealed that they used swallowed corticosteroid in 50%, proton pump inhibitors in 66%, elemental diet/ food elimination in 13% and systemic corticosteroid in 13%. Conclusions: Failure to

  11. The role of the prostaglandin D2 receptor, DP, in eosinophil trafficking

    DEFF Research Database (Denmark)

    Schratl, Petra; Royer, Julia F; Kostenis, Evi


    of DP has remained unclear. We report in this study that, in addition to CRTH2, the DP receptor plays an important role in eosinophil trafficking. First, we investigated the release of eosinophils from bone marrow using the in situ perfused guinea pig hind limb preparation. PGD2 induced the rapid...... that eosinophils in human bone marrow specimens expressed DP and CRTH2 receptors at similar levels. Eosinophils isolated from human peripheral blood likewise expressed DP receptor protein but at lower levels than CRTH2. In agreement with this, the chemotaxis of human peripheral blood eosinophils was inhibited both...

  12. IgE, mast cells, and eosinophils in atopic dermatitis. (United States)

    Liu, Fu-Tong; Goodarzi, Heidi; Chen, Huan-Yuan


    Atopic dermatitis (AD) is a chronic inflammatory skin disease with specific immune and inflammatory mechanisms. Atopy is among the major features of the diagnosis criteria for AD but is not an essential feature. Thus, patients diagnosed with AD can be atopic or non-atopic. This review focuses on the role of IgE, mast cells, and eosinophils in the pathogenesis of AD. The known functions of IgE in allergic inflammation suggest that IgE and IgE-mediated mast cell and eosinophil activation contribute to AD, but direct evidence supporting this is scarce. The level of IgE (thus the degree of allergic sensitization) is associated with severity of AD and contributed by abnormality of skin barrier, a key feature of AD. The function of IgE in development of AD is supported by the beneficial effect of anti-IgE therapy in a number of clinical studies. The role of mast cells in AD is suggested by the increase in the mast cell number and mast cell activation in AD lesions and the association between mast cell activation and AD. It is further suggested by their role in mouse models of AD as well as by the effect of therapeutic agents for AD that can affect mast cells. The role of eosinophils in AD is suggested by the presence of eosinophilia in AD patients and eosinophil infiltrates in AD lesions. It is further supported by information that links AD to cytokines and chemokines associated with production, recruitment, and activation of eosinophils.

  13. Bacteremia with Streptococcus pneumoniae

    DEFF Research Database (Denmark)

    Christensen, J S; Jensen, T G; Kolmos, H J


    We conducted a hospital-based cohort study among adult patients with first-time Streptococcus pneumoniae bacteremia (SPB) from 2000 through 2008. Patients were identified in a population-based bacteremia database and followed up for mortality through the Danish Civil Registration System (CRS...... age of the patients was 65 years. The focal diagnosis of the SPB was pneumonia in 381 (79 %) patients, followed in frequency by meningitis in 33 (7 %) patients. Of the 481 patients, 390 (81 %) had community-acquired SPB. Of these, 23 (6 %) did not have sepsis, 132 (34 %) had sepsis, 224 (57 %) had...

  14. Lung ultrasound for diagnosis of pneumonia in emergency department. (United States)

    Pagano, Antonio; Numis, Fabio Giuliano; Visone, Giuseppe; Pirozzi, Concetta; Masarone, Mario; Olibet, Marinella; Nasti, Rodolfo; Schiraldi, Fernando; Paladino, Fiorella


    Lung ultrasound (LUS) in the emergency department (ED) has shown a significant role in the diagnostic workup of pulmonary edema, pneumothorax and pleural effusions. The aim of this study is to assess the reliability of LUS for the diagnosis of acute pneumonia compared to chest X-ray (CXR) study. The study was conducted from September 2013 to March 2015. 107 patients were admitted to the ED with a clinical appearance of pneumonia. All the patients underwent a CXR study, read by a radiologist, and an LUS, performed by a trained ED physician on duty. Among the 105 patients, 68 were given a final diagnosis of pneumonia. We found a sensitivity of 0.985 and a specificity of 0.649 for LUS, and a sensitivity of 0.735 and specificity of 0.595 for CXR. The positive predictive value for LUS was 0.838 against 0.7 for CXR. The negative predictive value of LUS was 0.960 versus 0.550 for CXR. This study has shown sensitivity, positive predictive value and negative predictive value of LUS compared to the CXR study for the diagnosis of acute pneumonia. These results suggest the use of bedside thoracic US first-line diagnostic tool in patients with suspected pneumonia.

  15. Epidemiological and clinical analysis of Mycoplasma pneumoniae infection in children with acute respiratory tract infection%呼吸道感染患儿肺炎支原体感染流行特点和临床分析

    Institute of Scientific and Technical Information of China (English)

    许蔓春; 马恒颢; 欧巧群; 罗爱武; 任广立; 王鲜艳; 荆丽娟


    Objective To summarize the epidemiology and clinical characteristics of Mycoplasma pneumoniae (MP) infection in children with acute respiratory tract infection (ARI) in Guangzhou. Methods MP was detected using an indirect immunofluorescent method in 2084 children with ARI. The relations between MP infection rate and the gender, age, season, site of infection and wheezing diseases were analyzed. Results A total of 433 children (20.8%) were positive for MP, including 222 boys (19.8%) and 211 girls (21.9%) without significant difference in the infection rate between the genders (P>0.05). In 0-to 3-year-old group, 106 children were positive for MP (15.0%), while in 3-to 5-year-old group and 5-to 14-year-old group, 163 (25.2%) and 164 (22.5%) were positive, respectively, showing a significant difference in the infection rate between the 3 groups (P0.05). Among the children with LRI, those having wheezing disease had significantly higher MP positivity rate than those without wheezing. Conclusion MP is a common causative agent for ARI in children. MP infection is not related to gender and infection site, but to age and season. Children over 3 years old are vulnerable to MP infection. MP infection can be associated with wheezing in LRI.%目的 探讨小儿呼吸道感染者肺炎支原体(MP)感染的流行特点和临床情况.方法 回顾性分析我院2004~2008年呼吸道感染住院患儿2084例,采用间接免疫荧光法检测MP,分析MP感染率与性别、年龄、季节、部位及与喘息性疾病的关系.结果 2084例呼吸道感染患儿中MP阳性患儿433例(20.8%),其中男性222例(19.8%),女性211例(21.9%),男性与女性MP发病率无统计学差异(P>0.05).不同年龄组MP发病率分别为:小于3岁组106例(15.0%),3~5岁组163例(25.2%),5~14岁组164例(22.5%),三组之间MP感染率差异有统计学意义(P<0.05).不同季节MP感染率分别为:1~3月:18.0%,4-6月:25.1%,7~9月:17.7%,10~12月:20.5%,不同季节之间MP感染率

  16. Curcumin alleviates eosinophilic meningitis through reduction of eosinophil count following albendazole treatment against Angiostrongylus cantonensis in mice. (United States)

    Shyu, Ling-Yuh; Chang, Han-Hsin; Hsu, Jeng-Dong; Lin, David Pei-Cheng; Teng, Ying-Hock; Lee, Hsiu-Hsiung


    Angiostrongylus cantonensis (A. cantonensis) is the most common cause of parasitic eosinophilic meningitis worldwide. By using an animal model of BALB/c mice infected with A. cantonensis, previous studies indicated that the anthelmintic drug, albendazole, could kill A. cantonensis larvae and prevent further infection. However, the dead larvae will induce severe immune responses targeting at brain tissues. To alleviate the detrimental effects caused by the dead larvae, we administered curcumin, a traditional anti-inflammatory agent, as a complementary treatment in addition to albendazole therapy, to determine whether curcumin could be beneficial for treatment. The results showed that although curcumin treatment alone did not reduce worm number, combined treatment by albendazole and curcumin helped to reduce eosinophil count in the cerebrospinal fluid, better than using albendazole alone. This alleviating effect did not affect albendazole treatment alone, since histological analysis showed similar worm eradication with or without addition of curcumin. Nevertheless, curcumin treatment alone and combined albendazole-curcumin treatment did not inhibit MMP-9 expression in the brain tissue. In conclusion, curcumin, when used as a complementary treatment to albendazole, could help to alleviate eosinophilic meningitis through suppression of eosinophil count in the cerebrospinal fluid.

  17. [National consensus for management of community acquired pneumonia in adults]. (United States)

    Saldías P, Fernando; Pérez C, Carlos


    Community acquired pneumonia (CAP) is an acute respiratory infection that affects pulmonary parenchyma, and is caused by community acquired microorganisms. In Chile, pneumonia represents the main cause of death due to infectious diseases and is the third specific cause of mortality in adults. In 1999, an experts committee in representation of "Sociedad Chilena de Enfermedades Respiratorias", presented the first National Guidelines for the Treatment of Adult Community Acquired Pneumonia, mainly based in foreign experience and documents, and adapted it to our National Health System Organization. During the last decade, impressive epidemiological and technological changes have occurred, making the update of guidelines for treatment of NAC by several international scientific societies, necessary. These changes include: new respiratory pathogens that are being identified in CAP and affect adult patients (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila); the increasing senescent adult population that carries multiple co-morbidities; the emergence of antimicrobial resistance among respiratory pathogens associated to massive antibiotic prescription; the development by the pharmaceutical industry of new drugs that are effective for pneumonia treatment (macrolides, ketolides and respiratory fluorquinolones); and the development of new diagnostic techniques for detection of antigens, antibodies, and bacterial DNA by molecular biology, useful in respiratory infections. Based on these antecedents, an Advisory Committee of "Sociedad Chilena de Enfermedades Respiratorias" and "Sociedad Chilena de Infectología" has reviewed the national and international evidence about CAP management in adults in order to update clinical recommendations for our country.

  18. Eosinophil peroxidase signals via epidermal growth factor-2 to induce cell proliferation.

    LENUS (Irish Health Repository)

    Walsh, Marie-Therese


    Eosinophils exert many of their inflammatory effects in allergic disorders through the degranulation and release of intracellular mediators, including a set of cationic granule proteins that include eosinophil peroxidase. Studies suggest that eosinophils are involved in remodeling. In previous studies, we showed that eosinophil granule proteins activate mitogen-activated protein kinase signaling. In this study, we investigated the receptor mediating eosinophil peroxidase-induced signaling and downstream effects. Human cholinergic neuroblastoma IMR32 and murine melanoma B16.F10 cultures, real-time polymerase chain reaction, immunoprecipitations, and Western blotting were used in the study. We showed that eosinophil peroxidase caused a sustained increase in both the expression of epidermal growth factor-2 (HER2) and its phosphorylation at tyrosine 1248, with the consequent activation of extracellular-regulated kinase 1\\/2. This, in turn, promoted a focal adhesion kinase-dependent egress of the cyclin-dependent kinase inhibitor p27(kip) from the nucleus to the cytoplasm. Eosinophil peroxidase induced a HER2-dependent up-regulation of cell proliferation, indicated by an up-regulation of the nuclear proliferation marker Ki67. This study identifies HER2 as a novel mediator of eosinophil peroxidase signaling. The results show that eosinophil peroxidase, at noncytotoxic levels, can drive cell-cycle progression and proliferation, and contribute to tissue remodeling and cell turnover in airway disease. Because eosinophils are a feature of many cancers, these findings also suggest a role for eosinophils in tumorigenesis.

  19. 酚妥拉明联合毛花苷丙治疗小儿肺炎合并急性心功能不全的疗效%Phentolamine and allocor in the treatment of infantile pneumonia complicated with acute heart failure

    Institute of Scientific and Technical Information of China (English)



    Objective:To investigate the effect of phentolamine combined with allocor in the treatment of infantile pneumonia complicated with acute heart failure.Methods:68 children with pneumonia complicated with acute heart failure were selected.They were randomly divided into the treatment group and the control group with 34 cases in each.Patients in the treatment group were given phentolamine combined with allocor,while patients in the control group were treated with allocor.Results:The total effect of the treatment group was better than that of the control group.The time of correcting heart failure of the treatment group was shorter than that of the control group.The differences were statistically significant(P<0.05).Conclusion:Phentolamine combined with allocor in the treatment of infantile pneumonia complicated with acute heart failure can shorten the time of correcting heart failure, and it also can improve the cure rate.%目的:探讨酚妥拉明联合毛花苷丙对小儿肺炎合并急性心功能不全的治疗作用。方法:收治小儿肺炎合并急性心功能不全患儿68例,随机分为治疗组和对照组,各34例,治疗组给予酚妥拉明联合毛花苷丙治疗,对照组给予毛花苷丙治疗。结果:治疗组总有效率优于对照组,治疗组心衰纠正时间短于对照组,差异均有统计学意义(P<0.05)。结论:酚妥拉明联合毛花苷丙治疗小儿肺炎合并急性心功能不全可缩短心衰的纠正时间,提高治愈率。

  20. Comparison of effects of alcaftadine and olopatadine on conjunctival epithelium and eosinophil recruitment in a murine model of allergic conjunctivitis

    Directory of Open Access Journals (Sweden)

    Santa J Ono


    Full Text Available Santa J Ono1, Keith Lane21Emory University School of Medicine and Emory Eye Center, Dobbs Ocular Immunology Laboratories, Atlanta, GA, USA; 2Ora Inc., 300 Brickstone Square, Andover, MA, USABackground: Antihistamines constitute the first line of therapy for allergic conjunctivitis, and are safe and effective in relieving the signs and symptoms of ocular allergy. Despite this, they are less effective than some other drugs in relieving delayed symptoms of allergic conjunctivitis. Recent evidence suggests that changes in the conjunctival epithelium may underlie aspects of delayed reactions. In this study we compared two antihistamines, olopatadine and alcaftadine, for their ability to modify epithelial cell changes associated with allergic conjunctivitis at time points selected to reflect late-phase reactions.Methods: Studies employed a modified conjunctival allergen challenge model. Sensitized mice were challenged with topical allergen with or without drug treatments. Treatment groups were assayed for acute-phase (15 minutes and delayed-phase (24 hours responses. Groups were scored for allergy symptoms (redness, itch, tearing, and edema and for conjunctival mast cell numbers. Delayed-phase groups were also examined for eosinophil numbers and for tight junctional protein expression.Results: Olopatadine-treated and alcaftadine-treated animals had similar efficacy profiles and mast cell numbers, suggesting both were effective at ameliorating symptoms of the acute phase. In contrast, alcaftadine-treated animals had significantly lower conjunctival eosinophil infiltration than either controls or olopatadine-treated animals. Allergen challenge caused a significant decrease in expression of the junctional protein, ZO-1, and this decrease was prevented by alcaftadine but not by olopatadine.Conclusion: Alcaftadine displays therapeutic properties beyond its antihistamine action. These include an ability to reduce conjunctival eosinophil recruitment, and a

  1. Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP. (United States)

    Kokosi, Maria A; Nicholson, Andrew G; Hansell, David M; Wells, Athol U


    In the 2013 reclassification of the idiopathic interstitial pneumonias (IIPs), two rare IIPs (idiopathic lymphoid interstitial pneumonia (LIP), idiopathic pleuroparenchymal fibroelastosis (IPPFE)) and two rare histologic patterns (acute fibrinous and organizing pneumonia (AFOP), bronchiolocentric pattern of interstitial pneumonia (BPIP)) are described. All these entities are rare with small series published to date, mostly containing primary and secondary forms of disease. LIP is histologically characterized by diffuse polyclonal lymphoid cell infiltrate surrounding the airways and expanding the interstitium. Thin-walled cysts and diffuse ground glass are considered the typical radiologic features. The clinical course is highly variable with corticosteroid responsiveness evident in approximately half of cases. IPPFE is defined histologically by coexisting upper lobe pleural and intra-alveolar fibrosis with elastosis. Dense subpleural irregular fibrosis and consolidation are the cardinal radiologic features. A history of recurrent lower respiratory tract infection is frequent. Responses to immunomodulation have not been reported and the rate of progression appears to be highly variable. AFOP is a rare histologic pattern lying within the spectrum of acute/subacute lung injury, characterized by organizing pneumonia and intra-alveolar fibrin deposition without hyaline membranes. BPIP is characterized histologically by fibrosis and/or inflammation confined to the alveolar interstitium around bronchovascular bundles, overlapping with peribronchial metaplasia and fibrosis in some series. Currently, AFOP and BPIP are both best viewed as histological entities rather than true clinical disorders, in the absence of characteristic associated imaging patterns and clinical features.

  2. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

    Energy Technology Data Exchange (ETDEWEB)

    Cilloniz, Catia; Torres, Antoni [Servicio de Neumologia, Hospital Clinic de Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), Instituto de Investigacion Biomedica Agusti Pi i Sunyer, Universidad de Barcelona (Spain); Rangel, Ernesto [Facultad de Medicina, Universidad Autonoma de Nayarit, Tepic (Mexico); Barlascini, Cornelius [Servizio di Igiene e Sanita Pubblica, Ospedale Generale di Sestri Levante, Sestri Levante (Italy); Piroddi, Ines Maria Grazia; Nicolini, Antonello, E-mail: [Servizio di Pneumologia, Ospedale Generale di Sestri Levante, Sestri Levante (Italy)


    Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. (author)

  3. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series * (United States)

    Cillóniz, Catia; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Torres, Antoni; Nicolini, Antonello


    Abstract Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. PMID:26398760

  4. Pulmonary tuberculosis in severely-malnourished or HIV-infected children with pneumonia: a review. (United States)

    Chisti, Mohammod Jobayer; Ahmed, Tahmeed; Pietroni, Mark A C; Faruque, Abu S G; Ashraf, Hasan; Bardhan, Pradip K; Hossain, Iqbal; Das, Sumon Kumar; Salam, Mohammed Abdus


    Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIV-positive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/ very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children

  5. Hypervirulent Klebsiella pneumoniae


    Patel, Payal K.; Russo, Thomas A.; Karchmer, Adolf W.


    Hypervirulent strains of Klebsiella pneumoniae are associated with abscess formation, commonly hepatic, and metastatic spread, even in healthy patients. We describe a case of this clinical syndrome, genotypic and phenotypic features of the isolate, and briefly review epidemiology, clinical manifestations, and pathogenesis of this underappreciated syndrome.

  6. Nasopharyngeal carriage of Streptococcus pneumonia in pneumonia-prone age groups in Semarang, Java Island, Indonesia

    NARCIS (Netherlands)

    H. Farida (Helmia); J.A. Severin (Juliëtte); M.H. Gasem; M. Keuter (Monique); H. Wahyono (Hendro); P. van den Broek (Peterhans); P.W.M. Hermans (Peter); H.A. Verbrugh (Henri)


    textabstractIntroduction: Streptococcus pneumoniae is a worldwide occurring pathogen Nasopharyngeal carriage of Streptococcus pneumoniae precedes pneumonia and other pneumococcal diseases in the community. Little is known about S. pneumoniae carriage in Indonesia, complicating strategies to control

  7. Nasopharyngeal Carriage of Streptococcus pneumonia in Pneumonia-Prone Age Groups in Semarang, Java Island, Indonesia

    NARCIS (Netherlands)

    Farida, H.; Severin, J.A.; Gasem, M.H.; Keuter, M.; Wahyono, H.; Broek, P van den; Hermans, P.W.M.; Verbrugh, H.A.


    INTRODUCTION: Streptococcus pneumoniae is a worldwide occurring pathogen Nasopharyngeal carriage of Streptococcus pneumoniae precedes pneumonia and other pneumococcal diseases in the community. Little is known about S. pneumoniae carriage in Indonesia, complicating strategies to control pneumococcal

  8. Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012.

    Directory of Open Access Journals (Sweden)

    Carmen Lucía Contreras

    Full Text Available Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described.Data from 2008-2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI.Among 1595 adults admitted with ARI, 1363 (82% had either urine testing (n = 1286 or blood culture (n = 338 performed. Of these, 188 (14% had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18-24 year-olds (2.75/100,000 and the highest among ≥65 year-olds (31.3/100,000. The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%.An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala.

  9. Mycoplasma pneumoniae: Current knowledge on nucleic acid amplification techniques and serological diagnostics

    Directory of Open Access Journals (Sweden)

    Katherine eLoens


    Full Text Available Mycoplasma pneumoniae (M. pneumoniae belongs to the class Mollicutes and has been recognized as a common cause of respiratory tract infections (RTIs, including community-acquired pneumonia (CAP, that occur worldwide and in all age groups. In addition, M. pneumoniae can simultaneously or sequentially lead to damage in the nervous system and has been associated with a wide variety of other acute and chronic diseases. During the past 10 years, the proportion of LRTI in children and adults, associated with M. pneumoniae infection has ranged from 0% to more than 50%. This variation is due to the age and the geographic location of the population examined but also due to the diagnostic methods used. The true role of M. pneumoniae in RTIs remains a challenge given the many limitations and lack of standardization of the applied diagnostic tool in most cases, with resultant wide variations in data from different studies.Correct and rapid diagnosis and/or management of M. pneumoniae infections is, however, critical to initiate appropriate antibiotic treatment and is nowadays usually done by PCR and/or serology. Several recent reviews have summarized current methods for the detection and identification of M. pneumoniae. This review will therefore provide a look at the general principles, advantages, diagnostic value, and limitations of the most currently used detection techniques for the etiological diagnosis of a M. pneumoniae infection as they evolve from research to daily practice.

  10. Assessment of Schistosoma mansoni induced intestinal inflammation by means of eosinophil cationic protein, eosinophil protein X and myeloperoxidase before and after treatment with praziquantel

    DEFF Research Database (Denmark)

    Reimert, Claus Michael; Tukahebwa, Edridah M.; Kabatereine, Narcis B.;


    Faecal concentrations of eosinophil cationic protein (ECP), eosinophil protein X (EPX) and myeloperoxidase (MPO) were measured in extracts of stool samples obtained from a cohort of people (n=182) living in Bugoigo, a fishing community on the Eastern shore of Lake Albert, Buliisa District, in Nor...

  11. A sensitive high throughput ELISA for human eosinophil peroxidase: a specific assay to quantify eosinophil degranulation from patient-derived sources. (United States)

    Ochkur, Sergei I; Kim, John Dongil; Protheroe, Cheryl A; Colbert, Dana; Condjella, Rachel M; Bersoux, Sophie; Helmers, Richard A; Moqbel, Redwan; Lacy, Paige; Kelly, Elizabeth A; Jarjour, Nizar N; Kern, Robert; Peters, Anju; Schleimer, Robert P; Furuta, Glenn T; Nair, Parameswaran; Lee, James J; Lee, Nancy A


    Quantitative high throughput assays of eosinophil-mediated activities in fluid samples from patients in a clinical setting have been limited to ELISA assessments for the presence of the prominent granule ribonucleases, ECP and EDN. However, the demonstration that these ribonucleases are expressed by leukocytes other than eosinophils, as well as cells of non-hematopoietic origin, limits the usefulness of these assays. Two novel monoclonal antibodies recognizing eosinophil peroxidase (EPX) were used to develop an eosinophil-specific and sensitive sandwich ELISA. The sensitivity of this EPX-based ELISA was shown to be similar to that of the commercially available ELISA kits for ECP and EDN. More importantly, evidence is also presented confirming that among these granule protein detection options, EPX-based ELISA is the only eosinophil-specific assay. The utility of this high throughput assay to detect released EPX was shown in ex vivo degranulation studies with isolated human eosinophils. In addition, EPX-based ELISA was used to detect and quantify eosinophil degranulation in several in vivo patient settings, including bronchoalveolar lavage fluid obtained following segmental allergen challenge of subjects with allergic asthma, induced sputum derived from respiratory subjects following hypotonic saline inhalation, and nasal lavage of chronic rhinosinusitis patients. This unique EPX-based ELISA thus provides an eosinophil-specific assay that is sensitive, reproducible, and quantitative. In addition, this assay is adaptable to high throughput formats (e.g., automated assays utilizing microtiter plates) using the diverse patient fluid samples typically available in research and clinical settings.

  12. Eosinophilic pleural or peritoneal effusions in dogs and cats: 14 cases (1986-1992). (United States)

    Fossum, T W; Wellman, M; Relford, R L; Slater, M R


    Case records of 9 dogs and 5 cats with eosinophilic effusions were reviewed. The animals ranged from 11 months to 13 years old. Seven animals had pleural effusions, 5 had peritoneal effusions, and 2 had pleural and peritoneal effusions. Neoplasia was confirmed in 6 animals and suspected in 1. Eosinophilic pleural effusion was diagnosed 2 days after pneumothorax developed as a consequence of thoracic tube placement in a cat, and pneumothorax was diagnosed in another cat with eosinophilic peritoneal effusion. Other abnormalities seen in 1 or 2 animals associated with eosinophilic effusion were radiographic signs of interstitial or peribronchial pulmonary infiltrates, a history of allergic respiratory tract and skin disease, intestinal lymphangiectasia and lung lobe torsion, chylothorax, bite wounds causing intestinal perforation, and feline leukemia virus infection. Based only on the protein concentration of the effusion, 7 effusions were classified as transudates and 7 were classified as exudates. Five of the 14 animals had eosinophilia (> 1,200 eosinophils/microliters); 3 of these animals had neoplastic disease. Mean eosinophil count in blood samples was not significantly different between animals with neoplasia and those without. Eosinophil counts in blood samples were not linearly related to counts in effusions; however, in some animals the number of eosinophils in the effusion was much higher than the eosinophil count in blood, suggesting concentration of eosinophils in the effusion.

  13. Small intestinal eosinophils regulate Th17 cells by producing IL-1 receptor antagonist. (United States)

    Sugawara, Reiko; Lee, Eun-Jung; Jang, Min Seong; Jeun, Eun-Ji; Hong, Chun-Pyo; Kim, Jung-Hwan; Park, Areum; Yun, Chang Ho; Hong, Sung-Wook; Kim, You-Me; Seoh, Ju-Young; Jung, YunJae; Surh, Charles D; Miyasaka, Masayuki; Yang, Bo-Gie; Jang, Myoung Ho


    Eosinophils play proinflammatory roles in helminth infections and allergic diseases. Under steady-state conditions, eosinophils are abundantly found in the small intestinal lamina propria, but their physiological function is largely unexplored. In this study, we found that small intestinal eosinophils down-regulate Th17 cells. Th17 cells in the small intestine were markedly increased in the ΔdblGATA-1 mice lacking eosinophils, and an inverse correlation was observed between the number of eosinophils and that of Th17 cells in the small intestine of wild-type mice. In addition, small intestinal eosinophils suppressed the in vitro differentiation of Th17 cells, as well as IL-17 production by small intestinal CD4(+)T cells. Unlike other small intestinal immune cells or circulating eosinophils, we found that small intestinal eosinophils have a unique ability to constitutively secrete high levels of IL-1 receptor antagonist (IL-1Ra), a natural inhibitor of IL-1β. Moreover, small intestinal eosinophils isolated from IL-1Ra-deficient mice failed to suppress Th17 cells. Collectively, our results demonstrate that small intestinal eosinophils play a pivotal role in the maintenance of intestinal homeostasis by regulating Th17 cells via production of IL-1Ra.

  14. Induction of Eosinophilic Esophagitis by Sublingual Pollen Immunotherapy

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    Stephan Miehlke


    Full Text Available Sublingual immunotherapy (SLIT is increasingly investigated and utilized for the treatment of food and pollen allergies. Previous case reports suggested that eosinophilic esophagitis (EoE might develop as a long-term complication in children after completion of oral immunotherapy. Here, we describe a 44-year-old female with a medical history of pollinosis who for the first time in her life developed complete manifestation of EoE (peak eosinophils 164/high power field 4 weeks after initiation of SLIT using specific soluble allergens (hazelnut, birch, alder according to previous specific serum IgE testing. After discontinuation of SLIT, EoE resolved completely within 4 weeks without any other medical intervention. During a follow-up of 12 months the patient remained free of any esophageal symptoms. This is the first case report demonstrating a close and therefore likely causative association between pollen SLIT and EoE in an adult patient.

  15. Eosinophilic Otitis Media: CT and MRI Findings and Literature Review

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    Chung, Won Jung; Lee, Jeong Hyun; Lim, Hyun Kyung; Yoon, Tae Hyun; Cho, Kyung Ja; Baek, Jung Hwan [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)


    Eosinophilic otitis media (EOM) is a relatively rare, intractable, middle ear disease with extremely viscous mucoid effusion containing eosinophils. EOM is associated with adult bronchial asthma and nasal allergies. Conventional treatments for otitis media with effusion (OME) or for chronic otitis media (COM), like tympanoplasty or mastoidectomy, when performed for the treatment of EOM, can induce severe complications such as deafness. Therefore, it should be differentiated from the usual type of OME or COM. To our knowledge, the clinical and imaging findings of EOM of temporal bone are not well-known to radiologists. We report here the CT and MRI findings of two EOM cases and review the clinical and histopathologic findings of this recently described disease entity.

  16. Mosquito bite-caused eosinophilic dermatitis in cats. (United States)

    Mason, K V; Evans, A G


    Eight cats had lesions on the nasal bridge, ears, and footpads, with histologic and hematologic features of a recently described seasonal form of eosinophilic granuloma complex. Four cats were examined in detail, and it was established that 2 of the 4 reacted to mosquito extract on intradermal skin testing read at 20 minutes. Neither of the 2 cats tested had deposits of immunoglobulins in lesional or perilesional skin. Lesions on all 4 cats resolved when kept at home behind insect screening, but flared up if the screening was removed. Mosquitoes that were observed to be biting and causing lesions were collected and identified. Other species of laboratory-reared mosquitoes were allowed to bite nonlesional skin of 1 affected cat, causing pruritus, erythematous crusting, and ulcerative lesions at the bite site, which was characterized histologically as eosinophilic dermatitis.

  17. [Differencial diagnosis of gastroesophageal reflux disease -- eosinophilic esophagitis: case report]. (United States)

    Franzius, M; Stolte, M; Porschen, R


    We report on a 22-year-old man with dysphagia and repeated bolus impaction in the esophagus for 10 years. Bolus impactions were frequently mobilised using an endoscope. At endoscopy, esophagitis IV degrees was described. After treatment with omeprazol there was no improvement. The patient was submitted to our hospital for fundoplication. pH-metry demonstrated an increased reflux. At endoscopy of the esophagus, we found red stripes which did not show the typical appearance of erosions. Manometry and X-ray films of the esophagus did not reveal any pathological findings. In combination with anamnesis, symptoms, and endoscopy, the diagnosis of eosinophilic esophagitis was documented by histology. After administration of oral corticosteroids a rapid improvement of the clinical symptoms was observed. The diagnosis of eosinophilic esophagitis should be kept in mind in patients with chronic symptoms of gastroesophageal reflux persisting despite medical therapy, pathological pH-metry and repeated bolus impactions.

  18. Eosinophilic pleuritis due to sparganum: a case report. (United States)

    Oh, Youngmin; Kim, Jeong-Tae; Kim, Mi-Kyeong; Chang, You-Jin; Eom, Keeseon; Park, Jung-Gi; Lee, Ki-Man; Choe, Kang-Hyeon; An, Jin-Young


    Sparganosis is a rare parasitic disease caused by migrating plerocercoid tapeworm larva of the genus Spirometra. Infection in humans is mainly caused by the ingestion of raw or inadequately cooked flesh of infected frogs, snakes, and chickens. Here, we report a rare case of a 45-year-old man who was admitted to our hospital with left lower chest pain. The chest radiograph and computed tomography (CT) scan revealed localized pleural effusion in the left lower lobe; further, peripheral blood eosinophilia and eosinophilic pleural effusion were present. Percutaneous catheter drainage was performed, which revealed long worm-shaped material that was identified as a sparganum by DNA sequencing. The patient showed clinical improvement after drainage of the sparganum. This study demonstrates the importance of considering parasitic diseases in the differential diagnosis of eosinophilic pleural effusion.

  19. Eosinophilic Enteritis with Ascites in a Patient with Overlap Syndrome

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    Spyros Aslanidis


    Full Text Available Gastrointestinal involvement is frequent in patients with systemic lupus erythematosus (SLE. Eosinophilic gastroenteritis, however, has only rarely been described in rheumatological conditions, despite its reported connection to autoimmune diseases, such as hypereosinophilic syndrome, vasculitides, and systemic mastoidosis. It presents typically with abdominal pain and diarrhea and is only exceptionally associated with ascites. Diagnosis can be problematic, as several other clinical conditions (malignancies, infection/tuberculosis, and inflammatory bowel diseases have to be ruled out. It is basically a nonsurgical disease, with excellent recovery on conservative treatment. We report the rare case of a young woman with overlap syndrome who presented with abdominal pain and ascites. The diagnosis of eosinophilic enteritis was made based on clinical, radiological, and laboratory criteria. The patient was treated with corticosteroids with excellent response.

  20. [Esophageal diseases: GERD, Barrett, achalasia and eosinophilic esophagitis]. (United States)

    Calvet, Xavier; Villoria, Albert


    At Digestive Disease Week (DDW) 2014, developments in esophageal disease were presented. Highlights include: the usefulness of impedancemetry to diagnose reflux disease, or the effectiveness of PPIs for treating non-cardiac chest pain. Concerning Barrett's esophagus, its prevalence is identical in patients with and without reflux symptoms, Barrett segments less than 1cm probably do not require follow-up, and in older patients with long-segment Barrett, initial endoscopies overlooked up to 2% of significant lesions. Regarding achalasia, surgical myotomy is no more effective than endoscopic dilation and may even be less effective than peroral endoscopic myotomy (POEM). In terms of eosinophilic esophagitis, it is important to systematically take biopsies in patients with dysphagia so that cases of eosinophilic esophagitis are not overlooked. In addition, for this condition, routine endoscopic dilations not only do not seem useful in improving the course of the disease, but could also worsen the response to medical treatment.

  1. Emphysematous Eosinophilic Lymphangitis in the Ruminal Submucosa of Cattle. (United States)

    Ohfuji, S


    Twenty cattle (14 Holstein-Friesian, 3 Japanese Black, 3 Aberdeen Angus) ranging in age from 3 months to 8 years exhibited, at slaughter, emphysematous thickening of the ruminal submucosa owing to the appearance of numerous, contiguous, small gas bubbles. Microscopic changes in the ruminal submucosa consisted of (1) multiple cystic (emphysematous) lymphangiectasis that was frequently lined or occluded by granulomatous inflammatory infiltrates including macrophages, multinucleate giant cells, and eosinophils; (2) intralymphatic phagocytosis by macrophages and giant cells of eosinophils that showed positive labeling with the terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling assay; and (3) an inflammatory infiltrate extending from the area of lymphangitis into surrounding tissue, as well as edema, hemorrhage, fibrin exudation, fibroplasia, or capillary proliferation throughout the lesional submucosa. In addition, 15 (75%) of the cattle had globular leukocyte infiltrates in the mucosal epithelia of the rumen.

  2. Severe Varicella Pneumonia. A Pediatric Case Presentation

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    Ariel Efrén Uriarte Méndez


    Full Text Available The case of a 12 years child old child, white skin, obese, from urban procedence and with a history of Crohn's disease who was admitted to the Intensive Care Unit at the "Paquito González Cueto” Pediatric University Hospital because of bloody diarrhea and severe dehydration is presented. After controlling the acute phase, the patient was taken to the gastroenterology room where he began presenting vesicular lesions on the trunk, diagnosed as varicella. A further complication appeared when the patient developed a severe pneumonia that quickly evolved into an acute respiratory distress syndrome which required transfer to intensive care unit with intensive therapeutic intervention, especially ventilatory management. Both radiologic and laboratory parameters were very characteristic, similar to those described in the literature. Despite intensive sustained treatment, the patient died a month after diagnosis was performed. Considering how infrequent this complication is in the case of children, it was decided to have the case published.

  3. Eosinophilic fibrosing gastritis and toxoplasmosis in a cat. (United States)

    McConnell, James F; Sparkes, Andrew H; Blunden, Anthony S; Neath, Prue J; Sansom, Jane


    A 3-year-old, neutered male Tiffany cat was presented to the Animal Health Trust for investigation of pyrexia and a gastric lesion. Radiography and ultrasound showed severe thickening of the gastric wall and regional lymphadenopathy. There was altered gastric wall layering, predominately due to muscularis thickening. Histopathology confirmed eosinophilic fibrosing gastritis. The cat also had evidence of generalised Toxoplasma gondii infection, which may have been responsible for the gastric changes.

  4. Snake remedies and eosinophilic granuloma complex in cats. (United States)

    Aboutboul, Ronit


    Eosinophilic granuloma complex (EGC) is a syndrome occurring in cats, characterized by lesions affecting the skin and the oral cavity. Conventional treatment is mainly symptomatic and may have undesirable side effects. This paper summarizes homeopathic treatment with snake remedies of cats suffering from EGC. Snake remedies were chosen by individual repertorizations and administered in different dilutions. Reactions were mostly quick, leading to significant improvements, including complete recoveries.

  5. Comment on "Eosinophilic gastroenteritis: Clinical experience with 15 patients"

    Institute of Scientific and Technical Information of China (English)

    Peter J Kerr


    @@ To the Editor: I recently read the paper by Chen et al.[1] published in your Journal. The paper shows that there have been a few cases where medications have caused eosinophilia. Clozapine is an antipsychotic medication that can cause eosinophilia. It is pointed out in your paper "The diagnostic criteria included... 5), exclusion of intestinal lymphoma, Crohn's disease or other tumors." Table 2 shows symptoms associated with eosinophilic gastroenteritis,which are very like those in Crohn's disease.

  6. Evaluation of the Effectiveness of Antibiotics against Eosinophilic Pustular Folliculitis

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    Sachiko Ono


    Full Text Available Eosinophilic pustular folliculitis (EPF is a chronic intractable pruritic dermatosis. Although indomethacin is generally effective against EPF and considered as a first-line therapy, quite a few patients with indomethacin still suffer from the symptoms. Among other therapeutic options, some antibiotics have been reported to be effective; however, there has been no epidemiological description regarding oral antibiotics use in patients with EPF. In this study, we investigated the frequency of antibiotics use and the effectiveness in patients with EPF.

  7. Systemic lupus erythematosus presenting with eosinophilic enteritis: a case report

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    Kalany Mohammad


    Full Text Available Abstract Introduction Systemic lupus erythematosus (SLE is a multisystem disorder that may present with various symptoms. It may involve the gastrointestinal tract in a variety of ways; some of the most well-known ones are transaminitis, lupus mesenteric vasculitis, lupus enteritis and mesenteric vascular leakage. We describe a case of a patient with SLE who presented with a five-month history of diarrhea caused by eosinophilic enteritis. To the best of our knowledge, there are few cases reported in the literature of patients with SLE who initially present with chronic diarrhea due to eosinophilic enteritis. Case presentation A 38-year-old Persian Iranian woman was admitted with a five-month history of diarrhea and abdominal pain. A physical examination showed nothing abnormal. Initially, she had only lymphopenia and mild eosinophilia. No autoimmune or infectious etiology was detected to justify these abnormalities. A thorough evaluation was not helpful in finding the etiology, until she developed a scalp lesion similar to discoid lupus erythematosus. Computed tomography showed small bowel wall thickening. Briefly, she manifested full-blown SLE, and it was revealed that the diarrhea was caused by eosinophilic enteritis. Conclusion Considering SLE in a patient who presents with chronic diarrhea and lymphopenia may be helpful in earlier diagnosis and therapy. This is an original case report of interest to physicians who practice internal medicine, family medicine and gastroenterology.

  8. Elimination diets in the management of eosinophilic esophagitis

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    Wechsler JB


    Full Text Available Joshua B Wechsler, Sally Schwartz, Katie Amsden, Amir F Kagalwalla Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA Abstract: Eosinophilic esophagitis, an increasingly recognized chronic inflammatory disorder isolated to the esophagus, is triggered by an abnormal allergic response to dietary antigens. Current treatment includes swallowed topical steroids and dietary modification, which aim to resolve symptoms and prevent long-term complications such as formation of strictures. The dietary approach has become more widely accepted because long-term steroid therapy is associated with potential risks. Dietary treatment includes elemental and elimination diets. An exclusive elemental diet, which requires replacement of all intact protein with amino acid-based formula, offers the best response of all available therapies, with remission in up to 96% of subjects proving it to be superior to all other available therapies including topical steroids. However, compliance with this approach is challenging because of poor taste and monotony. The high cost of formula and the associated psychosocial problems are additional drawbacks of this approach. Empiric and allergy test-directed elimination diets have gained popularity given that elimination of a limited number of foods is much easier and as such is more readily acceptable. There is a growing body of literature supporting this type of therapy in both children and adults. This paper reviews the evidence for all types of dietary therapy in eosinophilic esophagitis. Keywords: eosinophilic esophagitis, dietary therapy, empiric elimination, elemental, allergy test-directed

  9. Eosinophils in fungus-associated allergic pulmonary disease

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    Sumit eGhosh


    Full Text Available Asthma is frequently caused and/or exacerbated by sensitization to fungal allergens, which are ubiquitous in many indoor and outdoor environments. Severe asthma with fungal sensitization is characterized by airway hyperresponsiveness and bronchial constriction in response to an inhaled allergen that is worsened by environmental exposure to airborne fungi and which leads to a disease course that is often very difficult to treat with standard asthma therapies. As a result of complex interactions among inflammatory cells, structural cells, and the intercellular matrix of the allergic lung, patients with sensitization to fungal allergens may experience a greater degree of airway wall remodeling and progressive, accumulated pulmonary dysfunction as part of the disease sequela. From their development in the bone marrow to their recruitment to the lung via chemokine and cytokine networks, eosinophils form an important component of the inflammatory milieu that is associated with this syndrome. Eosinophils are recognized as complex multi-factorial leukocytes with diverse functions in the context of allergic fungal asthma. In this review, we will consider recent advances in our understanding of the molecular mechanisms that are associated with eosinophil development and migration to the allergic lung in response to fungal inhalation, along with the eosinophil’s function in the immune response to and the immunopathology attributed to fungus-associated allergic pulmonary disease.

  10. Diagnosis and treatment of bacterial pneumonia in liver transplantation recipients: report of 33 cases

    Institute of Scientific and Technical Information of China (English)

    MA Yu-kui; YAN Lü-nan; LI Bo; LU Shi-chun; HUANG An-hua; WEN Tian-fu; ZENG Yong; CHENG Nan-sheng


    Background Bacterial pneumonia in the recipients of liver transplantation (LTX) is a common postoperative complication influencing the prognosis greatly. In this article, the diagnosis and treatment of bacterial pneumonia in 33 LTX recipients are reported. Methods From February 1999 to January 2003, a total of 103 patients underwent allogeneic LTX at our center; afterwards, a retrospective analysis was made on their postoperative clinical manifestations, including symptoms (expectoration, panting and fever), sign (rale), results of laboratory examinations (white blood cell count and sputum culture of tracheal secretions or pleural fluid culture), and chest X-ray films. The following data of the pneumonia and non-pneumonia groups were collected, and the rank sum test (SPSS 11.0, Wilcoxon's method) was used to analyze the duration of postoperative respirator utilization and the volume of pleural effusion through pleurocentesis or pleural drainage.Results In the 103 patients, 33 experienced 53 episodes of bacterial pneumonia during their hospital stay after transplantation, 14 of them (42.42%) had more than three manifestations of the seven mentioned above. The pathogens causing bacterial pneumonia included Pseudomonas aeruginosa (17.48%), Klebsiella pneumoniae (15.53%), Acinetobacter baumannii (10.68%), and Staphylococcus aureus (7.77%). Amilkacin, tienam, ciprofloxacin, vancomycin, etc. were the antibiotics of choice against those bacteria. Acute rejection occurred during the treatment of bacterial pneumonia in 16 patients, and 5 of them died. Wilcoxon's rank sum test of the data indicated that the pneumonia group had longer duration of postoperative ventilator treatment and larger volume of pleural effusion than the non-pneumonia group (P<0.05).Conclusions The clinical manifestations of pneumonia after LTX might be atypical,and special attention should be paid to the respiratory symptoms and signs within 2 months after LTX. Whenever the diagnosis of bacterial

  11. Escherichia fergusonii Associated with Pneumonia in a Beef Cow

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    Guillermo M. Rimoldi


    Full Text Available An adult Angus cow developed hyperthermia, prostration, and respiratory distress, dying 36 hours after the onset of clinical signs. The main finding during postmortem examination was a severe focally extensive pneumonia. Icterus and a chronic mastitis were also noticed. Histologic examination of the lungs detected fibrinonecrotic pneumonia, with large number of oat cells and intralesional Gram-negative bacterial colonies. Samples from lung lesions were collected, and a pure growth of Escherichia fergusonii was obtained. E. fergusonii is a member of Enterobacteriaceae, related to Escherichia coli and Salmonella sp. In veterinary medicine, E. fergusonii has been reported in calves and sheep with clinical cases suggestive of salmonellosis; in a horse and a goat with enteritis and septicemia; and in ostriches with fibrinonecrotic typhlitis. To our knowledge, this report represents the first description of E. fergusonii associated with an acute pneumonia in cattle.

  12. Zinc as an adjunct for childhood pneumonia - interpreting early results. (United States)

    Natchu, Uma Chandra Mouli; Fataki, Maulidi R; Fawzi, Wafaie W


    Zinc supplementation has been consistently shown to reduce the incidence of childhood pneumonia, but its effect on the course of pneumonia when administered as an adjunct to antibiotic therapy is still unclear. Three trials published to date have shown mixed results, and a recent trial from India raises the possibility that zinc may be detrimental in some circumstances. Study sites and designs differ, particularly in the timing of zinc treatment and in determining recovery from pneumonia, which can explain the differences in study findings. Serum zinc concentrations are unreliable indicators of zinc status, particularly during acute infectious illnesses. Subgroup analyses, especially using serum zinc levels, must be cautioned against. Future studies are needed that are large enough to be sufficiently powered to accommodate larger treatment failure rates, an issue that ongoing trials will hopefully address.

  13. Osteopontin promotes host defense during Klebsiella pneumoniae-induced pneumonia. (United States)

    van der Windt, G J W; Hoogerwerf, J J; de Vos, A F; Florquin, S; van der Poll, T


    Klebsiella pneumoniae is a common cause of nosocomial pneumonia. Osteopontin (OPN) is a phosphorylated glycoprotein involved in inflammatory processes, some of which is mediated by CD44. The aim of this study was to determine the role of OPN during K. pneumoniae-induced pneumonia. Wild-type (WT) and OPN knockout (KO) mice were intranasally infected with 10⁴ colony forming units of K. pneumoniae, or administered Klebsiella lipopolysaccharides (LPS). In addition, recombinant OPN (rOPN) was intranasally administered to WT and CD44 KO mice. During Klebsiella pneumonia, WT mice displayed elevated pulmonary and plasma OPN levels. OPN KO and WT mice showed similar pulmonary bacterial loads 6 h after infection; thereafter, Klebsiella loads were higher in lungs of OPN KO mice and the mortality rate in this group was higher than in WT mice. Early neutrophil recruitment into the bronchoalveolar space was impaired in the absence of OPN after intrapulmonary delivery of either Klebsiella bacteria or Klebsiella LPS. Moreover, rOPN induced neutrophil migration into the bronchoalveolar space, independent from CD44. In vitro, OPN did not affect K. pneumoniae growth or neutrophil function. In conclusion, OPN levels were rapidly increased in the bronchoalveolar space during K. pneumoniae pneumonia, where OPN serves a chemotactic function towards neutrophils, thereby facilitating an effective innate immune response.


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    E. N. Romanova


    Full Text Available Abstract. Defensin amounts in severe forms of influenza-associated pneumonia and acute respiratory distresssyndrome is increased to a lesser degree than in pneumonias with milder clinical course. This difference may be determined by selective accumulation of defensins in areas of infectious lesions. Mean content of α-defensins in non-severe pneumonias with influenza А/H1N1 accompanied by normocytosis or leukopenia, is higher than in bacterial pneumonias with leukocytosis. High levels of defensins, along with substantially increased neutrophil counts, associated with normocytosis or leukopenia, reflect a pronounced systemic inflammatory response caused by influenza А/H1N1.

  15. Suppression of Eosinophil Integrins Prevents Remodeling of Airway Smooth Muscle in Asthma (United States)

    Januskevicius, Andrius; Gosens, Reinoud; Sakalauskas, Raimundas; Vaitkiene, Simona; Janulaityte, Ieva; Halayko, Andrew J.; Hoppenot, Deimante; Malakauskas, Kestutis


    Background: Airway smooth muscle (ASM) remodeling is an important component of the structural changes to airways seen in asthma. Eosinophils are the prominent inflammatory cells in asthma, and there is some evidence that they contribute to ASM remodeling via released mediators and direct contact through integrin–ligand interactions. Eosinophils express several types of outer membrane integrin, which are responsible for cell–cell and cell–extracellular matrix interactions. In our previous study we demonstrated that asthmatic eosinophils show increased adhesion to ASM cells and it may be important factor contributing to ASM remodeling in asthma. According to these findings, in the present study we investigated the effects of suppression of eosinophil integrin on eosinophil-induced ASM remodeling in asthma. Materials and Methods: Individual combined cell cultures of immortalized human ASM cells and eosinophils from peripheral blood of 22 asthmatic patients and 17 healthy controls were prepared. Eosinophil adhesion was evaluated using eosinophil peroxidase activity assay. Genes expression levels in ASM cells and eosinophils were measured using quantitative real-time PCR. ASM cell proliferation was measured using alamarBlue® solution. Eosinophil integrins were blocked by incubating with Arg-Gly-Asp-Ser peptide. Results: Eosinophils from the asthma group showed increased outer membrane α4β1 and αMβ2 integrin expression, increased adhesion to ASM cells, and overexpression of TGF-β1 compared with eosinophils from the healthy control group. Blockade of eosinophil RGD-binding integrins by Arg-Gly-Asp-Ser peptide significantly reduced adhesion of eosinophils to ASM cells in both groups. Integrin-blocking decreased the effects of eosinophils on TGF-β1, WNT-5a, and extracellular matrix protein gene expression in ASM cells and ASM cell proliferation in both groups. These effects were more pronounced in the asthma group compared with the control group. Conclusion

  16. Indirect assessment of eosinophiluria in urinary schistosomiasis using eosinophil cationic protein (ECP) and eosinophil protein X (EPX)

    DEFF Research Database (Denmark)

    Reimert, C M; Ouma, J H; Mwanje, M T;


    of infection (eggs/10 ml of urine), albuminuria and pathological changes as detected by ultrasonography. ECP and EPX were determined by means of specific ELISA methods and levels were determined in both urine supernatants and extracted urine deposits (cells and cell debris). The level of ECP was significantly......The pre- and post-treatment level of eosinophiluria, as measured indirectly by the amount of free or cell bound eosinophil cationic protein (ECP) and eosinophil protein X (EPX) in urine from Schistosoma haematobium-infected Kenyan school children, were measured and compared with intensity...... and EPX could be extracted from the urine deposits from infected children, but due to the high amounts of EPX in urine deposit extracts from controls, extracted ECP gave the best discrimination between infected and non-infected children. While albuminuria disappeared in most children at the 6 week post...

  17. Electrocardiogram in pneumonia. (United States)

    Stein, Paul D; Matta, Fadi; Ekkah, Maan; Saleh, Tarek; Janjua, Muhammad; Patel, Yash R; Khadra, Helmi


    Findings on electrocardiogram may hint that pulmonary embolism (PE) is present when interpreted in the proper context and lead to definitive imaging tests. However, it would be useful to know if electrocardiographic (ECG) abnormalities also occur in patients with pneumonia and whether these are similar to ECG changes with PE. The purpose of this investigation was to determine ECG findings in patients with pneumonia. We retrospectively evaluated 62 adults discharged with a diagnosis of pneumonia who had no previous cardiopulmonary disease and had electrocardiogram obtained during hospitalization. The most prevalent ECG abnormality, other than sinus tachycardia, was minor nonspecific ST-segment or T-wave changes occurring in 13 of 62 (21%). Right atrial enlargement occurred in 4 of 62 (6.5%). QRS abnormalities were observed in 24 of 62 (39%). Right-axis deviation and S(1)S(2)S(3) were the most prevalent QRS abnormalities, which occurred in 6 of 62 (9.7%). Complete right bundle branch block and S(1)Q(3)T(3) pattern occurred in 3 of 62 (4.8%). ECG abnormalities that were not present within 1 month previously or abnormalities that disappeared within 1 month included left-axis deviation, right-axis deviation, right atrial enlargement, right ventricular hypertrophy, S(1)S(2)S(3), S(1)Q(3)T(3), low-voltage QRS complexes, and nonspecific ST-segment or T-wave abnormalities. In conclusion, electrocardiogram in patients with pneumonia often shows QRS abnormalities or nonspecific ST-segment or T-wave changes. ECG findings are similar to ECG abnormalities in PE and electrocardiogram cannot assist in the differential diagnosis.

  18. sICAM-1 intrathecal synthesis and release during the acute phase in children suffering from Coxsackie A9 and S. pneumoniae meningoencephalitis Sintesis intratecal de sICAM-1 y liberación durante la fase aguda en niños con meningoencefalitis por Coxsackie A9 y S pneumoniae

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    Alberto J. Dorta-Contreras


    Full Text Available The intercellular adhesion molecule is a transmembrane glycoprotein belonging to the immunoglobulin superfamily. Serum and cerebrospinal fluid (CSF soluble intercellular adhesion molecule 1 (sICAM-1 from normal control children as well as from children with Guillain-Barré syndrome (GBS, with Coxsackie A9 virus meningoencephalitis and with Streptococcus pneumoniae meningoencephalitis were studied. sICAM-1 was quantified using an immunoenzimatic assay and albumin using the immunodiffusion technique in both biological fluids. Increased sICAM-1 values in CSF in patients with GBS correspond to an increase of the albumin CSF/serum quotient. In contrast, in inflammatory diseases like S. pneumoniae and Coxsackie A9 virus meningoencephalitis an increased brain-derived fraction was observed. In particular cases these values are 60-65% and 70-75% respectively. The results indicate an additional synthesis of sICAM-1 in subarachnoidal space during central nervous system (CNS inflammatory process. An important role of sICAM-1 in the transmigration of different cell types into CSF during CNS inflammation in children with S. pneumoniae and Coxsackie A9 meningoencephalitis may be suggested.La molécula de adhesión intercelular es una glicoproteína que pertenece a la superfamilia de las inmunoglobulinas. Se estudiaron los niveles de molécula de adhesión intercelular tipo 1 soluble (sICAM-1 en suero y líquido cefalorraquídeo (LCR de niños con meningoencefalitis por Streptococcus pneumoniae y por Coxsackie A9 al igual que en niños con sindrome de Guillain-Barré (SGB. sICAM-1 fue cuantificado por ensayo inmunoenzimático y la albúmina por inmunodifusión en ambos líquidos biológicos. Los valores incrementados de sICAM-1 en LCR en los pacientes con GBS corresponden a valores aumentados de razón LCR/suero de albúmina. En contraste, en las enfermedades inflamatorias como las meningoencefalitis por S. pneumoniae y por Coxsackie A9 se observa un incremento

  19. Marked differences in GPs' diagnosis of pneumonia between Denmark and Spain: a cross-sectional study

    DEFF Research Database (Denmark)

    Christensen, S.F.; Jørgensen, L.C.; Cordoba Currea, Gloria Cristina


    BACKGROUND: In patients with lower respiratory tract infections (LRTIs) it is a challenge to identify who should be treated with antibiotics. According to international guidelines, antibiotics should be prescribed to patients with suspected pneumonia while acute bronchitis is considered a viral...... infection and should, generally, not be treated with antibiotics. Overdiagnosis of pneumonia in patients with LRTIs may lead to antibiotic overprescribing. AIMS: To investigate the prevalence of presumed pneumonia in patients with LRTI in two countries with different antibiotic prescribing rates (Denmark...... and Spain) and to compare which symptoms and clinical tests are of most importance for the GP when choosing a diagnosis of pneumonia rather than acute bronchitis. METHODS: A cross-sectional study including GPs from Denmark and Spain was conducted as part of the EU-funded project HAPPY AUDIT. A total of 2...

  20. Variation in genes encoding eosinophil granule proteins in atopic dermatitis patients from Germany

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    Epplen Jörg T


    Full Text Available Abstract Background Atopic dermatitis (AD is believed to result from complex interactions between genetic and environmental factors. A main feature of AD as well as other allergic disorders is serum and tissue eosinophilia. Human eosinophils contain high amounts of cationic granule proteins, including eosinophil cationic protein (ECP, eosinophil-derived neurotoxin (EDN, eosinophil peroxidase (EPO and major basic protein (MBP. Recently, variation in genes encoding eosinophil granule proteins has been suggested to play a role in the pathogenesis of allergic disorders. We therefore genotyped selected single nucleotide polymorphisms within the ECP, EDN, EPO and MBP genes in a cohort of 361 German AD patients and 325 healthy controls. Results Genotype and allele frequencies did not differ between patients and controls for all polymorphisms investigated in this study. Haplotype analysis did not reveal any additional information. Conclusion We did not find evidence to support an influence of variation in genes encoding eosinophil granule proteins for AD pathogenesis in this German cohort.

  1. /sup 111/In-labeled eosinophils: localization of inflammatory lesions and parasitic infections in mice

    Energy Technology Data Exchange (ETDEWEB)

    Runge, V.M.; Rand, T.H.; Clanton, J.A.; Jones, J.P.; Colley, D.G.; Partain, C.L.; James, A.E. Jr.


    Based upon recent development of practical isolation techniques for eosinophils, labeling and in vivo imaging of eosinophils has been achieved. Isolation of cells was performed utilizing a Percoll density gradient. The eosinophils were subsequently labeled by a modified /sup 111/In-oxine method. Migration of eosinophils in response to intradermal ear-pinna injections of SEA (soluble schistosoma egg antigen), S. mansoni eggs, E. coli, and turpentine was followed with gamma-ray camera imaging from 4 to 48 h. Maximal localization, determined by Gamma 11 data processing, occurred by 4-h post-injection of radiolabel. SEA and S. mansoni eggs provided a greater stimulus for localization than E. coli or turpentine. Neutrophils did not preferentially accumulate. Tissue distribution of labeled eosinophils was greatest in the spleen, followed by liver and bone. /sup 111/In-labeled-eosinophil scans are sensitive to parasitic infections, although somewhat nonspecific.

  2. Bronchiolitis Obliterans with Organizing Pneumonia (BOOP) (United States)

    ... What can you tell me about cryptogenic organizing pneumonia? Answers from Teng Moua, M.D. Previously called bronchiolitis obliterans with organizing pneumonia, cryptogenic organizing pneumonia (COP) is a rare lung ...

  3. Pneumonia bacteriana adquirida na comunidade


    Machado, Lais Del Prá Netto


    Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Farmácia, Florianópolis, 2015. A pneumonia pode ser causada por diversos microrganismos e classificada de forma abrangente, havendo poucos e frágeis estudos clínicos e epidemiológicos sobre pneumonias adquiridas na comunidade (PACs). Os patógenos mais frequentes nas PACs são Streptococcus pneumoniae e Haemophilus influenzae (em pneumonias típicas) e Mycoplasma pneumoni...

  4. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates. (United States)

    Farooqui, Habib; Jit, Mark; Heymann, David L; Zodpey, Sanjay


    The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3-3.9 million) episodes of severe pneumonia and 0.35 million (0.31-0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49-0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92-119 thousand) pneumococcal deaths occurred in India. The top contributors to India's pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results

  5. Expression of RANTES mRNA in skin lesions of feline eosinophilic plaque. (United States)

    Kimura, Tomoe; Kano, Rui; Maeda, Sadatoshi; Tsujimoto, Hajime; Nagata, Masahiko; Hasegawa, Atsuhiko


    One of the mechanisms of eosinophil infiltration is its induction by chemoattractants such as regulated upon activation, normal T-expressed and secreted (RANTES) which is a cysteine-cysteine chemokine that mediates chemotaxis and activation of eosinophils in humans and mice. Skin lesions of feline eosinophilic plaque are characterized by a predominant infiltration of eosinophils. The mechanism(s) of eosinophilic infiltration in the skin and/or mucosa of cats is unknown. It is possible that RANTES is involved. To investigate the presence of RANTES in the skin of cats with eosinophilic plaques and nonaffected skin, we cloned and sequenced the full-length feline RANTES cDNA gene, in order to determine whether it is present in the skin of cats with eosinophilic plaques and/or if it is present in normal adjacent skin. We were able to document the the expression of RANTES mRNAs in skin with feline eosinophilic plaque as well as in normal cat skin. The full-length cDNA sequence of the RANTES gene (742 bp) contained a single open reading frame of 276 bp encoding a protein of 92 amino acids. The amino acid sequence of feline RANTES shared 67 and 74% sequence identity with that of bovine and mouse RANTES genes, respectively. RT-PCR analysis on RANTES mRNA in the skin of cats with eosinophilic plaque revealed that its expression was higher in the eosinophilic plaque skin lesions than in the normal skin. The result suggested that RANTES might play a role to induce eosinophil infiltration in feline eosinophilic plaque lesions.

  6. Extracellular microvesicle production by human eosinophils activated by “inflammatory” stimuli

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    Praveen Akuthota


    Full Text Available A key function of human eosinophils is to secrete cytokines, chemokines and cationic proteins, trafficking and releasing these mediators for roles in inflammation and other immune responses. Eosinophil activation leads to secretion of pre-synthesized granule-stored mediators through different mechanisms, but the ability of eosinophils to secrete extracellular vesicles (EVs, very small vesicles with preserved membrane topology, is still poorly understood. In the present work, we sought to identify and characterize EVs released from human eosinophils during different conditions: after a culturing period or after isolation and stimulation with inflammatory stimuli, which are known to induce eosinophil activation and secretion: CCL11 (eotaxin-1 and tumor necrosis factor alpha (TNF-α. EV production was investigated by nanoscale flow cytometry, conventional transmission electron microscopy (TEM and pre-embedding immunonanogold EM. The tetraspanins CD63 and CD9 were used as EV biomarkers for both flow cytometry and ultrastructural immunolabeling. Nanoscale flow cytometry showed that human eosinophils produce EVs in culture and that a population of EVs expressed detectable CD9, while CD63 was not consistently detected. When eosinophils were stimulated immediately after isolation and analyzed by TEM, EVs were clearly identified as microvesicles (MVsoutwardly budding off the plasma membrane. Both CCL11 and TNF-α induced significant increases of MVs compared to unstimulated cells.TNF-α induced amplified release of MVs more than CCL11. Eosinophil MV diameters varied from 20-1000 nm. Immunonanogold EM revealed clear immunolabeling for CD63 and CD9 on eosinophil MVs, although not all MVs were labeled. Altogether, we identified, for the first time, that human eosinophils secrete MVs and that this production increases in response to inflammatory stimuli. This is important to understand the complex secretory activities of eosinophils underlying immune

  7. Oral and airway microbiota in HIV-infected pneumonia patients. (United States)

    Iwai, Shoko; Fei, Matthew; Huang, Delphine; Fong, Serena; Subramanian, Anuradha; Grieco, Katherine; Lynch, Susan V; Huang, Laurence


    Despite the increased frequency of recurrent pneumonia in HIV-infected patients and recent studies linking the airway bacterial community (microbiota) to acute and chronic respiratory infection, little is known of the oral and airway microbiota that exist in these individuals and their propensity to harbor pathogens despite antimicrobial treatment for acute pneumonia. This pilot study compared paired samples of the oral and airway microbiota from 15 hospitalized HIV-infected patients receiving antimicrobial treatment for acute pneumonia. Total DNA was extracted, bacterial burden was assessed by quantitative PCR, and amplified 16S rRNA was profiled for microbiome composition using a phylogenetic microarray (16S rRNA PhyloChip). Though the bacterial burden of the airway was significantly lower than that of the oral cavity, microbiota in both niches were comparably diverse. However, oral and airway microbiota exhibited niche specificity. Oral microbiota were characterized by significantly increased relative abundance of multiple species associated with the mouth, including members of the Bacteroides, Firmicutes, and TM7 phyla, while airway microbiota were primarily characterized by a relative expansion of the Proteobacteria. Twenty-two taxa were detected in both niches, including Streptococcus bovis and Chryseobacterium species, pathogens associated with HIV-infected populations. In addition, we compared the airway microbiota of five of these patients to those of five non-HIV-infected pneumonia patients from a previous study. Compared to the control population, HIV-infected patients exhibited relative increased abundance of a large number of phylogenetically distinct taxa, which included several known or suspected pathogenic organisms, suggesting that recurrent pneumonia in HIV-infected populations may be related to the presence of these species.

  8. Inhaled Corticosteroids Increase the Risk of Pneumonia in Patients With Chronic Obstructive Pulmonary Disease


    Lee, Ming-Chia; Lee, Chih-Hsin; Chien, Shu-Chen; Chang, Jer-Hwa; She, Han-Lin; Wang, Jann-Yuan; YU, MING-CHIH


    Abstract The association of inhaled corticosteroids (ICS) and pneumonia in patients with chronic obstructive pulmonary disease (COPD) is still controversial. From the National Health Insurance Database of Taiwan, COPD cases with history of acute exacerbation (AE) were identified (COPD cohort). Time-dependent Cox regression analysis was applied to investigate the risk factors for pneumonia with COPD severity controlled by surrogate variables. Among the COPD cohort, those who continuously used ...

  9. Combined Striatum, Brain Stem, and Optic Nerve Involvement due to Mycoplasma pneumoniae in an Ambulatory Child

    Directory of Open Access Journals (Sweden)

    Jin-Won Bae


    Full Text Available In children, Mycoplasma pneumoniae encephalitis has been characterized by acute onset of an encephalopathy associated with extrapyramidal symptoms and symmetric basal ganglia with or without brain stem involvement on magnetic resonance imaging. Our case, showing unilateral optic neuritis, ophthalmoplegia, no extrapyramidal symptoms, and typical striatal involvement on magnetic resonance imaging, broadens the spectrum of varying clinical manifestations of childhood M. pneumoniae-associated encephalopathy.

  10. Klebsiella Pneumoniae Multi-organ Abscesses not Accompanied by Liver Abscesses: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Taek; Park, Chul Hi; Hwang, Ho Kyung; Lee, Mi Ran; Lee, Dong Hoon; Kim, Min Ji [Dept. of Radiology, Seoul Medical Center, Seoul (Korea, Republic of)


    A Klebsiella pneumoniae infection has a tendency to spread to multiple organs. It is most commonly seen in patients with liver abscesses, but infection in more than three organs without liver abscesses is unusual. We report one case of a K. pneumoniae infection that presented acute pyelonephritis with left perirenal, anterior pararenal, left psoas, and prostate abscesses without liver abscesses in a diabetic patient. With effective antibiotics and ultrasound-guided percutaneous drainage, the patient recovered without significant sequelae.

  11. High-resolution CT findings of varicella-zoster pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Choo, Hye Jeung; Kim, Kun Il [Busan National Univ. Hospital, Busan (Korea, Republic of); Lee, Ki Nam [College of Medicine, Donga Univ., Busan (Korea, Republic of)


    To describe the high-resolution CT findings of varicella-zoster pneumonia. Seven adult patients with clinically and serologically diagnosed varicella-zoster pneumonia underwent HRCT scanning. One had undergone a kidney transplant, and the others were immunocompetent. The HRCT findings were retrospectively analyzed by two radiologists in terms of the presence of a nodule, pneumonia consolidation, ground-glass attenuation and pleural effusion, and with regard to the number, size and distribution of nodules. HRCT findings of varicella pneumonia included nodule (n=7), consolidation (n=3), diffuse ground-glass attenuation (n=1) and pleural effusion (n=1). Nodules were mostly 2-10 mm in size, and multiple (n=6), and zonal predominancy was not apparent. One case in which HRCT demonstrated diffuse ground-glass opacity and slight bilateral pleural effusion involved a patient in whom complications of acute respiratory distress syndrome occured. When HRCT demonstrates the presence of nodules 2-10 mm in size multiple nodules, or nodule surrounded by ground-glass attenuation, or the coalescence of nodules and consolidation is observed in adults with chickenpox, the varicella-zoster pneumonia should be included in the differential diagnosis.

  12. Spatio-temporal dynamics of pneumonia in bighorn sheep (United States)

    Cassirer, E. Frances; Plowright, Raina K.; Manlove, Kezia R.; Cross, Paul C.; Dobson, Andrew P.; Potter, Kathleen A.; Hudson, Peter J.


    Bighorn sheep mortality related to pneumonia is a primary factor limiting population recovery across western North America, but management has been constrained by an incomplete understanding of the disease. We analysed patterns of pneumonia-caused mortality over 14 years in 16 interconnected bighorn sheep populations to gain insights into underlying disease processes. 2. We observed four age-structured classes of annual pneumonia mortality patterns: all-age, lamb-only, secondary all-age and adult-only. Although there was considerable variability within classes, overall they differed in persistence within and impact on populations. Years with pneumonia-induced mortality occurring simultaneously across age classes (i.e. all-age) appeared to be a consequence of pathogen invasion into a naïve population and resulted in immediate population declines. Subsequently, low recruitment due to frequent high mortality outbreaks in lambs, probably due to association with chronically infected ewes, posed a significant obstacle to population recovery. Secondary all-age events occurred in previously exposed populations when outbreaks in lambs were followed by lower rates of pneumonia-induced mortality in adults. Infrequent pneumonia events restricted to adults were usually of short duration with low mortality. 3. Acute pneumonia-induced mortality in adults was concentrated in fall and early winter around the breeding season when rams are more mobile and the sexes commingle. In contrast, mortality restricted to lambs peaked in summer when ewes and lambs were concentrated in nursery groups. 4. We detected weak synchrony in adult pneumonia between adjacent populations, but found no evidence for landscape-scale extrinsic variables as drivers of disease. 5. We demonstrate that there was a >60% probability of a disease event each year following pneumonia invasion into bighorn sheep populations. Healthy years also occurred periodically, and understanding the factors driving these

  13. Circulating Human Eosinophils Share a Similar Transcriptional Profile in Asthma and Other Hypereosinophilic Disorders (United States)

    Barnig, Cindy; Dembélé, Doulaye; Paul, Nicodème; Poirot, Anh; Uring-Lambert, Béatrice; Georgel, Philippe; de Blay, Fréderic; Bahram, Seiamak


    Eosinophils are leukocytes that are released into the peripheral blood in a phenotypically mature state and are capable of being recruited into tissues in response to appropriate stimuli. Eosinophils, traditionally considered cytotoxic effector cells, are leukocytes recruited into the airways of asthma patients where they are believed to contribute to the development of many features of the disease. This perception, however, has been challenged by recent findings suggesting that eosinophils have also immunomodulatory functions and may be involved in tissue homeostasis and wound healing. Here we describe a transcriptome-based approach–in a limited number of patients and controls—to investigate the activation state of circulating human eosinophils isolated by flow cytometry. We provide an overview of the global expression pattern in eosinophils in various relevant conditions, e.g., eosinophilic asthma, hypereosinophilic dermatological diseases, parasitosis and pulmonary aspergillosis. Compared to healthy subjects, circulating eosinophils isolated from asthma patients differed in their gene expression profile which is marked by downregulation of transcripts involved in antigen presentation, pathogen recognition and mucosal innate immunity, whereas up-regulated genes were involved in response to non-specific stimulation, wounding and maintenance of homeostasis. Eosinophils from other hypereosinophilic disorders displayed a very similar transcriptional profile. Taken together, these observations seem to indicate that eosinophils exhibit non-specific immunomodulatory functions important for tissue repair and homeostasis and suggest new roles for these cells in asthma immunobiology. PMID:26524763

  14. 5-Lipoxygenase-Dependent Recruitment of Neutrophils and Macrophages by Eotaxin-Stimulated Murine Eosinophils

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    Ricardo Alves Luz


    Full Text Available The roles of eosinophils in antimicrobial defense remain incompletely understood. In ovalbumin-sensitized mice, eosinophils are selectively recruited to the peritoneal cavity by antigen, eotaxin, or leukotriene(LTB4, a 5-lipoxygenase (5-LO metabolite. 5-LO blockade prevents responses to both antigen and eotaxin. We examined responses to eotaxin in the absence of sensitization and their dependence on 5-LO. BALB/c or PAS mice and their mutants (5-LO-deficient ALOX; eosinophil-deficient GATA-1 were injected i.p. with eotaxin, eosinophils, or both, and leukocyte accumulation was quantified up to 24 h. Significant recruitment of eosinophils by eotaxin in BALB/c, up to 24 h, was accompanied by much larger numbers of recruited neutrophils and monocytes/macrophages. These effects were abolished by eotaxin neutralization and 5-LO-activating protein inhibitor MK886. In ALOX (but not PAS mice, eotaxin recruitment was abolished for eosinophils and halved for neutrophils. In GATA-1 mutants, eotaxin recruited neither neutrophils nor macrophages. Transfer of eosinophils cultured from bone-marrow of BALB/c donors, or from ALOX donors, into GATA-1 mutant recipients, i.p., restored eotaxin recruitment of neutrophils and showed that the critical step dependent on 5-LO is the initial recruitment of eosinophils by eotaxin, not the secondary neutrophil accumulation. Eosinophil-dependent recruitment of neutrophils in naive BALB/c mice was associated with increased binding of bacteria.

  15. Specific regulator of eosinophil apoptosis: Siglec-8-new hope for bronchial asthma treatment

    Institute of Scientific and Technical Information of China (English)

    FENG Yin-he; MAO Hui


    Objective It is known that Siglec-8 is selectively expressed on human eosinophils at a high level and mediates eosinophil apoptosis when crosslinked with its antibody.The aim of our review is to elucidate the molecular and biological characteristic of Siglec-8 and then discuss the function and possible mechanisms of Siglec-8 in eosinophils.Thereby,we will expand our understanding to the regulation of eosinophil apoptosis,and provide important clues to the treatment of asthma and other hyper-eosinophilic diseases.Data sources Most articles were identified by searching of PubMed online resources using the key term Siglecs.Study selection Mainly original milestone articles and critical reviews written by major pioneer investigators in the field were selected.Results Siglec-8 is selectively expressed on human eosinophil and can specifically induce eosinophil apoptosis.Conclusion The restricted expression of Siglec-8 on human eosinophil and the rapid progress in understanding its role as cell signaling and activation of death receptors have made it an attractive target for treatment of asthma and other hyper-eosinophilic diseases.


    Directory of Open Access Journals (Sweden)

    Yu. V. Kolobovnikova


    Full Text Available Eosinophils are polyfunctional leukocytes detected in excess in blood and in the focus of granulomatous inflammation in pulmonary TB.The research objective was to evaluate the adhesive properties as well as cytokine-secretory and antibacterial activity of blood eosinophils in pulmonary TB.The research has been conducted on eosinophils isolated from peripheral blood of 43 patients with freshly identified progressive destructive TB with and without eosinophilia. Using flow cytometry and ELISA, expression of CD9 and CD18 adhesion molecules on blood eosinophils has been studied along with the phagocyte and cytokine-secretory functions and activity of eosinophil granulocyte peroxidase.As a result of the research it has been established that in TB patients with eosinophilia the number of CD18-expressing eosinophils rises, whereas the amount of CD9+ remains within norm. Activation of the phagocyte function of blood eosinophil granulocytes is associated with the decrease in eosinophil peroxidase activity, while the increase in IL-5 and TNFα secretory reactivity is connected with oppositely directed changes in  IL-2 basal secretion by eosinophils in vitro (a fall in infiltrative TB and a rise in disseminated TB.

  17. Dyspnea and Wheezing after Adenosine Injection in a Patient with Eosinophilic Bronchitis

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    Rodrigo Cartin-Ceba


    Full Text Available A 58-year-old nonsmoker female was referred for evaluation of chronic cough of 13 months duration. After an initial work-up, the patient was diagnosed to have chronic cough due to eosinophilic bronchitis. The diagnostic work-up for eosinophilic bronchitis and bronchial biopsy is discussed. Eosinophilic bronchitis is differentiated from asthma. In addition, the patient developed dyspnea, flushing, and wheezing after the administration of adenosine during a cardiac stress test in spite of a negative methacholine challenge. This indirect stimulus of airway hyperresponsiveness suggests the possible involvement of mast cells in eosinophilic bronchitis.

  18. Persistence and complex evolution of fluoroquinolone-resistant Streptococcus pneumoniae clone. (United States)

    Ben-David, Debby; Schwaber, Mitchell J; Adler, Amos; Masarwa, Samira; Edgar, Rotem; Navon-Venezia, Shiri; Schwartz, David; Porat, Nurith; Kotlovsky, Tali; Polivkin, Nikolay; Weinberg, Irina; Lazary, Avraham; Ohana, Nissim; Dagan, Ron


    Prolonged outbreaks of multidrug-resistant Streptococcus pneumoniae in health care facilities are uncommon. We found persistent transmission of a fluroquinolone-resistant S. pneumoniae clone during 2006-2011 in a post-acute care facility in Israel, despite mandatory vaccination and fluoroquinolone restriction. Capsular switch and multiple antimicrobial nonsusceptibility mutations occurred within this single clone. The persistent transmission of fluoroquinolone-resistant S. pneumoniae during a 5-year period underscores the importance of long-term care facilities as potential reservoirs of multidrug-resistant streptococci.

  19. Klebsiella pneumoniae FimK Promotes Virulence in Murine Pneumonia. (United States)

    Rosen, David A; Hilliard, Julia K; Tiemann, Kristin M; Todd, Elizabeth M; Morley, S Celeste; Hunstad, David A


    Klebsiella pneumoniae, a chief cause of nosocomial pneumonia, is a versatile and commonly multidrug-resistant human pathogen for which further insight into pathogenesis is needed. We show that the pilus regulatory gene fimK promotes the virulence of K. pneumoniae strain TOP52 in murine pneumonia. This contrasts with the attenuating effect of fimK on urinary tract virulence, illustrating that a single factor may exert opposing effects on pathogenesis in distinct host niches. Loss of fimK in TOP52 pneumonia was associated with diminished lung bacterial burden, limited innate responses within the lung, and improved host survival. FimK expression was shown to promote serum resistance, capsule production, and protection from phagocytosis by host immune cells. Finally, while the widely used K. pneumoniae model strain 43816 produces rapid dissemination and death in mice, TOP52 caused largely localized pneumonia with limited lethality, thereby providing an alternative tool for studying K. pneumoniae pathogenesis and control within the lung.

  20. Bacteremic pneumonia caused by extensively drug-resistant Streptococcus pneumoniae. (United States)

    Kang, Cheol-In; Baek, Jin Yang; Jeon, Kyeongman; Kim, So Hyun; Chung, Doo Ryeon; Peck, Kyong Ran; Lee, Nam Yong; Song, Jae-Hoon


    The emergence of antimicrobial resistance threatens the successful treatment of pneumococcal infections. Here we report a case of bacteremic pneumonia caused by an extremely drug-resistant strain of Streptococcus pneumoniae, nonsusceptible to at least one agent in all classes but vancomycin and linezolid, posing an important new public health threat in our region.

  1. A comparative study of induction of pneumonia in mice with planktonic and biofilm cells of Klebsiella pneumoniae. (United States)

    Sharma, Sonica; Mohan, Harsh; Sharma, Saroj; Chhibber, Sanjay


    In the present study, the course of acute pneumonia in normal BALB/c mice infected by intranasal inoculation of planktonic and preformed biofilm cells (3 days old) of Klebsiella pneumoniae B5055 was studied and compared. With both cell forms the peak of infection was observed on the third post infection day, as assessed on the basis of lung bacterial load and corresponding pathology. There was an intense neutrophil infiltration in bronchoalveolar lavage fluid. Tissue damage was assessed on the basis of increased amounts of nitrite, malondialdehyde and lactate dehydrogenase in lung homogenates. The phagocytic potential of alveolar macrophages was lower in biofilm cell-induced infection than in that induced by planktonic cells. Biofilm cell induced infection generated significantly greater production of tumor necrosis factor-α and interleukin-1β on the third and fifth days of infection, respectively. Production of interleukin-10 was, however, variable. There was no significant difference in the ability of planktonic and biofilm cell forms of K. pneumoniae to induce acute pneumonia in mice in terms of bacterial counts and histopathological changes. However, biofilm cell-induced infection showed delayed clearance as compared to infection induced with the planktonic form.

  2. Successful early diagnosis and treatment in a case of Toxocara canis-induced eosinophilic myocarditis with eosinophil-rich pericardial effusion. (United States)

    Sangen, Hideto; Tanabe, Jun; Takano, Hitoshi; Shimizu, Wataru


    Fulminant myocarditis can become fatal if left untreated. Treatments for most types of myocarditis, including mechanical support, are limited. However, immediate systemic corticosteroids are known to be effective against eosinophilic myocarditis; therefore, prompt diagnosis of this disease is crucial. Unfortunately, the standard diagnostic tool for myocarditis, endomyocardial biopsy, does not provide immediate histopathological findings. Thus, a rapid diagnostic tool for identifying types of myocarditis is urgently required. We report here the first case of Toxocara canis-induced eosinophilic fulminant myocarditis which was diagnosed based on eosinophil-rich pericardial effusion where the patient recovered with early corticosteroid therapy.

  3. Chlamydia pneumoniae in the atherosclerotic plaques of coronary artery disease patients.

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    Morteza Izadi


    Full Text Available An association between Chlamydia pneumoniae (C. pneumoniae and cardiovascular disease has been demonstrated. In this study, we aimed to study this potential relationship in 105 Iranian patients. Coronary artery specimens from 105 Iranian patients undergoing CABG were analyzed by PCR method for C. pneumoniae. Serological evaluation for C. pneumoniae IgG and IgM was performed using ELISA. 53 specimens from mamillary artery were also investigated. C. pneumoniae PCR test result was positive for 23 (21.9% of patients with coronary artery atherosclerosis, but none of the specimens from the mamillary artery was positive for C. pneumoniae when it was evaluated by the PCR (P<0.001. Coronary artery disease patients with and without a history of unstable angina or myocardial infarction were comparable in C. pneumoniae PCR test positive rates (P=0.618. Relevance of IgG and IgM positivity were also studied by correlating it to the study parameters, but no difference was found. CRP was significantly higher in the IgM positive group (P<0.001. A significant proportion of coronary atherosclerotic plaques are infected with C. pneumoniae while no infection was found in the normal mamillary artery specimens. No association was found between acute coronary syndromes and serological and PCR positivity. Further prospective randomized controlled studies with large patient population are needed to confirm our findings.

  4. Multi-Drug-Resistant Klebsiella pneumoniae Pancreatitis: A New Challenge in a Serious Surgical Infection (United States)

    Tugal, Derin; Lynch, Melanie; Hujer, Andrea M.; Rudin, Susan; Perez, Federico


    Abstract Background: Klebsiella pneumoniae is an important cause of nosocomial infections, but its role in severe acute pancreatitis (SAP) is not well defined. Few cases of K. pneumoniae associated SAP have been reported. Due to the emergence of extended-spectrum beta-lactamases (ESBLs) and carbapenemases, treatment of multidrug-resistant (MDR) K. pneumoniae presents a challenge. Tigecycline and colistin have gained recent attention for their broad-spectrum antimicrobial activity. Methods: We describe a case of SAP due to K. pneumoniae bearing K. pneumoniae carbapenemase (KPC) treated successfully with colistin plus tigecycline and offer a review of similar experiences published in the literature. Results: The case reported herein required surgical drainage of multiple pancreatic abscesses and treatment with tigecycline and colistin. Our comparative analysis revealed a number of unique features associated with SAP due to K. pneumoniae: 1) underlying pancreatic injury, 2) multiple drug resistance determinants and virulence factors that complicate treatment, and 3) surgical debridement as a requirement for cure. Conclusion: As the prevalence of K. pneumoniae bearing KPC continues to increase in the healthcare setting, SAP caused by this MDR pathogen will become more common. Tigecycline plus colistin was a successful antibiotic regimen for the treatment of SAP due to K. pneumoniae bearing KPC. PMID:24850293

  5. Enteral Tube Feeding and Pneumonia (United States)

    Gray, David Sheridan; Kimmel, David


    To determine the effects of enteral tube feeding on the incidence of pneumonia, we performed a retrospective review of all clients at our institution who had gastrostomy or jejunostomy tubes placed over a 10-year period. Ninety-three subjects had a history of pneumonia before feeding tube insertion. Eighty had gastrostomy and 13, jejunostomy…

  6. Investigation of the sensitivities of two different serotypes of Streptococcus pneumoniae in C57BL/6mice with acute otitis media%两种不同血清型肺炎链球菌致C57BL/6小鼠急性中耳炎的敏感性差异

    Institute of Scientific and Technical Information of China (English)

    王维; 周爱娥; 黄益飞; 项云; 何於娟


    目的 比较两种不同血清型肺炎链球菌致C57BL/6小鼠急性中耳炎的敏感性.方法 实验组C57BL/6小鼠经鼓膜穿刺分别接种血清型为TIGR4和6B的肺炎链球菌,对照组采用相同方法接种等体积磷酸盐缓冲液(PBS).观察小鼠发病情况,分别于感染后第1、3、5、7天制备中耳组织切片,HE染色观察中耳组织损伤及炎性细胞浸润变化,同时收集中耳灌洗液,检测灌洗液中细菌载量、炎性细胞数量和细胞因子含量.结果 6B组小鼠生存率明显低于TIGR4组和PBS对照组,差异具有统计学意义(P<0.01).接种肺炎链球菌后,小鼠中耳灌洗液中以中性粒细胞为主,TIGR4组募集的炎性细胞数量明显多于6B组;中耳灌洗液中白细胞介素6和肿瘤坏死因子α含量明显升高,其中TIGR4组细胞因子水平均明显高于6B组;6B组小鼠中耳内的细菌清除更慢.结论 在C57 BL/6小鼠急性中耳炎模型中,6B型肺炎链球菌比TIGR4型致病性更强.%Objective To compare the sensitivities of two different serotypes of Streptococcus pneumoniae in acute otitis media of C57BL/6 mice.Methods The middle ear cavity of C57BL/6 mice were inoculated via intratympanic injection of Streptococcus pneumoniae TIGR4 or 6B 1 × 108 CFU,and the control group were inoculated equivalent phosphate buffered solution (PBS).The incidence of mice,development of otitis media and the middle ear lavage fluid pathological changes by HE staining,as well as cell counts and cytokine levels were investigated.Results After inoculated with Streptococcus pneumoniae TIGR4,6B and PBS,the survival rate of 6B group was significantly less than TIGR4 group and PBS control group (P <0.01).Inflammatory cells in the middle ear cavity were mainly neutrophils,and the inflammatory cells recruitment in TIGR4 group were more than 6B group; The levels of IL-6 and TNF-α in the middle ear lavage fluid in T1GR4 group and 6B group were significantly increased compared with PBS

  7. Lymphocytic Interstitial Pneumonia. (United States)

    Panchabhai, Tanmay S; Farver, Carol; Highland, Kristin B


    Lymphocytic interstitial pneumonia (LIP) is a rare lung disease on the spectrum of benign pulmonary lymphoproliferative disorders. LIP is frequently associated with connective tissue diseases or infections. Idiopathic LIP is rare; every attempt must be made to diagnose underlying conditions when LIP is diagnosed. Computed tomography of the chest in patients with LIP may reveal ground-glass opacities, centrilobular and subpleural nodules, and randomly distributed thin-walled cysts. Demonstrating polyclonality with immunohistochemistry is the key to differentiating LIP from lymphoma. The 5-year mortality remains between 33% and 50% and is likely to vary based on the underlying disease process.

  8. Role of IgE in Eosinophilic Otitis Media

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    Yukiko Iino


    Full Text Available Eosinophilic otitis media (EOM is an intractable otitis media characterized by the presence of a highly viscous yellow effusion containing eosinophils. It mainly occurs in patients with bronchial asthma and is resistant to conventional treatments for otitis media. Here we discuss the role of IgE in the pathogenesis of EOM. In middle ear effusion, a significantly higher IgE level was detected in EOM patients than in control patients with common otitis media with effusion. This IgE level was significantly higher (about 10 fold than the serum IgE level. In addition, many IgE-immunopositive cells were found in the middle ear mucosa. The IgE staining was mainly observed on mast cell surfaces, but also partially in the cytoplasm of cells that appeared to be plasma cells. These results suggested that IgE is produced locally in the middle ear mucosa. The existence of high-level IgE may exacerbate eosinophilic inflammation in the middle ear. One of the most distinct characteristics of EOM is the high incidence of sensory hearing loss independent of age. High-tone hearing loss is more frequently found and more severe in EOM patients than in control patients with common chronic otitis media. The concentration of IgE in middle ear effusion significantly and positively correlated with bone conduction hearing levels at 2 kHz and 4 kHz in EOM patients. Overproduction of IgE locally in the middle ear may be related to the pathological condition of EOM and eventually cause inner ear damage.

  9. GM-CSF Differentially Regulates Eosinophil and Neutrophil Adhesive Interactions with Vascular Endothelium in Vivo

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    Nooshin Sheikh Bahaie


    Full Text Available Allergic airway inflammation is characterized by elaboration of cytokines and chemokines leading to recruitment of inflammatory leukocytes, predominantly eosinophils, to the airways. Granulocyte macrophage colony stimulating factor (GM-CSF is generated in the lungs of human subjects with asthma in response to allergen challenge and is necessary for the development of allergen-induced bronchial eosinophilia in mice. The effect of GM-CSF on human eosinophil and neutrophil interactions with the vascular endothelium under conditions of blood flow was investigated in post-capillary venules of the rabbit mesentery by intravital microscopy.While GM-CSF significantly reduced the rolling fraction of neutrophils in vivo and induced consistent shedding of neutrophil L-selectin in vitro, its effect on eosinophil rolling was variable. Eosinophils from 57% of the donors demonstrated inhibition of rolling, while eosinophils from the remaining 43% of donors demonstrated no inhibition or increased rolling. The variable effect of GM-CSF on inhibition of eosinophil rolling was associated with variable shedding of L-selectin in vitro. In contrast to the differential effect of GM-CSF on neutrophils versus eosinophils, stimulation with phorbol myristate acetate demonstrated a similar degree of inhibition of rolling and L-selectin shedding by neutrophils and eosinophils suggesting that there was no defect in L-selectin shedding in the eosinophil donors who did not respond to GM-CSF. Overall, these studies demonstrate that GM-CSF consistently inhibits interaction of neutrophils with endothelium in vivo, whereas its effect on eosinophil-endothelial interactions is variable. GM-CSF may thus be one factor accounting for the varying percentage of eosinophils and neutrophils recruited to sites of allergic inflammation in different individuals.

  10. Eosinophilic gastroenteritis with cytomegalovirus infection in an immunocompetent child

    Institute of Scientific and Technical Information of China (English)

    Junji Takeyama; Daiki Abukawa; Katsushi Miura


    A 3-year-old boy developed transient protein-losing gastroenteropathy associated with cytomegalovirus (CMV) infection. Both IgG and IgM antibodies to CMV were positive in a serologic blood test. Upper gastrointestinal endoscopy showed multiple erosions throughout the body of the stomach, without enlarged gastric folds. Histological examination of the biopsy specimens indicated eosinophilic gastroenteritis and CMV infection. The patient had complete resolution without specific therapy for CMV in four weeks. An allergic reaction as well as CMV infection played important roles in the pathogenesis of this case.

  11. Myeloprolipherative disorder type chronic myeloid leukemia--eosinophilic form. (United States)

    Arnautovic-Custovic, Aida; Hasic, Samira; Kopic, Emina; Jahic, Azra; Jovic, Svetlana


    Chronic eosinophilic leukemia (CEL) is a very rare form of leucemia in the western world. Adequate response is seldomly achieved after treatment with corticosteroids, interferon-alfa (INF-alfa) and medications containing hydroxi-urea (Litalir). The study presents a patient with CEL with no initial therapeutic response to the use of corticosteroids, INF-alfa and hydroxy-urea, and with neither clinical nor hematological response. After setting a diagnosis of CEL, patient was ordinated Imatinib (Glivec tabbletes) in a daily dose of 200 mg. Two days afterwards there was an evident withdrawal of subjective and clinical symptoms of disease, and the complete blood count showed significant amendment.

  12. Are Pathogenic Leptospira Species Agents of Community-Acquired Pneumonia? Case Reports of Leptospirosis Presenting as Pneumonia. (United States)

    Gasem, M Hussein; Farida, Helmia; Ahmed, Ahmed; Severin, Juliţte A; Suryanto, Agus; Isbandrio, Bambang; Verbrugh, Henri A; Hartskeerl, Rudy A; van den Broek, Peterhans J


    We report four Indonesian cases meeting the clinical and radiological criteria for community-acquired pneumonia and other findings suggestive of leptospirosis. Quantitative PCR (qPCR) analyses of serum and urine samples and serology confirmed the diagnosis of leptospirosis in each. Results of qPCR analysis of throat swabs were concordant with those obtained with acute-phase serum samples, which suggests its potential for use as a noninvasive diagnostic tool for leptospirosis.

  13. Granzyme A impairs host defense during Streptococcus pneumoniae pneumonia. (United States)

    van den Boogaard, Florry E; van Gisbergen, Klaas P J M; Vernooy, Juanita H; Medema, Jan P; Roelofs, Joris J T H; van Zoelen, Marieke A D; Endeman, Henrik; Biesma, Douwe H; Boon, Louis; Van't Veer, Cornelis; de Vos, Alex F; van der Poll, Tom


    Streptococcus pneumoniae is the most common causative pathogen in community-acquired pneumonia (CAP). Granzyme A (GzmA) is a serine protease produced by a variety of cell types involved in the immune response. We sought to determine the role of GzmA on the host response during pneumococcal pneumonia. GzmA was measured in bronchoalveolar lavage fluid (BALF) harvested from CAP patients from the infected and contralateral uninfected side and in lung tissue slides from CAP patients and controls. In CAP patients, GzmA levels were increased in BALF obtained from the infected lung. Human lungs showed constitutive GzmA expression by both parenchymal and nonparenchymal cells. In an experimental setting, pneumonia was induced in wild-type (WT) and GzmA-deficient (GzmA(-/-)) mice by intranasal inoculation of S. pneumoniae In separate experiments, WT and GzmA(-/-) mice were treated with natural killer (NK) cell depleting antibodies. Upon infection with S. pneumoniae, GzmA(-/-) mice showed a better survival and lower bacterial counts in BALF and distant body sites compared with WT mice. Although NK cells showed strong GzmA expression, NK cell depletion did not influence bacterial loads in either WT or GzmA(-/-) mice. These results implicate that GzmA plays an unfavorable role in host defense during pneumococcal pneumonia by a mechanism that does not depend on NK cells.

  14. Antimicrobial Resistant Streptococcus pneumoniae

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    B Khanal


    Full Text Available Introduction: Pneumococcal infections are important cause of morbidity and mortality. Knowledge of antimicrobial susceptibility patterns plays important role in the selection of appropriate therapy. Present study was undertaken to analyze the susceptibility patterns of pneumococcal isolates against commonly used antimicrobials with special reference to determination of minimum inhibitory concentration (MIC of penicillin in a tertiary care hospital in eastern Nepal. Methods: Twenty-six strains of S. pneumoniae isolated from various clinical specimens submitted to microbiology laboratory were evaluated. All isolates were tested for antimicrobial susceptibility by disk diffusion method. MIC of penicillin was tested by broth dilution method. Results: Of the total isolates 19 (73% were from invasive infections. Seven isolates were resistant to cotrimoxazole. No resistance to penicillin was seen in disk diffusion testing. Less susceptibility to penicillin (MIC 0.1-1.0 mg/L was observed in five (17% isolates. High level resistance to penicillin was not detected. One isolate was multidrug resistant. Conclusions: S. pneumoniaeisolates with intermediate resistance to penicillin prevail in Tertiary Care Hospital in eastern Nepal, causing invasive and noninvasive infections. As intermediate resistance is not detected in routine susceptibility testing, determination of MIC is important. It helps not only in the effective management of life threatening infections but is also essential in continuous monitoring and early detection of resistance. In addition, further study on pneumococcal infections, its antimicrobial resistance profile and correlation with clinical and epidemiological features including serotypes and group prevalence is recommended in future. Keywords: antimicrobial susceptibility pattern, penicillin, Streptococcus pneumoniae.

  15. Pneumonia's second wind? A case study of the global health network for childhood pneumonia. (United States)

    Berlan, David


    Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues. Through document review and interviews with current, former and potential network members, this case study identifies five distinct eras of activity against childhood pneumonia: a period of isolation (post WWII to 1984), the duration of WHO's Acute Respiratory Infections (ARI) Programme (1984-1995), Integrated Management of Childhood illness's (IMCI) early years (1995-2003), a brief period of network re-emergence (2003-2008) and recent accelerating progress (2008 on). Analysis of these eras reveals the critical importance of building a shared identity in order to form an effective network and take advantage of emerging opportunities. During the ARI era, an initial network formed around a relatively narrow shared identity focused on community-level care. The shift to IMCI led to the partial dissolution of this network, stalled progress on addressing pneumonia in communities and missed opportunities. Frustrated with lack of progress on the issue, actors began forming a network and shared identity that included a broad spectrum of those whose interests overlap with pneumonia. As the network coalesced and expanded, its members coordinated and collaborated on conducting and sharing research on severity and tractability, crafting comprehensive strategies and conducting advocacy. These network activities exerted indirect influence leading to increased attention, funding, policies and some implementation.

  16. Effect of selective phosphodiesterase inhibitors on the rat eosinophil chemotactic response in vitro

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    Alessandra C Alves


    Full Text Available In the present study, we have performed a comparative analysis of the effect of selective inhibitors of phosphodiesterase (PDE type III, IV and V on eosinophil chemotaxis triggered by platelet activating factor (PAF and leukotriene B4 (LTB4 in vitro. The effect of the analogues N6-2'-O-dibutyryladenosine 3':5' cyclic monophosphate (Bt2 cyclic AMP and N2-2'-O- dibutyrylguanosine 3':5' cyclic monophosphate (Bt2 cyclic GMP has also been determined. The eosinophils were obtained from the peritoneal cavity of naive Wistar rats and purified in discontinuous Percoll gradients to 85-95% purity. We observed that pre-incubation of eosinophils with the PDE type IV inhibitor rolipram suppressed the chemotactic response triggered by PAF and LTB4, in association with an increase in the intracellular levels of cyclic AMP. In contrast, neither zaprinast (type V inhibitor nor type III inhibitors milrinone and SK&F 94836 affected the eosinophil migration. Only at the highest concentration tested did the analogue Bt2 cyclic AMP suppress the eosinophil chemotaxis, under conditions where Bt2 cyclic GMP was ineffective. We have concluded that inhibition of PDE IV, but not PDE III or V, was able to block the eosinophil chemotaxis in vitro, suggesting that the suppressive activity of selective PDE IV inhibitors on tissue eosinophil accumulation may, at least, be partially dependent on their ability to directly inhibit the eosinophil migration.

  17. A flow-cytometric method to evaluate eosinophil-mediated uptake of probiotic Lactobacillus reuteri. (United States)

    Kraemer, Laura S; Brenner, Todd A; Krumholz, Julia O; Rosenberg, Helene F


    Eosinophils are resident leukocytes of gut mucosa. Here we present a combined flow cytometric-antibiotic protection assay to identify mouse eosinophils capable of bacterial uptake, specifically, Gram-positive Lactobacillus reuteri, in studies performed ex vivo. The assay may be adapted for use in vivo.

  18. Morphology and staining behavior of neutrophilic and eosinophilic granulocytes of the common marmoset (Callithrix jacchus). (United States)

    Bleyer, Martina; Curths, Christoph; Dahlmann, Franziska; Wichmann, Judy; Bauer, Natali; Moritz, Andreas; Braun, Armin; Knauf, Sascha; Kaup, Franz-Josef; Gruber-Dujardin, Eva


    Common marmosets (Callithrix jacchus) are frequently used as translational animal models for human diseases. However, a comparative study of cytological and histochemical detection methods as well as morphometric and ultrastructural characterization of neutrophils and eosinophils in this species is lacking. Blood samples of house dust mite sensitized and allergen challenged as well as lipopolysaccharide (LPS) challenged marmosets were analyzed with different cytological and histological staining methods. Furthermore, cell size and number of nuclear segments were compared between neutrophils and eosinophils. Electron microscopy was performed to characterize the ultrastructure of granulocytes. Of all applied cytological stains, three allowed differentiation of eosinophils and neutrophils and, thus, reliable quantification in blood smears: May-Grünwald-Giemsa stain, Congo Red and Naphthol AS-D Chloroacetate-Esterase. For histology, Hematoxylin-Eosin (H&E) could not demonstrate clear differences, whereas Sirius Red, Congo Red, and Naphthol AS-D Chloroacetate Esterase showed capable results for identification of eosinophils or neutrophils in lung tissue. Morphometry revealed that marmoset neutrophils have more nuclear segments and are slightly larger than eosinophils. Ultrastructurally, eosinophils presented with large homogeneous electron-dense granules without crystalloid cores, while neutrophils were characterized by heterogeneous granules of different size and density. Additionally, sombrero-like vesicles were detected in tissue eosinophils of atopic marmosets, indicative for hypersensitivity-related piecemeal degranulation. In conclusion, we provide a detailed overview of marmoset eosinophils and neutrophils, important for phenotypic characterization of marmoset models for human airway diseases.

  19. Sequence variants affecting eosinophil numbers associate with asthma and myocardial infarction

    NARCIS (Netherlands)

    Gudbjartsson, Daniel F.; Bjornsdottir, Unnur S.; Halapi, Eva; Helgadottir, Anna; Sulem, Patrick; Jonsdottir, Gudrun M.; Thorleifsson, Gudmar; Helgadottir, Hafdis; Steinthorsdottir, Valgerdur; Stefansson, Hreinn; Williams, Carolyn; Hui, Jennie; Beilby, John; Warrington, Nicole M.; James, Alan; Palmer, Lyle J.; Koppelman, Gerard H.; Heinzmann, Andrea; Krueger, Marcus; Boezen, H. Marike; Wheatley, Amanda; Altmuller, Janine; Shin, Hyoung Doo; Uh, Soo-Taek; Cheong, Hyun Sub; Jonsdottir, Brynja; Gislason, David; Park, Choon-Sik; Rasmussen, Linda M.; Porsbjerg, Celeste; Hansen, Jakob W.; Backer, Vibeke; Werge, Thomas; Janson, Christer; Joensson, Ulla-Britt; Ng, Maggie C. Y.; Chan, Juliana; So, Wing Yee; Ma, Ronald; Shah, Svati H.; Granger, Christopher B.; Quyyumi, Arshed A.; Levey, Allan I.; Vaccarino, Viola; Reilly, Muredach P.; Rader, Daniel J.; Williams, Michael J. A.; van Rij, Andre M.; Jones, Gregory T.; Trabetti, Elisabetta; Malerba, Giovanni; Pignatti, Pier Franco; Boner, Attilio; Pescollderungg, Lydia; Girelli, Domenico; Olivieri, Oliviero; Martinelli, Nicola; Ludviksson, Bjorn R.; Ludviksdottir, Dora; Eyjolfsson, Gudmundur I.; Arnar, David; Thorgeirsson, Gudmundur; Deichmann, Klaus; Thompson, Philip J.; Wjst, Matthias; Hall, Ian P.; Postma, Dirkje S.; Gislason, Thorarinn; Gulcher, Jeffrey; Kong, Augustine; Jonsdottir, Ingileif; Thorsteinsdottir, Unnur; Stefansson, Kari


    Eosinophils are pleiotropic multifunctional leukocytes involved in initiation and propagation of inflammatory responses and thus have important roles in the pathogenesis of inflammatory diseases. Here we describe a genome-wide association scan for sequence variants affecting eosinophil counts in blo

  20. Eosinophillic myocarditis and coronary arteritis in a fatal case of asthma

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    Rupani Asha


    Full Text Available Mortality is very unusual in the case of asthma. We recently came across a fatal case of asthma which showed a rare combination of unusual complications like eosinophilic myocarditis, coronary arteritis, biventricular cardiac hypertrophy, eosinophilic pneumonitis and pulmonary hypertension.