WorldWideScience

Sample records for pneumonia differential diagnosis

  1. Radiographic features of Mycoplasma pneumoniae pneumonia: differential diagnosis and performance timing

    International Nuclear Information System (INIS)

    Miyashita, Naoyuki; Sugiu, Tadaaki; Kawai, Yasuhiro; Oda, Keiko; Yamaguchi, Tetsuya; Ouchi, Kazunobu; Kobashi, Yoshihiro; Oka, Mikio

    2009-01-01

    The Japanese Respiratory Society guidelines propose a differential diagnosis for atypical pneumonia and bacterial pneumonia using a scoring system for the selection of appropriate antibiotic. In order to improve this scoring system, the guidelines are seeking new specific parameter. The purpose of this study was to clarify the pattern of abnormalities with Mycoplasma pneumoniae pneumonia on chest computed tomography (CT) and whether the radiographic findings could distinguish M. pneumoniae pneumonia from Streptococcus pneumoniae pneumonia. A retrospective review was performed of the CT findings of 64 cases and 68 cases where M. pneumoniae and S. pneumoniae, respectively, were the only pathogen identified by the panel of diagnostic tests used. Of the 64 patients with M. pneumoniae pneumonia, bronchial wall thickening was observed most frequently (81%), followed by centrilobular nodules (78%), ground-glass attenuation (78%), and consolidation (61%). Bronchial wall thickening and centrilobular nodules were observed more often in M. pneumoniae patients than in S. pneumoniae patients (p < 0.0001). The presence of bilateral bronchial wall thickening or centrilobular nodules was only seen in patients with M. pneumoniae pneumonia. Using the scoring system of the Japanese Respiratory Society guidelines and chest CT findings, 97% of M. pneumoniae patients were suspected to be M. pneumoniae pneumonia without serology. When comparing the CT findings between early stage and progressed stage in the same patients with severe pneumonia, the radiographic features of early stage M. pneumoniae pneumonia were not observed clearly in the progressed stage. The present results indicate that the diagnosis of M. pneumoniae pneumonia would appear to be reliable when found with a combination of bronchial wall thickening and centrilobular nodules in the CT findings. However, these CT findings are not observed in progressed severe M. pneumoniae pneumonia patients

  2. Acute solitary localized pneumonia: CT diagnosis

    International Nuclear Information System (INIS)

    Li Tieyi

    1999-01-01

    Objective: To evaluate CT in the differential diagnosis of solitary localized pneumonia. Method: Only plain CT without contrast study was done because of different types of CT scanners weed. There were 25 cases with localized pneumonia with initial diagnosis as suspected peripheral bronchogenic carcinoma. All patients were over forty years of age, 84% 50-80 years, 13(52%) patients were asymptomatic, 5(20%) patients had bloody sputum. Results: The CT features were divided into three patterns: (1) irregular nodule with relatively well-defined margin, ground-glass opacity and a few punctuate high densities. (2) irregular nodule with sharply circumscribed, spiculate border and homogeneous density. (3) regular nodule with relatively well-defined margin, and homogeneous density. The third type was most frequent (60%) with predilection for the dorsal segments of the lower lobes, or the posterior basal segments. Of the 25 patients 3 had operation, the remaining cases were treated as pneumonia, the lesions were resolved in 18(82%) patients in 2-3 weeks. Conclusions: Sometimes it is very difficult to differentiate localized pneumonia from peripheral lung cancer on the basis of clinical presentation and imaging. The spiculate margins of irregular nodule shown on CT could be indeterminate on chest radiography, and as a result chest radiograph is helpful in differential diagnosis of localized pneumonia. Change in size of the lesion as observed at the same cross-section scan, smaller at mediastinal window than at lung window is in favor of localized pneumonia, however, with the exception of alveolar carcinoma, treatment with antibiotic therapy for a period of 2-3 weeks, helps differentiate these diseases

  3. Evaluation of usefulness of thallium-201-SPECT and CT images in differential diagnosis between organizing pneumonia and primary lung cancer

    International Nuclear Information System (INIS)

    Nakamura, Kazuhiko; Fujiwara, Yoshio; Ogawa, Hirofumi; Nakano, Kenji; Ogawa, Toshihide

    2007-01-01

    We tried differential diagnosis between organizing pneumonia and primary lung cancer using CT and 201 Tl single photon emission computed tomography (SPECT) images. CT images were estimated margin, air space consolidation, air bronchogram, ground-glass attenuation, spicula and indentation of the lesions. 201 Tl SPECT images were evaluated early and delayed lesion-to-normal contralateral lung uptake ratio (ER and DR) and retention index (RI). Clearness of margin and ground-glass attenuation of CT images of organizing pneumonia were significant different from those of primary lung cancer. On the other hand, DR and RI of organizing pneumonia were significant lower than those of primary lung cancer. We emphasized that 201 Tl SPECT was useful to evaluate differential diagnosis between organizing pneumonia and primary lung cancer. (author)

  4. Noninfectious differential diagnoses of pneumonia

    International Nuclear Information System (INIS)

    Wielandner, A.; Toelly, A.; Agarwal, P.; Bardach, C.

    2017-01-01

    In patients with a clinical suspicion of pneumonia, typical clinical and laboratory features along with the detection of infiltrates on chest X-ray are as a rule considered diagnostic and therapy is immediately initiated; however, studies have shown that in up to 5% of patients with an initial suspicion of pneumonia, another noninfectious pulmonary disease was the underlying cause. Early recognition and differentiation of diseases mimicking pneumonia are prerequisites for an adequate therapy. The aim of this review is to present the important noninfectious differential diagnoses of pneumonia and to provide the reader with tools for a systematic diagnostic approach. A literature search was carried out. As alterations in the lungs often result in similar imaging appearances and a differentiation between transudates, exsudates, blood and cells is not feasible by chest X-ray or CT, a systematic approach is essential to make an appropriate diagnosis. Hence, consideration of the temporal course, predominant pattern, distribution of findings, additional findings and clinical presentation are indispensable. (orig.) [de

  5. The radiological appearance of bacterial pneumonias and their differential diagnosis

    International Nuclear Information System (INIS)

    Wagner, H.H.; Fabel, H.; Medizinische Hochschule Hannover

    1985-01-01

    Under the influence of antibiotic therapy, bacterial pneumonias have undergone a remarkable change in the last few decades. Individual forms of pneumonia can be distinguished morphologically by their localization, the way in which they spread, their limitations, and their course. Clinically, opportunistic bacterial infections predominate. Increasingly, secondary pneumonias are observed in poststenotic areas, areas of infarction, in hypostatic areas, after aspiration, and in previously damaged lobes. Radiologic criteria for differentiating from atypical pneumonias (viruses, mycoplasmas and chlamydia) are discussed. (orig.) [de

  6. MRI differentiation of pneumonia-like mucinous adenocarcinoma and infectious pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Gaeta, Michele, E-mail: gaesam@hotmail.it [Department of Radiological Sciences, Policlinico ' G. Martino' , Via Consolare Valeria 1, 98100 Messina (Italy); Ascenti, Giorgio, E-mail: gascenti@unime.it [Department of Radiological Sciences, Policlinico ' G. Martino' , Via Consolare Valeria 1, 98100 Messina (Italy); Mazziotti, Silvio, E-mail: smazziotti@unime.it [Department of Radiological Sciences, Policlinico ' G. Martino' , Via Consolare Valeria 1, 98100 Messina (Italy); Contiguglia, Rosario, E-mail: rosariocontiguglia@libero.it [Department of Environment and Primary Prevention, Local Health Unit, Messina (Italy); Barone, Mario, E-mail: mario.barone@unime.it [Clinical and Experimental Department of Medicine and Pharmacology, Policlinico ' G. Martino' , Messina (Italy); Mileto, Achille, E-mail: achille.mileto@gmail.com [Department of Radiological Sciences, Policlinico ' G. Martino' , Via Consolare Valeria 1, 98100 Messina (Italy)

    2012-11-15

    Objective: To evaluate the role of MRI water-sensitive sequences in the differential diagnosis between pneumonia-like mucinous adenocarcinoma and infectious pneumonia. Subjects and methods: Twenty-three patients with pneumonia-like mucinous adenocarcinoma and 30 patients with infectious pneumonia underwent computed tomography (CT) and MRI. Two blinded and independent readers evaluated CT and MR images using a 3-level confidence scale in two separate sessions. Results were tested for statistical significance using the Fisher's exact test and the Cohen's k test. Results: On CT, the two readers respectively made correct diagnoses of mucinous adenocarcinoma in 17 out of 23 cases (73.9%), and in 15 out of 23 cases (65.2%). A correct diagnosis of infectious pneumonia was made in 22 out of 30 cases (73.3%), and in 24 out of 30 cases (80.0%). On MRI, both readers made correct diagnoses of mucinous adenocarcinoma in 23 out of 23 (100%) cases, and of infectious pneumonia in 30 out of 30 (100%) cases. Fisher's exact test showed a significant difference in the diagnosis of mucinous adenocarcinoma between MRI and CT for both readers, P = 0.01 for reader 1 and P = 0.002 for reader 2, respectively. A good agreement (k = 0.73) was found between the two readers on CT evaluation, whereas an almost perfect agreement (k = 1.00) was found for MRI. Conclusions: MRI with 'water-sensitive' sequences should be added in the diagnostic protocol of every patient with pulmonary consolidation suspected to be mucinous adenocarcinoma.

  7. MRI differentiation of pneumonia-like mucinous adenocarcinoma and infectious pneumonia

    International Nuclear Information System (INIS)

    Gaeta, Michele; Ascenti, Giorgio; Mazziotti, Silvio; Contiguglia, Rosario; Barone, Mario; Mileto, Achille

    2012-01-01

    Objective: To evaluate the role of MRI water-sensitive sequences in the differential diagnosis between pneumonia-like mucinous adenocarcinoma and infectious pneumonia. Subjects and methods: Twenty-three patients with pneumonia-like mucinous adenocarcinoma and 30 patients with infectious pneumonia underwent computed tomography (CT) and MRI. Two blinded and independent readers evaluated CT and MR images using a 3-level confidence scale in two separate sessions. Results were tested for statistical significance using the Fisher's exact test and the Cohen's k test. Results: On CT, the two readers respectively made correct diagnoses of mucinous adenocarcinoma in 17 out of 23 cases (73.9%), and in 15 out of 23 cases (65.2%). A correct diagnosis of infectious pneumonia was made in 22 out of 30 cases (73.3%), and in 24 out of 30 cases (80.0%). On MRI, both readers made correct diagnoses of mucinous adenocarcinoma in 23 out of 23 (100%) cases, and of infectious pneumonia in 30 out of 30 (100%) cases. Fisher's exact test showed a significant difference in the diagnosis of mucinous adenocarcinoma between MRI and CT for both readers, P = 0.01 for reader 1 and P = 0.002 for reader 2, respectively. A good agreement (k = 0.73) was found between the two readers on CT evaluation, whereas an almost perfect agreement (k = 1.00) was found for MRI. Conclusions: MRI with “water-sensitive” sequences should be added in the diagnostic protocol of every patient with pulmonary consolidation suspected to be mucinous adenocarcinoma.

  8. X-ray diagnosis of bronchial obstruction in chronic pneumonia

    International Nuclear Information System (INIS)

    Mamilyaev, R.M.

    1981-01-01

    Combined radiobronchological examination of patients with chronic pneumonia in the phase of reverse development of the disease has been performed. Severity, localization and extent of bronchial obstruction have been studied, depending on the phase of chronic pneumonia and aspects of lung tissue alterations. Bronchial lesions characteristic of chronic pneumonia were defined, as well as importance of x-ray examination methods for bronchial obstruction diagnosis. Three types of bronchial obstruction were distinguished: bronchoconstriction, bronchodilatation and their combination. With regard to the character and severity of bronchial and pulmonary tissue lesions 3 variants of chronic pneumonia are offered to be differentiated: bronchitic, bronchoectatic, and abscess-forming. The main significance in diagnosis of chronic pneumonia is attributed to combined x-ray examination, which also includes radiobronchological investigation in the first two variants of the disease [ru

  9. Radiological differential diagnosis in chronic aspiration pneumonia

    International Nuclear Information System (INIS)

    Hannig, C.; Wuttge-Hannig, A.; Hoermann, M.; Herrmann, I.F.; Neurologische Klinik Muenchen Tristanstrasse; Wuerzburg Univ.

    1989-01-01

    6% of all patients suffering from a cerebro-vascular injury die from aspiration pneumonia within the first year. The high temporal resolution of high-speed cineradiography (HFK) (50 frames/sec.) allows the recording of the 0.7 sec. process of pharyngeal swallow. Five case-examples are presented (total number of cases: 95) illustrating the possibility of differentiation between three types of aspiration by means of cineradiography. These types are the so-called pre-, intra- and postdeglutitive aspiration, that is aspiration before or after triggering of the swallowing reflex. This differentiation is of great therapeutic importance. The analysis of disturbances of pharyngo-laryngeal motility and the temporal coordination allows setting up individual surgical and/or conservative programme for rehabilitation. (orig.) [de

  10. Clinical and radiological diagnosis of chronic pneumonia in pneumoconiosis and dust bronchitis

    International Nuclear Information System (INIS)

    Shniger, N.U.; Blokhina, L.M.

    1983-01-01

    Clinical and radiologic symptomatology of chronic pneumonia is described for pneumoconiosis and chronic dust bronchitis. Combined X-ray methods of examination permit the physicians to discover this complication in dust diseases of the lungs in the presence of diffuse pneumosclerotic changes in 76.5+-3 % of cases. These data approach the values of chronic pneumonia incidence among the population. Chronic pneumonia diagnosis should be complex. If no less than 2 to 3 X-ray signs of the disease have been found simultaneously, the significance of radiologic diagnosis of chronic pneumonia in dust pathology of the lungs, rises. Radiologic examination, supported by clinical, anamnestic and laboratory data, allows one to differentiate chronic pneumonia from coniotuberculosis. Chest X-rays in dust pathology of the lungs, complicated by chronic pneumonia, should be carried out with regard to clinical indications

  11. The reversed halo sign: update and differential diagnosis

    Science.gov (United States)

    Godoy, M C B; Viswanathan, C; Marchiori, E; Truong, M T; Benveniste, M F; Rossi, S; Marom, E M

    2012-01-01

    The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air–space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population. PMID:22553298

  12. Differential diagnosis of inflammatory lung affections by x-ray in children

    Energy Technology Data Exchange (ETDEWEB)

    Faerber, D.

    1980-01-01

    As a consequence of the rise in neonatal infections by ..beta..-streptococci the clinical respiratory distress syndrome in neonates is becoming increasingly important for differential diagnosis. The present paper reports on special problems in differential X-ray diagnosis of ..beta..-streptococcus pneumonia as compared to inflammatory lung affections attributable to various causes.

  13. The contribution of CT-guided transthoracic lung biopsy to the diagnosis of organising pneumonia.

    Science.gov (United States)

    Metzger, F; Pernet, D; Manzoni, P; Ranfaing, E; Dalphin, J-C

    2010-09-01

    Organising pneumonia is a pulmonary disease with variable clinical and radiological features and with many differential diagnoses. Diagnosis is based on histology obtained by either transbronchial or surgical lung biopsy but these techniques have several disadvantages. The aim of this study was to evaluate the diagnostic yield of CT-guided transthoracic lung biopsy in organising pneumonia and to compare it to the usual diagnostic tools. Six cases of organising pneumonia diagnosed with CT-guided lung biopsy are reported and discussed. The role of CT-guided lung biopsy in the diagnosis of organising pneumonia was also reviewed in the literature. CT-guided transthoracic lung biopsies provided a higher rate of adequate samples than transbronchial biopsies (92-100% versus 77-86%). The samples were larger, which reduced the risks of misdiagnosis and increased the diagnostic yield (88-97% versus 26-55% in pulmonary nodules and 42-100% versus 66-75% in diffuse pulmonary disease). Complications were rare and generally not serious. CT-guided transthoracic lung biopsy may be considered in place of transbronchial biopsy in the diagnosis of organising pneumonia. Surgical lung biopsy remains the gold standard method for diagnosis. Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  14. Noninfectious differential diagnoses of pneumonia; Nichtinfektioese Differenzialdiagnosen von Pneumonien

    Energy Technology Data Exchange (ETDEWEB)

    Wielandner, A.; Toelly, A. [Medizinische Universitaet Wien, Universitaetsklinik fuer Radiologie und Nuklearmedizin, Wien (Austria); Agarwal, P. [Medizinische Universitaet Freiburg, Universitaetsklinik fuer Radiologie, Freiburg (Germany); Bardach, C. [Krankenhaus Hietzing, Abteilung fuer Radiologie, Wien (Austria)

    2017-01-15

    In patients with a clinical suspicion of pneumonia, typical clinical and laboratory features along with the detection of infiltrates on chest X-ray are as a rule considered diagnostic and therapy is immediately initiated; however, studies have shown that in up to 5% of patients with an initial suspicion of pneumonia, another noninfectious pulmonary disease was the underlying cause. Early recognition and differentiation of diseases mimicking pneumonia are prerequisites for an adequate therapy. The aim of this review is to present the important noninfectious differential diagnoses of pneumonia and to provide the reader with tools for a systematic diagnostic approach. A literature search was carried out. As alterations in the lungs often result in similar imaging appearances and a differentiation between transudates, exsudates, blood and cells is not feasible by chest X-ray or CT, a systematic approach is essential to make an appropriate diagnosis. Hence, consideration of the temporal course, predominant pattern, distribution of findings, additional findings and clinical presentation are indispensable. (orig.) [German] Bei der Verdachtsdiagnose Pneumonie sind die Kombination aus typischer Klinik, Labor und der Nachweis einer Verdichtung in der Roentgenthoraxaufnahme in der Regel diagnostisch und es wird umgehend mit der Therapie begonnen. Studien haben jedoch gezeigt, dass bei bis zu 5 % der Patienten mit Erstverdacht auf Pneumonie eine andere (pulmonale) Erkrankung zugrunde liegt. Ein fruehzeitiges Erkennen und eine Differenzierung von Erkrankungen, die eine Pneumonie vortaeuschen, sind fuer die weitere Behandlung essenziell. Uebersicht ueber wesentliche nichtinfektioese Differenzialdiagnosen der Pneumonie. Es wurde eine Literaturrecherche durchgefuehrt. Da krankhafte Lungenveraenderungen oft aehnliche Bilder hervorrufen und anhand der Roentgenthoraxaufnahme oder der CT-Untersuchung nicht zwischen Blut, Transsudat, Exsudat und Zellen differenziert werden kann, ist

  15. Spiral CT manifestations of spherical pneumonia

    International Nuclear Information System (INIS)

    Li Xiaohong; Yang Hongwei; Xu Chunmin; Qin Xiu

    2008-01-01

    Objective: To explore the Spiral CT manifestations and differential diagnosis of spherical pneumonia. Methods: 18 cases of spherical pneumonia and 20 cases of peripheral pulmonary carcinoma were selected, both of them were confirmed by clinic and/or pathology. The SCT findings of both groups were compared retrospectively. Results: Main spiral CT findings of spherical pneumonia were showed as followings: square or triangular lesions adjacent to pleura; with irregular shape, blurry, slightly lobulated margin, sometimes with halo sign. Small inflammatory patches and intensified vascular markings around the lesions were seen. Lesions became smaller or vanished after short-term anti-inflammatory treatment. Conclusion: Spherical pneumonia showed some characteristics on Spiral CT scan, which are helpful in diagnosis and differential diagnosis of this disease. (authors)

  16. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez, Jose L.; Vazquez, Ignacio; Garcia-Tejedor, Jose L. [Complejo Hospitalario Universitario de Vigo, Department of Radiology, Vigo (Spain); Gonzalez, Maria L.; Reparaz, Alfredo [Complejo Hospitalario Universitario de Vigo, Department of Pediatrics, Vigo (Spain)

    2007-12-15

    We present a 3-year-old child with severe extensive Mycoplasma pneumoniae pneumonia complicated with pneumomediastinum and pneumothorax. Pneumothorax and pneumomediastinum have only exceptionally been described in mild cases of the disease. The radiological findings, differential diagnosis and clinical course are discussed. (orig.)

  17. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia

    International Nuclear Information System (INIS)

    Vazquez, Jose L.; Vazquez, Ignacio; Garcia-Tejedor, Jose L.; Gonzalez, Maria L.; Reparaz, Alfredo

    2007-01-01

    We present a 3-year-old child with severe extensive Mycoplasma pneumoniae pneumonia complicated with pneumomediastinum and pneumothorax. Pneumothorax and pneumomediastinum have only exceptionally been described in mild cases of the disease. The radiological findings, differential diagnosis and clinical course are discussed. (orig.)

  18. Laboratory Diagnosis of Chlamydia Pneumoniae Infections

    Directory of Open Access Journals (Sweden)

    Rosanna W Peeling

    1995-01-01

    Full Text Available Chlamydia pneumoniae is an important cause of respiratory illness. There is a need for accurate and rapid laboratory diagnostic methods that will lead to improved patient care, appropriate use of antimicrobial therapy and a better understanding of the epidemiology of this emerging pathogen. Culture is highly specific but is technically demanding, expensive, has a long turnaround time and its sensitivity is highly dependent on transport conditions. Antigen detection tests such as enzyme immunoassay and direct fluorescent antibody assay, and molecular detection methods such as the polymerase chain reaction assay, may provide a rapid diagnosis without the requirement for stringent transport conditions. The results of these tests should be interpreted with caution until more thorough evaluation is available. Serology remains the method of choice. The limitations of different serological methods for the laboratory diagnosis of C pneumoniae are discussed.

  19. Analysis of clinical value of CT in the diagnosis of pediatric pneumonia and mycoplasma pneumonia

    OpenAIRE

    GONG, LIANG; ZHANG, CHONG-LIN; ZHEN, QING

    2016-01-01

    Pneumonia is an infectious disease of the lung causing mortality. Mycoplasma pneumonia (MP) is an atypical bacterial pneumonia that damages several organs. Lung computed tomography (CT) has been utilized in its identification. The aim of the present study was to examine the value of computed tomography diagnosis for pediatric MP. The present study prospectively analyzed the clinical and imaging data of 1,280 cases of pediatric MP in the out- and inpatient departments from March, 2010 to March...

  20. Pneumonia: challenges in the definition, diagnosis, and management of disease.

    Science.gov (United States)

    Ottosen, Julie; Evans, Heather

    2014-12-01

    Defining health care-associated pneumonia, which includes both hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), is problematic and controversial. Aspiration pneumonia is often included as a subtype of HAP but may be related to community-acquired aspiration events. Scoring systems exist and new surveillance guidelines have been implemented to make early recognition of pneumonia more precise and objective. Management and prevention should follow recommendations, including early empirical therapy, targeted therapy, and limited duration of treatment. Patients with trauma present a challenge to the diagnosis and management of pneumonia, because of increased risk for aspiration and underlying chest and pulmonary injury. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Cryptogenic organising pneumonia presenting with spontaneous pneumothorax and the value of procalcitonin: A case report.

    Science.gov (United States)

    Kang, Chong; Vali, Yusuf; Naeem, Muhammad; Reddy, Raja

    2017-01-01

    Cryptogenic Organising Pneumonia (COP) is a relatively rare condition and can be difficult to differentiate from Community acquired pneumonia (CAP). We report two cases which demonstrate the importance of considering this differential diagnosis in patients with spontaneous pneumothorax who have raised inflammatory markers or lung infiltrates. Our report highlights the value of serum procalcitonin as a biomarker in differentiating between community acquired pneumonia and cryptogenic organising pneumonia especially in the context of a high serum C-reactive protein. Furthermore, the cases show early diagnosis and prompt treatment with corticosteroids may impact the clinical outcome.

  2. Cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy.

    Science.gov (United States)

    Kahraman, Hasan; Tokur, Mahmut; Sayar, Hamide; Inci, Mehmet Fatih

    2013-06-10

    Cryptogenic organising pneumonia is not considered in the differential diagnosis of bilateral hilar and mediastinal lymphadenopathy. We submitted a patient presenting with bilateral hilar and mediastinal lymphadenopathy. We suspected diagnosis of sarcoidosis, but the patient was diagnosed as cryptogenic organising pneumonia with the histological result. This is the second case report of cryptogenic organising pneumonia presenting with bilateral hilar and mediastinal lymphadenopathy.

  3. Pneumococcal pneumonia: clinical features, diagnosis and management in HIV-infected and HIV noninfected patients.

    Science.gov (United States)

    Madeddu, Giordano; Fois, Alessandro Giuseppe; Pirina, Pietro; Mura, Maria Stella

    2009-05-01

    In this review, we focus on the clinical features, diagnosis and management of pneumococcal pneumonia in HIV-infected and noninfected patients, with particular attention to the most recent advances in this area. Classical clinical features are found in young adults, whereas atypical forms occur in immunocompromised patients including HIV-infected individuals. Bacteremic pneumococcal pneumonia is more frequently observed in HIV-infected and also in low-risk patients, according to the Pneumonia Severity Index (PSI). Pneumococcal pneumonia diagnostic process includes physical examination, radiologic findings and microbiologic diagnosis. However, etiologic diagnosis using traditional culture methods is difficult to obtain. In this setting, urinary antigen test, which recognizes Streptococcus pneumoniae cell wall C-polysaccharide, increases the probability of etiologic diagnosis. A correct management approach is crucial in reducing pneumococcal pneumonia mortality. The use of the PSI helps clinicians in deciding between inpatient and outpatient management in immunocompetent individuals, according to Infectious Diseases Society of America (IDSA)-American Thoracic Society (ATS) guidelines. Recent findings support PSI utility also in HIV-infected patients. Recently, efficacy of pneumococcal vaccine in reducing pneumococcal disease incidence has been evidenced in both HIV-infected and noninfected individuals. Rapid diagnosis and correct management together with implementation of preventive measures are crucial in order to reduce pneumococcal pneumonia related incidence and mortality in HIV-infected and noninfected patients.

  4. Cryptogenic organising pneumonia presenting with spontaneous pneumothorax and the value of procalcitonin: A case report

    Directory of Open Access Journals (Sweden)

    Chong Kang

    2017-01-01

    Full Text Available Cryptogenic Organising Pneumonia (COP is a relatively rare condition and can be difficult to differentiate from Community acquired pneumonia (CAP. We report two cases which demonstrate the importance of considering this differential diagnosis in patients with spontaneous pneumothorax who have raised inflammatory markers or lung infiltrates. Our report highlights the value of serum procalcitonin as a biomarker in differentiating between community acquired pneumonia and cryptogenic organising pneumonia especially in the context of a high serum C-reactive protein. Furthermore, the cases show early diagnosis and prompt treatment with corticosteroids may impact the clinical outcome.

  5. Mycoplasma pneumoniae meningoencephalitis: a case report

    Directory of Open Access Journals (Sweden)

    Mehmet Selçuk Bektaş

    2013-01-01

    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.

  6. 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

    2013-01-01

    importance to dyspnoea/polypnoea and C-reactive protein levels >50mg/L. None of the other typical symptoms of pneumonia had a significant influence. CONCLUSIONS: Our results indicate that GPs' diagnostic criteria for pneumonia differ substantially between Denmark and Spain. The high prevalence of pneumonia...... 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......,698 patients with LRTI were included. RESULTS: In Denmark, 47% of the patients with LRTI were classified with a diagnosis of pneumonia compared with 11% in Spain. In Spain, fever and a positive x-ray weighted significantly more in the diagnosis of pneumonia than in Denmark. Danish GPs, however, attached more...

  7. Metabolic Profiling in Patients with Pneumonia on Intensive Care.

    Science.gov (United States)

    Antcliffe, David; Jiménez, Beatriz; Veselkov, Kirill; Holmes, Elaine; Gordon, Anthony C

    2017-04-01

    Clinical features and investigations lack predictive value when diagnosing pneumonia, especially when patients are ventilated and when patients develop ventilator associated pneumonia (VAP). New tools to aid diagnosis are important to improve outcomes. This pilot study examines the potential for metabolic profiling to aid the diagnosis in critical care. In this prospective observational study ventilated patients with brain injuries or pneumonia were recruited in the intensive care unit and serum samples were collected soon after the start of ventilation. Metabolic profiles were produced using 1D 1 H NMR spectra. Metabolic data were compared using multivariate statistical techniques including Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA). We recruited 15 patients with pneumonia and 26 with brain injuries, seven of whom went on to develop VAP. Comparison of metabolic profiles using OPLS-DA differentiated those with pneumonia from those with brain injuries (R 2 Y=0.91, Q 2 Y=0.28, p=0.02) and those with VAP from those without (R 2 Y=0.94, Q 2 Y=0.27, p=0.05). Metabolites that differentiated patients with pneumonia included lipid species, amino acids and glycoproteins. Metabolic profiling shows promise to aid in the diagnosis of pneumonia in ventilated patients and may allow a more timely diagnosis and better use of antibiotics. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  8. Severe Pneumonia Caused by Legionella pneumophila: Differential Diagnosis and Therapeutic Considerations.

    Science.gov (United States)

    Chahin, Abdullah; Opal, Steven M

    2017-03-01

    Severe legionella pneumonia poses a diagnostic challenge and requires early intervention. Legionnaire's disease can have several presenting signs, symptoms, and laboratory abnormalities that suggest that Legionella pneumophila is the pathogen, but none of these are sufficient to distinguish L pneumophila pneumonia from other respiratory pathogens. L pneumophila is primarily an intracellular pathogen and needs treatment with antibiotics that efficiently enter the intracellular space. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Usefulness of Lung Ultrasound in the Diagnosis of Community-acquired Pneumonia in Children

    Directory of Open Access Journals (Sweden)

    Meng-Chieh Ho

    2015-02-01

    Conclusion: LUS is a sensitive diagnostic tool with which to identify pneumonia in children. It is also useful in following up the progress of pneumonia. We suggest that LUS is a complementary tool to chest radiography in the diagnosis of pneumonia in children and that the follow up of pneumonia by LUS can reduce the exposure of children to ionizing radiation.

  10. CT features of legionella pneumonia, compared with streptococcal pneumonia. A collaborative study

    International Nuclear Information System (INIS)

    Tokuda, Hitoshi; Sakai, Fumikazu; Goto, Hajime

    2007-01-01

    Legionella pneumophila pneumonia (LPP) is of serious concern for chest physicians for its potential lethality and difficulty of diagnosis. In spite of widespread use of urine antigen detection method, it remains one of the most difficult-to-treat disease among community acquired pneumonia. We investigated CT images of 38 cases of LPP, comparing them with wide spread Streptococcus pneumoniae pneumonia (SPP). We find that sharply demarcated consolidation scattered in ground-glass opacity is the most striking and pathognomonic feature of LPP, which is rarely found in SPP. Bronchiolitis was not found in LPP, while it is a relatively common finding in SPP, which could be the second clue of differentiation of these two diseases. (author)

  11. Diagnostic accuracy of computed tomography and histopathology in the diagnosis of usual interstitial pneumonia

    International Nuclear Information System (INIS)

    Aaloekken, Trond Mogens; Mynarek, Georg; Kolbenstvedt, Alf; Naalsund, Anne; Elnaes Berstad, Audun; Solberg, Steinar; Stroem, Erik H.; Scott, Helge; Soeyseth, Vidar

    2012-01-01

    Background: The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate. Purpose: To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP. Material and Methods: The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses. Results: There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (κ = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1). Conclusion: Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP

  12. Diagnostic accuracy of computed tomography and histopathology in the diagnosis of usual interstitial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Aaloekken, Trond Mogens; Mynarek, Georg; Kolbenstvedt, Alf (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway)), Email: trond.mogens.aalokken@rikshospitalet.no; Naalsund, Anne (Dept. of Pulmonology, Oslo Univ. Hospital Rikshospitalet (Norway)); Elnaes Berstad, Audun (Dept. of Radiology, Oslo Univ. Hospital Rikshospitalet, Oslo (Norway); Univ. of Oslo (Norway)); Solberg, Steinar (Dept. of Thoracic Surgery, Oslo Univ. Hospital Rikshospitalet (Norway)); Stroem, Erik H.; Scott, Helge (Dept. of Pathology, Oslo Univ. Hospital Rikshospitalet (Norway)); Soeyseth, Vidar (Univ. of Oslo (Norway); Depts. of Pulmonology, Akershus Univ. Hospital, Loerenskog (Norway))

    2012-04-15

    Background: The relative clinical benefit of histopathology and computed tomography (CT) in patients with idiopathic interstitial pneumonia (IIP) is under debate. Purpose: To analyze thin-section CT features and histopathologic findings in patients with usual interstitial pneumonia (UIP) in the clinical context of idiopathic pulmonary fibrosis (IPF), and to evaluate and compare diagnostic accuracy of the two methods among patients with an appropriate spectrum of IIP. Material and Methods: The study included 91 patients (49 men; mean age 53.2 years; median follow-up 7.2 years) with clinically suspected interstitial lung disease. All underwent surgical lung biopsy and thin-section CT. Two independent readers retrospectively assessed the CT images for the extent and pattern of abnormality and made a first-choice diagnosis. Two pathologists retrospectively assessed the histopathologic slides. In 64 patients with IIP, a retrospective composite reference standard identified 41 patients with UIP. CT characteristics of UIP and IIPs other than UIP were compared with univariate and multivariate analyses. Results: There was good agreement between the readers for the correct first-choice CT diagnosis of UIP (kappa = 0.79). The sensitivity, specificity, and positive predictive value of the CT diagnosis of UIP were 63%, 96%, and 96%, respectively. The sensitivity, specificity, and positive predictive value of the histological diagnosis of UIP were 73%, 74%, and 83%, respectively. The CT feature that best differentiated UIP from IIPs other than UIP was the extent of reticular pattern (odds ratio, 5.1). Conclusion: Surgical lung biopsy may not be warranted in patients with thin-section CT diagnosis of UIP

  13. CT findings of necrotizing pneumonia

    International Nuclear Information System (INIS)

    Kim, Hyae Young; Im, Jung Gi; Whang, Sung Il; Cheon, Jung Eun; Lee, Jae Kyo; Song, Jae Woo

    1998-01-01

    Necrotizing pneumonia causes necrosis of pulmonary parenchyma and may lead to pulmonary gangrene. Prior to the antibiotic era, extensive pulmonary involvement was potentially fatal, but the incidence of necrotizing pneumoniais now less common. On contrast-enhanced CT scans, consolidation with contrast enhancement containing necrotic foci with low attenuation and cavities is characteristic. Radiologic findings do not differ according to the causative organism and in most of cases, specific diagnosis may be impossible. Clinical findings and certain characteristic radiologic findings may be helpful for narrowing the differential diagnosis. We illustrate the clinical and radiologic characteristics of necrotizing pneumonia according to causative bacterial organisms

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

    International Nuclear Information System (INIS)

    Mihara, Naoki; Johkoh, Takeshi; Ichikado, Kazuya

    2000-01-01

    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)

  15. Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia

    International Nuclear Information System (INIS)

    Kim, Tae Hoon; Kim, Sang Jin; Ryu, Young Hoon; Chung, Soo Yoon; Seo, Jae Seung; Kim, Young Jin; Choi, Byoung Wook; Lee, Sun Hwa; Cho, Sang Ho

    2006-01-01

    The purpose of this study was to evaluate retrospectively the differential CT features of bronchioloalveolar carcinoma (BAC) mimicking pneumonia and infectious pneumonia at the lung periphery. CT images were reviewed in 47 patients with focal areas of parenchymal opacification at the lung periphery. We evaluated the presence of ground-glass attenuation, marginal conspicuity of the lesion, CT angiogram sign, air-bronchogram sign, a bubble-like low-attenuation area within the lesion, presence of pleural thickening and retraction associated with the lesion, presence of pleural effusion and extra-pleural fatty hypertrophy, presence of bronchial wall thickening proximal to the lesion, and air-trapping in the normal lung near the lesion. BAC (n=18) depicted the presence of a bubble-like low-attenuation area within the lesion, whereas infectious pneumonia (n=29) represented the pleural thickening associated with the lesion and bronchial wall thickening proximal to the lesion (P 0.05). The focal areas of the parenchymal opacification on the CT images may suggest infectious pneumonia rather than BAC when they show bronchial wall thickening proximal to the lesion and pleural thickening associated with the lesion, whereas BAC is characterized as the presence of a bubble-like low attenuation area within the tumor. (orig.)

  16. Differential CT features of infectious pneumonia versus bronchioloalveolar carcinoma (BAC) mimicking pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hoon [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Yongdong Severance Hospital, Department of Radiology, Seoul (Korea); Kim, Sang Jin; Ryu, Young Hoon; Chung, Soo Yoon; Seo, Jae Seung; Kim, Young Jin; Choi, Byoung Wook [Yonsei University College of Medicine, Department of Radiology, Seoul (Korea); Lee, Sun Hwa [NeoDin Medical Institute, Department of Clinical Pathology, Seoul (Korea); Cho, Sang Ho [Yonsei University College of Medicine, Department of Pathology, Seoul (Korea)

    2006-08-15

    The purpose of this study was to evaluate retrospectively the differential CT features of bronchioloalveolar carcinoma (BAC) mimicking pneumonia and infectious pneumonia at the lung periphery. CT images were reviewed in 47 patients with focal areas of parenchymal opacification at the lung periphery. We evaluated the presence of ground-glass attenuation, marginal conspicuity of the lesion, CT angiogram sign, air-bronchogram sign, a bubble-like low-attenuation area within the lesion, presence of pleural thickening and retraction associated with the lesion, presence of pleural effusion and extra-pleural fatty hypertrophy, presence of bronchial wall thickening proximal to the lesion, and air-trapping in the normal lung near the lesion. BAC (n=18) depicted the presence of a bubble-like low-attenuation area within the lesion, whereas infectious pneumonia (n=29) represented the pleural thickening associated with the lesion and bronchial wall thickening proximal to the lesion (P<0.05). The other CT findings showed no significant differences (P>0.05). The focal areas of the parenchymal opacification on the CT images may suggest infectious pneumonia rather than BAC when they show bronchial wall thickening proximal to the lesion and pleural thickening associated with the lesion, whereas BAC is characterized as the presence of a bubble-like low attenuation area within the tumor. (orig.)

  17. Lung scintigraphy in differential diagnosis of peripheral lung cancer and community-acquired pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Krivonogov, Nikolay G., E-mail: kng@cardio-tomsk.ru [Research Institute of Cardiology, Kievskaya Street 111a, Tomsk, 634012 (Russian Federation); Efimova, Nataliya Y., E-mail: efimova@cardio-tomsk.ru; Zavadovsky, Konstantin W.; Lishmanov, Yuri B. [Research Institute of Cardiology, Kievskaya Street 111a, Tomsk, 634012 (Russian Federation); Tomsk Polytechnic University, Lenin Avenue 30, Tomsk, 634050 (Russian Federation)

    2016-08-02

    Ventilation/perfusion lung scintigraphy was performed in 39 patients with verified diagnosis of community-acquired pneumonia (CAP) and in 14 patients with peripheral lung cancer. Ventilation/perfusion ratio, apical-basal gradients of ventilation (U/L(V)) and lung perfusion (U/L(P)), and alveolar capillary permeability of radionuclide aerosol were determined based on scintigraphy data. The study demonstrated that main signs of CAP were increases in ventilation/perfusion ratio, perfusion and ventilation gradient on a side of the diseased lung, and two-side increase in alveolar capillary permeability rate for radionuclide aerosol. Unlike this, scintigraphic signs of peripheral lung cancer comprise an increase in ventilation/perfusion ratio over 1.0 on a side of the diseased lung with its simultaneous decrease on a contralateral side, normal values of perfusion and ventilation gradients of both lungs, and delayed alveolar capillary clearance in the diseased lung compared with the intact lung.

  18. Lung scintigraphy in differential diagnosis of peripheral lung cancer and community-acquired pneumonia

    Science.gov (United States)

    Krivonogov, Nikolay G.; Efimova, Nataliya Y.; Zavadovsky, Konstantin W.; Lishmanov, Yuri B.

    2016-08-01

    Ventilation/perfusion lung scintigraphy was performed in 39 patients with verified diagnosis of community-acquired pneumonia (CAP) and in 14 patients with peripheral lung cancer. Ventilation/perfusion ratio, apical-basal gradients of ventilation (U/L(V)) and lung perfusion (U/L(P)), and alveolar capillary permeability of radionuclide aerosol were determined based on scintigraphy data. The study demonstrated that main signs of CAP were increases in ventilation/perfusion ratio, perfusion and ventilation gradient on a side of the diseased lung, and two-side increase in alveolar capillary permeability rate for radionuclide aerosol. Unlike this, scintigraphic signs of peripheral lung cancer comprise an increase in ventilation/perfusion ratio over 1.0 on a side of the diseased lung with its simultaneous decrease on a contralateral side, normal values of perfusion and ventilation gradients of both lungs, and delayed alveolar capillary clearance in the diseased lung compared with the intact lung.

  19. Organising pneumonia presenting as acute life threatening pulmonary haemorrhage.

    Science.gov (United States)

    Narasimhaiah, Damodhara Honnavally; Chakravorty, Indranil; Swamy, Rajiv; Prakash, Doraiswamy

    2011-11-08

    Organising pneumonia, previously called bronchiolitis obliterans organising pneumonia is a clinicopathological entity of unknown aetiology, which has been reported with increasing frequency. Various modes of presentation have been described such as cough, fever, weight loss and alveolar opacities on chest radiograph. Haemoptysis as primary presenting symptom has only rarely been reported. The authors report a case in which massive life-threatening haemoptysis was the major presenting symptom. No aetiology was identified for the haemoptysis and the diagnosis was confirmed on postmortem histology. This case highlights the importance of considering organising pneumonia in the differential diagnosis of acute severe haemoptysis.

  20. Characteristics of Consolidation, Centrilobular Nodule and Bronchus as CT Findings for the Differentiation between Tuberculosis and Pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Se Young; Chung, Myung Hee; Lim, Yeon Soo; Lim, Hyun Wook; Kahng, Ji Min [Bucheon St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Bucheon (Korea, Republic of); Sung, Mi Sook [Dept. of Radiology, St. Paul' s Hospital, The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of)

    2013-06-15

    To differentiate tuberculosis from pneumonia by computed tomography (CT) in cases difficult to diagnose clinically and radiologically. CT scans of 300 patients with tuberculosis and 234 patients with pneumonia were retrospectively analyzed. Parenchymal abnormalities, lymph nodes, pleural effusions and central bronchial narrowing were evaluated. The density of consolidation was measured by pre- and post-enhanced CT. Centrilobular nodules, granulomas, cavitations in both nodules as well as consolidation, conglomerated nodules, and enlarged lymph nodes occurred with significantly greater frequency in patients with tuberculosis than in those with pneumonia. Centrilobular nodules were larger and denser in tuberculosis patients. In consolidation, decreases in lung lobe volume and a bronchial beaded appearance (irregular narrowing and dilatation) were more frequent in patients with tuberculosis. The tuberculous consolidation had significantly lower mean enhancement and net enhancement than that from pneumonia. When the diagnostic criteria for tuberculosis were set as well-demarcated larger centrilobular nodules and/or a lowerly enhancing consolidation with internal beaded bronchi, the diagnostic accuracy was found to be 82.0%. Consolidation with a low level of enhancement, decreased lung lobe volume, and bronchi with irregular, beaded shape and denser and larger centrilobular nodules are helpful CT findings for the diagnosis of tuberculosis.

  1. Symptoms, Diagnosis and Treatment of Pneumonia

    Science.gov (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, ...

  2. CT characteristics of peripheral organizing pneumonia

    International Nuclear Information System (INIS)

    Yang, Seong Oh; Choi, Chul Soon; Kim, Myung Joon; Lee, Kyung Soo; Choi, Hyung Sik; Jun, Young Hwan; Park, Yong Koo

    1988-01-01

    Diagnostic dilemma of persistent mass-forming parenchymal opacity in the lung periphery occurs occasionally in the realm of diagnostic radiology. Until recently, literature on the role of computed tomography in peripheral organizing pneumonia, which is difficult to differentiate from malignancy, has little been published. We experienced one case of pathologically proven organizing pneumonia diagnosed preoperatively by chest CT. When it comes to solitary peripheral mass density in the lung, we think that CT can be proved useful in the diagnosis of benign organizing pneumonia by showing regular and smoothly corrugate margin, peripheral contrast enhancement with inner low density, and air-trapping by intervening normal lung parenchyma.

  3. Exogenous lipid pneumonia

    International Nuclear Information System (INIS)

    Bernasconi, A.; Gavelli, G.; Zompatori, M.; Galleri, C.; Zanasi, A.; Fabbri, M.; Bazzocchi, F.

    1988-01-01

    Exogenous lipid pneumonia (ELP) is caused by the aspiration of animal, vegetal or, more often, mineral oils. Even though it may also be acute, ELP is most frequently a chronic disease, affecting people with predisposing factors, such as neuromuscular disorders, structural abnormalities and so on; very often exogenous lipid pneumonia is found in tracheotomized patients. The pathology of lipid pneumonia is a chronic inflammatory process evolving in foreign-body-like reaction, and eventually in ''end-stage lung'' condition. Clinically, most patients are asymptomatic; few cases only present with cough, dyspnea and chest pain. Eight cases of ELP, studied over the past 3 years, are described in this paper. All the patients were examined by chest radiographs and standard tomograms; 3 patients underwent CT. X-ray features were mono/bilateral consolidation of the lower zones, with air bronchogram and variable reduction in volume. CT density was not specific for fat tissue. In all cases the diagnosis was confirmed at biopsy. In 5 patients, followed for at least one year, clinical-radiological features showed no change. Thus, complications of ELP (especially malignant evolution) could be excluded. The authors conclude that lipid pneumonia must be considered in differential diagnosis of patients with history of usage of oils and compatible X-ray findings. The usefulness of an accurate follow-up is stressed

  4. Differentiation of bacterial and non-bacterial community-acquired pneumonia by thin-section computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Isao [Department of Respiratory Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602 (Japan); Department of Respiratory Medicine, Kyoto University, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507 (Japan)], E-mail: isaoito@kuhp.kyoto-u.ac.jp; Ishida, Tadashi [Department of Respiratory Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602 (Japan)], E-mail: ishidat@kchnet.or.jp; Togashi, Kaori [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507 (Japan)], E-mail: ktogashi@kuhp.kyoto-u.ac.jp; Niimi, Akio [Department of Respiratory Medicine, Kyoto University, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507 (Japan)], E-mail: niimi@kuhp.kyoto-u.ac.jp; Koyama, Hiroshi [General Internal Medicine, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusa-Mukohatacho, Fushimi-ku, Kyoto 612-8555 (Japan)], E-mail: hkoyama-kyt@umin.ac.jp; Ishimori, Takayoshi [Department of Radiology, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602 (Japan)], E-mail: ti10794@kchnet.or.jp; Kobayashi, Hisataka [Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507 (Japan); Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10, Room 1B40, MSC1088, 10 Center Drive, Bethesda, MD 20892-1088 (United States)], E-mail: kobayash@mail.nih.gov; Mishima, Michiaki [Department of Respiratory Medicine, Kyoto University, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto 606-8507 (Japan)], E-mail: mishima@kuhp.kyoto-u.ac.jp

    2009-12-15

    Background and objective: The management of community-acquired pneumonia (CAP) depends, in part, on the identification of the causative agents. The objective of this study was to determine the potential of thin-section computed tomography (CT) in differentiating bacterial and non-bacterial pneumonia. Patients and methods: Thin-section CT studies were prospectively examined in hospitalized CAP patients within 2 days of admission, followed by retrospective assessment by two pulmonary radiologists. Thin-section CT findings on the pneumonias caused by each pathogen were examined, and two types of pneumonias were compared. Using multivariate logistic regression analyses, receiver operating characteristic (ROC) curves were produced. Results: Among 183 CAP episodes (181 patients, 125 men and 56 women, mean age {+-} S.D.: 61.1 {+-} 19.7) examined by thin-section CT, the etiologies of 125 were confirmed (94 bacterial pneumonia and 31 non-bacterial pneumonia). Centrilobular nodules were specific for non-bacterial pneumonia and airspace nodules were specific for bacterial pneumonia (specificities of 89% and 94%, respectively) when located in the outer lung areas. When centrilobular nodules were the principal finding, they were specific but lacked sensitivity for non-bacterial pneumonia (specificity 98% and sensitivity 23%). To distinguish the two types of pneumonias, centrilobular nodules, airspace nodules and lobular shadows were found to be important by multivariate analyses. ROC curve analysis discriminated bacterial pneumonia from non-bacterial pneumonia among patients without underlying lung diseases, yielding an optimal point with sensitivity and specificity of 86% and 79%, respectively, but was less effective when all patients were analyzed together (70% and 84%, respectively). Conclusion: Thin-section CT examination was applied for the differentiation of bacterial and non-bacterial pneumonias. Though showing some potential, this examination at the present time would

  5. Differentiation of bacterial and non-bacterial community-acquired pneumonia by thin-section computed tomography

    International Nuclear Information System (INIS)

    Ito, Isao; Ishida, Tadashi; Togashi, Kaori; Niimi, Akio; Koyama, Hiroshi; Ishimori, Takayoshi; Kobayashi, Hisataka; Mishima, Michiaki

    2009-01-01

    Background and objective: The management of community-acquired pneumonia (CAP) depends, in part, on the identification of the causative agents. The objective of this study was to determine the potential of thin-section computed tomography (CT) in differentiating bacterial and non-bacterial pneumonia. Patients and methods: Thin-section CT studies were prospectively examined in hospitalized CAP patients within 2 days of admission, followed by retrospective assessment by two pulmonary radiologists. Thin-section CT findings on the pneumonias caused by each pathogen were examined, and two types of pneumonias were compared. Using multivariate logistic regression analyses, receiver operating characteristic (ROC) curves were produced. Results: Among 183 CAP episodes (181 patients, 125 men and 56 women, mean age ± S.D.: 61.1 ± 19.7) examined by thin-section CT, the etiologies of 125 were confirmed (94 bacterial pneumonia and 31 non-bacterial pneumonia). Centrilobular nodules were specific for non-bacterial pneumonia and airspace nodules were specific for bacterial pneumonia (specificities of 89% and 94%, respectively) when located in the outer lung areas. When centrilobular nodules were the principal finding, they were specific but lacked sensitivity for non-bacterial pneumonia (specificity 98% and sensitivity 23%). To distinguish the two types of pneumonias, centrilobular nodules, airspace nodules and lobular shadows were found to be important by multivariate analyses. ROC curve analysis discriminated bacterial pneumonia from non-bacterial pneumonia among patients without underlying lung diseases, yielding an optimal point with sensitivity and specificity of 86% and 79%, respectively, but was less effective when all patients were analyzed together (70% and 84%, respectively). Conclusion: Thin-section CT examination was applied for the differentiation of bacterial and non-bacterial pneumonias. Though showing some potential, this examination at the present time would not

  6. Computed tomography in children with community-acquired pneumonia.

    Science.gov (United States)

    Andronikou, Savvas; Goussard, Pierre; Sorantin, Erich

    2017-10-01

    Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns.

  7. Computed tomography in children with community-acquired pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Andronikou, Savvas [Bristol Royal Hospital for Children and the University of Bristol, Department of Paediatric Radiology, Bristol (United Kingdom); University of Cape Town, Department of Radiology, Cape Town (South Africa); Goussard, Pierre [Tygerberg Hospital, Stellenbosch University, Department of Paediatrics and Child Health, Cape Town (South Africa); Sorantin, Erich [Medical University Graz, Department of Radiology, Graz (Austria)

    2017-10-15

    Diagnostic imaging plays a significant role in both the diagnosis and treatment of complications of pneumonia in children and chest radiography is the imaging modality of choice. Computed tomography (CT) on the other hand, is not currently a first-line imaging tool for children with suspected uncomplicated community-acquired pneumonia and is largely reserved for when complications of pneumonia are suspected or there is difficulty in differentiating pneumonia from other pathology. This review outlines the situations where CT needs to be considered in children with pneumonia, describes the imaging features of the parenchymal and pleural complications of pneumonia, discusses how CT may have a wider role in developing countries where human immunodeficiency virus (HIV) and tuberculosis are prevalent, makes note of the role of CT scanning for identifying missed foreign body aspiration and, lastly, addresses radiation concerns. (orig.)

  8. Pneumonia diagnosis in childhood and incidence of leukaemia, lymphoma and brain cancer

    DEFF Research Database (Denmark)

    Søgaard, Kirstine Kobberøe; Farkas, Dóra Körmendiné; Sørensen, Henrik Toft

    2017-01-01

    of pneumonia was a clinical marker of the three most common childhood cancers. DESIGN: Population-based cohort study. SETTING: Denmark, hospital diagnoses, 1994-2013. METHODS: Using national health registries, we compared the observed incidence of leukaemia, lymphoma and brain cancer among 83 935 children...... with a hospital-based pneumonia diagnosis with that expected among children in the general population. We calculated absolute cancer risks and standardised incidence ratios (SIRs) as a measure of relative risk. RESULTS: The cancer SIRs were substantially increased during the first 6 months of follow-up; lymphoid...

  9. Mycoplasma pneumoniae-Induced-Stevens Johnson Syndrome: Rare Occurrence in an Adult Patient

    Directory of Open Access Journals (Sweden)

    Samad Rasul

    2012-01-01

    Full Text Available Stevens-Johnson syndrome (SJS is an uncommon occurrence in Mycoplasma pneumoniae (M. pneumoniae infection (1–5% and has been mainly reported in children and young adults. We present a case of SJS in a 32-year-old male induced by M. pneumoniae infection. This patient presented with fever, cough, and massive occupation of mucus membranes with swelling, erythema, and necrosis accompanied by a generalized cutaneous rash. He clinically responded after treatment with antibiotics and IVIG. SJS is usually a drug-induced condition; however, M. pneumoniae is the commonest infectious cause and should be considered in the differential diagnosis.

  10. Radiography of the equine thorax and its differential diagnosis relevance; Die differenzialdiagnostische Bedeutung der röntgenologischen Thoraxuntersuchung beim Pferd

    Energy Technology Data Exchange (ETDEWEB)

    Klein, H. J. [Klinik fuer Pferde, Tieraerztliche Hochschule Hannover (Germany); Offeney, F.

    1990-07-01

    Commonly chronic obstructive pulmonary disease (COPD) is the cause of dyspnoe or loss of performance in the horse. Tracheobronchoscopy, cytology of tracheobronchial aspirates, interpleural pressure measurement, and arterial blood gas analysis improved diagnosis of equine respiratory disorders. Yet some intrathoraeie diseases, especially chronic pneumonia, are differential diagnosis problems. Radiography of the thorax improves the diagnosis of pneumonia and some other intrathoraeie diseases. The technique of the radiography of the thorax is described and radiographic findings in 166 horses suffering from respiratory diseases are evaluated. Theses horses showed pathologic radiographic findings caused by COPD (n =61), pneumonia (67), pleuritis (12), exercise-induced pulmonary haemorrhage (8), aspiration pneumonia (7), hydrothorax (6), pneumothorax (2), lung abseess (1); mediastinal tumor (1), and diaphragmatie hernia (1) [German] Die chronisch obstruktive Bronchitis (COB) ist die häufigste Ursache von Atembeschwerden oder Leistungsmangel beim Pferd. Tracheobronchoskopie, Tracheobronchialsekretzytologie, interpleurale Druckmessung und arterielle Blutgasanalyse verbesserten die Diagnostik respiratorischer Erkrankungen. Dennoch bestehen Probleme hinsichtlich der Differentialdiagnose zur COB, und zwar insbesondere bei chronischen Pneumonien. Die röntgenologische Thoraxuntersuchung verbessert die Diagnose von Pneumonien und einigen anderen intrathorakalen Erkrankungen. Die Technik der röntgenologischen Thoraxuntersuchung wird beschrieben, und die Befunde von 166 Pferden mit Erkrankungen der Atemorgane werden ausgewertet. Diese Pferde zeigten pathologische Röntgenbefunde als Folge einer COB (n =61), einer Pneumonie (67), einer Pleuritis (12), eines belastungsinduzierten Lungenblutens (8), einer Aspirationspneumonie (7), eines Hydrothorax (6), eines Pneumothorax (2), eines Lungenabszesses (1), eines mediastinalen Tumors (1) und einer Zwerchfellhernie (1)

  11. Dual-time-point 18F-FDG PET imaging for diagnosis of disease type and disease activity in patients with idiopathic interstitial pneumonia

    International Nuclear Information System (INIS)

    Umeda, Yukihiro; Demura, Yoshiki; Ishizaki, Takeshi; Ameshima, Shingo; Miyamori, Isamu; Saito, Yuji; Tsuchida, Tatsuro; Fujibayashi, Yasuhisa; Okazawa, Hidehiko

    2009-01-01

    Individual clinical courses of idiopathic interstitial pneumonia (IIP) are variable and difficult to predict because the pathology and disease activity are contingent, and chest computed tomography (CT) provides little information about disease activity. In this study, we applied dual-time-point [ 18 F]-fluoro-2-deoxy-D-glucose ( 18 F-FDG) positron emission tomography (PET), commonly used for diagnosis of malignant tumours, to the differential diagnosis and prediction of disease progression in IIP patients. Fifty patients with IIP, including idiopathic pulmonary fibrosis (IPF, n = 21), non-specific interstitial pneumonia (NSIP, n = 18) and cryptogenic organizing pneumonia (COP, n = 11), underwent 18 F-FDG PET examinations at two time points: scan 1 at 60 min (early imaging) and scan 2 at 180 min (delayed imaging) after 18 F-FDG injection. The standardized uptake values (SUV) at the two points and the retention index (RI-SUV) calculated from them were evaluated and compared with chest CT findings, disease progression and disease types. To evaluate short-term disease progression, all patients were examined by pulmonary function test every 3 months for 1 year after 18 F-FDG PET scanning. The early SUV for COP (2.47 ± 0.74) was significantly higher than that for IPF (0.99 ± 0.29, p = 0.0002) or NSIP (1.22 ± 0.44, p= 0.0025). When an early SUV cut-off value of 1.5 and greater was used to distinguish COP from IPF and NSIP, the sensitivity, specificity and accuracy were 90.9, 94.3 and 93.5%, respectively. The RI-SUV for IPF and NSIP lesions was significantly greater in patients with deteriorated pulmonary function after 1 year of follow-up (progressive group, 13.0 ± 8.9%) than in cases without deterioration during the 1-year observation period (stable group, -16.8 ± 5.9%, p 18 F-FDG PET are useful parameters for the differential diagnosis and prediction of disease progression in patients with IIP. (orig.)

  12. Squalene aspiration pneumonia in children: radiographic and CT findings as the first clue to diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyoung Ho [Clinical Research Institute, Seoul National University Hospital, Seoul (Korea); Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea); Kim, Woo Sun; Cheon, Jung-Eun; Kim, In-One; Yeon, Kyung Mo [Clinical Research Institute, Seoul National University Hospital, Seoul (Korea); Seo, Joon Beom [Clinical Research Institute, Seoul National University Hospital, Seoul (Korea); University of Ulsan, Department of Radiology, Asan Medical Center, Seoul (Korea)

    2005-06-01

    The diagnosis of squalene aspiration pneumonia in children is often difficult because of minimal non-specific symptoms. To investigate the radiological findings of squalene aspiration pneumonia in children. We reviewed the chest radiographs (n=8) and CT scans (n=), including high-resolution CT (n=3), of eight patients (four boys, four girls; age 3 months to 6 years) with squalene aspiration pneumonia. All patients presented minimal symptoms. Chest radiographs showed right-sided predominantly parahilar infiltrations. The extent and the opacity of the lesions decreased slowly during the follow-up period (mean 5.4 months) after halting the exposure. On CT, affected areas appeared as dense consolidations surrounded by ground-glass opacities showing a crazy-paving pattern in a geographic lobular distribution in all patients. The lesions were predominantly in the right lung and dependent areas in all patients and extensively involved all pulmonary lobes in five patients. These radiological findings, although non-specific, can lead to an appropriate diagnosis, particularly when patients present few symptoms. (orig.)

  13. Detection of pneumonia using free-text radiology reports in the BioSense system.

    Science.gov (United States)

    Asatryan, Armenak; Benoit, Stephen; Ma, Haobo; English, Roseanne; Elkin, Peter; Tokars, Jerome

    2011-01-01

    Near real-time disease detection using electronic data sources is a public health priority. Detecting pneumonia is particularly important because it is the manifesting disease of several bioterrorism agents as well as a complication of influenza, including avian and novel H1N1 strains. Text radiology reports are available earlier than physician diagnoses and so could be integral to rapid detection of pneumonia. We performed a pilot study to determine which keywords present in text radiology reports are most highly associated with pneumonia diagnosis. Electronic radiology text reports from 11 hospitals from February 1, 2006 through December 31, 2007 were used. We created a computerized algorithm that searched for selected keywords ("airspace disease", "consolidation", "density", "infiltrate", "opacity", and "pneumonia"), differentiated between clinical history and radiographic findings, and accounted for negations and double negations; this algorithm was tested on a sample of 350 radiology reports. We used the algorithm to study 189,246 chest radiographs, searching for the keywords and determining their association with a final International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis of pneumonia. Performance of the search algorithm in finding keywords, and association of the keywords with a pneumonia diagnosis. In the sample of 350 radiographs, the search algorithm was highly successful in identifying the selected keywords (sensitivity 98.5%, specificity 100%). Analysis of the 189,246 radiographs showed that the keyword "pneumonia" was the strongest predictor of an ICD-9-CM diagnosis of pneumonia (adjusted odds ratio 11.8) while "density" was the weakest (adjusted odds ratio 1.5). In general, the most highly associated keyword present in the report, regardless of whether a less highly associated keyword was also present, was the best predictor of a diagnosis of pneumonia. Empirical methods may assist in finding radiology

  14. Chest X-ray quality in the diagnosis of pneumonia in children: from prescription to optimization

    International Nuclear Information System (INIS)

    Estevan, M.; Cotelo, E.; Hortal, M.; Iraola, I.

    2008-01-01

    Acute lower respiratory tract infection (ALRI), primarily pneumonia, is the leading cause of childhood death in developing countries. The increasing incidence of antimicrobial resistance and the high cost of vaccines lead to considering the first strategy to reduce pneumonia deaths the early detection of the disease. Case management begins with the clinical examination and may continue with the prescription of a chest x-ray. Consequently, the radiograph should meet quality standards, and radiologists and paediatricians must know how to interpret the images. Special attention should be paid on patient dose due to children radiosensitivity, high frequency and chest x rays rejection rate. This paper is a retrospective study of chest radiographs performed in 5731 children with clinical diagnosis of ALRI assisted in three Uruguayan hospitals during the three year investigation supported by the Division of Vaccines and Immunization of the Pan American Health Organization (PAHO) that had the aim of estimating the burden of pneumonia (from 2001 to 2004). It is analyzed the prescription of radiographs during the diagnosis and in later controls (2220 children assisted in two of the three hospitals). Patient doses are estimated from technical parameters and equipment specifications. The investigation also analyzes patient doses that could have been avoided if paediatricians had managed the disease according to the established protocols. Results show that 82.4 % of chest X-rays diagnosed pneumonia and that some children underwent up to ten radiographs. Significant differences were found in patient dose in the three hospitals, concluding that education on image quality on chest radiographs of radiologists, paediatricians and radiological technologists is the first and best tool for the earlier diagnosis of pneumonia in children and for the application of Radiation Protection (RP) principles in medical exposures. (author)

  15. Pneumonia: high-resolution CT findings in 114 patients

    Energy Technology Data Exchange (ETDEWEB)

    Reittner, Pia [Department of Radiology, Vancouver Hospital and Health Sciences Center, 855 W. 12th Ave., Vancouver, BC (Canada); Department of Radiology, Karl Franzens University and University Hospital Graz, Auenbruggerplatz 9, 8036 Graz (Austria); Ward, Suzanne; Heyneman, Laura; Mueller, Nestor L. [Department of Radiology, Vancouver Hospital and Health Sciences Center, 855 W. 12th Ave., Vancouver, BC (Canada); Johkoh, Takeshi [Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0825 (Japan)

    2003-03-01

    The objective of the present study was to assess the high-resolution CT appearances of different types of pneumonia. The high-resolution CT scans obtained in 114 patients (58 immunocompetent, 59 immunocompromised) with bacterial, Mycoplasma pneumoniae, viral, fungal, and Pneumocystis carinii pneumonias were analyzed retrospectively by two independent observers for presence, pattern, and distribution of abnormalities. Areas of air-space consolidation were not detected in patients with viral pneumonia and were less frequently seen in patients with Pneumocystis carinii pneumonia (2 of 22 patients, 9%) than in bacterial (30 of 35, 85%), Mycoplasma pneumoniae (22 of 28, 79%), and fungal pneumonias (15 of 20, 75%; p<0.01). There was no significant difference in the prevalence or distribution of consolidation between bacterial, Mycoplasma pneumoniae, and fungal pneumonias. Extensive symmetric bilateral areas of ground-glass attenuation were present in 21 of 22 (95%) patients with Pneumocystis carinii pneumonia and were not seen in other pneumonias except in association with areas of consolidation and nodules. Centrilobular nodules were present less commonly in bacterial pneumonia (6 of 35 patients, 17%) than in Mycoplasma pneumoniae (24 of 28, 96%), viral (7 of 9, 78%), or fungal (12 of 20, 92%) pneumonia (p<0.01). Except for Pneumocystis carinii pneumonia and Mycoplasma pneumoniae pneumonia, which often have a characteristic appearance, high-resolution CT is of limited value in the differential diagnosis of the various types of infective pneumonia. (orig.)

  16. Pneumonia: high-resolution CT findings in 114 patients

    International Nuclear Information System (INIS)

    Reittner, Pia; Ward, Suzanne; Heyneman, Laura; Mueller, Nestor L.; Johkoh, Takeshi

    2003-01-01

    The objective of the present study was to assess the high-resolution CT appearances of different types of pneumonia. The high-resolution CT scans obtained in 114 patients (58 immunocompetent, 59 immunocompromised) with bacterial, Mycoplasma pneumoniae, viral, fungal, and Pneumocystis carinii pneumonias were analyzed retrospectively by two independent observers for presence, pattern, and distribution of abnormalities. Areas of air-space consolidation were not detected in patients with viral pneumonia and were less frequently seen in patients with Pneumocystis carinii pneumonia (2 of 22 patients, 9%) than in bacterial (30 of 35, 85%), Mycoplasma pneumoniae (22 of 28, 79%), and fungal pneumonias (15 of 20, 75%; p<0.01). There was no significant difference in the prevalence or distribution of consolidation between bacterial, Mycoplasma pneumoniae, and fungal pneumonias. Extensive symmetric bilateral areas of ground-glass attenuation were present in 21 of 22 (95%) patients with Pneumocystis carinii pneumonia and were not seen in other pneumonias except in association with areas of consolidation and nodules. Centrilobular nodules were present less commonly in bacterial pneumonia (6 of 35 patients, 17%) than in Mycoplasma pneumoniae (24 of 28, 96%), viral (7 of 9, 78%), or fungal (12 of 20, 92%) pneumonia (p<0.01). Except for Pneumocystis carinii pneumonia and Mycoplasma pneumoniae pneumonia, which often have a characteristic appearance, high-resolution CT is of limited value in the differential diagnosis of the various types of infective pneumonia. (orig.)

  17. Recurrent nitrofurantoin-induced giant cell interstitial pneumonia: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Boeun Lee

    2015-01-01

    Full Text Available Giant cell interstitial pneumonia (GIP is a rare form of chronic interstitial pneumonia typically associated with hard metal exposure. Only two cases of GIP induced by nitrofurantoin have been reported in the medical literature. We are reporting a case of recurrent nitrofurantoin-induced GIP. Although extremely rare, GIP needs to be included in the differential diagnosis in patients with chronic nitrofurantoin use who present with respiratory illness.

  18. Aerosolized pentamidine: Effect on diagnosis and presentation of Pneumocystis carinii pneumonia

    International Nuclear Information System (INIS)

    Jules-Elysee, K.M.; Stover, D.E.; Zaman, M.B.; Bernard, E.M.; White, D.A.

    1990-01-01

    The objective of this study was to determine the effect of previous aerosolized pentamidine therapy on diagnosis and presentation of Pneumocystis carinii pneumonia. This was a retrospective study of fifty-two consecutive patients with P. carinii pneumonia and underlying infection with the human immunodeficiency virus (HIV) who had bronchoscopy. Twenty-one patients who were on aerosolized pentamidine therapy served as the study group. Thirty-one patients who had not received the drug served as the control group. The yield of bronchoalveolar lavage for P. carinii pneumonia was 62% for the study group and 100% for the control group (P less than 0.05). This lower yield was significant for the subset of patients having their first episode of P. carinii pneumonia. The yield of transbronchial biopsy was similar for both groups of patients (81% compared with 84%). The yield of bronchoscopy was not influenced by use of zidovudine. Review of lavage specimen slides suggested that there may be fewer organisms present in patients receiving aerosolized pentamidine. An atypical roentgenographic presentation of upper lobe predominant infiltrates was seen in 38% of the study patients and 7% of the control patients. In addition, pneumothoraces and cystic changes were also frequently seen in the study patients. Gallium scans, when done, were also atypical in the study group. Markers of the severity of disease, however, were similar in both groups. The yield of bronchoalveolar lavage for P. carinii pneumonia in HIV-infected patients is lower in patients receiving aerosolized pentamidine. Unusual roentgenographic presentations and atypical gallium scans are also found in this setting

  19. 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: antonellonicolini@gmail.com [Servizio di Pneumologia, Ospedale Generale di Sestri Levante, Sestri Levante (Italy)

    2015-07-15

    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)

  20. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series

    International Nuclear Information System (INIS)

    Cilloniz, Catia; Torres, Antoni; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Nicolini, Antonello

    2015-01-01

    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)

  1. Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods

    Directory of Open Access Journals (Sweden)

    Kênia de Fátima Carrijo

    2014-06-01

    Full Text Available ABSTRACT. Carrijo K.F., Nascimento E.R., Pereira V.L.A., Morés N., Klein, C.S., Domingues L.M. & Tortelly R. [Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods.] Diagnóstico da pneumonia enzoótica suína pela inspeção sanitária post mortem: comparação com outros métodos de diagnóstico. Revista Brasileira de Veterinária Brasileira 36(2:188-194, 2014. Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Av. Pará, 1720, Bloco 2T, Jardim Umuarama, Uberlândia, MG 38400-902, Brasil. E-mail: keniacarrijo@ famev.ufu.br To compare the concordance of the diagnosis of porcine enzootic pneumonia (PEP by post-mortem Sanitary Inspection with other methods (histophatology and immunohistochemistry - IHC, were used lung tissue samples from 100 pigs slaughtered under sanitary inspection, and 50 of these had macroscopic lesions suggestive of PEP and 50 had no such lesions. These were fixed in 10% buffered formalin and processed by routine procedures for paraffin embedding and IHC technique for Mycoplasma hyopneumoniae using a monoespecific polyclonal antibody. The study demonstrating that there is concordance between the diagnosis of Sanitary Inspection with histophatology, between the diagnosis of Sanitary Inspection with IHC and histophatology with IHC. It can be conclude that when the lung has gross lesions of PEP, the probability the result is positive to M. hyopneumoniae by IHC and the presence of microscopic lesions increases. Thus, the microscopic diagnosis for PEP is feasible because it is associated to the other, so that the diagnosis given by the officials of Sanitary Inspection in slaughterhouses is not wrong; the macroscopic diagnosis is therefore a valid method for the diagnosis of PEP, it being understood this is not to say that the detection of M. hyopneumoniae.

  2. Does This Child Have Pneumonia?: The Rational Clinical Examination Systematic Review.

    Science.gov (United States)

    Shah, Sonal N; Bachur, Richard G; Simel, David L; Neuman, Mark I

    2017-08-01

    . Similarly, auscultatory findings were not associated with pneumonia diagnosis. The presence of moderate hypoxemia (oxygen saturation ≤96%; LR, 2.8 [95% CI, 2.1-3.6]; sensitivity, 64%; specificity, 77%) and increased work of breathing (grunting, flaring, and retractions; positive LR, 2.1 [95% CI, 1.6-2.7]) were signs most associated with pneumonia. The presence of normal oxygenation (oxygen saturation >96%) decreased the likelihood of pneumonia (LR, 0.47 [95% CI, 0.32-0.67]). Although no single finding reliably differentiates pneumonia from other causes of childhood respiratory illness, hypoxia and increased work of breathing are more important than tachypnea and auscultatory findings.

  3. Infection by Streptococcus pneumoniae in children with or without radiologically confirmed pneumonia

    Directory of Open Access Journals (Sweden)

    Dafne C. Andrade

    2018-01-01

    Conclusions: Among children with clinical diagnosis of community‐acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.

  4. Distribution and determinants of pneumonia diagnosis using Integrated Management of Childhood Illness guidelines: a nationally representative study in Malawi.

    Science.gov (United States)

    Uwemedimo, Omolara T; Lewis, Todd P; Essien, Elsie A; Chan, Grace J; Nsona, Humphreys; Kruk, Margaret E; Leslie, Hannah H

    2018-01-01

    Pneumonia remains the leading cause of child mortality in sub-Saharan Africa. The Integrated Management of Childhood Illness (IMCI) strategy was developed to standardise care in low-income and middle-income countries for major childhood illnesses and can effectively improve healthcare worker performance. Suboptimal clinical evaluation can result in missed diagnoses and excess morbidity and mortality. We estimate the sensitivity of pneumonia diagnosis and investigate its determinants among children in Malawi. Data were obtained from the 2013-2014 Service Provision Assessment survey, a census of health facilities in Malawi that included direct observation of care and re-examination of children by trained observers. We calculated sensitivity of pneumonia diagnosis and used multilevel log-binomial regression to assess factors associated with diagnostic sensitivity. 3136 clinical visits for children 2-59 months old were observed at 742 health facilities. Healthcare workers completed an average of 30% (SD 13%) of IMCI guidelines in each encounter. 573 children met the IMCI criteria for pneumonia; 118 (21%) were correctly diagnosed. Advanced practice clinicians were more likely than other providers to diagnose pneumonia correctly (adjusted relative risk 2.00, 95% CI 1.21 to 3.29). Clinical quality was strongly associated with correct diagnosis: sensitivity was 23% in providers at the 75th percentile for guideline adherence compared with 14% for those at the 25th percentile. Contextual factors, facility structural readiness, and training or supervision were not associated with sensitivity. Care quality for Malawian children is poor, with low guideline adherence and missed diagnosis for four of five children with pneumonia. Better sensitivity is associated with provider type and higher adherence to IMCI. Existing interventions such as training and supportive supervision are associated with higher guideline adherence, but are insufficient to meaningfully improve sensitivity

  5. Diagnosis and differential diagnosis of hydrocephalus in adults

    International Nuclear Information System (INIS)

    Langner, Soenke; Mensel, Birger; Kuehn, Jens Peter; Kirsch, Michael; Fleck, Steffen; Baldauf, Joerg

    2017-01-01

    Hydrocephalus is caused by an imbalance of production and absorption of cerebrospinal fluid (CSF) or obstruction of its pathways, resulting in ventricular dilatation and increased intracranial pressure. Imaging plays a crucial role in the diagnosis, differential diagnosis and planning of treatment. This review article presents the different types of hydrocephalus und their typical imaging appearance, describes imaging techniques, and discusses differential diagnoses of the different forms of hydrocephalus. Imaging plays a central role in the diagnosis of hydrocephalus. While magnetic resonance (MR) imaging is the first-line imaging modality, computed tomography (CT) is often the first-line imaging test in emergency patients.

  6. Mycoplasma Pneumoniae among Children Hospitalized with Community-acquired Pneumonia.

    Science.gov (United States)

    Kutty, Preeta K; Jain, Seema; Taylor, Thomas H; Bramley, Anna M; Diaz, Maureen H; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Edwards, Kathryn M; McCullers, Jonathan A; Pavia, Andrew T; Winchell, Jonas M; Schrag, Stephanie J; Hicks, Lauri A

    2018-05-17

    The burden and epidemiology of Mycoplasma pneumoniae (Mp) among U.S. children (<18 years) hospitalized with community-acquired pneumonia (CAP) are poorly understood. In the Etiology of Pneumonia in the Community (EPIC) study, we prospectively enrolled 2254 children hospitalized with radiographically-confirmed pneumonia from January 2010-June 2012 and tested nasopharyngeal/oropharyngeal swabs for Mp using real-time polymerase chain reaction (PCR). Clinical and epidemiological features of Mp-PCR-positive and -negative children were compared using logistic regression. Macrolide susceptibility was assessed by genotyping isolates. In the EPIC study, 182(8%) children were Mp-PCR-positive (median age: 7 years); 12% required intensive care and 26% had pleural effusion. No in-hospital deaths occurred. Macrolide resistance was found in 6/169(4%) isolates. Of 178(98%) Mp-PCR-positive children tested for co-pathogens, 50(28%) had ≥1 co-pathogen detected. Variables significantly associated with higher odds of Mp detection included age {10-17 years [adjusted odds ratio (aOR): 7.9 (95% confidence interval (CI): 4.5-13.6)] and 5-9 years [aOR: 4.8 (CI: 2.9-7.8)] vs. 2-4 years}, outpatient antibiotics ≤5 days pre-admission [aOR: 2.3 (CI: 1.5-3.4)], and co-pathogen detection [aOR: 2.1 (CI: 1.3-3.1)]. Clinical characteristics often seen included hilar lymphadenopathy, rales, headache, sore throat, and decreased breath sounds. Usually considered as a mild respiratory infection, M. pneumoniae was the most commonly detected bacteria among children ≥5 years hospitalized with CAP; one-quarter of whom had co-detections. Although associated with clinically non-specific symptoms, there was a need for intensive care support in some cases. M. pneumoniae should be included in the differential diagnosis for school-aged children hospitalized with CAP.

  7. Community-acquired pneumonia

    International Nuclear Information System (INIS)

    Poetter-Lang, S.; Herold, C.J.

    2017-01-01

    The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [de

  8. Pneumocystis carinii pneumonia in AIDS patients

    International Nuclear Information System (INIS)

    Wojtycha-Kwasnica, B.; Leszczynski, S.; Mian, M.; Mydlowska, A.

    1994-01-01

    On the basis of observed sixteen AIDS patients the authors discuss problems connected with early diagnosis, dynamics and differential diagnosis of chest radiographic findings during pneumocystis carinii pneumonia (pcp). 13 patients with P. carinii had the classic pulmonary appearance of this organism: a symmetrical diffuse perihilar interstitial infiltration and alveolar air-space consolidation. Pleural effusions and hilar adenopathy were characteristically absent. Three patients with pcp had unusual pulmonary features. In these cases the diagnosis was proven by laboratory tests and fiberooptic bronchoscopy. Early recognition of pulmonary findings improves the course of pcp. Contemporary existence of tuberculosis and Kaposi sarcoma makes worse the prognosis in AIDS patients with pcp. CT is an important part of the early diagnosis of pulmonary findings in pcp. (author)

  9. High-resolution computed tomography findings in chronic eosinophilic vs. cryptogenic organising pneumonia.

    Science.gov (United States)

    Mehrian, P; Doroudinia, A; Rashti, A; Aloosh, O; Dorudinia, A

    2017-11-01

    The similar clinical and computed tomography (CT) characteristics of cryptogenic organising pneumonia (COP) and chronic eosinophilic pneumonia (CEP) make precise diagnosis challenging. To help differentiate between COP and CEP using high-resolution CT (HRCT). Clinical data and HRCT images of COP and CEP patients referred to Masih Daneshvari Hospital, Tehran, Iran, from 2007 to 2015 were reviewed. Diagnosis of COP or CEP was confirmed using open lung biopsy or a combination of transbronchial biopsy, bronchoalveolar lavage fluid (BALF) analysis, peripheral eosinophilia and a favourable response to corticosteroids. Ground-glass opacity, a dominant ground-glass pattern, upper-lobe pneumonia, increased thickness of bronchial walls and a mosaic pattern in the lungs were more frequent in CEP. Lower-lobe pneumonia, subpleural reticulation, a dominant consolidation pattern, nodules and masses, non-septal linear opacities, bronchial dilation and a reverse halo sign were more frequent in COP. History of asthma, wheezing and peripheral eosinophilia was significantly more common in CEP than in COP. Distinguishing between CEP and COP based on HRCT alone is not always possible. However, in many cases, especially if the correct diagnosis cannot be established by other means, certain HRCT features can be very helpful.

  10. Differential diagnosis diphtheria adults

    Directory of Open Access Journals (Sweden)

    Yu. I. Liashenko

    2010-01-01

    Full Text Available A total of 1,824 human cases of diphtheria, treated at the Clinical Infectious Diseases Hospital SP Botkin (St. Petersburg during 1993, as well as 19 deaths in 1994. It is known that early diagnosis of infectious diseases, especially diphtheria, contributes to the favorable outcome of the disease. The diagnosis of diphtheria at the prehospital stage is always difficult. Presented in detail the differential diagnosis of the disease, clinically similar to diphtheria: Lacunal angina, angina Simanovsky, infectious mononucleosis, angina Ludwig’s angina Dugue, syphilis, non-infectious with clinical «masks» of diphtheria and other. Diphtheria epidemic of 1993–1994 in Russia and, in particular, in St. Petersburg, showed that the late admission of patients with diphtheria infection in hospitals, usually associated with irregular differential diagnosis of this dangerous disease.

  11. MALDI-TOF mass spectrometry for differentiation between Streptococcus pneumoniae and Streptococcus pseudopneumoniae.

    Science.gov (United States)

    van Prehn, Joffrey; van Veen, Suzanne Q; Schelfaut, Jacqueline J G; Wessels, Els

    2016-05-01

    We compared the Vitek MS and Microflex MALDI-TOF mass spectrometry platform for species differentiation within the Streptococcus mitis group with PCR assays targeted at lytA, Spn9802, and recA as reference standard. The Vitek MS correctly identified 10/11 Streptococcus pneumoniae, 13/13 Streptococcus pseudopneumoniae, and 12/13 S. mitis/oralis. The Microflex correctly identified 9/11 S. pneumoniae, 0/13 S. pseudopneumoniae, and 13/13 S. mitis/oralis. MALDI-TOF is a powerful tool for species determination within the mitis group. Diagnostic accuracy varies depending on platform and database used. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Diagnosis and Differential Diagnosis of Hydrocephalus in Adults.

    Science.gov (United States)

    Langner, Sönke; Fleck, Steffen; Baldauf, Jörg; Mensel, Birger; Kühn, Jens Peter; Kirsch, Michael

    2017-08-01

    Purpose  Hydrocephalus is caused by an imbalance of production and absorption of cerebrospinal fluid (CSF) or obstruction of its pathways, resulting in ventricular dilatation and increased intracranial pressure. Imaging plays a crucial role in the diagnosis, differential diagnosis and planning of treatment. Methods  This review article presents the different types of hydrocephalus und their typical imaging appearance, describes imaging techniques, and discusses differential diagnoses of the different forms of hydrocephalus. Results and Conclusion  Imaging plays a central role in the diagnosis of hydrocephalus. While magnetic resonance (MR) imaging is the first-line imaging modality, computed tomography (CT) is often the first-line imaging test in emergency patients. Key points   · Occlusive hydrocephalus is caused by obstruction of CSF pathways.. · Malabsorptive hydrocephalus is caused by impaired CSF absorption.. · The MR imaging protocol should always include sagittal high-resolution T2-weighted images.. · When an inflammatory etiology is suspected, imaging with contrast agent administration is necessary.. Citation Format · Langner S, Fleck S, Baldauf J et al. Diagnosis and Differential Diagnosis of Hydrocephalus in Adults. Fortschr Röntgenstr 2017; 189: 728 - 739. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Radiographic findings of mycoplasma pneumonia in adult

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Jin; Kim, Mi Hye; Choe, Kyu Ok [College of Medicine, Yonsei University, Seoul (Korea, Republic of)

    1991-05-15

    Mycoplasma pneumonia has known to be a not uncommon disease. However, the differential diagnosis of mycoplasm pneumonia with other viral pneumonia is difficult because of its variable clinical symptoms and atypical radiologic findings. A retrospective review was made of plain chest radiologic findings and clinical manifestations of 33 patients, who were admitted at Yonsei University Hospital from January, 1985 to February, 1990. The most prevalent age was 4th decade (33%) and main symptoms were cough (24/33), fever (2/33) and sputum (20/22). The most frequent season was winter (50%). The radiologic patterns were predominently interstitial (15/33), combined (13/33) and predominently alveolar (5/33) lesion. In alveolar infiltration cases (n 18), unilateral single lobe involvement was the most common (17/18) and left lower lobe (8/18) was predominently involved. Associated radiologic findings were hilar lymphadenopathy (4/33), pleural effusion (4/33) and cardiomegaly (7/33)

  14. Diagnosis of Acute Respiratory Distress Syndrome in Nosocomial Pneumonia

    Directory of Open Access Journals (Sweden)

    A. N. Kuzovlev

    2009-01-01

    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

  15. Viral pneumonia in adults in sub-Saharan Africa – epidemiology, aetiology, diagnosis and management

    Directory of Open Access Journals (Sweden)

    Antonia Ho

    2014-06-01

    Full Text Available Community-acquired pneumonia causes substantial morbidity and mortality in sub-Saharan Africa with an estimated 131 million new cases each year. Viruses – such as influenza virus, respiratory syncytial virus and parainfluenza virus – are now recognised as important causes of respiratory disease in older children and adults in the developed world following the emergence of sensitive molecular diagnostic tests, recent severe viral epidemics, and the discovery of novel viruses. Few studies have comprehensively evaluated the viral aetiology of adult pneumonia in Africa, but it is likely to differ from Western settings due to varying seasonality and the high proportion of patients with immunosuppression and co-morbidities. Emerging data suggest a high prevalence of viral pathogens, as well as multiple viral and viral/bacterial infections in African adults with pneumonia. However, the interpretation of positive results from highly sensitive polymerase chain reaction tests can be challenging. Therapeutic and preventative options against viral respiratory infections are currently limited in the African setting. This review summarises the current state of the epidemiology, aetiology, diagnosis and management of viral pneumonia in sub-Saharan Africa.

  16. Acute respiratory failure caused by organizing pneumonia secondary to antineoplastic therapy for non-Hodgkin's lymphoma

    Science.gov (United States)

    Santana, Adriell Ramalho; Amorim, Fábio Ferreira; Soares, Paulo Henrique Alves; de Moura, Edmilson Bastos; Maia, Marcelo de Oliveira

    2012-01-01

    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 suggestive. Organizing pneumonia may be idiopathic or linked to collagen diseases, drugs and cancer and usually responds to corticosteroid therapy. The diagnosis was anatomopathological, but the patient's clinical condition precluded performing a lung biopsy. Organizing pneumonia should be a differential diagnosis in patients with apparent pneumonia and a progression that is unfavorable to antimicrobial treatment. PMID:23917942

  17. Cavitary Cryptogenic Organizing Pneumonia and abnormalities of the Basal Ganglia Case presentation

    International Nuclear Information System (INIS)

    Prieto, Enrique; Mora, Alfonso Sergio

    2007-01-01

    Cryptogenic Organizing Pneumonia (COP) is a pulmonary disorder with a wide spectrum of radiological features. A case of a young patient of 16 years old is shown with CAT appearance of multiple cavitary nodules in both lungs that responded with a complete resolution after corticosteroid therapy. This patient also reveals abnormalities of the basal ganglia as the result of hypoxic ischemic encephalopathy associated with the acute presentation of this disorder. We justify the inclusion of COP in the differential diagnosis of multiple cavitary nodules, and it is discussed the differential diagnosis of her abnormalities of the basal ganglia

  18. Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods

    OpenAIRE

    Kênia de Fátima Carrijo; Elmiro Rosendo do Nascimento; Virginia Léo de Almeida Pereira; Nelson Morés; Catia Silene Klein; Leonardo Muliterno Domingues; Rogerio Tortelly

    2014-01-01

    ABSTRACT. Carrijo K.F., Nascimento E.R., Pereira V.L.A., Morés N., Klein, C.S., Domingues L.M. & Tortelly R. [Diagnosis of porcine enzootic pneumonia by post mortem sanitary inspection: comparison with other diagnostic methods.] Diagnóstico da pneumonia enzoótica suína pela inspeção sanitária post mortem: comparação com outros métodos de diagnóstico. Revista Brasileira de Veterinária Brasileira 36(2):188-194, 2014. Faculdade de Medicina Veterinária, Universidade Federal de Uberlândia, Av. Par...

  19. Pneumonia Pneumosistis

    OpenAIRE

    I Wayan Gustawan; BNP Arhana; Putu Siadi Purniti; IB Subanada; K Dewi Kumara Wati

    2016-01-01

    Pneumonia pnemosistis merupakan penyebab kesakitan yang serius dan kematian pada kasus gangguan sistem imun. Pneumonia pnemosistis merupakan infeksi oportunistik tersering pada kasus yang terinfeksi HIV, leukemia dan anak yang menerima transplantasi organ. Organisme penyebab adalah Pneumocystis carinii. Manifestasi klinis berupa gangguan pernapasan disertai penyakit dasarnya. Diagnosis pasti ditegakkan dengan ditemukannya organisme dalam pemeriksaan mikroskopis. Pengobatan secara ...

  20. Diagnostic approach to localised organising pneumonia--A case report.

    Science.gov (United States)

    Djurić, Mirna; Považan, Djordje; Djurić, Dejan; Eri, Živka; Trudić, Anika

    2015-08-01

    Localised organising pneumonia, radiologically presented with oval or round shadows mimicing lung cancer or metastases, is a major issue in differential diagnosis. A female patient was hospitalized to clarified the etiology of multiple nodular lung lesions. The chest X-ray and the chest computed tomography (CT) revealed bilateral patchy and nodular shadows, and round lung lesions, respectively. Neither sputum analyses, nor histology of bronchoscopy samples clarified the etiology of these lung lesions. As secondary deposits in the lungs were suspected, video-assisted thoracoscopy and anterolateral right minithoracotomy with atypical upper and lower lobe resection were performed. The frozen-section analysis suggested the benign nature of the lesion, and the definite histopathological finding of localised organising pneumonia was established. Due to bilateral lung lesions, corticosteroids were applied. Seven weeks later, the chest CT finding revealed a total regression of the lesions. A surgical resection was necessary to diagnose the localised organising pneumonia which mimiced secondary malignant lesions, thus establishing the definite etiology of lung lesions. Bronchoscopic cryobiopsy, recently introduced in order to obtain peripheral lung biopsy samples, has provided new possibilities in the diagnosis and treatment of neoplastic and non-neoplastic lung diseases.

  1. Diagnosis of Ewing's sarcoma in the thoracic spine - problems in differential diagnosis

    International Nuclear Information System (INIS)

    Schaub, T.; Dittrich, H.M.; Gutjahr, P.; Antoniadis, A.; Wolff, P.

    1986-01-01

    Spinal Ewing's sarcomas are rare and cause problems in differential diagnosis. The radiologic, nuclear medicine and CT findings in two children with histologically proven Ewing's sarcoma are presented and problems in differential diagnosis discussed. Biopsy should be done early. (orig.) [de

  2. Primary Sjogrens syndrome, with lymphocytic interticial pneumonia and cystic pulmonary disease

    International Nuclear Information System (INIS)

    Vallejo, Jimi Mejia; Bayona, Jorge Carrillo; Iglesias Gamarra, Antonio; Rondon Federico Sanchez Contreras Alvaro, Restrepo Jose Felix

    2007-01-01

    The primary Sjogrens syndrome (PSS) is a chronic autoimmune exocrinopathy characterized by lymphocytic infiltration of glandular and extraglanduIar tissue, the lung involvement is heterogeneous; the aim of this study is report the first case in Colombia of PSS with Iymphocytic intersticiaI pneumonia and cystic pulmonary disease discuss differential diagnosis and the initial diagnostic and therapeutic work up

  3. Severe Community-acquired Pneumonia Due to Legionella pneumophila Serogroup 6

    Directory of Open Access Journals (Sweden)

    Chung-Yu Chen

    2006-01-01

    Full Text Available Legionella pneumophila is a common cause of sporadic community-acquired pneumonia, but culture-proven legionellosis is rarely diagnosed. There is no laboratory test for Legionnaires' disease that can detect all patients with the disease. Culture is the standard diagnostic method and should be initiated as soon as possible in suspected cases. We describe a rare case of community-acquired pneumonia caused by L. pneumophila serogroup 6. A 77-year-old man was admitted to a tertiary care hospital because of high fever, productive cough, and progressive dyspnea. Chest radiography showed bilateral pneumonia, which led to respiratory failure necessitating mechanical ventilatory support. Despite antibiotic therapy, his condition continued to deteriorate and acute renal failure also developed. Urine was negative for L. pneumophila. Culture of the sputum yielded L. pneumophila serogroup 6, although there was no elevation of the serum antibody titer. Pneumonia resolved gradually and he was extubated after treatment with levofloxacin followed by erythromycin. L. pneumophila other than serogroup 1 should be included in the differential diagnosis of patients with suspected atypical community-acquired pneumonia.

  4. Clinical signs of pneumonia in children: association with and prediction of diagnosis by fuzzy sets theory

    Directory of Open Access Journals (Sweden)

    Pereira J.C.R.

    2004-01-01

    Full Text Available The present study compares the performance of stochastic and fuzzy models for the analysis of the relationship between clinical signs and diagnosis. Data obtained for 153 children concerning diagnosis (pneumonia, other non-pneumonia diseases, absence of disease and seven clinical signs were divided into two samples, one for analysis and other for validation. The former was used to derive relations by multi-discriminant analysis (MDA and by fuzzy max-min compositions (fuzzy, and the latter was used to assess the predictions drawn from each type of relation. MDA and fuzzy were closely similar in terms of prediction, with correct allocation of 75.7 to 78.3% of patients in the validation sample, and displaying only a single instance of disagreement: a patient with low level of toxemia was mistaken as not diseased by MDA and correctly taken as somehow ill by fuzzy. Concerning relations, each method provided different information, each revealing different aspects of the relations between clinical signs and diagnoses. Both methods agreed on pointing X-ray, dyspnea, and auscultation as better related with pneumonia, but only fuzzy was able to detect relations of heart rate, body temperature, toxemia and respiratory rate with pneumonia. Moreover, only fuzzy was able to detect a relationship between heart rate and absence of disease, which allowed the detection of six malnourished children whose diagnoses as healthy are, indeed, disputable. The conclusion is that even though fuzzy sets theory might not improve prediction, it certainly does enhance clinical knowledge since it detects relationships not visible to stochastic models.

  5. Dual-time-point {sup 18}F-FDG PET imaging for diagnosis of disease type and disease activity in patients with idiopathic interstitial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Umeda, Yukihiro; Demura, Yoshiki; Ishizaki, Takeshi; Ameshima, Shingo [University of Fukui, Department of Respiratory Medicine, Yoshida-gun, Fukui (Japan); Miyamori, Isamu [University of Fukui, Third Department of Internal Medicine, Yoshida-gun, Fukui (Japan); Saito, Yuji [Fujita Health University, Division of Respirology and Allergology, Department of Internal Medicine, School of Medicine, Toyoake, Aichi (Japan); Tsuchida, Tatsuro [University of Fukui, Department of Radiology, Yoshida-gun, Fukui (Japan); Fujibayashi, Yasuhisa; Okazawa, Hidehiko [University of Fukui, Biomedical Imaging Research Center, Yoshida-gun, Fukui (Japan)

    2009-07-15

    Individual clinical courses of idiopathic interstitial pneumonia (IIP) are variable and difficult to predict because the pathology and disease activity are contingent, and chest computed tomography (CT) provides little information about disease activity. In this study, we applied dual-time-point [{sup 18}F]-fluoro-2-deoxy-D-glucose ({sup 18}F-FDG) positron emission tomography (PET), commonly used for diagnosis of malignant tumours, to the differential diagnosis and prediction of disease progression in IIP patients. Fifty patients with IIP, including idiopathic pulmonary fibrosis (IPF, n = 21), non-specific interstitial pneumonia (NSIP, n = 18) and cryptogenic organizing pneumonia (COP, n = 11), underwent {sup 18}F-FDG PET examinations at two time points: scan 1 at 60 min (early imaging) and scan 2 at 180 min (delayed imaging) after {sup 18}F-FDG injection. The standardized uptake values (SUV) at the two points and the retention index (RI-SUV) calculated from them were evaluated and compared with chest CT findings, disease progression and disease types. To evaluate short-term disease progression, all patients were examined by pulmonary function test every 3 months for 1 year after {sup 18}F-FDG PET scanning. The early SUV for COP (2.47 {+-} 0.74) was significantly higher than that for IPF (0.99 {+-} 0.29, p = 0.0002) or NSIP (1.22 {+-} 0.44, p= 0.0025). When an early SUV cut-off value of 1.5 and greater was used to distinguish COP from IPF and NSIP, the sensitivity, specificity and accuracy were 90.9, 94.3 and 93.5%, respectively. The RI-SUV for IPF and NSIP lesions was significantly greater in patients with deteriorated pulmonary function after 1 year of follow-up (progressive group, 13.0 {+-} 8.9%) than in cases without deterioration during the 1-year observation period (stable group, -16.8 {+-} 5.9%, p < 0.0001). However, the early SUV for all IIP types provided no additional information of disease progression. When an RI-SUV cut-off value of 0% and greater was

  6. Clinical and radiological aspects of limited forms of infiltrative pulmonary tuberculosis and slowly resolving pneumonia

    International Nuclear Information System (INIS)

    Caraiani, Olga; Lesnic, Evelina; Niguleanu, Adriana; Niguleanu, Radu

    2016-01-01

    Despite of a clearly defined diagnostic algorithm of pulmonary tuberculosis, low sensibility of contemporary laboratory methods in limited forms of pulmonary tuberculosis contributes to a difficult differential diagnosis with community acquired pneumonia, especially with slowly resolving pneumonia. A case-control, prospective, selective, comparative and descriptive study was performed using a group of 180 patients, divided into two samples: I group - 125 cases with limited form of pulmonary infiltrative tuberculosis; II group - 55 cases with slowly resolving community-acquired pneumonia. The findings identified the prevalence of intoxication syndrome in the slowly resolving pneumonia sample. Lung destructions and bronchogenous dissemination was identified only in the tuberculosis sample. A higher impact of comorbidities and old age was more relevant in slowly resolving pneumonia sample. Clinical and radiological improvement was established in most patients of both groups, but the considerable resorption of lung infiltrates predominated in slowly resolving pneumonia sample. (authors)

  7. Tuberculous pneumonia and bacteriaI pneumonia in diabetic patients: comparison of CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoo Kyung; Shim, Sung Shine [College of Medicine, Chungnam Univ., Daejeon (Korea, Republic of); Kim, Jin Hwan [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

    2004-07-01

    To compare the CT findings of tuberculous pneumonia (TBPN) with those of bacterial pneumonia (BAPN) in diabetic patients and to evaluate the usefulness of CT in the differential diagnosis of these two diseases. The chest CT scans of 23 diabetic patients with TBPN (M:F=21:2; mean age, 59 yrs.) and of 37 diabetic patients with BAPN (M:F=21:16; mean age, 63 yrs.) were evaluated by two radiologists with regard to low attenuation areas in regions of consolidation, cavities, air bronchogram, volume changes, ground-glass attenuation, findings of bronchogenic spread, and other associated findings. The involvement of each segment was recorded in all patients. The frequencies of multiple small low-attenuation areas in regions of consolidation (52%, 0%), multiple cavities (35%, 3%), loss of volume (70%, 30%) and findings of bronchogenic spread (96%, 30%) were significantly higher in TBPN than in BAPN (p< .05). Low-attenuation masses and bizarre-shaped cavities were noted only in TBPN. Large areas of ground-glass attenuation (4%, 38%) and bilateral pleural effusions (0%, 19%) were more common in BAPN, while air-bronchogram was common in both groups (96%, 86%). The involvement of the superior segment was significantly more common in TBPN (p< .05). In the diabetic patients with pulmonary consolidation, CT findings of multiple small low-attenuation areas, multiple cavities, bizarre-shaped cavities, low attenuation masses in cavities, volume loss, and findings of bronchogenic spread are more suggestive of TBPN, while large areas of ground-glass attenuation and bilateral pleural effusions are more suggestive of BAPN. CT may be useful in the differential diagnosis between TBPN and BAPN.

  8. Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.

    Science.gov (United States)

    Reamy, Brian V; Williams, Pamela M; Odom, Michael Ryan

    2017-09-01

    Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made. Validated clinical decision rules are available to help exclude coronary artery disease. Viruses are common causative agents of pleuritic chest pain. Coxsackieviruses, respiratory syncytial virus, influenza, parainfluenza, mumps, adenovirus, cytomegalovirus, and Epstein-Barr virus are likely pathogens. Treatment is guided by the underlying diagnosis. Nonsteroidal anti-inflammatory drugs are appropriate for pain management in those with virally triggered or nonspecific pleuritic chest pain. In patients with persistent symptoms, persons who smoke, and those older than 50 years with pneumonia, it is important to document radiographic resolution with repeat chest radiography six weeks after initial treatment.

  9. Specimen collection for the diagnosis of pediatric pneumonia

    NARCIS (Netherlands)

    Hammitt, Laura L.; Murdoch, David R.; Scott, J. Anthony G.; Driscoll, Amanda; Karron, Ruth A.; Levine, Orin S.; O'Brien, Katherine L.; Black, Robert; Bhutta, Zulfiqar A.; Campbell, Harry; Cherian, Thomas; Crook, Derrick W.; de Jong, Menno D.; Dowell, Scott F.; Graham, Stephen M.; Klugman, Keith P.; Lanata, Claudio F.; Madhi, Shabir A.; Martin, Paul; Nataro, James P.; Piazza, Franco M.; Qazi, Shamim; Zar, Heather J.

    2012-01-01

    Diagnosing the etiologic agent of pneumonia has an essential role in ensuring the most appropriate and effective therapy for individual patients and is critical to guiding the development of treatment and prevention strategies. However, establishing the etiology of pneumonia remains challenging

  10. [Non allergic simple eosinophilic pneumonia--Löffler syndrome--a case report study].

    Science.gov (United States)

    Meta-Jevtović, Ivana; Tomović, Miroslav S; Mojsilović, Slavica; Petrović, Marina

    2008-01-01

    Löffler syndrome is an acute, pneumonia of unknown ethiology. This disease is not often associated with bronchial asthma. In its asymptomatic form, this disease is reversible, transient, self-limited with no requests for specific therapy regimen. In the symptomatic form, as well as during its progression, treatment with steroids is very effective. Furthermore, in both acute eosinophilic and idiopathic chronic eosinophilic form, this kind of therapy ensures survival. The case of a 53-year-old Caucasian woman was presented with 2-month history of low grade fever, shortness of breath, cough and reduced exercise tolerance. Although she had an allergic accident on insects in history, non allergy reactions as well as an obstructive disease with that kind of origin were not detected on admission. The diagnosis of simple eosinophilic pneumonia (SEP) (Löffler's syndrome) was confirmed by transbronchial biopsy and by sternal testing. The peripheral blood eosinophilia with pulmonary eosinophilic infiltrates on X ray chest radiography were observed during clinical examination. Biopsy specimen of the lung parenchym showed changes associated with Löffler's syndrome. The diagnosis was, also, confirmed according to the radiographic findings of unilateral migratory infiltrates consistent pneumonia. Churg Strauss syndrome (CSS) has to be considered in this differential diagnosis. Frequently, this disease has extrinsic bronchial asthma with eosinophilic pneumonia in history: asthma is often associated with allergic bronchopulmonary aspergillosis. In the reported case, treatment with steroids resulted in a marked clinical improvement compared to nonsteroid therapy.

  11. Virome and bacteriome characterization of children with pneumonia and asthma in Mexico City during winter seasons 2014 and 2015

    Science.gov (United States)

    Romero-Espinoza, Jose A.; Moreno-Valencia, Yazmin; Coronel-Tellez, Rodrigo H.; Castillejos-Lopez, Manuel; Hernandez, Andres; Dominguez, Aaron; Miliar-Garcia, Angel; Barbachano-Guerrero, Arturo; Perez-Padilla, Rogelio; Alejandre-Garcia, Alejandro

    2018-01-01

    Background Acute asthma exacerbations and pneumonia are important causes of morbidity and mortality in children and may coexist in the same children, although symptom overlap may lead to difficulties in diagnosis. Microbial and viral diversity and differential abundance of either may play an important role in infection susceptibility and the development of acute and chronic respiratory diseases. Objectives To describe the virome and bacteriome present in the upper respiratory tract of hospitalized children with a clinical diagnosis of asthma and pneumonia during an acute exacerbation and an acute respiratory illness ARI episode respectively. Methods During the winter seasons of 2013–2014 and 2014–2015, 134 nasopharyngeal swabs samples of children <15 years of age with ARI hospitalized at a referral hospital for respiratory diseases were selected based on clinical diagnosis of asthma or pneumonia. The virome and bacteriome were characterized using Whole Genome Sequencing (WGS) and in-house bioinformatics analysis pipeline. Results The Asthma group was represented mainly by RV-C, BoV-1 and RSV-B and the pneumonia group by Bacteriophage EJ-1 and TTMV. TTV was found in both groups with a similar amount of reads. About bacterial composition Moraxella catarrhalis, Propionibacterium acnes and Acinetobacter were present in asthma and Veillonella parvula and Mycoplasma pneumoniae in pneumonia. Streptococcus pneumoniae and Haemophilus influenzae were mostly found with both asthma and pneumonia. Conclusions Our results show a complex viral and bacterial composition in asthma and pneumonia groups with a strong association of RV-C presence in asthmatic children. We observed Streptococcus pneumoniae and Haemophilus influenzae concurrently in both groups. PMID:29447223

  12. [The role of endotracheal aspiration in the diagnosis of ventilator associated pneumonia].

    Science.gov (United States)

    Gürgün, Alev; Korkmaz Ekren, Pervin; Bacakoğlu, Feza; Başoğlu, Ozen Kaçmaz; Dirican, Nigar; Aydemir, Şöhret; Nart, Deniz; Sayıner, Abdullah

    2013-01-01

    Ventilator associated pneumonia (VAP) is one of the most important causes of mortality in patients treated with invasive mechanical ventilation (IMV) in intensive care unit (ICU). Microbiological examinations are required as clinical and radiological findings are usually insufficient in the diagnosis. Twenty four patients who were receiving IMV because of respiratory failure, had a Clinical Pulmonary Infection Score (CPIS) of ≥ 6 in the follow-up and died with the suspicion of VAP were enrolled in our study. Six patients were excluded as post-mortem biopsy could not be performed. The patients who had pre-mortem CPIS ≥ 6, in whom a causative organism was identified from the culture of post-mortem lung biopsy and/or histopathological examination of lung biopsy was compatible with pneumonia were diagnosed as VAP. In the 18 patients in whom a post-mortem lung biopsy was performed, quantitative culture results of endotracheal aspirate performed 48 hours prior to death were compared with microbiological and histopathological results of post-mortem lung biopsy specimens, and the role of endotracheal aspirate in the diagnosis of VAP was evaluated retrospectively. Out of 18 patients (12 men, mean age 67.0 ± 13.0 years) included in the study, 11 (61.1%) were diagnosed as VAP. The quantitative culture of endotracheal aspirate was positive in 9 (81.8%) out of 11 patients diagnosed as VAP. The sensitivity, specificity, positive and negative predictive values of endotracheal aspirate culture for identifying VAP were found to be 81.8%, 14.3%, 60.0% and 33.3%, respectively. Our study shown that quantitative culture of endotracheal aspirate is a practical and reliable method that can be used for the diagnosis of VAP in patients receiving IMV in ICU and having CPIS ≥ 6.

  13. Prevalence of Mycoplasma pneumoniae : A cause for community ...

    African Journals Online (AJOL)

    Prevalence of Mycoplasma pneumoniae : A cause for community‑acquired ... Atypical pneumonia caused by Mycoplasma pneumoniae is a leading cause of ... microscopic and biochemical studies for better diagnosis of these pathogens.

  14. [Mycoplasma pneumoniae meningoencephalitis].

    Science.gov (United States)

    Cambonie, G; Sarran, N; Leboucq, N; Luc, F; Bongrand, A F; Slim, G; Lassus, P; Fournier-Favre, S; Montoya, F; Astruc, J; Rieu, D

    1999-03-01

    Severe central nervous system diseases, such as encephalitis, have been reported in association with Mycoplasma pneumoniae infections. After an ENT infection, a 9-year-old boy with Down's syndrome developed encephalitis revealed by an acute alteration in consciousness. Head computed tomography showed, after 2 weeks, an infiltration in the basal ganglia region. The diagnosis of Mycoplasma pneumoniae encephalitis was made; recovery was complete in a few weeks. Mycoplasma pneumoniae infection should be considered in all cases of acute encephalopathy; yet the pathogenesis of the disorder is unknown and the treatment uncertain.

  15. Comparison of PCR, culture, and serological tests for diagnosis of Mycoplasma pneumoniae respiratory tract infection in children

    NARCIS (Netherlands)

    Dorigo-Zetsma, J. W.; Zaat, S. A.; Wertheim-van Dillen, P. M.; Spanjaard, L.; Rijntjes, J.; van Waveren, G.; Jensen, J. S.; Angulo, A. F.; Dankert, J.

    1999-01-01

    For diagnosis of Mycoplasma pneumoniae infection we compared two rapid tests, PCR and the immunoglobulin M immunofluorescence assay (IgM IFA), with culture and the complement fixation test (CFT), in a prospective study among 92 children with respiratory tract infection and 74 controls. Based on

  16. Diagnosis and differential diagnosis of Graves' orbitopathy in MRI

    International Nuclear Information System (INIS)

    Daubner, D.; Spieth, S.; Engellandt, K.; Kummer, R. von

    2012-01-01

    Imaging of Graves' orbitopathy (GO) includes radiological and nuclear medicine procedures. Depending on the method used they provide information about the distribution and activity of the disease. Magnetic resonance imaging (MRI) is not only a helpful tool for making the diagnosis it also enables differentiation of the active and inactive forms of GO due to intramuscular edema. The modality is therefore appropriate to evaluate the disease activity and the course of therapy. The disease leads to the typical enlargement of the muscle bodies of the extraocular muscles. The inferior rectus, medial rectus and levator palpebrae muscles are mostly involved. Signal changes of the intraconal and extraconal fat tissue are possible and a bilateral manifestation is common. The differential diagnosis includes inflammatory diseases and tumors, of which orbital pseudotumor (idiopathic, unspecific orbital inflammation), ocular myositis and orbital lymphoma are the most important. The specific patterns (localization, involvement of orbital structures and signal changes) can be differentiated by MRI. (orig.) [de

  17. Diagnosis and Treatment of Community-Acquired Pneumonia in Children

    Directory of Open Access Journals (Sweden)

    I.A. Karymdzhanov

    2016-02-01

    The initial antibiotic therapy of community-acquired pneumonia is carried out empirically. In the treatment of severe community-acquired pneumonia in children from 2 months to 5 years, the drug of choice is amoxicillin orally. Macrolides are the drugs of choice for children aged 5 to 16 years. In severe pneumonia, drugs of choice are amoxicillin clavulanate, 2nd–4th generation cephalosporins. In general, the duration of antibiotic therapy in the community-acquired pneumonia caused by typical bacteria is 7–10 days, by atypical bacteria — 10–14 days. In the real clinical practice, the errors associated with the choice of drug, route of administration, dosage, regimen of application, length of treatment are frequent during antibacterial therapy.

  18. [The role of endotracheal aspirate culture in the diagnosis of ventilator-associated pneumonia: a meta analysis].

    Science.gov (United States)

    Wang, Fei; He, Bei

    2013-01-01

    To investigate the role of endotracheal aspirate (EA) culture in the diagnosis and antibiotic management in ventilator-associated pneumonia (VAP). We searched CNKI, Wanfang, PUBMED and EMBASE databases published from January 1990 to December 2011, to find relevant literatures on VAP microbiological diagnostic techniques including EA and bronchoalveolar lavage (BALF). The following key words were used: ventilator associated pneumonia, diagnosis and adult. Meta-analysis was performed and the sensitivity and specificity of EA on VAP diagnosis were calculated. Our literature search identified 1665 potential articles, 8 of which fulfilled our selection criteria including 561 patients with paired cultures. Using BALF quantitative culture as reference standard, the sensitivity and specificity of EA were 72% and 71%. When considering quantitative culture of EA only, the sensitivity and specificity improved to 90% and 65%, while the positive and the negative predictive values were 68% and 89% respectively. However, the sensitivity and specificity of semi-quantitative culture of EA were only 50% and 80%, with a positive predictive value of 77% and a negative predictive value of 58% respectively. EA culture had relatively poor sensitivity and specificity, although quantitative culture of EA only could improve the sensitivity. Initiating therapy on the basis of EA quantitative culture may still result in excessive antibiotic usage. Our data suggested that EA could provide some information for clinical decision but could not replace the role of BALF quantitative culture in VAP diagnosis.

  19. Virome and bacteriome characterization of children with pneumonia and asthma in Mexico City during winter seasons 2014 and 2015.

    Science.gov (United States)

    Romero-Espinoza, Jose A; Moreno-Valencia, Yazmin; Coronel-Tellez, Rodrigo H; Castillejos-Lopez, Manuel; Hernandez, Andres; Dominguez, Aaron; Miliar-Garcia, Angel; Barbachano-Guerrero, Arturo; Perez-Padilla, Rogelio; Alejandre-Garcia, Alejandro; Vazquez-Perez, Joel A

    2018-01-01

    Acute asthma exacerbations and pneumonia are important causes of morbidity and mortality in children and may coexist in the same children, although symptom overlap may lead to difficulties in diagnosis. Microbial and viral diversity and differential abundance of either may play an important role in infection susceptibility and the development of acute and chronic respiratory diseases. To describe the virome and bacteriome present in the upper respiratory tract of hospitalized children with a clinical diagnosis of asthma and pneumonia during an acute exacerbation and an acute respiratory illness ARI episode respectively. During the winter seasons of 2013-2014 and 2014-2015, 134 nasopharyngeal swabs samples of children pneumonia. The virome and bacteriome were characterized using Whole Genome Sequencing (WGS) and in-house bioinformatics analysis pipeline. The Asthma group was represented mainly by RV-C, BoV-1 and RSV-B and the pneumonia group by Bacteriophage EJ-1 and TTMV. TTV was found in both groups with a similar amount of reads. About bacterial composition Moraxella catarrhalis, Propionibacterium acnes and Acinetobacter were present in asthma and Veillonella parvula and Mycoplasma pneumoniae in pneumonia. Streptococcus pneumoniae and Haemophilus influenzae were mostly found with both asthma and pneumonia. Our results show a complex viral and bacterial composition in asthma and pneumonia groups with a strong association of RV-C presence in asthmatic children. We observed Streptococcus pneumoniae and Haemophilus influenzae concurrently in both groups.

  20. Aspiration pneumonia: a review of modern trends.

    Science.gov (United States)

    DiBardino, David M; Wunderink, Richard G

    2015-02-01

    The purpose was to describe aspiration pneumonia in the context of other lung infections and aspiration syndromes and to distinguish between the main scenarios commonly implied when the terms aspiration or aspiration pneumonia are used. Finally, we aim to summarize current evidence surrounding the diagnosis, microbiology, treatment, risks, and prevention of aspiration pneumonia. Medline was searched from inception to November 2013. All descriptive or experimental studies that added to the understanding of aspiration pneumonia were reviewed. All studies that provided insight into the clinical aspiration syndromes, historical context, diagnosis, microbiology, risk factors, prevention, and treatment were summarized within the text. Despite the original teaching, aspiration pneumonia is difficult to distinguish from other pneumonia syndromes. The microbiology of pneumonia after a macroaspiration has changed over the last 60 years from an anaerobic infection to one of aerobic and nosocomial bacteria. Successful antibiotic therapy has been achieved with several antibiotics. Various risks for aspiration have been described leading to several proposed preventative measures. Aspiration pneumonia is a disease with a distinct pathophysiology. In the modern era, aspiration pneumonia is rarely solely an anaerobic infection. Antibiotic treatment is largely dependent on the clinical scenario. Several measures may help prevent aspiration pneumonia. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Diagnosis of verminous pneumonia via sonography-guided fine-needle pulmonary parenchymal aspiration in a cat

    Directory of Open Access Journals (Sweden)

    Jennifer Gambino

    2016-04-01

    Full Text Available Case summary A 9-year-old, male neutered, indoor–outdoor domestic shorthair cat from the northern Alabama countryside presented for a 3 week history of coughing, lethargy and an episode of self-resolving dyspnea that occurred 1 week prior to presentation. Three-view thoracic radiographs revealed a moderate-to-severe, diffuse, mixed bronchial to structured interstitial (miliary-to-nodular pulmonary pattern in all lung lobes with peribronchial cuffing and multifocal areas of mild patchy alveolar opacity. Ultrasound-guided evaluation and fine-needle aspiration of the caudodorsal lung parenchyma was performed with sedation. Cytology revealed many widely scattered Aelurostrongylus abstrusus larvae and ova. Upon the confirmed diagnosis of A abstrusus verminous pneumonia, treatment with fenbendazole and selamectin resulted in complete resolution of clinical signs within 6 weeks of the initial diagnosis. Relevance and novel information We report herein the first documented case in the Americas of A abstrusus verminous pneumonia diagnosed via cytologic evaluation of an in vivo, percutaneous ultrasound-guided fine-needle aspirate of affected lung. Additionally, to our knowledge, we offer the first account of the sonographic (pulmonary features of the disease.

  2. A prospective study of the diagnostic utility of sputum Gram stain in pneumonia.

    Science.gov (United States)

    Anevlavis, Stavros; Petroglou, Niki; Tzavaras, Athanasios; Maltezos, Efstratios; Pneumatikos, Ioannis; Froudarakis, Marios; Anevlavis, Eleftherios; Bouros, Demosthenes

    2009-08-01

    Sputum Gram stain and culture have been said to be unreliable indicators of the microbiological diagnosis of bacterial pneumonia. The etiological diagnosis of pneumonia is surrounded by great degree of uncertainty. This uncertainty should be and can be calculated and incorporated in the diagnosis and treatment. To determine the diagnostic accuracy and diagnostic value of sputum Gram stain in etiological diagnosis and initial selection of antimicrobial therapy of bacterial community acquired pneumonia (CAP). DESIGN-METHOD: Prospective study of 1390 patients with CAP admitted January 2002-June 2008, to our institutions. Of the 1390 patients, 178 (12.8%) fulfilled the criteria for inclusion into this study (good-quality sputa and presence of the same microorganism in blood and sputum cultures which was used as gold standard for assessing the diagnostic accuracy and diagnostic value of sputum Gram stain). The sensitivity of sputum Gram stain was 0.82 for Pneumococcal pneumonia, 0.76 for Staphylococcal pneumonia, 0.79 for Haemophilus influenzae pneumonia and 0.78 for Gram-negative bacilli pneumonia. The specificity of sputum Gram stain was 0.93 for Pneumococcal pneumonia, 0.96 for Staphylococcal pneumonia, 0.96 for H. influenzae pneumonia and 0.95 for Gram-negative bacilli pneumonia. The positive likelihood ratio (LR+) was 11.58 for Pneumococcal pneumonia, 19.38 for Staphylococcal pneumonia, 16.84 for H. influenzae pneumonia, 14.26 for Gram-negative bacilli pneumonia. The negative likelihood ratio (LR-) was 0.20 for Pneumococcal pneumonia, 0.25 for Staphylococcal pneumonia, 0.22 for H. influenzae pneumonia, and 0.23 for Gram-negative bacilli pneumonia. Sputum Gram stain is a dependable diagnostic test for the early etiological diagnosis of bacterial CAP that helps in choosing orthological and appropriate initial antimicrobial therapy.

  3. Detection of Mycoplasma pneumoniae in simulated and true clinical throat swab specimens by nanorod array-surface-enhanced Raman spectroscopy.

    Directory of Open Access Journals (Sweden)

    Suzanne L Hennigan

    Full Text Available The prokaryote Mycoplasma pneumoniae is a major cause of respiratory disease in humans, accounting for 20% of all community-acquired pneumonia and the leading cause of pneumonia in older children and young adults. The limitations of existing options for mycoplasma diagnosis highlight a critical need for a new detection platform with high sensitivity, specificity, and expediency. Here we evaluated silver nanorod arrays (NA as a biosensing platform for detection and differentiation of M. pneumoniae in culture and in spiked and true clinical throat swab samples by surface-enhanced Raman spectroscopy (SERS. Three M. pneumoniae strains were reproducibly differentiated by NA-SERS with 95%-100% specificity and 94-100% sensitivity, and with a lower detection limit exceeding standard PCR. Analysis of throat swab samples spiked with M. pneumoniae yielded detection in a complex, clinically relevant background with >90% accuracy and high sensitivity. In addition, NA-SERS correctly classified with >97% accuracy, ten true clinical throat swab samples previously established by real-time PCR and culture to be positive or negative for M. pneumoniae. Our findings suggest that the unique biochemical specificity of Raman spectroscopy, combined with reproducible spectral enhancement by silver NA, holds great promise as a superior platform for rapid and sensitive detection and identification of M. pneumoniae, with potential for point-of-care application.

  4. The urinary antigen tests have high sensitivity in diagnosis of Pneumococcus caused community-acquired pneumonia posterior to antimicrobial therapy.

    Science.gov (United States)

    Chen, Ming; Zhou, Ming; Xiao, Wei; Ai, Biao; Liu, Xuezheng; Li, Yan

    2014-11-01

    Antibiotic treatment before microbiological test significant reduces the positive rate of culture methods of Streptococcus pneumoniae. The Binax NOW S. pneumoniae immunochromatographic test (ICT) has become a more commonly used procedure to diagnose S. pneumoniae from community-acquired pneumonia in adults. However, performance of this test after empirical antimicrobial therapy is uncertain. Therefore, in this prospective study, we evaluate the impact of antimicrobial therapy on sensitivity of ICT test in 487 hospitalized adult patients. The results showed that 192 (39.4 %) and 295 (60.6 %) specimens were collected before (Group 1) or after antibiotic treatment (Group 2), respectively. S. pneumoniae was detected by ICT in 21 (10.9 %) patients in the Group 1 and 39 (13.2 %) in the Group 2 and their positive rates were not different (P > 0.05). However, The positive rate of blood and pleural fluid was declined from 5.7 to 2.7 % and sputum, from 9.9 to 4.7 % after the antibiotic treatment, respectively. This study confirmed that the ICT urinary antigen test remained to have a high sensitivity for diagnosis of pneumococcal infection after empiric antibiotic treatment was started. The ICT urinary antigen test would have a potential to guide the right choice of therapy for pneumonia in adults earlier.

  5. Comparison of clinicoradiologic manifestation of nonspecific interstitial pneumonia and usual interstitial pneumonia/idiopathic pulmonary fibrosis: A report from NRITLD

    Directory of Open Access Journals (Sweden)

    Tafti Saeid

    2008-01-01

    Full Text Available Background: Ever since Katzenstein and Fiorelli introduced the term nonspecific interstitial pneumonia (NSIP to denote those cases of interstitial pneumonia that cannot be categorized as any of the other types of idiopathic interstitial pneumonias (IIP, there has been continuing debate on whether it is a real clinical entity or not. The American Thoracic Society/European Respiratory Symposium task group tried to identify idiopathic NSIP as a separate disease and exclude it from the category of IIP. However, it appears that the clinical presentation of NSIP and usual interstitial pneumonia (UIP are the same. Objective : To show that the radiologic features of NSIP and UIP should be relied upon, instead of clinical presentation and pathologic findings, to differentiate between the two. Materials and Methods: Consecutive patients who had received a diagnosis of either NSIP or UIP on the basis of open lung biopsy between January 2001 and December 2007 were identified for inclusion in this retrospective review. The study included 61 subjects: 32 men and 29 women with a mean age of 59.39 ± 14.5 years. Chest computed tomography images of all the cases were collected for a review. High resolution computed tomography (HRCT and all pathologic specimens were also evaluated. A weighted kappa coefficient was used to evaluate whether radiology can be used instead of biopsy for the diagnosis of NSIP and UIP. Comparison of the mean ages and the time intervals (i.e., interval between symptom onset and the time of diagnosis in the UIP and NSIP groups was done using the Mann-Whitney U test. Association between gender and biopsy result was evaluated by the Fisher exact test. Data were evaluated using SPSS, v.13. Results : Sixty-one patients were included in this study, 32 were male and 29 were female. On the basis of biopsy findings, 50 (82% patients had UIP and 11 (18% had NSIP. Thirty (60% of the 50 patients who had UIP were male and 20 (40% were female; 2 (18

  6. Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?

    International Nuclear Information System (INIS)

    Rigsby, Cynthia K.; Strife, Janet L.; Johnson, Neil D.; Atherton, Harry D.; Kotagal, Uma R.; Pommersheim, William

    2004-01-01

    In our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed. To determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children. Three radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs. A majority interpretation of at least two radiologists for the frontal views alone was compared with majority interpretation of the frontal and lateral combined views for the radiographic diagnosis of pneumonia. ''Pneumonia'' was defined as a focus of streaky or confluent lung opacity. For the radiographic diagnosis of pneumonia, the sensitivity and specificity of the frontal view alone were 85% and 98%, respectively. For the confluent lobar type of pneumonia, the sensitivity and specificity increased to 100%. When the frontal view alone yields a diagnosis of confluent lobar pneumonia, this is highly reliable. However, nonlobar types of infiltrates will be underdiagnosed in 15% of patients using the frontal view alone. The clinical impact of these radiographically underdiagnosed pneumonias needs to be assessed prior to implementing the practice of using only frontal radiographs for diagnosing pneumonia. (orig.)

  7. Is the frontal radiograph alone sufficient to evaluate for pneumonia in children?

    Energy Technology Data Exchange (ETDEWEB)

    Rigsby, Cynthia K. [Department of Radiology, Children' s Hospital Medical Center, 3333 Burnet Avenue, OH 45229, Cincinnati (United States); Department of Medical Imaging No. 9, Children' s Memorial Hospital, 2300 Children' s Plaza, IL 60614, Chicago (United States); Strife, Janet L.; Johnson, Neil D. [Department of Radiology, Children' s Hospital Medical Center, 3333 Burnet Avenue, OH 45229, Cincinnati (United States); Atherton, Harry D.; Kotagal, Uma R. [Department of Health Policy and Clinical Effectiveness, Children' s Hospital Medical Center, 3333 Burnet Avenue, OH 45229, Cincinnati (United States); Pommersheim, William [Department of Radiology, Children' s Hospital Medical Center, 3333 Burnet Avenue, OH 45229, Cincinnati (United States); Wake Forest University Baptist Medical Center, Department of Radiology, Meads Hall, 2nd Floor, NC 27157, Winston-Salem (United States)

    2004-05-01

    In our cost- and radiation-conscious environment, the feasibility of performing only a frontal radiograph for the diagnosis of pneumonia in children needs to be reassessed. To determine the diagnostic efficacy of the frontal radiograph alone in comparison to the frontal and lateral combined radiographs for the radiographic diagnosis of pneumonia in children. Three radiologists retrospectively and independently reviewed the frontal radiographs alone and separately reviewed the frontal and lateral radiographs of 1,268 children referred from the emergency room for chest radiographs. A majority interpretation of at least two radiologists for the frontal views alone was compared with majority interpretation of the frontal and lateral combined views for the radiographic diagnosis of pneumonia. ''Pneumonia'' was defined as a focus of streaky or confluent lung opacity. For the radiographic diagnosis of pneumonia, the sensitivity and specificity of the frontal view alone were 85% and 98%, respectively. For the confluent lobar type of pneumonia, the sensitivity and specificity increased to 100%. When the frontal view alone yields a diagnosis of confluent lobar pneumonia, this is highly reliable. However, nonlobar types of infiltrates will be underdiagnosed in 15% of patients using the frontal view alone. The clinical impact of these radiographically underdiagnosed pneumonias needs to be assessed prior to implementing the practice of using only frontal radiographs for diagnosing pneumonia. (orig.)

  8. Analysis of invasive pneumonia-causing strains of Streptococcus pneumoniae: serotypes and antimicrobial susceptibility.

    Science.gov (United States)

    Yoshioka, Cristina R M; Martinez, Marina B; Brandileone, Maria C C; Ragazzi, Selma B; Guerra, Maria L L S; Santos, Silvia R; Shieh, Huei H; Gilio, Alfredo E

    2011-01-01

    To identify the most common pneumococcal serotypes in children hospitalized with invasive pneumonia, correlate isolated serotypes with those included in conjugate vaccines, and ascertain the sensitivity of the isolated pneumococcal strains to penicillin and other antibiotics. From January 2003 to October 2008, a retrospective study of hospitalized children with a diagnosis of Streptococcus pneumoniae pneumonia was conducted at the university hospital of Universidade de São Paulo. Criteria for inclusion were: age greater than 29 days and less than 15 years, radiological and clinical diagnosis of pneumonia, and isolation of Streptococcus pneumoniae in blood cultures and/or pleural effusion. The study included 107 children. The most common serotypes were 14 (36.5%), 1 (16%), 5 (14.6%), 6B (6.3%) and 3 (4.2%). The proportion of identified serotypes contained in the heptavalent, 10-valent and 13-valent conjugate vaccines was 53.1, 86.5, and 96.9%, respectively. Pneumococcal strains were sensitive to penicillin (minimum inhibitory concentration, MIC ≤ 2 µg/mL) in 100 cases (93.5%) and displayed intermediate resistance (MIC = 4 µg/mL) in 7 cases (6.5%). No strains were penicillin-resistant (MIC ≥ 8 µg/mL) according to the Clinical and Laboratory Standards Institute 2008 standards. Tested isolates were highly sensitive to vancomycin, rifampicin, ceftriaxone, clindamycin, erythromycin, and chloramphenicol. Our results confirm a significant potential impact of conjugate vaccines, mainly 10-valent and 13-valent, on invasive pneumonia. Furthermore, susceptibility testing results show that penicillin is still the treatment of choice for invasive pneumonia in our setting.

  9. Ground-glass opacity at high resolution CT: an approach for differential diagnosis

    International Nuclear Information System (INIS)

    Spina, Juan C.; Rogondino, Jose; Vidales, Valeria; Rolnik, Maria C.; Montanari, Mariano; Salazar, Santiago N.

    2004-01-01

    Purpose: To evaluate the Ground-Glass Opacity in high resolution computed tomography (HRCT) with its underlying abnormality and anatomic distribution and its correlation with different etiologies. Methods: A 38 patients series, (32 men, 16 women, mean age 54,6 years, range 20-28) was retrospectively analyzed. They were evaluated with high resolution computed tomography, 2 mm thick sections and 10 mm of interval. Contrast intravenous iodinated contrast (no-ionic) was injected in 11 patients. The final diagnosis was made with sputum analysis, bronchioalveolar lavage, trans bronchial biopsy and open lung biopsy. Results: The differential diagnosis of ground glass opacity is based on analyzing their anatomic resolution and the underlying pathology in the lung parenchyma. Centrilobular distribution indicated early air-spaces pathology produced in our series by 21 infections, 4 pulmonary hemorrhages, 1 hypersensitivity pneumonitis and 1 descamative interstitial pneumonitis. Panlobular distribution, alveolar proteinosis (1 case) sarcoidosis (1 case) drug toxicity 1 case and one case of pneumocystis carinii. Peripherical distribution typical of early idiopathic fibrosis (1). Bronchiolitis obliterans with organizing pneumonia (1). Structural alterations of the lung parenchyma with bronchiectasias was seen in 16 cases, cystic lesions in 3 cases, sub pleural linear opacities 4 cases, peribronchovascular interstitial thickening or nodularity and emphysema in 10 cases. Conclusion: HRCT is useful to evaluate ground glass opacities pattern with the anatomic distribution and the underlying structural pathology. These findings under some clinical circumstances can suggest a specific diagnosis in most cases, indicating a potentially treatable disease. (author)

  10. Differential diagnosis of rheumatic diseases

    International Nuclear Information System (INIS)

    Lingg, G.; Schorn, C.

    2006-01-01

    Which imaging modalities are appropriate for the Differential diagnosis of Rheumatic diseases. MRI has far most the highest sensitivity and is unequaled in its brilliant presentation of Anatomy and Pathology. But it is sometimes forgotten, that this is at least in part the result of carefully selected sequences, dedicated to the expected result. In a method totally independent of any result, this should not be the case. In contrary this method should be highly standardised and regardless what will be the findings. This is true for Plain X-ray. It will be shown, that already the outer silhouette of the soft parts with different features of swelling, and differences in density and even more - defects or appositions of the bony silhouette in the majority of cases at least will allow to classify the patient for a group of diseases and in many cases will lead to a definite diagnosis. Differential diagnoses like Rheumatoid Arthritis versus Psoriatic Arthritis or simply but not always simple - inflammatory Arthritis versus degenerative disease - are allowed to be answered definitely, not always so in MRI. The condition of the subchondral bone can give hints, how advanced and how active the disease is at present. Plain X-ray offers high specifity in the differential diagnoses of Rheumatic diseases, it is well standardised and it is a device, to use independent from any suspected findings. So it is the method of choice for questions of differential diagnosis. This is even more true, thinking of the possibility, to investigate all clinically involved regions with not to much extended efforts, whereas MRI and CT are used normally for only one region. (orig.) [de

  11. Pneumocystis Pneumonia

    Science.gov (United States)

    ... among 16 patients after kidney transplantation. Journal of clinical microbiology 2008;46:966-71. Pifer LL, Hughes WT, ... diagnosis of Pneumocystis jirovecii pneumonia: a meta-analysis. Clinical microbiology and infection 2013;19:39-49. CDC. Pneumocystis ...

  12. Differential microRNAs expression in serum of patients with lung cancer, pulmonary tuberculosis, and pneumonia.

    Science.gov (United States)

    Abd-El-Fattah, Amal A; Sadik, Nermin Abdel Hamid; Shaker, Olfat Gamil; Aboulftouh, Mariam Lotfy

    2013-01-01

    MicroRNAs (miRNAs) play critical regulatory roles in the physiological and pathological processes. The high stability of miRNAs in human serum represents attractive novel diagnostic biomarkers of clinical conditions. Several studies have shown that aberrant expression of miRNAs in human cancer including lung cancer, but little is known about their effects on some infectious lung diseases such as pulmonary tuberculosis (TB) and pneumonia. In this study, we investigated miRNA expression pattern in serum of Egyptian patients with lung cancer, TB, and pneumonia compared with matched healthy controls. Using microarray-based expression profiling followed by real-time quantitative polymerase chain reaction validation, we compared the levels of a series of circulating miRNAs (miR-21, miR-155, miR-182, and miR-197) in serum from patients with lung cancer (n = 65), pulmonary tuberculosis (n = 29), pneumonia (n = 29), and transudate (n = 16) compared with matched healthy controls (n = 37). MiRNA SNORD68 was the housekeeping endogenous control. We found that the serum levels of miR-21, miR-155, and miR-197 were significantly elevated in the patients with lung cancer and pneumonia whereas miR-182 and miR-197 levels were increased only in patients with lung cancer and TB, respectively, compared with controls. Receiver operating characteristic analysis revealed that miR-182, miR-155, and miR-197 have superior diagnostic potential in discriminating patients with lung cancer, pneumonia, and TB, respectively, from controls. Our results conclude that the differential expression of the four studied miRNAs can be potential non-invasive biomarkers for patients with lung cancer, TB and pneumonia.

  13. Value of CT in the diagnosis of ventilator-associated pneumonia

    International Nuclear Information System (INIS)

    Hahn, U.; Pereira, P.; Laniado, M.; Claussen, C.D.; Heininger, A.

    1999-01-01

    Purpose: To analyse the diagnostic accuracy of computed tomography (CT) in ventilator-associated pneumonia (VAP). Materials and methods: 23 patients on mechanical ventilation with a new pulmonary abnormality on chest X-ray were examined with both spiral-CT and high-resolution CT. The diagnosis VAP was made according to prospectively defined criteria. Bronchoscopic specimen asservation with protected specimen brushing (PSB) served as gold standard. Results: With PSB, 11 of 23 patients were found to have VAP. CT showed a sensitivity and specificity of 53% and 63%, respectively. Ground glass infiltrates appeared to have a 100% specificity but were found in only 5/11 patients. Conclusions: CT is not the method of choice for diagnosing VAP. Groundglass infiltrates seeming to be highly specific are only inconstantly found. (orig.) [de

  14. Specific phobias in older adults: characteristics and differential diagnosis.

    Science.gov (United States)

    Coelho, Carlos M; Gonçalves, Daniela C; Purkis, Helena; Pocinho, Margarida; Pachana, Nancy A; Byrne, Gerard J

    2010-08-01

    Differential diagnosis implies identifying shared and divergent characteristics between clinical states. Clinical work with older adults demands not only the knowledge of nosological features associated with differential diagnosis, but also recognition of idiosyncratic factors associated with this population. Several factors can interfere with an accurate diagnosis of specific phobia in older cohorts. The goal of this paper is to review criteria for specific phobia and its differential diagnosis with panic disorder, agoraphobia, post-traumatic stress disorder and obsessive compulsive disorder, while stressing the specific factors associated with aging. A literature search regarding specific phobia in older adults was carried out using PubMed. Relevant articles were selected and scanned for further pertinent references. In addition, relevant references related to differential diagnosis and assessment were used. Etiologic factors, specificity of feared stimulus or situation, fear predictability and the nature of phobic situations are key points to be assessed when implementing a differential diagnosis of specific phobia. First, age-related sensory impairments are common and interfere both with information processing and communication. Second, medical illnesses create symptoms that might cause, interfere with, or mimic anxiety. Third, cohort effects might result in underreporting, through the inability to communicate or recognize anxiety symptoms, misattributing them to physical conditions. Finally, diagnostic criteria and screening instruments were usually developed using younger samples and are therefore not adapted to the functional and behavioral characteristics of older samples.

  15. Radiological diagnosis in AIDS - associated diseases: survey and differential diagnosis

    International Nuclear Information System (INIS)

    Rademaker, J.; Frahm, C.

    1997-01-01

    Acute manifestations of illnesses in patients with HIV-infection or AIDS will benefit from rapid diagnosis. Radiologic examinations provide substantial information to narrow the differential diagnosis. This article reviews clinically important HIV-associated diseases for the radiologist. The braod spectrum of possible manifestations is illustrated by the accompanying case reports that typify the complexity of diagnoses in this growing problem worldwide. (orig.) [de

  16. Radiologic discussion on Klebsiella pneumonia in 89 cases

    International Nuclear Information System (INIS)

    Zhang Chunsheng; Li Xuejun; Tai Hanzhen; Wang Guohua; Qi Shi

    2007-01-01

    Objective: To evaluate the diagnostic value of radiology and CT scanning in Klebsiella pneumoniae. Methods: The clinical, radiologic data and CT films of 89 patients with Klebsiella pneumoniae were retrospectively analyzed. Results: Three types of chest X-ray and computed tomography (CT) findings for Klebsiella pneumonia were found. (1)Increased pulmonary markings occured in 31 cases. (2)35 cases with single lesions showed frequently involvement in the upper or lower lobe of right lung. When lesion was involved in the upper lobe, it developed oblique fissure shift down in radiology films and represent stalactitic symptom in CT imagining. (3)In 23 cases with Klebsiella pneumonia showed typical cavitary lung abscesses. Conclusion: The radiologic findings of Klebsiella pneumoniae were complicated and hard to make a good diagnosis. Combined the imaging features with the clinic data, sometimes, we can get the right diagnosis in some cases with typical Klebsiella pneumoniae. (authors)

  17. Differential diagnosis of disseminated periventricular calcifications

    Energy Technology Data Exchange (ETDEWEB)

    Rieger, P.; Piepgras, U.

    1986-08-01

    Juvenile disseminated periventricular calcifications may occur in tuberous sclerosis, toxoplasmosis, cytomegaly, and in tuberculous meningitis. Cysticercosis, by contrast, does not result in corresponding intracerebral foci until an older age. Differential diagnosis is no problem if clinical findings are typical (tuberous sclerosis) or if serological verification is positive. However, any unclear clinical diagnosis can often be secured by CT.

  18. Hypersensitivity pneumonia-nonspecific interstitial pneumonia/fibrosis histopathologic presentation: a study in diagnosis and long-term management.

    Science.gov (United States)

    Jacobs, Robert L; Andrews, Charles P

    2003-02-01

    Nonspecific interstitial pneumonia/fibrosis (NSIP) has been classified a form of idiopathic interstitial pneumonia/fibrosis. We have shown that cases of NSIP without demonstrable serum precipitins may be caused by inhalation of high levels of mold and/or bacteria in closed environments. We report a patient with a clinical and histopathologic diagnosis of NSIP without serum precipitins caused by a microbial contamination in her home. Her case was converted from an acute to an insidious clinical presentation by inadequate remediation. A prolonged avoidance-challenge technique demonstrated that this case of NSIP was a form of hypersensitivity pneumonia that was reversible by effective remediation. The patient was identified by compatible signs and symptoms, roentgenographic studies, pulmonary function tests, and a transbronchial lung biopsy. She was further evaluated with a detailed environmental history, serologic tests, and investigation of the home environment. An environmental avoidance and challenge technique was performed to confirm cause and effect and to determine that remediation had been effective. Review of the biopsy showed NSIP and failed to reveal any non-caseating granuloma formation. Investigation of the home revealed a Cladosporium species contamination of the air conditioning system and Penicillium species beneath an entryway carpet. Serum precipitins to commercial antigens of common mold to the south Texas area were negative. Avoidance and challenge techniques confirmed the home as the causative environment in this case of NSIP. The patient has been free of signs and symptoms and has taken no medication for interstitial lung disease over the past 30 months. Some cases of NSIP may be caused by inhalation of microbial antigen(s) in a closed environment. An environmental challenge technique was an effective method to determine the causative environment and confirm that remediation had been effective. Inadequate remediation may lead to symptomatic

  19. Differential diagnosis of tuberculous pleural effusion and malignant

    International Nuclear Information System (INIS)

    Na, Eui Sung; Kim, Young Nam; Lee, Mee Ran; Oh, Yu Whan; Kang, Eun Young

    1997-01-01

    The purpose of this study is to evaluate the diagnostic accuracy of CT in the differential diagnosis of tuberculous and malignant pleural effusion whether or not lung lesions are present, and to investigate the CT findings used for this differential diagnosis. This study involved 30 patients with tuberculous pleural effusion (mean age, 44.6 years; M : F = 19:11) and 20 with malignant pleural effusion (mean age, 57.2 years; M: F=10:10). All 50 patients underwent enhanced CT chest scans, and the respective conditions were pathologically confirmed. Two radiologists unaware of the pathologic results and distributions of patients reviewed these scans, CT findings of pleural effusions, their diagnoses, and the degree of confidence of their diagnoses. In most cases, CT provided correct differential diagnosis between tuberculous and malignant pleural effusion. It can help determine the nature of associated lung and pleural lesions, and specific findings of the latter, and can accurately differentiate tuberculous and malignant pleural effusion. (author). 20 refs., 3 tabs., 5 figs

  20. Chest radiographic findings of tuberculous pneumonia

    International Nuclear Information System (INIS)

    Jung, Seung Hye; Sung, Dong Wook; Yoon, Yup; Lim, Jae Hoon

    1991-01-01

    When tuberculous pneumonia appears as a segmental or loabr consolidation, its is difficult to differentiate tuberculous pneumonia from nontuberculous bacterial pneumonia radiologically. The object of this study was to define the typical radiographic findings of tuberculous pneumonia through comparative analysis of tuberculous and nontuberculous pneumonia. A review of chest radiolograph in 29 patients with tuberculous pneumonia and in 23 patients with nontuberculous bacterial pneumonia was made with regard to homogeneity, volume loss, air-fluid level within the cavities, air-bronchogram, pleural disease, and predilection sites. The characteristic findings of tuberculous pneumonia are a heterogeneous density of infiltration (66%), evidence of volume loss of infiltrative lesion (52%), and cavity formation (48%) without air - fluid level. An associated parameter of analysis is the relative absence of leukocytosis (76%)

  1. Differential diagnosis of disseminated periventricular calcifications

    International Nuclear Information System (INIS)

    Rieger, P.; Piepgras, U.

    1986-01-01

    Juvenile disseminated periventricular calcifications may occur in tuberous sclerosis, toxoplasmosis, cytomegaly, and in tuberculous meningitis. Cysticercosis, by contrast, does not result in corresponding intracerebral foci until an older age. Differential diagnosis is no problem if clinical findings are typical (tuberous sclerosis) or if serological verification is positive. However, any unclear clinical diagnosis can often be secured by CT. (orig.) [de

  2. Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non-Pneumocystis carinii pneumonia in AIDS patients

    International Nuclear Information System (INIS)

    Hidalgo, A.; Mauleon, S.; Andreu, J.; Caceres, J.; Falco, V.; Crespo, M.; Ribera, E.; Pahissa, A.

    2003-01-01

    The aim of this study was to assess the value of high-resolution CT in distinguishing between Pneumocystis carinii and non-Pneumocystis carinii pneumonia (PCP) in patients HIV-positive and high risk to have PCP. We performed a prospective study in 30 patients with <200 CD4 lymphocytes, clinical symptoms of pulmonary disease and chest X-ray non-conclusive for pulmonary infection. Evaluated CT findings included ground-glass opacities, reticulation, tree-in-bud appearance, consolidation, cystic lesions, bronchiectasis and lymphadenopathies. The diagnosis of ''examination suggestive of PCP'' was applied to cases showing a diffuse or predominant ground-glass pattern in the upper fields, associated or not with reticulations and small cystic lesions. The sensitivity, specificity, positive predictive value and negative predictive value of high-resolution computed tomography (HRCT) for the diagnosis of PCP was 100, 83.3, 90.5 and 100%, respectively. Pneumocystis carinii pneumonia was not demonstrated in any of the cases classified as ''examination not suggestive of PCP''. Significant small airway disease was not observed in any of the PCP cases. We conclude that HRCT is a reliable method for differentiating PCP from other infectious processes in HIV-positive patients and a good method to rule our PCP. Its inclusion in the diagnostic algorithm of lung infections is justified in these patients. (orig.)

  3. ON DIFFERENTIAL DIAGNOSIS BETWEEN AUTISTIC DISORDER AND ASPERGER’S SYNDROME

    Directory of Open Access Journals (Sweden)

    Stefan Todorov

    2012-11-01

    Full Text Available The differential diagnosis between Autistic disorder (AD and Asperger’s syndrome (AS in most cases is quite difficult since most of the symptoms are clinically undistinguished. Several factors complicate the diagnosis of AS- an autism spectrum disorder (ASD. It is considered by some authors to be simply a milder version of autistic disorder. Problems in diagnosis include disagreement among diagnostic criteria, controversy over the distinction between AS and other ASD forms or even whether AS exists as a separate syndrome, and over- and under-diagnosis. Our paper is based on the diagnostic and differential diagnostic criteria of DSM-IV, ICD-10 and our clinical experience.In the process of diagnosis and differential diagnosis we, naturally, illustrate and discuss the similarities and differences between the two disorders.

  4. The classification, natural history and radiological/histological appearance of idiopathic pulmonary fibrosis and the other idiopathic interstitial pneumonias

    Directory of Open Access Journals (Sweden)

    G. Raghu

    2008-12-01

    Full Text Available The idiopathic interstitial pneumonias (IIPs are a heterogeneous group of rare interstitial lung diseases (ILDs or diffuse parenchymal lung diseases, which, as their name implies, are of unknown aetiology. The past 10 yrs have seen important advances in the classification of the IIPs into idiopathic pulmonary fibrosis (IPF and its corresponding histopathological pattern of usual interstitial pneumonia (UIP, plus six non-IPF IIP subtypes. The present article will look at the current classification of IIPs, arising from the Consensus Statement of the American Thoracic Society and European Respiratory Society, and discusses the importance of differential diagnosis of IPF from the non-IPF IIP subtypes, especially nonspecific interstitial pneumonia. Diagnosis of IIPs is a dynamic process involving close collaboration between pulmonologists, radiologists and pathologists. Increasingly accurate diagnosis of IPF has been made possible by the use of high-resolution computed tomography (HRCT and refinements in surgical lung biopsy. In IPF, a lung HRCT will typically reveal irregular reticular opacities, traction bronchiestasis and, most importantly, peripheral honeycombing. In contrast, histological examination shows evidence of UIP manifesting as typically subpleural and paraseptal established fibrosis, often with honeycomb changes, associated with mild chronic inflammation and varying numbers of fibroblastic foci in continuity with the edges of areas of established fibrosis. Despite these advances, obtaining a consistent and uniform diagnosis of idiopathic interstitial pneumonias is difficult, with studies showing significant disagreement in the diagnosis of interstitial lung diseases between academic centres of expertise and community-based clinicians. Greater interaction between academic and community clinicians, together with improved education, is needed to bridge this gap.

  5. Radiology of bacterial pneumonia

    International Nuclear Information System (INIS)

    Vilar, Jose; Domingo, Maria Luisa; Soto, Cristina; Cogollos, Jonathan

    2004-01-01

    Bacterial pneumonia is commonly encountered in clinical practice. Radiology plays a prominent role in the evaluation of pneumonia. Chest radiography is the most commonly used imaging tool in pneumonias due to its availability and excellent cost benefit ratio. CT should be used in unresolved cases or when complications of pneumonia are suspected. The main applications of radiology in pneumonia are oriented to detection, characterisation and follow-up, especially regarding complications. The classical classification of pneumonias into lobar and bronchial pneumonia has been abandoned for a more clinical classification. Thus, bacterial pneumonias are typified into three main groups: Community acquired pneumonia (CAD), Aspiration pneumonia and Nosocomial pneumonia (NP).The usual pattern of CAD is that of the previously called lobar pneumonia; an air-space consolidation limited to one lobe or segment. Nevertheless, the radiographic patterns of CAD may be variable and are often related to the causative agent. Aspiration pneumonia generally involves the lower lobes with bilateral multicentric opacities. Nosocomial Pneumonia (NP) occurs in hospitalised patients. The importance of NP is related to its high mortality and, thus, the need to obtain a prompt diagnosis. The role of imaging in NP is limited but decisive. The most valuable information is when the chest radiographs are negative and rule out pneumonia. The radiographic patterns of NP are very variable, most commonly showing diffuse multifocal involvement and pleural effusion. Imaging plays also an important role in the detection and evaluation of complications of bacterial pneumonias. In many of these cases, especially in hospitalised patients, chest CT must be obtained in order to better depict these associate findings

  6. Radiology of bacterial pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Vilar, Jose E-mail: vilar_jlu@gva.es; Domingo, Maria Luisa; Soto, Cristina; Cogollos, Jonathan

    2004-08-01

    Bacterial pneumonia is commonly encountered in clinical practice. Radiology plays a prominent role in the evaluation of pneumonia. Chest radiography is the most commonly used imaging tool in pneumonias due to its availability and excellent cost benefit ratio. CT should be used in unresolved cases or when complications of pneumonia are suspected. The main applications of radiology in pneumonia are oriented to detection, characterisation and follow-up, especially regarding complications. The classical classification of pneumonias into lobar and bronchial pneumonia has been abandoned for a more clinical classification. Thus, bacterial pneumonias are typified into three main groups: Community acquired pneumonia (CAD), Aspiration pneumonia and Nosocomial pneumonia (NP).The usual pattern of CAD is that of the previously called lobar pneumonia; an air-space consolidation limited to one lobe or segment. Nevertheless, the radiographic patterns of CAD may be variable and are often related to the causative agent. Aspiration pneumonia generally involves the lower lobes with bilateral multicentric opacities. Nosocomial Pneumonia (NP) occurs in hospitalised patients. The importance of NP is related to its high mortality and, thus, the need to obtain a prompt diagnosis. The role of imaging in NP is limited but decisive. The most valuable information is when the chest radiographs are negative and rule out pneumonia. The radiographic patterns of NP are very variable, most commonly showing diffuse multifocal involvement and pleural effusion. Imaging plays also an important role in the detection and evaluation of complications of bacterial pneumonias. In many of these cases, especially in hospitalised patients, chest CT must be obtained in order to better depict these associate findings.

  7. Differential diagnosis of hyponatraemia.

    LENUS (Irish Health Repository)

    Thompson, Chris

    2012-03-01

    The appropriate management of hyponatraemia is reliant on the accurate identification of the underlying cause of the hyponatraemia. In the light of evidence which has shown that the use of a clinical algorithm appears to improve accuracy in the differential diagnosis of hyponatraemia, the European Hyponatraemia Network considered the use of two algorithms. One was developed from a nephrologist\\'s view of hyponatraemia, while the other reflected the approach of an endocrinologist. Both of these algorithms concurred on the importance of assessing effective blood volume status and the measurement of urine sodium concentration in the diagnostic process. To demonstrate the importance of accurate diagnosis to the correct treatment of hyponatraemia, special consideration was given to hyponatraemia in neurosurgical patients. The differentiation between the syndrome of inappropriate antidiuretic hormone secretion (SIADH), acute adrenocorticotropic hormone (ACTH) deficiency, fluid overload and cerebral salt-wasting syndrome was discussed. In patients with SIADH, fluid restriction has been the mainstay of treatment despite the absence of an evidence base for its use. An approach to using fluid restriction to raise serum tonicity in patients with SIADH and to identify patients who are likely to be recalcitrant to fluid restriction was also suggested.

  8. Update on the diagnosis and treatment of Pneumocystis pneumonia.

    Science.gov (United States)

    Carmona, Eva M; Limper, Andrew H

    2011-02-01

    Pneumocystis is an opportunistic fungal pathogen that causes an often-lethal pneumonia in immunocompromised hosts. Although the organism was discovered in the early 1900s, the first cases of Pneumocystis pneumonia in humans were initially recognized in Central Europe after the Second World War in premature and malnourished infants. This unusual lung infection was known as plasma cellular interstitial pneumonitis of the newborn, and was characterized by severe respiratory distress and cyanosis with little or no fever and no pathognomic physical signs. At that time, only anecdotal cases were reported in adults and usually these patients had a baseline malignancy that led to a malnourished state. In the 1960-1970s additional cases were described in adults and children with hematological malignancies, but Pneumocystis pneumonia was still considered a rare disease. However, in the 1980s, with the onset of the HIV epidemic, Pneumocystis prevalence increased dramatically and became widely recognized as an opportunistic infection that caused potentially life-treating pneumonia in patients with impaired immunity. During this time period, prophylaxis against this organism was more generally instituted in high-risk patients. In the 1990s, with widespread use of prophylaxis and the initiation of highly active antiretroviral therapy (HAART) in the treatment of HIV-infected patients, the number of cases in this specific population decreased. However, Pneumocystis pneumonia still remains an important cause of severe pneumonia in patients with HIV infection and is still considered a principal AIDS-defining illness. Despite the decreased number of cases among HIV-infected patients over the past decade, Pneumocystis pneumonia continues to be a serious problem in immunodeficient patients with other immunosuppressive conditions. This is mostly due to increased use of immunosuppressive medications to treat patients with autoimmune diseases, following bone marrow and solid organ

  9. iTRAQ-based Quantitative Proteomics Study in Patients with Refractory Mycoplasma pneumoniae Pneumonia.

    Science.gov (United States)

    Yu, Jia-Lu; Song, Qi-Fang; Xie, Zhi-Wei; Jiang, Wen-Hui; Chen, Jia-Hui; Fan, Hui-Feng; Xie, Ya-Ping; Lu, Gen

    2017-09-25

    Mycoplasma pneumoniae (MP) is a leading cause of community-acquired pneumonia in children and young adults. Although MP pneumonia is usually benign and self-limited, in some cases it can develop into life-threating refractory MP pneumonia (RMPP). However, the pathogenesis of RMPP is poorly understood. The identification and characterization of proteins related to RMPP could provide a proof of principle to facilitate appropriate diagnostic and therapeutic strategies for treating paients with MP. In this study, we used a quantitative proteomic technique (iTRAQ) to analyze MP-related proteins in serum samples from 5 patients with RMPP, 5 patients with non-refractory MP pneumonia (NRMPP), and 5 healthy children. Functional classification, sub-cellular localization, and protein interaction network analysis were carried out based on protein annotation through evolutionary relationship (PANTHER) and Cytoscape analysis. A total of 260 differentially expressed proteins were identified in the RMPP and NRMPP groups. Compared to the control group, the NRMPP and RMPP groups showed 134 (70 up-regulated and 64 down-regulated) and 126 (63 up-regulated and 63 down-regulated) differentially expressed proteins, respectively. The complex functional classification and protein interaction network of the identified proteins reflected the complex pathogenesis of RMPP. Our study provides the first comprehensive proteome map of RMPP-related proteins from MP pneumonia. These profiles may be useful as part of a diagnostic panel, and the identified proteins provide new insights into the pathological mechanisms underlying RMPP.

  10. CT on diagnosis and differential diagnosis of adrenal neuroblastoma from nephroblastoma in children

    International Nuclear Information System (INIS)

    Han Jingtian; Shen Guoqiang; Yang Huayuan

    2000-01-01

    Objective: To evaluate the effect of CT on diagnosis and differential diagnosis of children's adrenal neuroblastoma from nephroblastoma. Materials and Method: To analyse the CT manifestations on 36 cases of adrenal neuroblastoma and 32 cases of nephroblastoma both confirmed by postoperative pathologic diagnosis. Results: The adrenal neuroblastoma is a kind of extrarenal tumor, so the kidney kept its original form and showed some compressive features. The incidence of tumor calcification appeared mostly in rough and speckle-piece form was high. While the nephroblastoma is a renal tumor. The surrounding renal parenchyma showed a specific 'new-moon shape' intensification. Conclusion: CT is one of the most valuable and effective means of examination to diagnose adrenal neuroblastoma and differentiate it from nephroblastoma. It can provide important information for making correct diagnosis, planning proper therapy and assessing prognosis

  11. [Differential diagnosis between borderline personality disorder and bipolar disorder].

    Science.gov (United States)

    Herbst, Luis

    2010-01-01

    The relationship between bipolar disorder and borderline personality disorder remains controversial since in both conditions there are overlapping and similar symptomatic dimensions. Symptomatic dimensions suitable to subserve differential diagnosis are: mood, mood variability mode, and personal and family history. Characteristics of psychotic symptoms may also be useful in the differentiation. On the other hand, anxiety symptoms, neuropsychological profiles, neuro-imaging procedures and biomarkers seem not to contribute to differentiate between both diseases. The presentation of nonsuicidal self mutilation behavior can offer some differences between bipolar and borderline personality disorders, but both can coexist in clinical comorbid forms and do not significantly contribute to the differential diagnosis. Differential diagnosis is complicated by the fact that a low percentage of patients can experience comorbidity of both conditions. In this work we review all these issues, and particularly emphasize the importance of sitematically take into account the patient background, the course that follows his or her disorder, together with the outcome in response to medical decisions.

  12. Mycoplasma pneumoniae and atypical Stevens-Johnson syndrome: a case series.

    Science.gov (United States)

    Ravin, Karen A; Rappaport, Lara D; Zuckerbraun, Noel S; Wadowsky, Robert M; Wald, Ellen R; Michaels, Marian M

    2007-04-01

    Mycoplasma pneumoniae is a common cause of community-acquired respiratory illness in the adolescent population. Stevens-Johnson syndrome is an extrapulmonary manifestation that has been associated with M. pneumoniae infections. Three adolescent males presented within a 1-month period with M. pneumoniae respiratory illnesses and severe mucositis but without the classic rash typical of Stevens-Johnson. Diagnosis was facilitated by the use of a polymerase chain reaction-based assay. This case series highlights the potential for M. pneumoniae-associated Stevens-Johnson syndrome to occur without rash and supports the use of polymerase chain reaction for early diagnosis.

  13. Differential diagnosis of Jakob-Creutzfeldt disease.

    Science.gov (United States)

    Paterson, Ross W; Torres-Chae, Charles C; Kuo, Amy L; Ando, Tim; Nguyen, Elizabeth A; Wong, Katherine; DeArmond, Stephen J; Haman, Aissa; Garcia, Paul; Johnson, David Y; Miller, Bruce L; Geschwind, Michael D

    2012-12-01

    To identify the misdiagnoses of patients with sporadic Jakob-Creutzfeldt disease (sCJD) during the course of their disease and determine which medical specialties saw patients with sCJD prior to the correct diagnosis being made and at what point in the disease course a correct diagnosis was made. Retrospective medical record review. A specialty referral center of a tertiary academic medical center. One hundred sixty-three serial patients over a 5.5-year period who ultimately had pathologically proven sCJD. The study used the subset of 97 patients for whom we had adequate medical records. Other diagnoses considered in the differential diagnosis and types of medical specialties assessing patients with sCJD. Ninety-seven subjects' records were used in the final analysis. The most common disease categories of misdiagnosis were neurodegenerative, autoimmune/paraneoplastic, infectious, and toxic/metabolic disorders. The most common individual misdiagnoses were viral encephalitis, paraneoplastic disorder, depression, vertigo, Alzheimer disease, stroke, unspecified dementia, central nervous system vasculitis, peripheral neuropathy, and Hashimoto encephalopathy. The physicians who most commonly made these misdiagnoses were primary care physicians and neurologists; in the 18% of patients who were diagnosed correctly at their first assessment, the diagnosis was almost always by a neurologist. The mean time from onset to diagnosis was 7.9 months, an average of two-thirds of the way through their disease course. Diagnosis of sCJD is quite delayed. When evaluating patients with rapidly progressive dementia with suspected neurodegenerative, autoimmune, infectious, or toxic/metabolic etiology, sCJD should also be included in the differential diagnosis, and appropriate diagnostic tests, such as diffusion brain magnetic resonance imaging, should be considered. Primary care physicians and neurologists need improved training in sCJD diagnosis.

  14. Clinicoroentgenological control in chronic pneumonia

    International Nuclear Information System (INIS)

    Mamilyaev, R.M.

    1984-01-01

    A comprehensive clinicoroentgenological study was used to examine 494 patients with chronic pneumonia. Morphological and functional changes observed in the pulmonary pare and functional changes observed in the pulmonary parenchyma and bronchial tree were studied. Types of pneumosclerosis, tigns of exacerbation of chronic pneumonia and abscess formation, morphological and functional disorders of bronchial penetrability in the pneumonic zone were described. Three forms of chronic pneumonia: bronchial, bronchiectatic and abscessing are signled out. The bronchial form is subdivided into chronic pneumonia with chronic bronchitis without deformity and wi.th deforming chronic bronchitis. In the bronchiectatic form pneumonia can be with cylindrical, saccular and cyst-like bronchiectasia. The general diagnosis of chronic pneumonia is established clinically depending on type and variants in 89-94% of cases, by X-ray and sonographic findings in all patients; types and variants of disease are most frequently defined after bronchography

  15. FETOMATERNAL HAEMORRHAGE – DIFFERENTIAL DIAGNOSIS – CASE REPORT

    Directory of Open Access Journals (Sweden)

    Jadranka Domazet-Fink

    2002-07-01

    Full Text Available Background. There are several different causes for fetomaternal haemorrhage. Sinusoidal pattern, which is relatively characteristic for fetal anaemia, may in its final stages completely disappear. Differential diagnosis of silent trace of cardiotocogram with late decelerations is quite difficult to solve.Case report. A case of unusual injury of a pregnant woman is described. The injury led to fetomaternal haemorrhage. Typical sinusoidal pattern cardiotocogram was not seen and the differential diagnosis was hard to determine. Because of prompt intervention and efficient postnatal therapy the child and mother are both well. The dilemmas in regards to differential diagnosis are being discussed.Conclusions. It is important to be very careful in history taking even if the situation is urgent. If there is no explanation for pathological cardiotocogram, decision must be made according to pregnant woman’s wishes. Kleihauer-Betke test, which is easy to perform and gives much information, is described.

  16. Mialgias: Approaches to differential diagnosis, treatment

    Directory of Open Access Journals (Sweden)

    Nadezhda Aleksandrovna Shostak

    2013-01-01

    Full Text Available Differential diagnosis in muscle pains often presents great difficulties so all existing signs of the disease should be carefully considered to make its diagnosis and to prescribe adequate therapy. The paper considers the causes of muscle pains, laboratory and instrumental studies (immunological tests, determination of the level of specific muscular enzymes, primarily creatine phosphokinase – CPK, etc., and the main reasons for enhanced plasma CPK activity. It also describes acute and chronic mialgias associated with enhanced plasma CPK activity, as well as diseases in which mialgias are related to the normal level of CPK, myofascial syndrome (MFS and fibromyalgia (FM in particular. The characteristic features of MFS are given in its diagnostic criteria. It is stated that a differential diagnosis should be made between MFS and major muscle pain-associated abnormalities, such as polymyalgia rheumatica, FM, etc. Diagnosticcriteria for polymyalgia rheumatica are given. A MFS treatment algorithm is presented. Local exposure methods applied to altered musculoligamentous structures in combination with myorelaxants and non-steroidal anti-inflammatory drugs assume paramount importance in MFS.

  17. Addenbrooke's Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia.

    Science.gov (United States)

    Larner, A J

    2007-07-01

    The Addenbrooke's Cognitive Examination (ACE) is reported to be a highly sensitive and specific "bedside" test for the diagnosis of dementia, but large pragmatic studies of its use in day-to-day clinical practice are lacking. This study measured diagnostic accuracy of ACE in a large cohort of consecutive patients referred to a dedicated Cognitive Function Clinic. Consecutive new referrals over a 3.5-year period were administered the ACE (n=285). ACE scores and subscores (VLOM ratio) were compared to clinical diagnoses of dementia and dementia subtype, established on the basis of widely accepted diagnostic criteria and at least 12-month follow-up. ACE had good sensitivity, specificity, and positive predictive value for the diagnosis of dementia, with excellent diagnostic accuracy as measured by area under the receiver operating characteristic curve. However, a lower cutoff than that used in the index paper was required for optimum test sensitivity and specificity. ACE VLOM ratio subscore for the differential diagnosis of Alzheimer's disease and frontotemporal dementia proved less accurate. This study suggests that ACE is useful for the diagnosis of dementia in routine clinical practice but that other instruments may be required for the differential diagnosis of the dementia syndrome.

  18. Achondroplasia Presenting with Pneumonia in a Two Months Old Boy

    Directory of Open Access Journals (Sweden)

    Huseyin Bilgin

    2014-03-01

    Full Text Available Achondroplasia is one of the common chondrodysplasias with an inheritance is autosomal dominant, but in around 85% the phenotype is the result of a new mutation. Achondroplasia develops as a result of dysplasia of enchondral formation due to the mutation of fibroblast growth factor receptor 3. A 2-month-old boy was referred to the our hospital with cough and fever. Craniofacially the head appeared large and also frontal bossing and depressed nasal bridge was demonstrated. Narrow lumbar interpedicular distances, normal trunk length, short-wide pelvis, micromelic upper extremities and rhizomelic lower extremities were seen on x-ray examination. The clinically and radiographically diagnosis of achondroplasia with heart failure secondary to pneumonia was performed. Achondroplasia, presenting with respiratory disorders and short limb should be differentiated from metatropic dysplasia and campomelic dysplasia. Achondroplasia may had similar findings with other dwarfism and differentiate diagnosis from other achondroplasia like diseases needs team work which includes pediatry, radiology and medical genetic for better patient care and family counseling.

  19. Disseminated dendriform pulmonary ossification associated with usual interstitial pneumonia: incidence and thin-section CT-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Sung; Chung, Myung Jin [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Seoul (Korea); Han, Joungho [Sungkyunkwan University School of Medicine, Department of Pathology, Seoul (Korea); Chung, Man Pyo [Sungkyunkwan University School of Medicine, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Seoul (Korea); Choi, Yong Soo [Sungkyunkwan University School of Medicine, Division of Thoracic Surgery, Seoul (Korea)

    2005-08-01

    The aim of this work was to assess the incidence of disseminated pulmonary dendriform ossification in usual interstitial pneumonia and nonspecific interstitial pneumonia, and to correlate thin-section computed tomography (CT) and histopathologic findings. We retrospectively reviewed thin-section CT and pathologic specimens of biopsy-proven usual interstitial pneumonia (75 patients, 57 men and 18 women, mean age 60 years, range 29-83 years) and nonspecific interstitial pneumonia (44 patients, 9 men and 35 women, mean age 55 years, range 20-73 years). On review of CT and histopathologic specimens, diffuse dendriform ossification was identified in five (four men and one woman, age range 41-68 years, mean 58 years) of 75 patients (6.7%) with usual interstitial pneumonia. It was not seen in any of 44 patients with nonspecific interstitial pneumonia. With thin-section CT (osteoporosis window; window width 818, level 273), disseminated dendriform pulmonary ossification was detected as multiple tiny calcifications in bibasilar subpleural lungs (100% sensitive and 100% specific when compared with histopathologic findings as the gold standard). The thin-section CT finding of multiple tiny calcifications in bibasilar subpleural lungs might be of some help in the differential diagnosis between usual interstitial pneumonia and nonspecific interstitial pneumonia, considering they were not seen in any patients with nonspecific interstitial pneumonia (0%, 0/44) in our series. (orig.)

  20. Disseminated dendriform pulmonary ossification associated with usual interstitial pneumonia: incidence and thin-section CT-pathologic correlation

    International Nuclear Information System (INIS)

    Kim, Tae Sung; Chung, Myung Jin; Han, Joungho; Chung, Man Pyo; Choi, Yong Soo

    2005-01-01

    The aim of this work was to assess the incidence of disseminated pulmonary dendriform ossification in usual interstitial pneumonia and nonspecific interstitial pneumonia, and to correlate thin-section computed tomography (CT) and histopathologic findings. We retrospectively reviewed thin-section CT and pathologic specimens of biopsy-proven usual interstitial pneumonia (75 patients, 57 men and 18 women, mean age 60 years, range 29-83 years) and nonspecific interstitial pneumonia (44 patients, 9 men and 35 women, mean age 55 years, range 20-73 years). On review of CT and histopathologic specimens, diffuse dendriform ossification was identified in five (four men and one woman, age range 41-68 years, mean 58 years) of 75 patients (6.7%) with usual interstitial pneumonia. It was not seen in any of 44 patients with nonspecific interstitial pneumonia. With thin-section CT (osteoporosis window; window width 818, level 273), disseminated dendriform pulmonary ossification was detected as multiple tiny calcifications in bibasilar subpleural lungs (100% sensitive and 100% specific when compared with histopathologic findings as the gold standard). The thin-section CT finding of multiple tiny calcifications in bibasilar subpleural lungs might be of some help in the differential diagnosis between usual interstitial pneumonia and nonspecific interstitial pneumonia, considering they were not seen in any patients with nonspecific interstitial pneumonia (0%, 0/44) in our series. (orig.)

  1. Isolated femoral hypoplasia: an intrauterine differential diagnosis to campomelia

    Energy Technology Data Exchange (ETDEWEB)

    Koerber, Friederike; Benz-Bohm, Gabriele [University of Cologne, Department of Paediatric Radiology, Cologne (Germany); Schoenau, Eckard [University of Cologne, Department of Paediatrics, Cologne (Germany); Horwitz, A.Eldad [Klinikum Krefeld, Department of Paediatric Radiology, Krefeld (Germany)

    2005-06-01

    The isolated form of femoral bowing is an important differential diagnosis of campomelia. Therefore, knowledge of isolated anomalies is fundamental for prenatal diagnosis, especially for the differential diagnosis from severe syndromes. Four cases are presented to discuss the differential diagnosis of femoral bowing including a review of the literature. We report four newborn babies with unilateral bowing and shortening of the femur. Three had no further anomaly; one child had additional abnormalities due to coumarin embryopathy. The radiological findings were shortened femora with bowing and varus deformity and cortical thickening on the concave side. All other parts showed normal bone structure. The aetiology of femoral bowing is unknown. Early damage of the cartilaginous model followed by remodelling with thickening on the concave side of the bone similar to the healing of malaligned fractures is suspected. The isolated form of femoral bowing without any other anomalies has to be differentiated from complex and more often severe congenital syndromes such as campomelia. Postpartum radiological examination should be reduced to a single exposure of the affected limb and follow-up should be done by clinical examination. (orig.)

  2. Developing a semantic web model for medical differential diagnosis recommendation.

    Science.gov (United States)

    Mohammed, Osama; Benlamri, Rachid

    2014-10-01

    In this paper we describe a novel model for differential diagnosis designed to make recommendations by utilizing semantic web technologies. The model is a response to a number of requirements, ranging from incorporating essential clinical diagnostic semantics to the integration of data mining for the process of identifying candidate diseases that best explain a set of clinical features. We introduce two major components, which we find essential to the construction of an integral differential diagnosis recommendation model: the evidence-based recommender component and the proximity-based recommender component. Both approaches are driven by disease diagnosis ontologies designed specifically to enable the process of generating diagnostic recommendations. These ontologies are the disease symptom ontology and the patient ontology. The evidence-based diagnosis process develops dynamic rules based on standardized clinical pathways. The proximity-based component employs data mining to provide clinicians with diagnosis predictions, as well as generates new diagnosis rules from provided training datasets. This article describes the integration between these two components along with the developed diagnosis ontologies to form a novel medical differential diagnosis recommendation model. This article also provides test cases from the implementation of the overall model, which shows quite promising diagnostic recommendation results.

  3. The value of electrocardiography for differential diagnosis in wide QRS complex tachycardia.

    Science.gov (United States)

    Sousa, Pedro A; Pereira, Salomé; Candeias, Rui; de Jesus, Ilídio

    2014-03-01

    Correct diagnosis in wide QRS complex tachycardia remains a challenge. Differential diagnosis between ventricular and supraventricular tachycardia has important therapeutic and prognostic implications, and although data from clinical history and physical examination may suggest a particular origin, it is the 12-lead surface electrocardiogram that usually enables this differentiation. Since 1978, various electrocardiographic criteria have been proposed for the differential diagnosis of wide complex tachycardias, particularly the presence of atrioventricular dissociation, and the axis, duration and morphology of QRS complexes. Despite the wide variety of criteria, diagnosis is still often difficult, and errors can have serious consequences. To reduce such errors, several differential diagnosis algorithms have been proposed since 1991. However, in a small percentage of wide QRS tachycardias the diagnosis remains uncertain and in these the wisest decision is to treat them as ventricular tachycardias. The authors' objective was to review the main electrocardiographic criteria and differential diagnosis algorithms of wide QRS tachycardia. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non-Pneumocystis carinii pneumonia in AIDS patients

    Energy Technology Data Exchange (ETDEWEB)

    Hidalgo, A.; Mauleon, S.; Andreu, J.; Caceres, J. [Department of Radiology, Hospital General Universitari Vall d' Hebron, Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Paseo Vall d' Hebron 119-129, 08035 Barcelona (Spain); Falco, V.; Crespo, M.; Ribera, E.; Pahissa, A. [Department of Medicine, Service of Infectious Diseases, Hospital General Universitari Vall d' Hebron, Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Paseo Vall d' Hebron 119-129, 08035 Barcelona (Spain)

    2003-05-01

    The aim of this study was to assess the value of high-resolution CT in distinguishing between Pneumocystis carinii and non-Pneumocystis carinii pneumonia (PCP) in patients HIV-positive and high risk to have PCP. We performed a prospective study in 30 patients with <200 CD4 lymphocytes, clinical symptoms of pulmonary disease and chest X-ray non-conclusive for pulmonary infection. Evaluated CT findings included ground-glass opacities, reticulation, tree-in-bud appearance, consolidation, cystic lesions, bronchiectasis and lymphadenopathies. The diagnosis of ''examination suggestive of PCP'' was applied to cases showing a diffuse or predominant ground-glass pattern in the upper fields, associated or not with reticulations and small cystic lesions. The sensitivity, specificity, positive predictive value and negative predictive value of high-resolution computed tomography (HRCT) for the diagnosis of PCP was 100, 83.3, 90.5 and 100%, respectively. Pneumocystis carinii pneumonia was not demonstrated in any of the cases classified as ''examination not suggestive of PCP''. Significant small airway disease was not observed in any of the PCP cases. We conclude that HRCT is a reliable method for differentiating PCP from other infectious processes in HIV-positive patients and a good method to rule our PCP. Its inclusion in the diagnostic algorithm of lung infections is justified in these patients. (orig.)

  5. Differential diagnosis of focal pancreatitis and pancreatic cancer

    NARCIS (Netherlands)

    van Gulik, T. M.; Moojen, T. M.; van Geenen, R.; Rauws, E. A.; Obertop, H.; Gouma, D. J.

    1999-01-01

    The differentiation of focal, chronic pancreatitis (CP) and pancreatic cancer (PAC) poses a diagnostic dilemma. Both conditions may present with the same symptoms and signs. The complexity of differential diagnosis is enhanced because PAC is frequently associated with secondary inflammatory changes

  6. A case of urticarial vasculitis in a female patient with lupus: Mycoplasma pneumoniae infection or lupus reactivation?

    Science.gov (United States)

    Diplomatico, Mario; Gicchino, Maria Francesca; Ametrano, Orsola; Marzuillo, Pierluigi; Olivieri, Alma Nunzia

    2017-05-01

    A 17-year-old female patient affected by systemic lupus erythematosus (SLE) (who had been taking 300 mg/die of hydroxychloroquine for 3 years), Graves' disease (treated with 10 mg/die of tapazole), and celiac disease came to our attention for urticarial vasculitis. She had been taking prednisone (25 mg/die) for 3 days, and her blood tests showed high levels of Mycoplasma pneumoniae IgM and IgG antibodies. The association between urticaria and M. pneumoniae infections can be present in up to 7% of the cases and, to the best of our knowledge, only two reports of urticarial vasculitis and M. pneumoniae in adults are available in the literature. Urticarial vasculitis can also be a rare cutaneous manifestation of SLE (affecting 2% of the patients), and our case is the first in the literature describing the coexistence of M. pneumoniae infection, SLE, and urticarial vasculitis in a pediatric patient, a case that rises an important differential diagnosis issue about the origin of urticarial vasculitis: SLE reactivation or urticarial vasculitis due to M. pneumoniae infection?

  7. Labaratory capacity of differential anemia diagnosis

    Directory of Open Access Journals (Sweden)

    L. M. Meshсheryakova

    2015-06-01

    Full Text Available The paper presents the laboratory values by which modern differential diagnosis of anemias can be performed. This takes into account a widerange of laboratory tests, including: serum ferritin, erythrocyte ferritin, serum iron, total serum iron binding capacity, iron transferrin saturation,transferrin, transferrin receptor, serum vitamin B12, erythrocyte vitamin B12, serum folate, erythrocyte folate, hepsidin, HIF-1 (hypoxiainducible factor-1, immunoglobulins on erythrocytes end others. The combination of these studies helps to accurate diagnosis and appropriate therapy.

  8. Labaratory capacity of differential anemia diagnosis

    Directory of Open Access Journals (Sweden)

    L. M. Meshсheryakova

    2015-01-01

    Full Text Available The paper presents the laboratory values by which modern differential diagnosis of anemias can be performed. This takes into account a widerange of laboratory tests, including: serum ferritin, erythrocyte ferritin, serum iron, total serum iron binding capacity, iron transferrin saturation,transferrin, transferrin receptor, serum vitamin B12, erythrocyte vitamin B12, serum folate, erythrocyte folate, hepsidin, HIF-1 (hypoxiainducible factor-1, immunoglobulins on erythrocytes end others. The combination of these studies helps to accurate diagnosis and appropriate therapy.

  9. HRCT findings of pulmonary complications in non-AIDS immunocompromised patients. Are they useful in differential diagnosis?

    International Nuclear Information System (INIS)

    Emoto, Takuya; Matsumoto, Tsuneo; Tanaka, Nobuyuki; Miura, Gouji; Kawamura, Takeo; Matsunaga, Naofumi

    2003-01-01

    This study was designed to evaluate the diagnostic value of characteristic high-resolution CT (HRCT) findings in the differential diagnosis of acute pulmonary complications (APCs) in immunocompromised patients and to investigate how to improve diagnostic accuracy. We reviewed the chest CT images of 103 consecutive immunocompromised non-acquired immunodeficiency syndrome (AIDS) patients with APCs. The presence, extent, and anatomical distribution of the CT findings were assessed by two radiologists. The sensitivity and positive predictive value (PPV) of each criterion determined by the combination of CT findings that were characteristic in previous studies were calculated. The average sensitivity of each criterion was 0.50 in the total cases. There were many false positives, and the PPVs of some criteria were low. Among the significantly less frequent CT findings, the frequency of bronchovascular bundle thickening was 0% in cytomegaloviral pneumonia (CMV P). The absence of this finding improved the diagnostic accuracy of CMV P. Because the combination of only characteristic HRCT findings in each disease was of relatively limited value in making a diagnosis, infrequent findings should be also added to the CT criteria to improve accuracy. (author)

  10. Value of Lung Ultrasonography in the Diagnosis and Outcome Prediction of Pediatric Community-Acquired Pneumonia with Necrotizing Change.

    Directory of Open Access Journals (Sweden)

    Shen-Hao Lai

    Full Text Available Lung ultrasonography has been advocated in diagnosing pediatric community-acquired pneumonia. However, its function in identifying necrotizing pneumonia, a complication, has not been explored. This study investigated the value of lung ultrasonography in diagnosing pediatric necrotizing pneumonia and its role in predicting clinical outcomes.We retrospectively reviewed 236 children with community-acquired pneumonia who were evaluated using lung ultrasonography within 2-3 days after admission. The ultrasonographic features assessed included lung perfusion, the presence of hypoechoic lesions, and the amount of pleural effusion. Chest computed tomography was also performed in 96 patients as clinically indicated. Detailed records of clinical information were obtained.Our results showed a high correlation between the degree of impaired perfusion in ultrasonography and the severity of necrosis in computed tomography (r = 0.704. The degree of impaired perfusion can favorably be used to predict massive necrosis in computed tomography (area under the receiver operating characteristic curve, 0.908. The characteristics of impaired perfusion and hypoechoic lesions in ultrasonography were associated with an increased risk of pneumatocele formation (odds ratio (OR, 10.11; 95% CI, 2.95-34.64 and the subsequent requirement for surgical lung resection (OR, 8.28; 95% CI, 1.86-36.93. Furthermore, a longer hospital stay would be expected if moderate-to-massive pleural effusion was observed in addition to impaired perfusion in ultrasonography (OR, 3.08; 95% CI, 1.15-8.29.Lung ultrasonography is favorably correlated with chest computed tomography in the diagnosis of necrotizing pneumonia, especially regarding massive necrosis of the lung. Because it is a simple and reliable imaging tool that is valuable in predicting clinical outcomes, we suggest that ultrasonography be applied as a surrogate for computed tomography for the early detection of severe necrotizing

  11. Pseudomona pseudomallei community acquired pneumonia

    International Nuclear Information System (INIS)

    Severiche, Diego

    1998-01-01

    This is the first published case report en Colombia about pseudomona pseudomallei community acquired pneumonia. This uncommon pathogen is from the epidemiological standpoint a very important one and medical community should be aware to look after it in those patients where no other etiological pathogen is recovered. A brief summary about epidemiology is showed, emphasizing those regions where it can be found. Likewise, comments about the differential diagnosis are important since it should be considered in those patients where tuberculosis is suspected. This is particularly representative for countries with high tuberculosis rates. Furthermore, a microbiological review is shown, emphasizing on isolation techniques, descriptions about therapeutics and other regarding treatment issues according international standards. Finally; a description about the clinical picture, laboratory findings, treatment and evolution of the case reported are shown for discussion

  12. Diagnosis and differential diagnosis of hydrocephalus in adults; Diagnostik und Differenzialdiagnostik des Hydrozephalus beim Erwachsenen

    Energy Technology Data Exchange (ETDEWEB)

    Langner, Soenke; Mensel, Birger; Kuehn, Jens Peter; Kirsch, Michael [Univ. Medicine Greifswald (Germany). Inst. for Diagnostic Radiology and Neuroradiology; Fleck, Steffen; Baldauf, Joerg [Univ. Medicine Greifswald (Germany). Dept. of Neurosurgery

    2017-08-15

    Hydrocephalus is caused by an imbalance of production and absorption of cerebrospinal fluid (CSF) or obstruction of its pathways, resulting in ventricular dilatation and increased intracranial pressure. Imaging plays a crucial role in the diagnosis, differential diagnosis and planning of treatment. This review article presents the different types of hydrocephalus und their typical imaging appearance, describes imaging techniques, and discusses differential diagnoses of the different forms of hydrocephalus. Imaging plays a central role in the diagnosis of hydrocephalus. While magnetic resonance (MR) imaging is the first-line imaging modality, computed tomography (CT) is often the first-line imaging test in emergency patients.

  13. Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia.

    Science.gov (United States)

    Esayag, Yaacov; Nikitin, Irina; Bar-Ziv, Jacob; Cytter, Ruth; Hadas-Halpern, Irith; Zalut, Todd; Yinnon, Amos M

    2010-01-01

    To assess the diagnostic value of the chest radiograph for the diagnosis of pneumonia in bedridden patients, using non-contrast-enhanced high-resolution chest computed tomography (CT) as the gold standard. We prospectively evaluated bedridden patients hospitalized with moderate to high clinical probability of pneumonia. Chest radiographs were interpreted in a blinded fashion by 3 observers and classified as definite, normal, or uncertain for pneumonia. Chest CT was obtained within 12 hours of chest radiograph. We applied Bayesian analysis to assess the accuracy of chest radiograph in the diagnosis of pneumonia. In a 5-month period, 58 patients were evaluated, 31 (53%) were female. Their chest radiographs were interpreted as negative, uncertain, or positive for pneumonia in 31 (53%), 15 (26%), and 12 (21%) patients, respectively, while CT confirmed pneumonia in 11 (35%), 10 (67%), and in 10 (83%). The sensitivity of the chest radiograph to diagnose pneumonia was 65%, the specificity was 93%, the positive and negative predictive values were, respectively, 83% and 65%, while the overall accuracy was 69% (95% confidence interval, 50%-79%). In bedridden patients with suspected pneumonia, a normal chest radiograph does not rule out the diagnosis, hence, a chest CT scan might provide valuable diagnostic information. Copyright 2010 Elsevier Inc. All rights reserved.

  14. Diagnosis and differential diagnosis of cerebro-vascular malformations by CT

    International Nuclear Information System (INIS)

    Schumacher, M.; Stoeter, P.; Voigt, K.

    1980-01-01

    In 38 patients, the diagnosis of a cerebrovascular malformation (17 arteriovenous angiomas including one low-flow- and two venous angiomas; 10 aneurysms; 4 arteriovenous fistulae of the cavernous sinus, the tentorium and one of the Great Vein of Galen; 6 megadolical basilar arteries) was initially made by computertomographic (CT) examination, including contrast enhancement. The characteristic and pathognomonic CT findings are described and compared with those of cerebral angiography also done in these cases. The problems of differential diagnosis and the reasons for a false CT diagnosis in 5 other patients with a cerebro-vascular malformation are investigated; and the diagnostic value of cerebral angiography and CT is discussed and their complementary functions are being pointed out. (orig.) 891 MG/orig. 892 MKO [de

  15. CHLAMYDIA PNEUMONIAE – THE PREVALENCE OF ANTIBODIES IN HEALTHY POPULATION AND IN PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

    Directory of Open Access Journals (Sweden)

    Darja Keše

    2001-06-01

    Full Text Available Background. To determinate the prevalence rates of Chlamydia pneumoniae infections in Slovenia and to evaluate the importance of C. pneumoniae infections at patients with community acquired pneumonia (CAP.Materials and methods. With the microimmunofluorescence test (micro-IF we evaluated the presence of C. pneumoniae specific antibodies in 1036 healthy subjects, in two periods of time, in 1991–93 and 1997–1998. We also tested the pair sera collected from 2118 patients with CAP between 1993–1999.Results. We demonstrated that C. pneumoniae infections are common in our population, as we detected IgG antibodies in 43.1% of healthy population. The prevalence rate of C. pneumoniae infections statistically significant increased in two periods of time. Acute C. pneumoniae infections were proved in 15.9% of all patients with CAP.Conclusions. C. pneumoniae is important respiratory pathogen also in our community. The infections are more common in older patients. Because C. pneumoniae like other Chlamydia species has tendency to cause chronic disease, it is reasonable to diagnose this bacterium in respiratory patients. It is also recommended to test convalescent sera at serologic laboratory diagnosis.

  16. The enhanced pneumococcal LAMP assay: a clinical tool for the diagnosis of meningitis due to Streptococcus pneumoniae.

    Directory of Open Access Journals (Sweden)

    Dong Wook Kim

    Full Text Available BACKGROUND: Streptococcus pneumoniae is a leading cause of invasive bacterial disease in developed and developing countries. We studied the loop-mediated isothermal amplification (LAMP technique to assess its suitability for detecting S. pneumoniae nucleic acid in cerebrospinal fluid (CSF. METHODOLOGY/PRINCIPAL FINDINGS: We established an improved LAMP assay targeting the lytA gene (Streptococcus pneumoniae [Sp] LAMP. The analytical specificity of the primers was validated by using 32 reference strains (10 Streptococcus and seven non-Streptococcus species plus 25 clinical alpha-hemolytic streptococcal strains, including four S. pneumoniae strains and 21 other strains (3 S. oralis, 17 S. mitis, and one Streptococcus species harboring virulence factor-encoding genes (lytA or ply. Within 30 minutes, the assay could detect as few as 10 copies of both purified DNA and spiked CSF specimens with greater sensitivity than conventional polymerase chain reaction (PCR. The linear determination range for this assay is 10 to 1,000,000 microorganisms per reaction mixture using real-time turbidimetry. We evaluated the clinical sensitivity and specificity of the Sp LAMP assay using 106 randomly selected CSF specimens from children with suspected meningitis in Korea, China and Vietnam. For comparison, CSF specimens were also tested against conventional PCR and culture tests. The detection rate of the LAMP method was substantially higher than the rates of PCR and culture tests. In this small sample, relative to the LAMP assay, the clinical sensitivity of PCR and culture tests was 54.5% and 33.3%, respectively, while clinical specificity of the two tests was 100%. CONCLUSIONS/SIGNIFICANCE: Compared to PCR, Sp LAMP detected S. pneumoniae with higher analytical and clinical sensitivity. This specific and sensitive LAMP method offers significant advantages for screening patients on a population basis and for diagnosis in clinical settings.

  17. Immune Thrombocytopenia Associated with Mycoplasma pneumoniae Infection

    Directory of Open Access Journals (Sweden)

    Catarina Gouveia

    2018-01-01

    Full Text Available Immune thrombocytopenia (ITP related to Mycoplasma pneumoniae infection is a rare condition and usually associated with a severe clinical course. We here report a case of a young man with a clinical diagnosis of severe ITP secondary to M. pneumoniae infection. The clinical features, therapy and outcome are presented.

  18. Differential diagnosis in the pediatric radiology

    International Nuclear Information System (INIS)

    Rijn, Rick R. van; Blickmann, Johan G.

    2012-01-01

    The book on differential diagnosis in the pediatric radiology covers the following issues: (1) Thorax, mediastinum, heart ad large blood vessels. (2) Abdomen and gastrointestinal tract. (3) Urogenital tract. (4) Skull, intracranial space and spinal cord. (5) Skeleton, bone joints and soft tissue. (6) Normative values.

  19. A case of chemical pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Woo; Eun, Choung Ki; Choi, Byung Soo; Park, Soo Sung [Chungang University School of Medicine, Seoul (Korea, Republic of)

    1974-10-15

    A case of chemical pneumonia due to the fumes of nitric acid and chemical compounds was encountered, and it is reported with a review of the literatures. A 19 year old Korean male working in an electric materials manufacturing factory of poor facilities dealing with chemical compounds showed initial symptoms closely similar to those of pulmonary tuberculosis of hematogenous disseminating type, and a roentgenogram was hardly helpful for differentiating chemical pneumonia from pulmonary tuberculous of hematogenous disseminating type. The clinical course in this case was very favourable as compared with those of pulmonary tuberculosis and bacterial pneumonia.

  20. A case of chemical pneumonia

    International Nuclear Information System (INIS)

    Lee, Sung Woo; Eun, Choung Ki; Choi, Byung Soo; Park, Soo Sung

    1974-01-01

    A case of chemical pneumonia due to the fumes of nitric acid and chemical compounds was encountered, and it is reported with a review of the literatures. A 19 year old Korean male working in an electric materials manufacturing factory of poor facilities dealing with chemical compounds showed initial symptoms closely similar to those of pulmonary tuberculosis of hematogenous disseminating type, and a roentgenogram was hardly helpful for differentiating chemical pneumonia from pulmonary tuberculous of hematogenous disseminating type. The clinical course in this case was very favourable as compared with those of pulmonary tuberculosis and bacterial pneumonia

  1. Value of 67Ga scintigraphy in primary diagnosis and follow-up of opportunistic pneumonias in patients with AIDS

    International Nuclear Information System (INIS)

    Tatsch, K.; Knesewitsch, P.; Kirsch, C.M.; Kueffer, G.; Doerner, G.; Moser, E.; Matuschke, A.; Bogner, J.; Goebel, F.D.

    1988-01-01

    Opportunistic pneumonias are a life-threatening complication in patients with AIDS. Early diagnosis and therapy is necessary to improve prognosis. This study was designed to assess the value of 67 Ga scintigraphy in the primary detection and follow-up of these special pneumonias. 67 Ga scintigraphy was performed in 40 patients: 10 normal controls and 30 HIV-positive patients with AIDS or AIDS-related complex (ARC). 67 Ga scan results were compared with current chest radiographs and the results of pathogen detection. The evaluation of positive scans was based on a quantification of the pulmonary uptake, expressed as a pulmonary/soft-tissue uptake ratio. Only 8/30 patients had a normal scan, 22/30 showed diffuse (13/22) or focal (9/22) increases of pulmonary uptake. In 7/8 patients with normal scans the chest radiograph was negative as well. The one patient with negative scan but positive chest radiograph had pulmonary Kaposi's sarcoma. In 11/22 patients the 67 Ga scan and chest radiograph were positive simultaneously. In the other 11/22 patients with positive scans chest radiographs were initially negative but showed pathology in 5 cases within 1-2 weeks. The reason for positive scans in most cases was an opportunistic lung infection; other forms of pneumonia were only observed in two cases. The defined uptake ratio demonstrated to be a highly sensitive parameter for monitoring pneumonia and the effects of therapy in follow-up studies. In conclusion, quantitative 67 Ga scintigraphy proved to be a reliable and highly sensitive method for primary detection and follow-up of opportunistic pneumonias in patients with AIDS. (orig.) [de

  2. Serum Fragments of Tau for the Differential Diagnosis of Alzheimer's Disease

    DEFF Research Database (Denmark)

    Inekci, Dilek; Henriksen, K.; Linemann, T.

    2015-01-01

    Differential diagnosis of AD is still a challenge due to overlapping features with other types of dementia. Biomarkers for the differential diagnosis of AD can improve the diagnostic value of the disease and ensure an appropriate treatment of patients. The aim of this study was to evaluate...

  3. Percutaneous CT-Guided Core Needle Biopsy Versus Fine Needle Aspiration in Diagnosing Pneumonia and Mimics of Pneumonia

    International Nuclear Information System (INIS)

    Thanos, Loukas; Galani, Panagiota; Mylona, Sophia; Pomoni, Maria; Mpatakis, Nikolaos

    2004-01-01

    The purpose of this study was to determine the diagnostic value of percutaneous core needle biopsy (CNB) relative to fine needle aspiration (FNA) in patients with pneumonia and pneumonia mimics. In this prospective study we present our experience with 48 thoracic FNAs and CNBs carried out on 48 patients with pneumonia and pneumonia mimics. Samples were obtained from all patients using both CNB (with an automated 18-G core biopsy needle and a gun) and FNA (with a 22-G needle). A specific diagnosis was made in 10/48 cases (20.83%) by FNA and in 42/48 (87.5%) by CNB. The main complications encountered were pneumothorax (n = 4) and hemoptysis (n = 2), yielding a total complication rate of 12.5%. We concluded that CNB using an automated biopsy gun results in a higher diagnostic accuracy for pneumonia and pneumonia mimic biopsies than FNA. Complications should be considered and proper patient observation should follow the procedure

  4. Clinical behavior of Streptococcus pneumoniae meningoencephalitis Comportamiento clinico y terapéutico de la meningoencefalitis por Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    Raisa Bu-Coifiu Fanego

    2009-12-01

    Full Text Available OBJECTIVE: There was an increased number of cases of meningoencephalitis caused by Streptococcus pneumoniae, after the successful vaccination campaigns against Neisseria meningitidis and Haemophilus influenzae. This paper aims at describing the clinical characteristics, the laboratory findings, the complications, and the therapeutic management of these patients, who have been suffering from this disease since 1993 to 2006. METHOD: Twelve children with Streptococcus pneumoniae meningoencephalitis admitted to the pediatric hospital of San Miguel del Padron, City of Havana in this period were assessed. RESULTS: Children under one year are the most frequently affected. Septic shock and brain edema were the most severe complications. Three patients died, implying that this disease has a serious course. Early treatment of brain edema is very important to reduce mortality. The elective drugs for treatment of these cases of Streptococcus pneumoniae meningoencephalitis were vancomycin combined with cephalosporin, cefotaxime or ceftriaxone type. CONCLUSION: Patients with Streptococcus pneumoniae meningoencephalitis show clinical characteristics, complications, and sequels that are different to other bacterial meningoencephalitis, meaning that they could be helpful for physicians considering the differential diagnosis of meningoencephalitis.OBJETIVO: Existe un incremento de la meningoencefalitis producida por Streptococcus pneumoniae, después de las campañas exitosas de vacunación contra Neisseria meningitidis y Haemophilus influenzae. El objetivo de este trabajo es describir las caracteristicas clinicas, los hallazgos de laboratorio, las complicaciones y el manejo terapéutico de los pacientes que sufrieron esta enfermedad desde 1993 a 2006. MÉTODO: Se estudiaron doce niños con meningoencefalitis por Streptococcus pneumoniae ingresados en el Hospital Pediátrico de San Miguel del Padrón, Ciudad de La Habana en este periodo. RESULTADOS: Los ni

  5. Lung ultrasound for the diagnosis of community-acquired pneumonia in children.

    Science.gov (United States)

    Stadler, Jacob A M; Andronikou, Savvas; Zar, Heather J

    2017-10-01

    Ultrasound (US) has been proposed as an alternative first-line imaging modality to diagnose community-acquired pneumonia in children. Lung US has the potential benefits over chest radiography of being radiation free, subject to fewer regulatory requirements, relatively lower cost and with immediate bedside availability of results. However, the uptake of lung US into clinical practice has been slow and it is not yet included in clinical guidelines for community-acquired pneumonia in children. The aim of this review is to give an overview of the equipment and techniques used to perform lung US in children with suspected pneumonia and the interpretation of relevant sonographic findings. We also summarise the current evidence of diagnostic accuracy and reliability of lung US compared to alternative imaging modalities in children and critically consider the strengths and limitations of lung US for use in children presenting with suspected community-acquired pneumonia.

  6. Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder

    Directory of Open Access Journals (Sweden)

    Michelle Nigri Levitan

    2013-12-01

    Full Text Available Objective: To present the most relevant findings regarding the Brazilian Medical Association guidelines for the diagnosis and differential diagnosis of panic disorder. Methods: We used the methodology proposed by the Brazilian Medical Association for the Diretrizes Project. The MEDLINE (PubMed, Scopus, Web of Science, and LILACS online databases were queried for articles published from 1980 to 2012. Searchable questions were structured using the PICO format (acronym for “patient” [or population], “intervention” [or exposure], “comparison” [or control], and “outcome”. Results: We present data on clinical manifestations and implications of panic disorder and its association with depression, drug abuse, dependence and anxiety disorders. In addition, discussions were held on the main psychiatric and clinical differential diagnoses. Conclusions: The guidelines are proposed to serve as a reference for the general practitioner and specialist to assist in and facilitate the diagnosis of panic disorder.

  7. Differential diagnosis of myelitis; Differenzialdiagnostik der Myelitis

    Energy Technology Data Exchange (ETDEWEB)

    Langner, Soenke [Universitaetsmedizin Greifswald (Germany). Inst. fuer Diagnostische Radiologie und Neuroradiologie

    2016-09-15

    Acute transverse Myelitis is an inflammatory myelopathy characterized by rapid onset of bilateral neurological symptoms. There is a vast array of differential diagnoses and the underlying pathology often cannot be identified on clinical examination alone. Therefore neuroimaging has a central role in narrowing the differential diagnosis. This review aims to provide a summary of common causes of non-traumatic myelopathies, many of which may have similar radiological appearance.

  8. [A retrospective clinicopathological study of aspiration pneumonia in the elderly].

    Science.gov (United States)

    Pu, Chun; Zhong, Xuefeng; Fang, Fang; Yang, Yimeng; Xu, Xiaomao; Sun, Tieying

    2014-08-01

    To explore the clinicopathological characteristics of aspiration pneumonia in the elderly. The clinical data of 30 cases of autopsy-proven aspiration pneumonia in Beijing Hospital from 1973 to 2002 were reviewed. The patients consisted of 28 males and 2 females, aged from 63 to 103 [mean (83 ± 9)] years. Only 15 cases were clinically diagnosed as aspiration pneumonia before death. Concomitant diseases were severe and complex, mostly coronary disease, cerebrovascular disease, hypertension, COPD, and diabetes mellitus. All the patients suffered from at least 3 concomitant diseases. Long-term bedridden and nasogastric feeding was seen in 11 and 17 patients respectively. The clinical presentation and chest X-ray of aspiration pneumonia in the elderly were nonspecific and variable. Mixed infections were common . The main bacteria isolated were Gram-negative bacilli, in particular Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Escherichia coli and Candida albicans. By pathology, macrophages with foreign bodies were found in all the 30 cases and multiple small abscesses were found in 14 cases. The lesions were adjacent to the bronchioles and in the lung tissue around the bronchioles, mostly multi-lobar and bilateral. Unilateral or bilateral pleural effusion developed in 20 patients. The accordance between radiological and pathological diagnosis of aspiration pneumonia was very poor. The foci of infection detected by X-ray were proven by autopsy in 13 patients, while pleural effusions in X-ray were proven by autopsy in 15 patients. Multi-concomitant diseases, mixed infection and extra-pulmonary presentations were common in elderly patients with aspiration pneumonia. Multiple small abscesses were the pathological characteristics of aspiration pneumonia in the aged. A definite clinical diagnosis of aspiration pneumonia was difficult. Recurrent silent microaspiration was a feature of aspiration in the elderly. The assessment of risk factor of aspiration played an

  9. Radiological diagnosis and differential diagnosis of headache

    International Nuclear Information System (INIS)

    Langner, S.; Kirsch, M.

    2015-01-01

    Headache is very common and affects almost everyone at some point. It is one of the most common disorders that leads patients to see their physician. All different forms have the nociception via trigeminal nerve fibers in common. Beside the clinical course headaches are classified as either primary or secondary, with the latter having an identifiable structural or biochemical cause. Imaging has a low diagnostic yield in primary headache but play an important role in the differential diagnosis of secondary forms. An overview of different forms of secondary headache is given, outlining diagnostic procedures and the morphologic imaging features of each syndrome.

  10. Chronic necrotising pneumonia caused by Aspergillus niger.

    Science.gov (United States)

    Wiggins, J; Clark, T J; Corrin, B

    1989-01-01

    A woman with asthma developed chronic necrotising semi-invasive pneumonia due to mixed Aspergillus niger and Candida albicans infection; though not severely immunosuppressed, she may have been predisposed by long term oral corticosteroid and recurrent oral antibiotic treatment. The diagnosis should be considered in patients with chronic airflow limitation who develop cavitating pneumonia. Images PMID:2763249

  11. Computerized tomography in radiodiagnosis of pneumonia

    International Nuclear Information System (INIS)

    Degtyareva, I.A.; Mamaev, V.V.; Savchenko, A.P.

    1989-01-01

    Experience in the use of computerized tomography (CT) in combined radiodiagnosis of pneumonia was analysed. It has been concluded that CT objectively reflects morphological inflammatory changes and permits their all-round assessment over time. The diagnosis of pneumonia in CT is based on classical x-ray symptoms. As compared to survery radiography CT reveals symptoms of pneumonia to the full at earlier stages. CT is an important additional method of investigation of inflammatory pulmonary diseases but it should not be used separately without survey radiography. In a majority of cases when CT is performed there is no need in x-ray tomography

  12. Exhaled Breath Metabolomics for the Diagnosis of Pneumonia in Intubated and Mechanically-Ventilated Intensive Care Unit (ICU-Patients

    Directory of Open Access Journals (Sweden)

    Pouline M. P. van Oort

    2017-02-01

    Full Text Available The diagnosis of hospital-acquired pneumonia remains challenging. We hypothesized that analysis of volatile organic compounds (VOCs in exhaled breath could be used to diagnose pneumonia or the presence of pathogens in the respiratory tract in intubated and mechanically-ventilated intensive care unit patients. In this prospective, single-centre, cross-sectional cohort study breath from mechanically ventilated patients was analysed using gas chromatography-mass spectrometry. Potentially relevant VOCs were selected with a p-value < 0.05 and an area under the receiver operating characteristics curve (AUROC above 0.7. These VOCs were used for principal component analysis and partial least square discriminant analysis (PLS-DA. AUROC was used as a measure of accuracy. Ninety-three patients were included in the study. Twelve of 145 identified VOCs were significantly altered in patients with pneumonia compared to controls. In colonized patients, 52 VOCs were significantly different. Partial least square discriminant analysis classified patients with modest accuracy (AUROC: 0.73 (95% confidence interval (CI: 0.57–0.88 after leave-one-out cross-validation. For determining the colonization status of patients, the model had an AUROC of 0.69 (95% CI: 0.57–0.82 after leave-one-out cross-validation. To conclude, exhaled breath analysis can be used to discriminate pneumonia from controls with a modest to good accuracy. Furthermore breath profiling could be used to predict the presence and absence of pathogens in the respiratory tract. These findings need to be validated externally.

  13. Imaging appearances of cholesterol pneumonia

    International Nuclear Information System (INIS)

    Miao Yanwei; Zhang Jingwen; Wu Jianlin; Zhou Yong; Li Mingwu; Lei Zhen; Shi Lifu

    2006-01-01

    Objection: To analyze the imaging appearances of cholesterol pneumonia. Methods We retrospectively analyzed the X-ray and CT findings of 3 patients with cholesterol pneumonia confirmed pathologically and reviewed correlative literature. Results: Lesions similar to mass were found in X-ray and CT imaging of three cases. Two of them appeared cavity with fluid-level and one showed multiple ring enhancement after CT contrast. The course of disease was very. long and it had no respond to antibiotic therapy. Amounts of foam cells rich in cholesterol crystal were detected in pathological examination. Conclusions: Cholesterol pneumonia is a rare chronic pulmonary idiopathic disease, and the radiological findings can do some help to its diagnosis. (authors)

  14. Differential diagnosis of rheumatic illnesses. 4. compl. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Zeidler, Henning; Michel, Beat

    2009-01-01

    The number of the possible differential diagnosis of rheumatic illnesses is extraordinarily high. This circumstance makes the diagnostics a difficult field with numerous pitfalls. The correct and complete diagnosis however is a condition for the correct therapy. This book facilitates this way from the symptom to the diagnosis for the reader: A detailed representation of the fundamentals (anamnesis, investigation findings, laboratory diagnostics and imaging) a detailed description of all important differential diagnosis follows. The meanwhile fourth edition of this standard work was completely revised and updated. An indispensable guide book for all persons which treat patients with rheumatic illnesses [de

  15. [Differential diagnosis of chronic myeloic leucemia in infancy (author's transl)].

    Science.gov (United States)

    Binder, C; Pichler, E; Radaskiewicz, T; Scheibenreiter, S

    1976-01-01

    A 3 months old girl presented with significant enlargement of liver, spleen and lymphnodes, with moderate anemia, thrombopenia and leucocytosis. In the differential count there was a shift to the left and an increase of monocyte-like cells (35%). Differential diagnosis included leucemoid reaction, infectious mononucleosis, myelo-proliferative disorder with a missing C chromosome and chronic myeloid leucemia. Clinical symptoms, cytochemistry and caryotype of bone marrow cells suggested infantile chronic myeloic leucemia and normal ALP index and possibly normal HbF. Treatment with 6-mercaptopurine was followed by partial remission. The therapeutic consequences of exact differential diagnosis are discussed.

  16. Analysis of fatty acids in Ghee and olive oil and their probable causal effect in lipoid pneumonia

    Directory of Open Access Journals (Sweden)

    Zein Mirghani

    2010-11-01

    Full Text Available Aim: To analyze and identify the fatty acids found in homemade ghee and in olive oil and compare those to fatty acids found in bronchoalevolar lavage of children with lipoid pneumonia.Methods: The fatty acids found in homemade fat ”Ghee” and olive oil were analyzed by gas chromatography. Methyl ester derivatives suitable for GC analysis were prepared directly from olive oil or from Ghee using anhydrous methanolic-HCl. Bronchoscopy and bronchoalevolar lavage was performed in eight children aged between 2 and 4 years, all with history of using homemade ghee and/or olive oil in the recumbent position.Results: The analysis of fatty acids in Ghee and olive oil show similar gas chromatographic pattern as those of bronchoalevolar lavage.Conclusion: The three fatty acids responsible for the deleterious effects of lipoid pneumonia were identified. Lipoid pneumonia should be one of the differentials diagnosis in children  presenting with respiratory distress. (Med J Indones 2010; 19:252-7Keywords: Bronchoalevolar lavage, gas chromatography, Ghee, methyl esters, lipoid pneumonia

  17. Radioisotope diagnosis of pneumonia with the help of labelled microspheres of the blood serum albumin of man (experimental study)

    International Nuclear Information System (INIS)

    Khachirov, Dzh.G.; Petriev, V.M.

    1978-01-01

    The level of accumulation of albumin- 131 I microspheres in the lungs of intact animals reaches 90 per cent of the activity of the introduced preparation. In experimental pneumonia the inclusion of the preparation comprises 81.1+-6.23 per cent. The elimination of the labelled preparation from the lungs in experimental pneumonia occurs two times as slow than that in the control. The labelled microspheres of albumin make it possible to visualize the focus of inflammation, its spreading, conduct observations in dynamics. The peculiarities of accumulation and elimination from the lungs of the mentioned preparation make it possible with its help to differentiate pathological conditions of the lungs: inflammatory process, malignant neoformations and experimental embolism of the pulmonary artery

  18. Strategies to improve clinical management of community-acquired pneumonia

    NARCIS (Netherlands)

    Meijvis, S.C.A.

    2012-01-01

    Despite advances during the last few decades in the prevention, diagnosis and treatment of community-acquired pneumonia (CAP), its incidence remains high. In this thesis, strategies are described for improvement of the quality of clinical management in patients with pneumonia and for the reduction

  19. Retrospective Study of Disease Incidence and Type of Pneumonia ...

    African Journals Online (AJOL)

    Dr Olaleye

    with one or two aggregate bronchial associated lymphoid tissue (BALT). Table IV gives the histopathological diagnosis, bronchopneumonia was predominant with fibrinous (6) or suppurative (2) pattern, others were interstitial pneumonia (3), broncho-interstitial pneumonia with giant cells (8) and a collapsed lung. Table 3.

  20. Molecular epidemiology of C. pneumoniae infections

    Directory of Open Access Journals (Sweden)

    Alisa Shurdhi

    2010-06-01

    Full Text Available Introduction. Chlamydophila pneumoniae (C. pneumoniae is one of the most common respiratory pathogen, with an incidence of infection varying from 6% to 20%. The present study aimed to assess the incidence of C. pneumoniae infections in patients with acute respiratory diseases using a RealTime PCR (RT-PCR method. Methods. In the period January 2007-December 2008 279 biological samples coming from patients (190 males and 89 females with acute respiratory infections was collected and tested. Samples have been extracted using NucliSens easyMag Biomerieu according to manufacturer’s instructions and amplified by LightCycler Real-Time PCR Roche for the detection of C. pneumoniae DNA. Results. Data analysis revealed a higher prevalence of C. pneumoniae infections in male patients (7.9% than in females (5.6%. In addition, it is interesting to note that the incidence of C. pneumoniae infection was higher 28.6% in the period February - April. Conclusions. The results obtained in this study confirm the utility of molecular techniques in laboratory diagnosis and epidemiological investigations of respiratory infection caused by C. pneumoniae. RT-PCR have proved to be a rapid and a reliable technique to monitor and treat opportunely C. pneumoniae infections to avoid short and medium/long term complications.

  1. Intralobar bronchopulmonary sequestration with large aberrant vessel presenting as recurrent pneumonias

    International Nuclear Information System (INIS)

    Noomani, A.Z.; Toori, K.U.

    2014-01-01

    Bronchopulmonary sequestration is a rare congenital malformation of the lower respiratory tract comprising of a nonfunctioning lung tissue mass that lacks normal communication with the tracheobronchial tree. The diagnosis may be easily missed as many of the symptoms of bronchopulmonary sequestration overlap with that of other pulmonary diseases. Bronchopulmonary sequestration can be complicated by recurrent infections, hemorrhage and malignant transformation and, therefore, needs to be timely diagnosed and resected to decrease both morbidity and mortality. A high degree of suspicion in the differential diagnosis helps diagnose the positive cases. The parenchymal abnormalities associated with bronchopulmonary sequestration are best visualized using computed tomography, although their appearance is variable. We report the case of a 14 years old boy with intralobar bronchopulmonary sequestration with the sole manifestation of recurrent pneumonias. (author)

  2. Congenital intracerebral teratoma: a rare differential diagnosis in newborn hydrocephalus

    Energy Technology Data Exchange (ETDEWEB)

    Storr, U. [Landratsamt Neuburg-Schrobenhausen, Gesundheitsamt, Neuburg an der Donau (Germany)]|[Hospital for Sick Children, Erlangen-Nuernberg Univ., Nuernberg (Germany); Rupprecht, T. [Hospital for Sick Children, Erlangen-Nuernberg Univ., Nuernberg (Germany); Bornemann, A. [Inst. for General Pathology, Erlangen-Nuernberg Univ., Nuernberg (Germany); Ries, M. [Hospital for Sick Children, Erlangen-Nuernberg Univ., Nuernberg (Germany); Beinder, E. [Dept. of Obstetrics and Gynecology, Erlangen-Nuernberg Univ., Nuernberg (Germany); Boewing, B. [Hospital for Sick Children, Erlangen-Nuernberg Univ., Nuernberg (Germany); Harms, D. [Hospital for Sick Children, Erlangen-Nuernberg Univ., Nuernberg (Germany)

    1997-03-01

    Cogenital hydrocephalus is caused by a broad spectrum of underlying disorders. In the majority of cases it is due to aqueductal stenosis and other distinct congenital anomalies, like Arnold-Chiari malformation. Nevertheless, in the differential diagnosis rare conditions such as cerebral malignancies must also be considered. We present two cases of congenital intracerebral teratoma as a differential diagnosis in congenital obstructive hydrocephalus. A teratoma is suggested when a rapidly growing hydrocephalus with a central calcified and vascularized mass is found sonographically. Regular cerebral structures using cannot be detected. Early diagnosis in such cases is of clinical importance as the prognosis of congential intracerebral teratoma is generally very poor. (orig.)

  3. Congenital intracerebral teratoma: a rare differential diagnosis in newborn hydrocephalus

    International Nuclear Information System (INIS)

    Storr, U.; Rupprecht, T.; Bornemann, A.; Ries, M.; Beinder, E.; Boewing, B.; Harms, D.

    1997-01-01

    Cogenital hydrocephalus is caused by a broad spectrum of underlying disorders. In the majority of cases it is due to aqueductal stenosis and other distinct congenital anomalies, like Arnold-Chiari malformation. Nevertheless, in the differential diagnosis rare conditions such as cerebral malignancies must also be considered. We present two cases of congenital intracerebral teratoma as a differential diagnosis in congenital obstructive hydrocephalus. A teratoma is suggested when a rapidly growing hydrocephalus with a central calcified and vascularized mass is found sonographically. Regular cerebral structures using cannot be detected. Early diagnosis in such cases is of clinical importance as the prognosis of congential intracerebral teratoma is generally very poor. (orig.)

  4. Validation of sputum Gram stain for treatment of community-acquired pneumonia and healthcare-associated pneumonia: a prospective observational study.

    Science.gov (United States)

    Fukuyama, Hajime; Yamashiro, Shin; Kinjo, Kiyoshi; Tamaki, Hitoshi; Kishaba, Tomoo

    2014-10-18

    The usefulness of sputum Gram stain in patients with community-acquired pneumonia (CAP) is controversial. There has been no study to evaluate the diagnostic value of this method in patients with healthcare-associated pneumonia (HCAP). The purpose of this study was to evaluate the usefulness of sputum Gram stain in etiological diagnosis and pathogen-targeted antibiotic treatment of CAP and HCAP. We conducted a prospective observational study on hospitalized patients with pneumonia admitted to our hospital from August 2010 to July 2012. Before administering antibiotics on admission, Gram stain was performed and examined by trained physicians immediately after sputum samples were obtained. We analyzed the quality of sputum samples and the diagnostic performance of Gram stain. We also compared pathogen-targeted antibiotic treatment guided by sputum Gram stain with empirical treatment. Of 670 patients with pneumonia, 328 were CAP and 342 were HCAP. Sputum samples were obtained from 591 patients, of these 478 samples were good quality. The sensitivity and specificity of sputum Gram stain were 62.5% and 91.5% for Streptococcus pneumoniae, 60.9% and 95.1% for Haemophilus influenzae, 68.2% and 96.1% for Moraxella catarrhalis, 39.5% and 98.2% for Klebsiella pneumoniae, 22.2% and 99.8% for Pseudomonas aeruginosa, 9.1% and 100% for Staphylococcus aureus. The diagnostic yield decreased in patients who had received antibiotics or patients with suspected aspiration pneumonia. Pathogen-targeted treatment provided similar efficacy with a decrease in adverse events compared to empirical treatment. Sputum Gram stain is highly specific for the etiologic diagnosis and useful in guiding pathogen-targeted antibiotic treatment of CAP and HCAP.

  5. Congenital heart disease: a hard case for differential diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    David Gonçalves Nordon

    2012-04-01

    Full Text Available ABSTRACT Congenital heart diseases are important malformations that might compromise not only the patient's survival, but also his/her quality of life. We present the case of a female newborn who presented cardiovascular unbalance and cianosis in spite of her previous month of life without any complication. Her differential diagnosis was rather difficult, due not only to restrictions of exams available for diagnosis, but also to their sensibility and specificity. We discuss such differential diagnosis and the complicated development of the case.

  6. Phocomelia: Case report and differential diagnosis.

    Science.gov (United States)

    Osadsky, Captain Rasto

    2011-01-01

    While rarely seen in the present-day Western world, phocomelia is not uncommon in underdeveloped countries. Phocomelia is an abnormality in which the limbs are not fully formed. It may be inherited as an autosomal recessive or dominant disorder. This case concerns a 12-year-old Afghan boy with multiple skeletal anomalies, most prominently of his right arm, including aplasia of the entire proximal humerus, hypoplasia of the clavicle and scapula, and absence of the radial ray and thumb. A hypoplastic left thumb was also present. Other anomalies included thoracic scoliosis, upper thoracic hemivertebrae, and mild cardiomegaly. The differential diagnosis and likely diagnosis are discussed.

  7. Viral pneumonias: Typical and atypical findings

    International Nuclear Information System (INIS)

    Westhoff-Bleck, M.; Bleck, J.S.; Schirg, E.

    1987-01-01

    The clinical and radiological features of viral pneumonias are summarized and discussed. Although viral infections of the lung belong to atypical pneumonias they demonstrate not always the radiographic pattern of an interstitial pneumonia. Characteristic radiographic findings are quite rare. In most cases the microbial etiology cannot be predicted from chest radiographs. The appearance varies depending on the virulence of the organism and the resistence of the host. In this regard knowledge of epidemiological data as well as patients condition and underlying disease is of utmost importance. Differentiation between community- and hospital-acquired infection may be very helpful. (orig.) [de

  8. Impact of Acute Kidney Injury in Patients Hospitalized With Pneumonia.

    Science.gov (United States)

    Chawla, Lakhmir S; Amdur, Richard L; Faselis, Charles; Li, Ping; Kimmel, Paul L; Palant, Carlos E

    2017-04-01

    Pneumonia is a common cause of hospitalization and can be complicated by the development of acute kidney injury. Acute kidney injury is associated with major adverse kidney events (death, dialysis, and durable loss of renal function [chronic kidney disease]). Because pneumonia and acute kidney injury are in part mediated by inflammation, we hypothesized that when acute kidney injury complicates pneumonia, major adverse kidney events outcomes would be exacerbated. We sought to assess the frequency of major adverse kidney events after a hospitalization for either pneumonia, acute kidney injury, or the combination of both. We conducted a retrospective database analysis of the national Veterans Affairs database for patients with a admission diagnosis of International Classification of Diseases-9 code 584.xx (acute kidney injury) or 486.xx (pneumonia) between October 1, 1999, and December 31, 2005. Three groups of patients were created, based on the diagnosis of the index admission and serum creatinine values: 1) acute kidney injury, 2) pneumonia, and 3) pneumonia with acute kidney injury. Patients with mean baseline estimated glomerular filtration rate less than 45 mL/min/1.73 m were excluded. The primary endpoint was major adverse kidney events defined as the composite of death, chronic dialysis, or a permanent loss of renal function after the primary discharge. The observations of 54,894 subjects were analyzed. Mean age was 68.7 ± 12.3 years. The percentage of female was 2.4, 73.3% were Caucasian, and 19.7% were African-American. Differences across the three diagnostic groups were significant for death, 25% decrease in estimated glomerular filtration rate from baseline, major adverse kidney events following admission, and major adverse kidney events during admission (all p pneumonia + acute kidney injury group (51% died and 62% reached major adverse kidney events). In both unadjusted and adjusted time to event analyses, patients with pneumonia + acute kidney injury

  9. [Comparison of endotracheal aspiration and mini-BAL culture results in the diagnosis of ventilator-associated pneumonia].

    Science.gov (United States)

    Artuk, Cumhur; Gül, Hanefi Cem; Mert, Gürkan; Karakaş, Ahmet; Bedir, Orhan; Eyigün, Can Polat

    2012-07-01

    The objective of this study was to compare the results of cultures obtained by mini-bronchoalveolar lavage (BAL) and endotracheal aspiration (ETA) techniques, used for rapid and accurate determination of pathogens causing ventilator-associated pneumonia (VAP) in intensive care units. Of the 92 patients on mechanical ventilation followed at the emergency intensive care unit of our hospital between June 2010 and June 2011, 30 (32.2%) patients were diagnosed as VAP and they were included in this study. VAP diagnosis were based on the clinical and radiological findings. Clinical pulmonary infection score (CPIS) of > 6 was accepted as the clinical criteria of VAP. Initially ETA samples were collected from the patients followed by mini-BAL sampling 15 minutes later, together with urine and two blood cultures. Microbiological evaluation and identification were performed by conventional methods and Phoenix 100 (BD Diagnostic Systems, ABD) automated system. In quantitative culture analysis, > 10.000 cfu/ml for BAL and > 100.000 cfu/ml for ETA were accepted as the positive result. The mean ages of VAP-developed (n= 30; 18 were male) and nondeveloped (n= 62; 39 were male) patients were 68.23 ± 16.19 and 52.16 ± 10.41 years, respectively, and the mean durations of mechanical ventilation were 29.57 ± 15.78 and 12.11 ± 6.01 days, respectively. Multivariate logistic regression analysis showed that older age (pVAP development. There was also a statistically significant difference in CPIS values between patients who developed VAP and not (6.8 ± 1.15 and 2.71 ± 1.06, respectively; pVAP diagnosis was found to be useful in patients on mechanical ventilation. In our study, a total of 16 strains (six A.baumannii, three P.aeruginosa, one K.pneumoniae, six S.aureus) were isolated from ETA cultures, while 34 strains (16 A.baumannii, six P.aeruginosa, four K.pneumoniae, two E.coli, six S.aureus) were isolated from mini-BAL cultures of 30 VAP patients. The contamination rate for ETA

  10. [The differential diagnosis of amyotrophic lateral sclerosis and subacute herpes virus myelitis].

    Science.gov (United States)

    Levitsky, G N; Zavalishin, E E; Chub, R V; Morozova, E A; Serkov, S V

    2016-01-01

    Differential diagnosis of incurable and potentially curable neurological diseases is an urgent problem of modern neurology. The authors present a case report of subacute herpes virus myelitis, a rare complication of herpes infection by Varicella-Zoster virus. The differential diagnosis with amyotrophic lateral sclerosis is described.

  11. The neuromuscular differential diagnosis of joint hypermobility

    NARCIS (Netherlands)

    Donkervoort, S.; Bonnemann, C.G.; Loeys, B.L.; Jungbluth, H.; Voermans, N.C.

    2015-01-01

    Joint hypermobility is the defining feature of various inherited connective tissue disorders such as Marfan syndrome and various types of Ehlers-Danlos syndrome and these will generally be the first conditions to be considered by geneticists and pediatricians in the differential diagnosis of a

  12. Differential diagnosis of ataque de nervios.

    Science.gov (United States)

    Oquendo, M A

    1995-01-01

    Characteristics of ataque de nervios, a culturally condoned expression of distress that is most frequently seen in Hispanic women, are described. It has symptoms in common with affective and anxiety disorders, with which it can co-occur, and these are delineated for purposes of differential diagnosis. Possible reasons for the preponderance of the condition in women are discussed, along with suggested intervention strategies.

  13. Methods for Real-Time PCR-Based Diagnosis of Chlamydia pneumoniae, Chlamydia psittaci, and Chlamydia abortus Infections in an Opened Molecular Diagnostic Platform.

    Science.gov (United States)

    Opota, Onya; Brouillet, René; Greub, Gilbert; Jaton, Katia

    2017-01-01

    The advances in molecular biology of the last decades have dramatically improved the field of diagnostic bacteriology. In particular, PCR-based technologies have impacted the diagnosis of infections caused by obligate intracellular bacteria such as pathogens from the Chlamydiacae family. Here, we describe a real-time PCR-based method using the Taqman technology for the diagnosis of Chlamydia pneumoniae, Chlamydia psittaci, and Chlamydia abortus infection. The method presented here can be applied to various clinical samples and can be adapted on opened molecular diagnostic platforms.

  14. Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings.

    Science.gov (United States)

    Ellington, Laura E; Gilman, Robert H; Chavez, Miguel A; Pervaiz, Farhan; Marin-Concha, Julio; Compen-Chang, Patricia; Riedel, Stefan; Rodriguez, Shalim J; Gaydos, Charlotte; Hardick, Justin; Tielsch, James M; Steinhoff, Mark; Benson, Jane; May, Evelyn A; Figueroa-Quintanilla, Dante; Checkley, William

    2017-07-01

    Pneumonia is a leading cause of morbidity and mortality in children worldwide; however, its diagnosis can be challenging, especially in settings where skilled clinicians or standard imaging are unavailable. We sought to determine the diagnostic accuracy of lung ultrasound when compared to radiographically-confirmed clinical pediatric pneumonia. Between January 2012 and September 2013, we consecutively enrolled children aged 2-59 months with primary respiratory complaints at the outpatient clinics, emergency department, and inpatient wards of the Instituto Nacional de Salud del Niño in Lima, Peru. All participants underwent clinical evaluation by a pediatrician and lung ultrasonography by one of three general practitioners. We also consecutively enrolled children without respiratory symptoms. Children with respiratory symptoms had a chest radiograph. We obtained ancillary laboratory testing in a subset. Final clinical diagnoses included 453 children with pneumonia, 133 with asthma, 103 with bronchiolitis, and 143 with upper respiratory infections. In total, CXR confirmed the diagnosis in 191 (42%) of 453 children with clinical pneumonia. A consolidation on lung ultrasound, which is our primary endpoint for pneumonia, had a sensitivity of 88.5%, specificity of 100%, and an area under-the-curve of 0.94 (95% CI 0.92-0.97) when compared to radiographically-confirmed clinical pneumonia. When any abnormality on lung ultrasound was compared to radiographically-confirmed clinical pneumonia the sensitivity increased to 92.2% and the specificity decreased to 95.2%, with an area under-the-curve of 0.94 (95% CI 0.91-0.96). Lung ultrasound had high diagnostic accuracy for the diagnosis of radiographically-confirmed pneumonia. Added benefits of lung ultrasound include rapid testing and high inter-rater agreement. Lung ultrasound may serve as an alternative tool for the diagnosis of pediatric pneumonia. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights

  15. The cryptogenic organizing pneumonia: the analysis of CT features

    International Nuclear Information System (INIS)

    Zhu Xiaohua; Li Tiannv; You Zhengqian; Ma Jun; Jiang Sen

    2007-01-01

    Objective: To improve our understanding concerning radiographic manifestations of cryptogenic organizing pneumonia (COP). Methods: The diagnosis of cryptogenic organizing pneumonia was made based on clinical and radiological features, and was verified with lung biopsy and pathological examination in 23 cases. All data were analyzed and relevant literatures were reviewed. Results: CT scans revealed multi- patch shadows, patchy air-space consolidations in 15 cases, often located in predominantly subpleural and(or) both inferior lungs, with or ground-glass opacities, bronchiectasis, and cords. Lesion sites changed over time in some patients. Corticosteroid treatment led to significant improvement in most cases. Conclusions: The diagnosis of cryptogenic organizing pneumonia required the converging evidence from clinical and radiological manifestations as well as pathologies. It is important to appreciate CT manifestations of COP. (authors)

  16. Accuracy of the interpretation of chest radiographs for the diagnosis of paediatric pneumonia.

    Directory of Open Access Journals (Sweden)

    Mohamed A Elemraid

    Full Text Available World Health Organization (WHO radiological classification remains an important entry criterion in epidemiological studies of pneumonia in children. We report inter-observer variability in the interpretation of 169 chest radiographs in children suspected of having pneumonia.An 18-month prospective aetiological study of pneumonia was undertaken in Northern England. Chest radiographs were performed on eligible children aged ≤16 years with clinical features of pneumonia. The initial radiology report was compared with a subsequent assessment by a consultant cardiothoracic radiologist. Chest radiographic changes were categorised according to the WHO classification.There was significant disagreement (22% between the first and second reports (kappa = 0.70, P<0.001, notably in those aged <5 years (26%, kappa = 0.66, P<0.001. The most frequent sources of disagreement were the reporting of patchy and perihilar changes.This substantial inter-observer variability highlights the need for experts from different countries to create a consensus to review the radiological definition of pneumonia in children.

  17. Differential diagnosis of cystic bone tumors in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Refior, H.J.; Stuerz, H.

    1982-09-01

    Skeletal changes leading to a suspicion of the presence of a tumour frequently occur in childhood with the roentgenological manifestation of a cyst. X-ray morphology can differ depending upon the localisation and the course. In childhood, however such findings are mainly classified as tumour-like bone lesions. This group comprises, inter alia, the juvenile bone cyst, the aneurysmatic bone cyst and fibrous dysplasia. However, it is necessary to exclude by differential diagnosis - even though the main age of manifestation is after completion of growth - genuine bone tumours with cystic phenomena, such as the giant cell tumour, chondroma or chondroblastoma. Verification of the diagnosis can be effected via radiologic-diagnostic methods such as tomography and angiography as well as computerized tomography. The use of scintigraphy of the skeleton can likewise be indicated. Numerous laboratory parameters can be used in individual cases to exclude certain diagnoses. Taking these aspects into consideration, the article reviews differential diagnosis of the most frequent skeletal affections in childhood. Great emphasis is given to the ranking and importance of the individual diagnostic methods.

  18. Differential diagnosis and treatment of periodontitis-mimicking actinomycosis.

    Science.gov (United States)

    Kim, Nam Ryang; Park, Jun-Beom; Ko, Youngkyung

    2012-12-01

    Actinomycosis is an uncommon chronic granulomatous disease that presents as a slowly progressive, indolent, indurated infiltration with multiple abscesses, fistulas, and sinuses. The purpose of this article is to report on a case of actinomycosis with clinical findings similar to periodontitis. A 46-year-old female presented with recurrent throbbing pain on the right first and second molar of the mandible three weeks after root planing. Exploratory flap surgery was performed, and the bluish-gray tissue fragment found in the interproximal area between the two molars was sent for histopathology. The diagnosis from the biopsy was actinomycosis. The clinical and radiographic manifestations of this case were clinically indistinguishable from periodontitis. The patient did not report any symptoms, and she is scheduled for a follow-up visit. The present study has identified periodontitis-mimicking actinomycosis. Actinomycosis should be included in the differential diagnosis in cases with periodontal pain and inflammation that do not respond to nonsurgical treatment for periodontitis. More routine submissions of tissue removed from the oral cavity for biopsies may be beneficial for differential diagnosis.

  19. Pneumonia lipóide

    Directory of Open Access Journals (Sweden)

    Gunther Kissmann

    2008-07-01

    Full Text Available Resumo: Dentre as afecções pulmonares exógenas, a pneumonia lipóide (PL, causada pela broncoaspiração de lipídeos, é uma doença pouco diagnosticada. Ela resulta da reacção tipo corpo estranho que se segue à presença de material lipídico dentro do parênquima pulmonar. Em geral, o agente etiológico é o óleo mineral utilizado como agente laxativo. Doentes com histórico de constipação intestinal e uso crónico de óleo mineral, com tosse e dispneia, devem ser pesquisados quanto a esta doença. Apresentamos um caso de pneumonia lipóide associada ao uso de óleo mineral como agente laxativo, acentuamos as dificuldades relacionadas com a definição diagnóstica e revemos a literatura pertinente ao tema.Rev Port Pneumol 2008; XIV (4: 545-549 Abstract: Lipoid pneumonia (LP is a pneumonitis resulting from the aspiration of lipids, and is commonly associated with the use of mineral oil as a laxative. LP is relatively unfamiliar to clinicians and is probably underdiagnosed. Making a diagnosis of LP requires a high degree of clinical suspicion. The aim of this publication are to present a case of a patient with LP and to increase physician awareness of LP, its diagnosis and prevention.Rev Port Pneumol 2008; XIV (4: 545-549 Palavras-chave: Pneumonia lipóide, óleo mineral, doenças pulmonares intersticiais, idoso, Key-words: Lipid pneumonia, mineral oil, interstitial lung diseases, aged

  20. Klebsiella Pneumoniae Liver Abscess: A Case Series of Six Asian Patients.

    Science.gov (United States)

    Oikonomou, Katerina G; Aye, Myint

    2017-09-26

    BACKGROUND Liver abscesses represent a serious infection of hepatic parenchyma and are associated with significant morbidity and mortality. The emergence of a new hypervirulent variant of Klebsiella pneumoniae, which can cause serious infections in the Asian population, is under investigation. We report a case series of six Asian patients hospitalized at our institution from January 2013 to November 2015 for liver abscess due to Klebsiella pneumoniae. CASE REPORT Charts of six Asian patients were retrospectively reviewed. Four patients were male and two were female. The mean age was 53 years (range: 35-64 years). All patients had no known past medical history of immunodeficiency. Three patients had multiple liver abscesses at the time of initial presentation. In five patients, the source of entry of the pathogenic microorganism was unknown and in one patient the suspected source of entry was the gastrointestinal tract. In three patients there was also concomitant Klebsiella pneumoniae bacteremia. The mean duration of antibiotic treatment was seven weeks and the mean duration of hospital stay was 13.5 days. CONCLUSIONS Liver abscess should always be included in the differential diagnosis in cases of sepsis without obvious source and/or in the clinical scenarios of fever, abdominal pain, and liver lesions.

  1. Coronavirus 229E-related pneumonia in immunocompromised patients.

    Science.gov (United States)

    Pene, Frédéric; Merlat, Annabelle; Vabret, Astrid; Rozenberg, Flore; Buzyn, Agnès; Dreyfus, François; Cariou, Alain; Freymuth, François; Lebon, Pierre

    2003-10-01

    Coronaviruses strains 229E and OC43 have been associated with various respiratory illnesses ranging from the self-resolving common cold to severe pneumonia. Although chronic underlying conditions are major determinants of severe respiratory virus infections, few data about coronavirus-related pneumonia in immunocompromised patients are available. Here we report 2 well-documented cases of pneumonia related to coronavirus 229E, each with a different clinical presentation. Diagnosis was made on the basis of viral culture and electron microscopy findings that exhibited typical crown-like particles and through amplification of the viral genome by reverse transcriptase-polymerase chain reaction. On the basis of this report, coronaviruses should be considered as potential causative microorganisms of pneumonia in immunocompromised patients.

  2. DIFFERENTIAL DIAGNOSIS OF CUTANEOUS LEISHMANIAS IS AND PARACOCCIDIOIDOMYCOSIS: CASE REPORT

    Directory of Open Access Journals (Sweden)

    Thaísa da Silva Vieira

    2017-01-01

    Full Text Available The polymorphism of the clinical presentation of paracoccidioidomycosis allows it to be included in the differential diagnosis of various clinical conditions, including cutaneous leishmaniasis. This study aims to discuss the difficulty of establishing the differential diagnosis between paracoccidioidomycosis and american cutaneous leishmaniasis in the case of patients from rural areas with chronic ulcerative lesion in the oral and nasal mucosa. This is a case report of an adult patient, coming from rural Itagi, Bahia, admitted to the public Hospital Prado Valadares (HGPV, in Jequié-BA. Thus, the case report aims to contribute to the medical and scientific community in the description of the clinical aspects of the lesions for the early diagnosis and prevention of the impacts of disabilities and injuries

  3. Point-of-care lung ultrasound in children with community acquired pneumonia.

    Science.gov (United States)

    Yilmaz, Hayri Levent; Özkaya, Ahmet Kağan; Sarı Gökay, Sinem; Tolu Kendir, Özlem; Şenol, Hande

    2017-07-01

    To present lung ultrasound findings in children assessed with suspected pneumonia in the emergency department and to show the benefit of lung ultrasound in diagnosing pneumonia in comparison with chest X-rays. This observational prospective study was performed in the pediatric emergency department of a single center. Point of care lung ultrasound was performed on each child by an independent sonographer blinded to the patient's clinical and chest X-ray findings. Community acquired pneumonia was established as a final diagnosis by two clinicians based on the recommendations in the British Thoracic Society guideline. One hundred sixty children with a mean age of 3.3±4years and a median age of 1.4years (min-max 0.08-17.5years) were investigated. Final diagnosis in 149 children was community-acquired pneumonia. Lung ultrasound findings were compatible with pneumonia in 142 (95.3%) of these 149 children, while chest X-ray findings were compatible with pneumonia in 132 (88.5%). Pneumonia was confirmed with lung ultrasound in 15 of the 17 patients (11.4%) not evaluated as compatible with pneumonia at chest X-ray. While pneumonia could not be confirmed with lung ultrasound in seven (4.6%) patients, findings compatible with pneumonia were not determined at chest X-ray in two of these patients. When lung ultrasound and chest X-ray were compared as diagnostic tools, a significant difference was observed between them (p=0.041). This study shows that lung ultrasound is at least as useful as chest X-ray in diagnosing children with community-acquired pneumonia. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Pneumonia in patients on the background of blood cancer

    Directory of Open Access Journals (Sweden)

    Pertseva T.A.

    2014-03-01

    Full Text Available Problematic issues of etiologic diagnosis and treatment of community-acquired and nosocomial pneumonia are being studied actively. At the same time specific features of pneumonia in patients with severe immune defects, against blood cancer including are studied insufficiently. By the result of microbiological examinations of 149 patients with pneumonia on the background of blood cancer, who have undergone treatment in hematological center of CE “Dnipropetrovsk local multi-field clinical hospital №4” in 2010-2012, bacterial causative agents were determined in 59,7% of accidents, among which gram-negative microorganisms made up 69,7%, gram-positive – 30,3%. In 63% of accidents the asso¬ciations of causative agents were determined: the combination of fungal flora made up 58, 4% bacterial associations – 25, 8%. Invasive methods of research have demonstrated a considerably bigger informativeness in determination of possible etiological diagnosis of pneumonia. In determination of causative agent in fluid of brochoalveolar lavage the part of positive results made up 77,4% against 30,3% in examination of sputum.

  5. High-resolution CT of lymphoid interstitial pneumonia

    International Nuclear Information System (INIS)

    Vilgrain, V.; Frija, J.; Yana, C.; Couderc, L.J.; David, M.; Clauvel, J.P.; Laval-Jeantet, M.

    1989-01-01

    Three patients with lymphoid interstitial pneumonia (two HIV 1+ patients with chronic lymphadenopathic syndromes and one with a not-characterized autoimmune disease) have been studied with high-resolution computed tomography (HR-CT). This technique reveals septal lines, small reticulonodular opacities, polyhedral micronodular opacities, 'ground-glass' opacities and a dense, subpleural, curved broken line in one patient. The lesions dominate in the bases of the lungs. They are not characteristic for lymphoid interstitial pneumonia. If a patient presents with a chronic lymphadenopathic syndrome, the diagnosis of an opportunistic infection should not be automatically made, since the syndrome can be caused by lymphoid interstitial pneumonia [fr

  6. Clinical utility of capillary polymerase chain reaction for diagnosis of Cytomegalovirus pneumonia.

    Science.gov (United States)

    Honda, J; Yonemitsu, J; Kitajima, H; Yosida, N; Fumirori, T; Oizumi, K

    2001-01-01

    The purpose of this retrospective study was to assess the diagnostic efficacy of CMV DNA detection by capillary PCR in patients with interstitial pneumonia. Of 882 samples taken from 363 patients, 317 were obtained from sputum, 94 from BAL fluid, 291 from blood and 180 from urine. PCR for CMV was positive in 58 samples (6.6%), with positive detection for 6.9% of sputum, 10.6% of BAL fluid, 4.1% of blood and 7.8% of urine samples. CMV pneumonia was diagnosed retrospectively in 34 (9.4%) of the 363 patients by demonstration of CMV antigen-positive cytomegalic inclusion bodies in lung tissue sections. The positive and negative predictive values were 100% (10/10) and 98.8% (83/84) for the BAL fluid samples and 95.5% (21/22) and 99.7% (294/295) for the sputum samples, respectively. Clinical sensitivity and specificity were 90.9% (10/11) and 100% (83/83) for the BAL fluid samples and 95.5% (21/22) and 99.7% (294/295) for the sputum samples, respectively. However, the blood and urine samples showed poor clinical sensitivity and low positive predictive values. We suggest that the use of capillary PCR for BAL fluid and sputum samples is very useful for diagnosing CMV pneumonia in patients with interstitial pneumonia in whom CMV pneumonia is suspected.

  7. CT scan findings of fungal pneumonia

    International Nuclear Information System (INIS)

    Heckmann, M.; Uder, M.; Bautz, W.; Heinrich, M.

    2008-01-01

    The importance of fungal infection of the lung in immunocompromised patients has increased substantially during the last decades. Numerically the most patients are those with neutropenia, e.g. patients with malignancies or solid organ and stem cell transplantation, chemotherapy, corticosteroid use and HIV infection. Although fungal infections can occur in immunocompetent patients, their frequency in this population is rare. The clinical symptoms such as fever accompanied with non-productive cough are unspecific. In some patients progression to hypoxemia and dyspnea may occur rapidly. In spite of improved antifungal therapy morbidity and mortality of these infections are still high. Therefore an early and non-invasive diagnosis is very important. That is why CT and even better High-Resolution-CT (HR-CT) is a very important modality in examining immunocompromised patients with a probability of fungal infection. CT is everywhere available and, as a non-invasive method, able to give the relevant diagnose efficiently. This paper should give an overview about the radiologic findings and possible differential diagnosis of diverse pulmonary fungal infections in CT. Pneumonias caused by Aspergillus, Cryptococcus, Candida, Histoplasma, Mucor and Geotrichum capitatum are illustrated. (orig.)

  8. Necrotizing pneumonia after pharyngitis due to fusobacterium necrophorum

    Energy Technology Data Exchange (ETDEWEB)

    Kleinman, P K; Flowers, R A

    1984-01-01

    A case of necrotizing pneumonia secordary to Fusobacterium necrophorum is reported. This anaerobic infection commonly originates in the upper respiratory tract and is often accompanied by multiple system disease due to hematogeneous seeding. When the lungs are involved, diffuse necrotizing pneumonia with pleural effusions and cavitation result. The course is prolonged, and the diagnosis is frequently delayed. With appropriate antibiotics, the prognosis is good.

  9. [Increasing incidence of community-acquired pneumonia caused by atypical microorganisms].

    Science.gov (United States)

    Tazón-Varela, M A; Alonso-Valle, H; Muñoz-Cacho, P; Gallo-Terán, J; Piris-García, X; Pérez-Mier, L A

    2017-09-01

    Knowing the most common microorganisms in our environment can help us to make proper empirical treatment decisions. The aim is to identify those microorganisms causing community-acquired pneumonia. An observational, descriptive and prospective study was conducted, including patients over 14 years with a clinical and radiographic diagnosis of community-acquired pneumonia during a 383 consecutive day period. A record was made of sociodemographic variables, personal history, prognostic severity scales, progress, and pathogenic agents. The aetiological diagnosis was made using blood cultures, detection of Streptococcus pneumoniae and Legionella pneumophila urinary antigens, sputum culture, influenza virus and Streptococcus pyogenes detection. Categorical variables are presented as absolute values and percentages, and continuous variables as their means and standard deviations. Of the 287 patients included in the study (42% women, mean age 66±22 years), 10.45% died and 70% required hospital admission. An aetiological diagnosis was achieved in 43 patients (14.98%), with 16 microorganisms found in 59 positive samples. The most frequently isolated pathogen was Streptococcus pneumonia (24/59, 41%), followed by gram-negative enteric bacilli, Klebsiella pneumonia, Escherichia coli, Serratia marcescens and Enterobacter cloacae isolated in 20% of the samples (12/59), influenza virus (5/59, 9%), methicillin-resistant Staphylococcus aureus (3/59, 5%), Pseudomonas aeruginosa (2/59, 3%), Moraxella catarrhalis (2/59, 3%), Legionella pneumophila (2/59, 3%), and Haemophilus influenza (2/59, 3%). Polymicrobial infections accounted for 14% (8/59). A high percentage of atypical microorganisms causing community-acquired pneumonia were found. Copyright © 2016 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Prostatic paracoccidioidomycosis: differential diagnosis of prostate cancer

    Directory of Open Access Journals (Sweden)

    Daniel Lima Lopes

    2009-02-01

    Full Text Available Symptomatic prostatic paracoccidioidomycosis (PCM is a very rare condition; however, it may express as a typical benign prostatic hyperplasia or a simulating prostatic adenocarcinoma. This case report presents PCM mimicking prostatic adenocarcinoma. The purpose of this paper is to call the general physician's attention to this important differential diagnosis.

  11. MRT versus CT in the diagnosis of pneumonia. Evaluation of a T2-weighted utrafast turbo-spin-echo sequence (UTSE)

    International Nuclear Information System (INIS)

    Leutner, C.; Lutterbey, G.; Kuhl, C.K.; Flacke, S.; Schild, H.H.; Glasmacher, A.; Theisen, A.; Wardelmann, E.; Grohe, C.

    1999-01-01

    Purpose: To evaluate a T 2 -weighted URSE sequence for the assessment of pulmonary infiltrations in comparison to CT. Methods: 28 MRT scans of 22 patients with confirmed pneumonia were recorded on a 1.5 Tesla apparatus with an expiratory and diastolic triggered, T 2 -weighted ultrafast-spin-echo sequence in axial slice mode with the following parameters: TR eff /T E /Turbofactor 2000-4000/90 ms/21-23; slice thickness/separation 6/0.6 mm; FOV 360 mm; 24 slices. 24 spiral CTs (sice thickness/table advance: 1-2 mm/10 mm) were available for comparison. The separate evaluation of MRTs and CTs was performed by three radiologists in a consensus procedure with regard to pulmonary lesions (e.g., infiltration, round foci, net patterns) and image quality of the MRTs (4-step scale). Results: In 71% of the cases the CTs and MRTs agreed with the diagnosis and representation of the lesions, in 25% MRT was superior. MRT was better for the detection of pulmonary abscesses. In 93% the image quality of the MRT was very good to good. Conclusions: MRT in the technique presented here is in most cases equal to CT for the detection of pneumonia. Diagnosis of pulmonary abscesses seems to be better with MRT. (orig.) [de

  12. Influenza A (H1N1) organising pneumonia.

    Science.gov (United States)

    Torrego, Alfons; Pajares, Virginia; Mola, Anna; Lerma, Enrique; Franquet, Tomás

    2010-04-27

    In November 2009, countries around the world reported confirmed cases of pandemic influenza H1N1, including over 6000 deaths. No peak in activity has been seen. The most common causes of death are pneumonia and acute respiratory distress syndrome. We report a case of a 55-year-old woman who presented with organising pneumonia associated with influenza A (H1N1) infection confirmed by transbronchial lung biopsy. Organising pneumonia should also be considered as a possible complication of influenza A (H1N1) infection, given that these patients can benefit from early diagnosis and appropriate specific management.

  13. CLINIC, DIFFERENTIAL DIAGNOSIS AND TREATMENT OF GALACTOSEMIA

    Directory of Open Access Journals (Sweden)

    N.V. Zhurkova

    2008-01-01

    Full Text Available The data of different firms of hereditary galactosemia was analyzed in this article. Clinical and biochemical characteristics and molecular and genetic features of diagnostics of this disease were described. The information about differential diagnosis and problems, related with hereditary galactozemia screening in Russia was given.Key words: children, galactosemia, treatment, screening.

  14. Clinical and histopathological differential diagnosis of eosinophilic pustular folliculitis.

    Science.gov (United States)

    Fujiyama, Toshiharu; Tokura, Yoshiki

    2013-06-01

    Eosinophilic pustular folliculitis (EPF) is an inflammatory disease characterized by repeated pruritic follicular papules and pustules arranged in arcuate plaques, and folliculotropic infiltration of eosinophils. The diagnosis of EPF is occasionally difficult and problematic because EPF may share the clinical appearance and histological findings with other diseases. Moreover, EPF has several clinical subtypes, including the classical type, infantile type and immunosuppression-associated type. Because the therapies of EPF are relatively specific as compared to eczematous disorders, accurate diagnosis is essential for the management of EPF. Clinical differential diagnoses include tinea, acne, rosacea, eczematous dermatitis, granuloma faciale, autoimmune annular erythema, infestations and pustular dermatosis. Histologically, cutaneous diseases with eosinophilic infiltrates can be differentially diagnosed. Follicular mucinosis, mycosis fungoides and other cutaneous T-cell lymphomas are the most important differential diagnoses both clinically and histopathologically. It should be kept in mind particularly that the initial lesions of cutaneous T-cell lymphoma resemble EPF. © 2013 Japanese Dermatological Association.

  15. CT diagnosis and differential diagnosis of malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Xiong Juxin; Yang Zenian; Luo Zhongyao

    2008-01-01

    Objective: To study the CT features of malignant pleural mesothelioma and improve diagnostic accuracy. Methods: The CT findings of 14 patients with malignant pleural mesothelioma proven by surgery or histopathology were analyzed retrospectively. CT plain scan was performed in all cases, 9 cases received both CT plain scan and contrast CT scan. Results: All the cases demonstrated various pleural thickening including diffuse pleural thickening (n=10). Among all the cases, there were nodular pleural thickening (n=4), lumpy pleural thickening (n=7), ring-like pleural thickening (n=3). Pleural thickness which was more than 1.0 cm was found in 12 cases. Pleural effusion (n=10), mediastinum immobilization (n=10) and thoracic cavity stricture in the trouble side (n=10) were also revealed. Conclusion: Obvious characteristics in cases with malignant pleural mesothelioma was showed in CT examination, which plays an important role in the diagnosis and differential diagnosis of this disease. (authors)

  16. Epidemiology of organising pneumonia in Iceland

    Science.gov (United States)

    Gudmundsson, G; Sveinsson, O; Isaksson, H J; Jonsson, S; Frodadottir, H; Aspelund, T

    2006-01-01

    Background Cryptogenic organising pneumonia (COP) has also been called idiopathic bronchiolitis obliterans organising pneumonia. In secondary organising pneumonia (SOP) the causes can be identified or it occurs in a characteristic clinical context. The aim of this study was to determine the incidence and epidemiological features of COP and SOP nationwide in Iceland over an extended period. Methods A retrospective study of organising pneumonia (OP) in Iceland over 20 years was conducted and the epidemiology and survival were studied. All pathological reports of patients diagnosed with or suspected of having COP or SOP in the period 1984–2003 were identified and the pathology samples were re‐evaluated using strict diagnostic criteria. Results After re‐evaluation, 104 patients fulfilled the diagnostic criteria for OP (58 COP and 46 SOP). The mean annual incidence of OP was 1.97/100 000 population (1.10/100 000 for COP and 0.87/100 000 for SOP). The mean age at diagnosis was 67 years with a wide age range. The most common causes of death were lung diseases other than OP, and only one patient died from OP. Patients with OP had a lower rate of survival than the general population, but there was no statistical difference between COP and SOP. Conclusions The incidence of OP is higher than previously reported, suggesting that OP needs to be considered as a diagnosis more often than has been done in the past. PMID:16809413

  17. Body imaging in the differential diagnosis of jaundice

    International Nuclear Information System (INIS)

    Kuno, Nobuyoshi; Endo, Tokiko; Kasugai, Tatsuzo

    1981-01-01

    Forty-five jaundiced patients with confirmed pancreatico-biliary diseases were studied to determine the value of body imaging in the differential diagnosis of jaundice. In this study, body imaging included five tests, which were US, CT, ERCP, PTC and RI. The results indicate that each to these five tests is useful and highly accurate in differentiating between obstructive and nonobstructive jaundice (about 90%). The site of obstruction was delineated in 91.3%, 90.9%, 82.5%, 66.7% and 50% by PTC, ERCP, CT, US and RI, respectively. ERCP, PTC, CT, US and RI helped determine the etiology of jaundice in 79.5%, 65.2%, 57.5%, 50% and 0%, respectively. ERCP and US were highly accurate in establishing the diagnosis of resectable pancreatico-biliary cancer with obstructive jaundice. On the basis of these results, we propose a diagnostic approach to obstructive jaundice as in Table 5. (author)

  18. Necrotizing Pseudomonas aeruginosa Community-Acquired Pneumonia: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Satish Maharaj

    2017-01-01

    Full Text Available Lung cavities are not typically associated with community-acquired pneumonia (CAP. CAP due to P. aeruginosa is rare and even less commonly causes necrotizing pneumonia. We report a case of P. aeruginosa CAP that progressed to necrotizing pneumonia and was eventually fatal. Procalcitonin (PCT has been well investigated in guiding antibiotic therapy (especially CAP in adults. In this case, PCT at presentation and sequentially was negative. We discuss this caveat and present hypotheses as to the sensitivity and specificity of PCT and C-reactive protein (CRP in these patients. To better characterize P. aeruginosa CAP, we undertook a review of cases indexed in PubMed from 2001 to 2016 (n=9. The data reveal that risk factors for P. aeruginosa CAP include smoking, alcohol use, obstructive lung disease, sinusitis, and hot tub use. The route of infection for P. aeruginosa CAP remains unknown. One of the most interesting findings on reviewing cases was that P. aeruginosa CAP involves the right upper lobe in the vast majority. We suggest that when physicians in the community see patients with distinctly upper lobe necrotizing or cavitary pneumonia, they should consider P. aeruginosa in their differential diagnosis. Further studies are needed to clarify route of infection, role of PCT and CRP, and optimal therapy including drug and duration.

  19. Long-term mortality after IPD and bacteremic versus non-bacteremic pneumococcal pneumonia

    NARCIS (Netherlands)

    Wagenvoort, Gertjan H. J.; Sanders, Elisabeth A. M.; de Melker, Hester E.; van der Ende, Arie; Vlaminckx, Bart J.; Knol, Mirjam J.

    2017-01-01

    Short-term mortality after invasive pneumococcal disease (IPD) and pneumococcal pneumonia is high but data on long-term mortality (including the comparison between bacteremic and non-invasive/non-bacteremic pneumococcal pneumonia) within the first years after diagnosis are scarce. Adult patients

  20. Predictive Value of Respiratory Rate Thresholds in Pneumonia ...

    African Journals Online (AJOL)

    A study was carried out to determine the predictive value of respiratory rate in the clinical diagnosis of pneumonia in 101 children with respiratory symptoms of <28 days duration. Clinical, demographic and anthropometric variables were obtained at presentation while confirmation of the diagnosis was by a chest x-ray in ...

  1. Detection of pneumonia associated pathogens using a prototype multiplexed pneumonia test in hospitalized patients with severe pneumonia.

    Directory of Open Access Journals (Sweden)

    Berit Schulte

    Full Text Available Severe pneumonia remains an important cause of morbidity and mortality. Polymerase chain reaction (PCR has been shown to be more sensitive than current standard microbiological methods--particularly in patients with prior antibiotic treatment--and therefore, may improve the accuracy of microbiological diagnosis for hospitalized patients with pneumonia. Conventional detection techniques and multiplex PCR for 14 typical bacterial pneumonia-associated pathogens were performed on respiratory samples collected from adult hospitalized patients enrolled in a prospective multi-center study. Patients were enrolled from March until September 2012. A total of 739 fresh, native samples were eligible for analysis, of which 75 were sputa, 421 aspirates, and 234 bronchial lavages. 276 pathogens were detected by microbiology for which a valid PCR result was generated (positive or negative detection result by Curetis prototype system. Among these, 120 were identified by the prototype assay, 50 pathogens were not detected. Overall performance of the prototype for pathogen identification was 70.6% sensitivity (95% confidence interval (CI lower bound: 63.3%, upper bound: 76.9% and 95.2% specificity (95% CI lower bound: 94.6%, upper bound: 95.7%. Based on the study results, device cut-off settings were adjusted for future series production. The overall performance with the settings of the CE series production devices was 78.7% sensitivity (95% CI lower bound: 72.1% and 96.6% specificity (95% CI lower bound: 96.1%. Time to result was 5.2 hours (median for the prototype test and 43.5 h for standard-of-care. The Pneumonia Application provides a rapid and moderately sensitive assay for the detection of pneumonia-causing pathogens with minimal hands-on time.Deutsches Register Klinischer Studien (DRKS DRKS00005684.

  2. Antibiotic treatment and the diagnosis of Streptococcus pneumoniae in lower respiratory tract infections in adults

    DEFF Research Database (Denmark)

    Korsgaard, Jens; Møller, Jens Kjølseth; Kilian, Mogens

    2005-01-01

    OBJECTIVE: To analyze the possible influence of antibiotic treatment on the results of different diagnostic tests for the diagnosis of lower respiratory tract infections with Streptococcus pneumoniae. MATERIAL AND METHODS: A prospective cohort of 159 unselected adult immunocompetent patients...... admitted to Silkeborg County Hospital in Denmark with community-acquired lower respiratory tract infections underwent microbiological investigations with fiber-optic bronchoscopy with bronchoalveolar lavage, blood and sputum culture and urine antigen test for type-specific polysaccharide capsular antigens...... was positive in both systems, making a total of 22 patients with documented pneumococcal infection. As a positive culture test was dependent on the absence of antibiotic treatment, whereas a positive urine antigen test depended on antibiotic treatment within 48 hours, the two tests were complementary...

  3. Massive empyema caused by Mycoplasma pneumoniae in an adult: A case report

    Directory of Open Access Journals (Sweden)

    Ron Merav

    2006-02-01

    Full Text Available Abstract Background Mycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well. Complications of M.pneumoniae infections include CNS involvement but other as pericarditis were also reported. The lack of feasible culture methods and under appreciation of the pathogens ability to cause invasive disease leads to reduced number of diagnosed M.pneumoniae related complications. In contrast to many other respiratory pathogens causing pneumonia, M. pneumoniae related severe pleural complications were almost never reported. Case presentation We report a previously healthy 57 years old woman presented with indolent massive right pleural effusion, leukocytosis and elevated ESR. Extensive microbiological evaluation didn't reveal any pathogen in the pus even before antibiotic treatment was started. Surprisingly, M.pneumoniae DNA was detected in the pus from the empyema using PCR designed to detect M.pneumoniae. A serological assay (Serodia-Myco II using convalescent serum was indeterminate with a titer of 1:80. The patient responded well to a treatment that included right thoracotomy with pleural decortication and a combination of antibiotics and anti-inflammatory medications. Conclusion M.pneumoniae related empyema was never reported before in adult patients and was reported in only a few pediatric patients. In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment. The only pathogen detected was M.pneumoniae. In this patient, serology was not helpful in establishing the diagnosis of M.pneumoniae related diseases, as was suggested before for older patients. We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods.

  4. Genetic point-of-care diagnosis of Mycoplasma pneumoniae infection using LAMP assay.

    Science.gov (United States)

    Kakuya, Fujio; Kinebuchi, Takahiro; Fujiyasu, Hiroaki; Tanaka, Ryosuke; Kano, Hiroki

    2014-08-01

    Mycoplasma pneumoniae (MP) is a major pathogen of lower respiratory tract infection (LRTI) in children. A rapid diagnostic method during the acute phase is required for the prescription of effective antibiotics. A prospective, single-centered study was conducted on community-acquired LRTI in children. We regarded the day of fever onset as the first day of illness. In part 1, we studied 191 patients with signs of LRTI. We compared diagnostic reliability using loop-mediated isothermal amplification (LAMP) assay and serological testing at the first visit. In part 2, we evaluated the clinical characteristics of 117 patients with positive LAMP assay. In part 1, 31 patients met the definite MP infection criteria. LAMP assay had a sensitivity of 96.8% and specificity of 100%, whereas enzyme immunoassay had a sensitivity of 38.7% and specificity of 76.9%, and particle agglutination test had a sensitivity of 19.4% and specificity of 93.1%. In part 2, of 106 patients with fever, 100 patients were diagnosed by the day 7 of illness. The diagnosis was made a mean of 3.5 ± 2.1 days after the onset of fever. LAMP assay had excellent sensitivity and specificity for the detection of acute MP infection at the first visit. This assay can diagnose MP infection during the very acute phase. LAMP assay is appropriate for genetic point-of-care diagnosis of MP infection in hospital laboratories. © 2014 Japan Pediatric Society.

  5. 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

    Directory of Open Access Journals (Sweden)

    Filippo Luca Fimognari

    2017-01-01

    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.

  6. Nasal rhinosporidiosis: differential diagnosis of fungal sinusitis and inverted papilloma

    Directory of Open Access Journals (Sweden)

    Crosara, Paulo Fernando Tormin Borges

    2009-03-01

    Full Text Available Introduction: Clinical case report of rhinosporidiosis, a rare and chronic granulomatous disease, caused by Rhinosporidium seeberi. Objective: To include this disease in the differential diagnoses of polypoid lesions of the nasal mass. Report: A male patient from the North of Brazil evolved a three-year papilomatous polypoid lesion of the left nasal cavity. He was submitted to sinusectomy with resection of the entire lesion, located in ethmoid bulla and uncinated process. Inverted papilloma or fungal sinusitis were differential diagnoses. The histopathological examination revealed a strong infestation by numerous fungal structures with sporangia shape full of sporangiospores. The microorganisms were positive for colorations of Grocott, PAS and Mayer's Mucicarmin; opposite from Coccidioides immitis, which presents no contrast by the mucicarmin. We didn't choose complimentary treatment and after one year of follow-up he presents with no sign of recurrence. Final Comments: Rhinosporidiosis must be considered to be a nasal polypoid lesion differential diagnosis. In the intranasal lesions diagnosis we should keep in mind the patient's origin. The anatomopathological study is mandatory to set the diagnosis. In the rhinosporidiosis, the surgical exeresis can be a curative treatment.

  7. Meckel Syndrome: Genetics, Perinatal Findings, and Differential Diagnosis

    Directory of Open Access Journals (Sweden)

    Chih-Ping Chen

    2007-03-01

    Full Text Available Meckel syndrome (MKS is a lethal, autosomal recessive disorder characterized by occipital encephalocele, bilateral renal cystic dysplasia, hepatic ductal proliferation, fibrosis and cysts, and polydactyly. Genetic heterogeneity of MKS has been established by three reported MKS loci, i.e., MKS1 on 17q23, MKS2 on 11q13, and MKS3 on 8q21.13-q22.1. MKS1 encodes a component of flagellar apparatus basal body proteome, which is associated with ciliary function. MKS3 encodes a seven-transmembrane receptor protein, meckelin. The identification of the MKS3 gene as well as the MKS1 gene enables molecular genetic testing for at-risk families, and allows accurate genetic counseling, carrier testing, and prenatal diagnosis. Pregnancies with MKS fetuses may be associated with an elevated maternal serum α-fetoprotein level and an abnormal screening result in the second-trimester maternal serum screening test. The classic MKS triad of occipital encephalocele, postaxial polydactyly, and bilateral enlarged multicystic kidneys can be diagnosed before the 14th gestational weeks by ultrasonography. However, later in pregnancy, severe oligohydramnios may make the diagnosis of polydactyly and encephalocele difficult. Differential diagnosis for MKS includes autosomal recessive polycystic kidney disease, trisomy 13, Smith-Lemli-Opitz syndrome, hydrolethalus syndrome, Senior-Loken syndrome, Joubert syndrome, Bardet-Biedl syndrome, and oral-facial-digital syndrome type 1. This article provides an overview of genetics, perinatal findings, and differential diagnosis of MKS. The ciliopathy underlies the pathogenesis of MKS. Prenatal diagnosis of bilateral enlarged multicystic kidneys should alert MKS and prompt a thorough investigation of central nervous system malformations and polydactyly.

  8. [Bacteremic pneumococcal pneumonia].

    Science.gov (United States)

    Pineda Solas, V; Pérez Benito, A; Domingo Puiggros, M; Larramona Carrera, H; Segura Porta, F; Fontanals Aymerich, D

    2002-11-01

    Streptococcus pneumonia is the most common bacterial cause of community-acquired pneumonia in children. The reference standard for etiological diagnosis is isolation of S. pneumoniae from blood Since the advent of conjugate vaccines, disease caused by this organism can now be prevented. Many studies have been performed of the global incidence of invasive pneumococcal infections and of pneumococcal meningitis but few studies investigated bacteremic pneumococcal pneumonia and its complications in children. To determine the incidence, patient characteristics, clinical signs, laboratory data, percentage and days of hospitalization, response to antibiotic treatment, antibiotic resistance, complications and causal serogroups of bacteremic pneumococcal pneumonia in our environment in order to estimate requirements for systematic vaccination programs. From January 1990 to May 2001, data on all pediatric cases of invasive pneumococcal infections diagnosed in our hospital were collected. Several characteristics of patients with bacteremic pneumococcal pneumonia were analyzed. Bacteremic pneumococcal pneumonia was diagnosed in patients with positive blood or pleural fluid cultures for S. pneumoniae and radiographically evident pulmonary infiltrate. The incidence of both types of pneumonia were determined according to population census data. All S. pneumonia strains were sent to the Pneumococci Reference Laboratory of the Instituto Carlos III in Madrid for serotyping. We estimated the serotype coverage of the pneumococcal 7-valent conjugate vaccine according to the serotypes included in this vaccine and their distribution. Forty cases of bacteremic pneumococcal pneumonia were diagnosed, yielding an incidence of 17,10 and 5 cases per 10(5) children aged less than 2, 4 and 15 years old respectively. The mean age was 50 months and 43% were aged less than 4 years. Peaks occurred in January, March, April and May. A total of 77.5% of the patients were admitted to hospital and the

  9. Are Pathogenic Leptospira Species Agents of Community-Acquired Pneumonia? Case Reports of Leptospirosis Presenting as Pneumonia

    NARCIS (Netherlands)

    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.

    2016-01-01

    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

  10. Parkinsonian syndroms: Clinical phenotype, differential diagnosis and disease progression

    International Nuclear Information System (INIS)

    Storch, A.

    2002-01-01

    Parkinsonian syndromes include idiopathic Parkinson's disease (IPD), other neurodegenerative diseases with parkinsonism, the so-called atypical parkinsonian syndromes, and symptomatic parkinsonian syndromes, such as Wilson's disease. IPD is the most frequent disease with parkinsonism as the main clinical feature and is responsible for approx. 80% of all parkinsonian syndromes. Atypical parkinsonian syndromes are the most important differential diagnoses of IPD. The two most frequent types are multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). For clinical diagnosis it is essential to take a careful medical history and to examine the patients physically in regular intervals. However, various clinico-pathological studies have shown that approx. 25% of patients with clinical diagnosis of IPD may have other causes of parkinsonism. Selected technical investigations, in particular functional imaging of the central dopaminergic system using PET or SPECT, may help to make clinical diagnosis more secure. This paper reviews the clinical features and diagnostic findings in diseases with parkinsonism and summarises the difficulties in establishing early and differential diagnoses. (orig.) [de

  11. ICON: An artificial intelligence approach to radiologic differential diagnosis

    International Nuclear Information System (INIS)

    Swett, H.A.; Miller, P.L.

    1986-01-01

    ICON is a computer system, developed using artificial intelligence techniques, that is designed to help radiologists manage the large body of knowledge needed to perform differential diagnosis in radiology. The system's domain is lung disease in patients with lymphoproliferative disorders. The radiologist proposes a diagnostic hypothesis which he or she thinks explains the known clinical and chest radiographic findings. ICON responds with an English-language prose critique that discusses how and why the proposed diagnosis is or is not supported by the clinical literature and suggests further findings or clinical information that might make the diagnosis more secure

  12. [ENDOSONOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF THE COMMON BILE DUCT STENOSIS].

    Science.gov (United States)

    Solodinina, E N; Starkov, Y G; Shumkin, L V

    2015-01-01

    The article states the results of examination and treatment of 57 patients with stenosis of the common bile duct of various genesis. The main aim of the work is criteria definition and evaluation of diagnostic significance of endosonography in the differential diagnosis of benign and malignant common bile duct stenosis. The paper presents a methodology of endoscopic ultrasound and basic criteria for the differential diagnosis of tumors and other lesions of the extrahepatic bile ducts. A comparative analysis of endosonography, ultrasound, CT, MRCP was conducted. The sensitivity of endosonography in determining the nature of the common bile duct stenosis was 97.7%, a specificity 100% and accuracy 98.2%, which is superior to other methods of radiological diagnosis. In comprehensive surgical centers endosonography should be used as a method of specifying the final diagnosis to determine the nature of the common bile duct stenosis, particularly at low constriction location.

  13. Pathology and differential diagnosis of chronic, noninfectious gastritis.

    Science.gov (United States)

    Polydorides, Alexandros D

    2014-03-01

    The histologic finding of chronic inflammation in an endoscopic mucosal biopsy of the stomach (chronic gastritis) is very common and usually reflects the presence of Helicobacter pylori infection. However, infectious organisms are not always present in biopsy material, and some cases of chronic gastritis do not result from H. pylori infection. Thus, the differential diagnosis of this finding is an important one for pathologists to keep in mind. This review presents the three most common and clinically significant causes of chronic, noninfectious gastritis, namely, autoimmune atrophic gastritis, lymphocytic gastritis, and gastric involvement in the setting of inflammatory bowel disease, especially Crohn disease. For each entity, a brief discussion of its etiology and pathogenesis, a review of the clinical and endoscopic features, and a description of the microscopic findings are presented in the context of the differential diagnosis of chronic gastritis with emphasis on helpful histopathologic hints and long-term sequelae. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. The differential diagnosis of ritual abuse allegations.

    Science.gov (United States)

    Bernet, W; Chang, D K

    1997-01-01

    Because psychiatrists do not have a consistent way to classify and define the forms of child abuse that may be mistaken for ritual abuse, the objective of this paper is to create a comprehensive differential diagnosis of allegations of ritual abuse. The authors reviewed 60 articles, chapters, and books that contained allegations of ritual abuse or behaviors that might be mistaken for ritual abuse, that were made by patients or caretakers. This paper clarifies the behaviors that represent or may be mistaken for ritual abuse: Cult-based ritual abuse, pseudoritualistic abuse, activities by organized satanic groups, repetitive psychopathological abuse, sexual abuse by pedophiles, child pornography portraying ritual abuse, distorted memory, false memory, false report due to a severe mental disorder, pseudologia phantastica, adolescent behavior simulating ritual abuse, epidemic hysteria, deliberate lying, and hoaxes. The differential diagnosis of allegations of ritual abuse is important in both clinical and forensic psychiatry. In some cases, it will not be possible to tell whether a particular allegation is factual or what the underlying mental processes are. It is important to separate the role of the mental health professional as therapist from the role as an expert witness in court.

  15. Differential diagnosis of genetic disease by DNA restriction fragment length polymorphisms

    NARCIS (Netherlands)

    Bolhuis, P. A.; Defesche, J. C.; van der Helm, H. J.

    1987-01-01

    DNA restriction fragment length polymorphisms (RFLPs) are used for diagnosis of genetic disease in families known to be affected by specific disorders, but RFLPs can be also useful for the differential diagnosis of hereditary disease. An RFLP pattern represents the inheritance of chromosomal markers

  16. Improving the Diagnosis of Legionella Pneumonia within a Healthcare System through a Systematic Consultation and Testing Program.

    Science.gov (United States)

    Decker, Brooke K; Harris, Patricia L; Muder, Robert R; Hong, Jae H; Singh, Nina; Sonel, Ali F; Clancy, Cornelius J

    2016-08-01

    Legionella testing is not recommended for all patients with pneumonia, but rather for particular patient subgroups. As a result, the overall incidence of Legionella pneumonia may be underestimated. To determine the incidence of Legionella pneumonia in a veteran population in an endemic area after introduction of a systematic infectious diseases consultation and testing program. In response to a 2011-2012 outbreak, the VA Pittsburgh Healthcare System mandated infectious diseases consultations and testing for Legionella by urine antigen and sputum culture in all patients with pneumonia. Between January 2013 and December 2015, 1,579 cases of pneumonia were identified. The incidence of pneumonia was 788/100,000 veterans per year, including 352/100,000 veterans per year and 436/100,000 veterans per year with community-associated pneumonia (CAP) and health care-associated pneumonia, respectively. Ninety-eight percent of patients with suspected pneumonia were tested for Legionella by at least one method. Legionella accounted for 1% of pneumonia cases (n = 16), including 1.7% (12/706) and 0.6% (4/873) of CAP and health care-associated pneumonia, respectively. The yearly incidences of Legionella pneumonia and Legionella CAP were 7.99 and 5.99/100,000 veterans, respectively. The sensitivities of urine antigen and sputum culture were 81% and 60%, respectively; the specificity of urine antigen was >99.97%. Urine antigen testing and Legionella cultures increased by 65% and 330%, respectively, after introduction of our program. Systematic testing of veterans in an endemic area revealed a higher incidence of Legionella pneumonia and CAP than previously reported. Widespread urine antigen testing was not limited by false positivity.

  17. [Current status of diagnosis and treatment of community-acquired pneumonia in Shanghai revealed by a questionnaire analysis].

    Science.gov (United States)

    Liu, J; Zhang, J; Cheng, Q J; Xu, J F; Jie, Z J; Jiao, Y; Huang, Y; Qu, J M

    2018-04-12

    Objective: To understand the current status of diagnosis and treatment of community-acquired pneumonia (CAP) among doctors in various hospitals across Shanghai, for the purpose of promoting the 2016 clinical practice guidelines for adult CAP of China. Methods: A questionnaire was designed to address the common questions in CAP management. The responses were collected via WeChat and the data were analyzed. Results: A total of 1 254 valid questionnaires were received, 46.1% from tertiary , 26.4% from secondary and 27.5% from primary care hospitals. Of these valid respondents, 31.4% were respiratory physicians and 68.6% from non-respiratory physicians. When diagnosing CAP, 78.1% of the doctors would use chest CT in more than 50% of the patients. Regarding the tools for evaluating the severity of CAP, 60.3% of the respondents would prefer CURB-65. "Respiratory failure requiring mechanical ventilation and septic shock" were the most common criteria for admission to ICU. Blood culture was not widely used in severe CAP regardless of the level of hospitals ( P >0.05). The results of this survey showed that the top 5 pathogenic microorganisms of CAP were Streptococcus pneumoniae, Mycoplasma pneumoniae, Klebsiella pneumoniae, Haemophilus influenza and Chlamydia pneumoniae. For non-severe CAP patients, all the doctors tended to select monotherapy. The most frequently used antimicrobial regimen for severe CAP was third- or fourth-generation cephalosporin monotherapy. As for combination therapy, the most frequently used regimen in tertiary hospitals was "carbapenem plus vancomycin" , while in primary and secondary hospitals it was "β-lactams plus macrolides" . More doctors from primary hospitals and non-respiratory medicine would consider "complete resolution of pulmonary opacity" as the indication to discontinue antimicrobial therapy or to discharge patients, and "prolonged high fever" , "large area consolidation" , "multiple lobe-segment involvement " as the indication for

  18. [Examination about utility of a Streptococcus pneumoniae capsular antigen swiftness search kit urine in a pneumonia patient].

    Science.gov (United States)

    Hashikita, Giichi; Yamaguti, Toshiyuki; Tachi, Yoshimi; Kishi, Etsuko; Kawamura, Toru; Takahashi, Shun; Arai, Yukie; Koyama, Sachie; Huruhata, Toshihumi; Itabashi, Akira; Oka, Yoko; Yamazaki, Tsutomu; Maesaki, Sigefumi

    2005-01-01

    We investigated the usefullness of Binax NOW urine antigen test, an immunochromatographic assay that binds any soluble Streptococcus pneumoniae antigen (C polysaccharide) for the diagnosis of penumoniae form September 2003 to March 2005. We used 372 samples form the patinets with pneumoniae diagnosed for blood or sputum cultuter or gram-stained sputum smear. Out of 24 culture positive specimens, Binax NOW urine antigen test, showed positive in 18 (75%) specimens. The sensitivity of sputum and blood culture was 71.7% and 83.3%, respectively. Binax NOW urine antigen test was seemed false positives in 55 samples, false negatives in 6 samples. The specificity of Binax NOW urine antigen test was evaluated 84.1%. Overall agreement among tests was 83.6%. When compared to culture, false negative urine antigen may be the result of colonizing S. pneumoniae in sputum or pneumonia caused by an agent other than S. pneumoniae. CRP values for cases were both urine antigen and culture were positive ranged from 40 mg/dl to 10 mg/dl while urine antigen and culture negative cases were predominantly less than 10 mg/dl. Positive blood and pleural fluid culture cases were consistently associated with strongly positive urine antigen tests. Non-agreement between urine antigen, culture, and microscopy may be the result of specimen quality, labile nature of S. pneumoniae and antimicrobial therapy.

  19. Thoracic splenosis as a differential diagnosis of juxtapleural nodules

    Directory of Open Access Journals (Sweden)

    B. Lopes

    2014-01-01

    Full Text Available Thoracic splenosis is rare and consists of ectopic implantation of splenic tissue into the chest after concomitant thoracic and abdominal trauma with diaphragm injury. It occurs in about 18% of cases of splenic ruptures. In almost all cases, diagnosis is given incidentally once patients are usually asymptomatic. Thoracic splenosis should be considered as a differential diagnosis in all patients with history of trauma presenting with juxtapleural nodules in chest computed tomography. However, malignant conditions should be ruled out firstly. Biopsy is not essential for the diagnosis once nuclear medicine can confirm splenosis in patients with pertinent history of trauma and suggestive tomographic image. We present a typical case of thoracic splenosis whose diagnosis was made by nuclear medicine and no invasive procedures were required.

  20. FEATURES OF PNEUMONIA IN HIV-INFECTED PATIENTS

    Directory of Open Access Journals (Sweden)

    M. T. Vatutin

    2016-01-01

    Full Text Available The article presents the clinical, diagnostic and treatment features of pneumocystis pneumonia in HIV-infected patients. The clinical case of diagnosis verification in a patient 58 years old with severe respiratory failure is described.

  1. Immune response to Mycoplasma pneumoniae P1 and P116 in patients with atypical pneumonia analyzed by ELISA

    Directory of Open Access Journals (Sweden)

    Birkelund Svend

    2004-02-01

    Full Text Available Abstract Background Serology is often used for the diagnosis of Mycoplasma pneumoniae. It is important to identify specific antigens that can distinguish between the presence or absence of antibodies against M. pneumoniae. The two proteins, P116 and P1, are found to be immunogenic. By using these in ELISA it is possible to identify an immune response against M. pneumoniae in serum samples. Results A recombinant protein derived from the P116 protein and one from the P1 protein were used in two ELISA tests, rP116-ELISA and rP1-ELISA. Human serum samples from patients with atypical pneumonia were tested and compared to the results of the complement fixation test. There was a good agreement between the two tests but the rP1-ELISA showed the best discrimination between positive and negative samples. Conclusion Two ELISA tests based on recombinant proteins have been analysed and compared to the complement fixation test results. The two ELISA tests were found suitable for use in serodiagnostics of M. pneumoniae infections. The use of specific antigens eliminates the risk of cross reaction to an immune response against other bacteria.

  2. Imaging of round pneumonia and mimics in children

    Energy Technology Data Exchange (ETDEWEB)

    Restrepo, Ricardo; Palani, Rajaneeshankar; Matapathi, Uma M.; Wu, Yen-Ying [Miami Children' s Hospital, Department of Radiology, Miami, FL (United States)

    2010-12-15

    Various diseases in the pediatric age group can present as an intrathoracic rounded opacity on a chest radiograph. The purpose of this pictorial essay is to emphasize the imaging appearance of round pneumonia, an entity that occurs especially in the pediatric population. Additional pathologies with similar chest radiographic appearances are also presented. The diagnosis of round pneumonia should be made in children who have the typical clinical presentation along with chest radiographs demonstrating the characteristic findings. (orig.)

  3. On the Problem of Differential Diagnosis of Inflammatory and Functional Bowel Diseases

    Directory of Open Access Journals (Sweden)

    I.Ya. Budzak

    2013-04-01

    Full Text Available The paper describes the problems of differential diagnosis of inflammatory (ulcerative colitis, Crohn’s disease and functional (irritable bowel syndrome disease of the intestine. The necessity of such differential diagnosis in certain categories of patients was noted. The possibilities of instrumental and laboratory methods of study are shown. Particular attention is paid to the definition of fecal tests — calprotectin and lactoferrin. An analysis of the studies of their information content has been carried out.

  4. Diagnosis of Tuberculosis Following World Health Organization–Recommended Criteria in Severely Malnourished Children Presenting With Pneumonia

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Faruque, Abu Syed Golam; Bardhan, Pradip Kumar; Ahmed, Tahmeed

    2017-01-01

    Evidences on diagnosis of tuberculosis (TB) following the World Health Organization (WHO) criteria in children with severe acute malnutrition (SAM) are lacking. We sought to evaluate the WHO criteria for the diagnosis of TB in such children. In this prospective study, we enrolled SAM children aged <5 with radiological pneumonia. We collected induced sputum and gastric lavage for smear microscopy, mycobacterial culture, and Xpert MTB/RIF. Using the last 2 methods as the gold standard, we determined sensitivity, specificity, and positive and negative predictive values of WHO criteria (n = 388). However, Xpert MTB/RIF was performed on the last 214 children. Compared to mycobacterial culture–confirmed TB, sensitivity and specificity (95% confidence interval) of WHO criteria were 40 (14% to 73%) and 84 (80% to 87%), respectively. Compared to culture- and/or Xpert MTB/RIF-confirmed TB, the values were 22% (9% to 43%) and 83 (79% to 87%), respectively. Thus, the good specificity of the WHO criteria may help minimize overtreatment with anti-TB therapy in SAM children, especially in resource-limited settings. PMID:28229100

  5. Diagnosis of Tuberculosis Following World Health Organization–Recommended Criteria in Severely Malnourished Children Presenting With Pneumonia

    Directory of Open Access Journals (Sweden)

    Mohammod Jobayer Chisti MBBS, MMed, PhD

    2017-01-01

    Full Text Available Evidences on diagnosis of tuberculosis (TB following the World Health Organization (WHO criteria in children with severe acute malnutrition (SAM are lacking. We sought to evaluate the WHO criteria for the diagnosis of TB in such children. In this prospective study, we enrolled SAM children aged <5 with radiological pneumonia. We collected induced sputum and gastric lavage for smear microscopy, mycobacterial culture, and Xpert MTB/RIF. Using the last 2 methods as the gold standard, we determined sensitivity, specificity, and positive and negative predictive values of WHO criteria (n = 388. However, Xpert MTB/RIF was performed on the last 214 children. Compared to mycobacterial culture–confirmed TB, sensitivity and specificity (95% confidence interval of WHO criteria were 40 (14% to 73% and 84 (80% to 87%, respectively. Compared to culture- and/or Xpert MTB/RIF-confirmed TB, the values were 22% (9% to 43% and 83 (79% to 87%, respectively. Thus, the good specificity of the WHO criteria may help minimize overtreatment with anti-TB therapy in SAM children, especially in resource-limited settings.

  6. Diagnosis of Tuberculosis Following World Health Organization-Recommended Criteria in Severely Malnourished Children Presenting With Pneumonia.

    Science.gov (United States)

    Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Shahid, Abu S M S B; Shahunja, K M; Das, Sumon Kumar; Faruque, Abu Syed Golam; Bardhan, Pradip Kumar; Ahmed, Tahmeed

    2017-01-01

    Evidences on diagnosis of tuberculosis (TB) following the World Health Organization (WHO) criteria in children with severe acute malnutrition (SAM) are lacking. We sought to evaluate the WHO criteria for the diagnosis of TB in such children. In this prospective study, we enrolled SAM children aged <5 with radiological pneumonia. We collected induced sputum and gastric lavage for smear microscopy, mycobacterial culture, and Xpert MTB/RIF. Using the last 2 methods as the gold standard, we determined sensitivity, specificity, and positive and negative predictive values of WHO criteria (n = 388). However, Xpert MTB/RIF was performed on the last 214 children. Compared to mycobacterial culture-confirmed TB, sensitivity and specificity (95% confidence interval) of WHO criteria were 40 (14% to 73%) and 84 (80% to 87%), respectively. Compared to culture- and/or Xpert MTB/RIF-confirmed TB, the values were 22% (9% to 43%) and 83 (79% to 87%), respectively. Thus, the good specificity of the WHO criteria may help minimize overtreatment with anti-TB therapy in SAM children, especially in resource-limited settings.

  7. Lipoid Pneumonia in a Gas Station Attendant

    Directory of Open Access Journals (Sweden)

    Gladis Isabel Yampara Guarachi

    2014-01-01

    Full Text Available The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement.

  8. Contrast-Enhanced Ultrasonography in Differential Diagnosis of Benign and Malignant Ovarian Tumors

    Science.gov (United States)

    Qiao, Jing-Jing; Yu, Jing; Yu, Zhe; Li, Na; Song, Chen; Li, Man

    2015-01-01

    Objective To evaluate the accuracy of contrast-enhanced ultrasonography (CEUS) in differential diagnosis of benign and malignant ovarian tumors. Methods The scientific literature databases PubMed, Cochrane Library and CNKI were comprehensively searched for studies relevant to the use of CEUS technique for differential diagnosis of benign and malignant ovarian cancer. Pooled summary statistics for specificity (Spe), sensitivity (Sen), positive and negative likelihood ratios (LR+/LR−), and diagnostic odds ratio (DOR) and their 95%CIs were calculated. Software for statistical analysis included STATA version 12.0 (Stata Corp, College Station, TX, USA) and Meta-Disc version 1.4 (Universidad Complutense, Madrid, Spain). Results Following a stringent selection process, seven high quality clinical trials were found suitable for inclusion in the present meta-analysis. The 7 studies contained a combined total of 375 ovarian cancer patients (198 malignant and 177 benign). Statistical analysis revealed that CEUS was associated with the following performance measures in differential diagnosis of ovarian tumors: pooled Sen was 0.96 (95%CI = 0.92∼0.98); the summary Spe was 0.91 (95%CI = 0.86∼0.94); the pooled LR+ was 10.63 (95%CI = 6.59∼17.17); the pooled LR− was 0.04 (95%CI = 0.02∼0.09); and the pooled DOR was 241.04 (95% CI = 92.61∼627.37). The area under the SROC curve was 0.98 (95% CI = 0.20∼1.00). Lastly, publication bias was not detected (t = −0.52, P = 0.626) in the meta-analysis. Conclusions Our results revealed the high clinical value of CEUS in differential diagnosis of benign and malignant ovarian tumors. Further, CEUS may also prove to be useful in differential diagnosis at early stages of this disease. PMID:25764442

  9. Exogenous lipoid pneumonia: high-resolution CT findings

    International Nuclear Information System (INIS)

    Lee, J.S.; Song, K.S.; Lim, T.H.; Im, J.G.; Seo, J.B.

    1999-01-01

    The aim of this study was to assess high-resolution computed tomography (HRCT) findings of exogenous lipoid pneumonia. High-resolution computed tomography was obtained in 25 patients with proven exogenous lipoid pneumonia resulting from aspiration of squalene (derived from shark liver oil). Diagnosis was based on biopsy (n = 9), bronchoalveolar lavage (n = 8), or sputum cytology and clinical findings (n = 8). The clinical history of taking squalene was confirmed in all patients. The CT findings were classified into three patterns: diffuse ground-glass opacity, consolidation, and interstitial abnormalities. Distribution of the abnormalities, duration of taking squalene, predisposing factors for aspiration, and route of administration were analyzed. Ten patients showed diffuse ground-glass opacity pattern. Seven of 10 patients had predisposing conditions such as unconsciousness, pharyngeal dysmotility, or motor disturbances, and 6 patients had a recent history of taking large amount of squalene through nasal route. Seven patients who had consolidation pattern had a history of taking squalene for several months and did not have any predisposing factor. All of the 5 patients who had a pattern of interstitial abnormalities had a history of taking squalene longer than 1 year and showed segmental distribution of interstitial thickening with interposing ground-glass opacities. Three patients simultaneously had two different patterns at different lobes of the lung. The HRCT findings of lipoid pneumonia are ground-glass opacities, consolidation, and interstitial abnormalities. These HRCT findings with appropriate inquiries could be useful for diagnosis of exogeneous lipoid pneumonia. (orig.)

  10. Characteristic of inapperceptive pneumonia according to materials of fluorographic examination of population

    International Nuclear Information System (INIS)

    Frejdzon, M.N.; Volynskaya, N.E.

    1984-01-01

    189 (15.5%) cases of pneumonia disclosed during preventive examination of 2202 patients in policlinics for 5 years are analysed. Conclusion is drawn on importance of fluorographic preventive examination of population in pic periods of catarrhal diseases (for diagnosis of not clearly expressed and asymptomatic pneumonia). True number of asymptomatic pneumonia is considerably lower than that registered before X-ray examination. Improvement of diagnostic method is possible with thorough clinical examination of patients

  11. Legionella pneumonia presenting with bilateral flank pain, hyponatraemia and acute renal failure

    OpenAIRE

    Birkin, Celia; Biyani, Chandra Shekhar; Browning, Anthony J.

    2011-01-01

    Legionnaires’ disease (LD) is an often overlooked but a possible cause of sporadic community acquired pneumonia. High fever, cough and gastrointestinal symptoms are non-specific symptoms. Hyponatremia is more common in LD than pneumonia linked with other causes. A definitive diagnosis is usually confirmed by culture, urinary antigen testing for Legionella species. Macolide or quinolone antibiotic is the treatment of choice. We describe a case of Legionella pneumonia presenting with high fever...

  12. [Diagnosis and differential diagnosis of bronchial asthma].

    Science.gov (United States)

    Gillissen, A; Bauer, T; Richter, F; Leonhardt, P

    2001-11-01

    Asthma and COPD (chronic obstructive pulmonary disease) are the most important obstructive pulmonary diseases. Patient's history and physical evaluation give major hints of the underlying disease. Further diagnostic measures comprise lung function analysis including spirometry, plethysmography and--in severe cases--blood gas analysis. Bronchial hyperreactivity may be quantified with an unspecific inhalative provocation test. In many cases allergic diseases are accompanied by asthma. Thus, allergy tests--particularly skin prick tests--have to be carried out. To further define an underlying allergy, in some cases even specific inhalative provocation tests have to be performed. X-ray of the thorax and other imaging techniques, detailed blood analysis, further diagnosis of the upper respiratory tract and the cardiac system may have to be carried out a) to quantify the effects of a severe form of asthma or COPD on other organs, and b) for differential diagnostic examinations.

  13. [Cross-cultural adaptation of the community-acquired pneumonia score questionnaire in patients with mild-to-moderate pneumonia in Colombia].

    Science.gov (United States)

    Bernal-Vargas, Mónica Alejandra; Cortés, Jorge Alberto; Sánchez, Ricardo

    2017-01-24

    One of the strategies for the rational use of antibiotics is the use of the score for community-acquired pneumonia (CAP Score). This instrument clinically evaluates patients with community-acquired pneumonia, thereby facilitating decision making regarding the early and safe withdrawal of antibiotics. To generate a translation and cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire in Spanish. Authorization for cross-cultural adaptation of the Community-Acquired Pneumonia (CAP) Score questionnaire was obtained; the recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the European Organisation for Research and Treatment of Cancer (EORTC) were carried out through the following stages: forward translation, reconciliation, backward translation, harmonization, obtaining a provisional questionnaire, and applying the questionnaire in a pilot test. The pilot test was conducted at a second-level public hospital in Bogotá after the study was approved by the ethics and research institutional boards. The changes suggested by the forward translators were applied. There were no discrepancies between the backward and forward translations, consequently, no revisions were necessary. Five items had modifications based on suggestions made by eleven patients hospitalized with a diagnosis of community-acquired pneumonia during the pilot test. A Spanish version of the Community-Acquired Pneumonia (CAP) Score was crossculturally adapted and is now available.

  14. Community-acquired pneumonia; Ambulant erworbene Pneumonien

    Energy Technology Data Exchange (ETDEWEB)

    Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)

    2017-01-15

    The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [German] Anhand der klinischen Symptome und laborchemischen Befundkonstellation alleine ist es oft nicht moeglich, die Diagnose einer ambulant erworbenen Pneumonie (''community-acquired pneumonia'', CAP) zu stellen. Bei jedem Patienten mit Verdacht auf CAP sollte eine Roentgenthoraxaufnahme in 2 Ebenen angefertigt werden. Weiter muss eine Risikostratifizierung im Sinne der Entscheidung ambulante Therapie vs. Hospitalisierung erfolgen. Anhand der Analyse radiologischer Muster sowie deren Verteilung und Ausdehnung koennen eine grobe Zuordnung zu sogenannten Erregergruppen sowie eine Differenzierung zwischen viralen und bakteriellen Infektionen gelingen. Da

  15. Streptococcus pneumoniae necrotizing fasciitis in systemic lupus erythematosus.

    Science.gov (United States)

    Sánchez, A; Robaina, R; Pérez, G; Cairoli, E

    2016-04-01

    Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory. © The Author(s) 2015.

  16. [Community-acquired Acinetobacter pneumonia].

    Science.gov (United States)

    Bernasconi, E; Wüst, J; Speich, R; Flury, G; Krause, M

    1993-08-21

    We report the history of a 38-year-old male native of Sri Lanka admitted to the emergency ward because of chest pain and shortness of breath. On physical and radiographic examination a bilateral predominantly right-sided pneumonia was found. The patient was admitted to the medical ICU and an antibiotic regimen with amoxicillin/clavulanic acid and erythromycin was initiated. Shortly afterwards septic shock developed. The patient was intubated and received high doses of catecholamines. He died 30 hours after admission to the hospital. Cultures from sputum, tracheal aspirate and blood grew Acinetobacter baumanni. Acinetobacter is an ubiquitous gram-negative rod with coccobacillary appearance in clinical specimens, that may appear gram-positive due to poor discoloration on Gram-stain. It is a well known causative agent of nosocomial infections, particularly in intensive care units. Community-acquired pneumonias, however, are quite rare. Sporadic cases have been reported from the US, Papua-New Guinea and Australia. Interestingly, these pneumonias are fulminant and have a high mortality. Chronic obstructive lung disease, diabetes, and tobacco and alcohol consumption appear to be predisposing factors. Due to the rapid course and poor prognosis, prompt diagnosis and adequate antibiotic treatment are indicated. Antibiotics use for community-acquired pneumonias, such as amoxicillin/clavulanic acid or macrolides, are not sufficient. Appropriate antibiotics for the initial treatment of suspected Acinetobacter infections include imipenem and carboxy- and ureidopenicillins combined with an aminoglycoside.

  17. Exogenous lipoid pneumonia – a case report of a fire-eater

    International Nuclear Information System (INIS)

    Pielaszkiewicz-Wydra, Magdalena; Homola-Piekarska, Bożena; Szcześniak, Ewa; Ciołek-Zdun, Monika; Fall, Andrzej

    2012-01-01

    Exogenous lipoid pneumonia is an uncommon condition caused by inhalation or aspiration of a fatty substance. It usually presents as chronic respiratory illness mimicking interstitial lung diseases. Acute exogenous lipoid pneumonia is uncommon and typically is caused by an episode of aspiration of a large quantity of a petroleum-based product. Radiological findings vary and may imitate many other diseases. We present a rare case of acute exogenous lipoid pneumonia in a fire-eater who aspirated liquid paraffin during his flame-blowing show (fire-eater’s lung). He was admitted to the hospital with productive cough, fever, hemoptysis, chest pain and dyspnea. Diagnosis was made on the basis of history of exposure to fatty substance, characteristic findings in CT examination and presence of lipid-laden macrophages in bronchoalveolar lavage fluid. Acute exogenous lipoid pneumonia is a very rare disease that typically occurs in fire-eaters and is called a fire-eater’s lung. The diagnosis is made on the basis of typical history and radiological, as well as histopathological findings

  18. Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children.

    Science.gov (United States)

    Chochua, Sopio; D'Acremont, Valérie; Hanke, Christiane; Alfa, David; Shak, Joshua; Kilowoko, Mary; Kyungu, Esther; Kaiser, Laurent; Genton, Blaise; Klugman, Keith P; Vidal, Jorge E

    2016-01-01

    We assessed nasopharyngeal (NP) carriage of five pathogens in febrile children with and without acute respiratory infection (ARI) of the upper (URTI) or lower tract, attending health facilities in Tanzania. NP swabs collected from children (N = 960) aged 2 months to 10 years, and with a temperature ≥38°C, were utilized to quantify bacterial density of S. pneumoniae (Sp), H. influenzae (Hi), M. catarrhalis (Mc), S. aureus (Sa), and N. meningitidis (Nm). We determined associations between presence of individual species, densities, or concurrent carriage of all species combination with respiratory diseases including clinical pneumonia, pneumonia with normal chest radiography (CXR) and endpoint pneumonia. Individual carriage, and NP density, of Sp, Hi, or Mc, but not Sa, or Nm, was significantly associated with febrile ARI and clinical pneumonia when compared to febrile non-ARI episodes. Density was also significantly increased in severe pneumonia when compared to mild URTI (Sp, p<0.002; Hi p<0.001; Mc, p = 0.014). Accordingly, concurrent carriage of Sp+, Hi+, and Mc+, in the absence of Sa- and Nm-, was significantly more prevalent in children with ARI (p = 0.03), or clinical pneumonia (p<0.001) than non-ARI, and in children with clinical pneumonia (p = 0.0007) than URTI. Furthermore, Sp+, Hi+, and Mc+ differentiated children with pneumonia with normal CXR, or endpoint pneumonia, from those with URTI, and non-ARI cases. Concurrent NP carriage of Sp, Hi, and Mc was a predictor of clinical pneumonia and identified children with pneumonia with normal CXR and endpoint pneumonia from those with febrile URTI, or non-ARI episodes.

  19. Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children.

    Directory of Open Access Journals (Sweden)

    Sopio Chochua

    Full Text Available We assessed nasopharyngeal (NP carriage of five pathogens in febrile children with and without acute respiratory infection (ARI of the upper (URTI or lower tract, attending health facilities in Tanzania.NP swabs collected from children (N = 960 aged 2 months to 10 years, and with a temperature ≥38°C, were utilized to quantify bacterial density of S. pneumoniae (Sp, H. influenzae (Hi, M. catarrhalis (Mc, S. aureus (Sa, and N. meningitidis (Nm. We determined associations between presence of individual species, densities, or concurrent carriage of all species combination with respiratory diseases including clinical pneumonia, pneumonia with normal chest radiography (CXR and endpoint pneumonia.Individual carriage, and NP density, of Sp, Hi, or Mc, but not Sa, or Nm, was significantly associated with febrile ARI and clinical pneumonia when compared to febrile non-ARI episodes. Density was also significantly increased in severe pneumonia when compared to mild URTI (Sp, p<0.002; Hi p<0.001; Mc, p = 0.014. Accordingly, concurrent carriage of Sp+, Hi+, and Mc+, in the absence of Sa- and Nm-, was significantly more prevalent in children with ARI (p = 0.03, or clinical pneumonia (p<0.001 than non-ARI, and in children with clinical pneumonia (p = 0.0007 than URTI. Furthermore, Sp+, Hi+, and Mc+ differentiated children with pneumonia with normal CXR, or endpoint pneumonia, from those with URTI, and non-ARI cases.Concurrent NP carriage of Sp, Hi, and Mc was a predictor of clinical pneumonia and identified children with pneumonia with normal CXR and endpoint pneumonia from those with febrile URTI, or non-ARI episodes.

  20. Delayed puberty and hypogonadotropic hypogonadism. Differential diagnosis and treatment

    NARCIS (Netherlands)

    Snoep, Marinus Cornelis

    1978-01-01

    This thesis describes a method enabling a prospecrive differential diagnosis to be made berween delayed puberty (DP) and hypogonadotropic hypogonadism (HH). The influence of androgen administration on the gonadal feedback sysrem of patients with delayed puberty was also studied. ... Zie: Summary

  1. Transient tachypnea of the newborn and congenital pneumonia: a comparative study.

    Science.gov (United States)

    Costa, Sandra; Rocha, Gustavo; Leitão, Andreia; Guimarães, Hercília

    2012-07-01

    Identify perinatal risk factors for transient tachypnea and pneumonia in neonates, and compare the outcome of these clinical conditions during the Neonatal Intensive Care Unit (NICU) stay. Retrospective review of newborns admitted to a level III NICU, comparing patients with transient tachypnea, pneumonia and a control group of healthy neonates. We included 202 patients with transient tachypnea, 29 with pneumonia and 498 controls. Perinatal infectious risk factors were more frequent in patients with pneumonia than in transient tachypnea (p ventilatory support more frequently and for a longer period. Comparing with controls, Apgar score at one and five minutes was higher in controls than in patients with pneumonia (p0.032 and p newborns with transient tachypnea and pneumonia are indistinguishable at presentation but clinical evolution is significantly different. The presence of perinatal infectious risk supports the diagnosis of pneumonia. Low Apgar score at one and five minutes was associated with both diseases, suggesting that etiologic factors may already be present at birth.

  2. Giant arachnoid granulation: differential diagnosis of acute headache

    International Nuclear Information System (INIS)

    Peters, S.A.; Heyer, C.M.; Frombach, E.

    2007-01-01

    Full text: We present a case of intense, rapidly evolving headache clinically mimicking meningitis, subarachnoid haemorrhage or venous sinus thrombosis. Clinical examination, standard blood work and central nervous system studies were non-contributory and effectively ruled out these diagnoses. Cranial multidetector CT studies before and after application of intravenous contrast medium performed prior to lumbar tap disclosed a non-enhancing ovoid mass filling the superior sagittal sinus. This lesion posed a differential to venous sinus thrombosis, but ultimately fulfilled the criteria of a giant arachnoid granulation. The imaging characteristics and differential diagnosis of giant arachnoid granulations are discussed

  3. Emergency Medicine Evaluation of Community-Acquired Pneumonia: History, Examination, Imaging and Laboratory Assessment, and Risk Scores.

    Science.gov (United States)

    Long, Brit; Long, Drew; Koyfman, Alex

    2017-11-01

    Pneumonia is a common infection, accounting for approximately one million hospitalizations in the United States annually. This potentially life-threatening disease is commonly diagnosed based on history, physical examination, and chest radiograph. To investigate emergency medicine evaluation of community-acquired pneumonia including history, physical examination, imaging, and the use of risk scores in patient assessment. Pneumonia is the number one cause of death from infectious disease. The condition is broken into several categories, the most common being community-acquired pneumonia. Diagnosis centers on history, physical examination, and chest radiograph. However, all are unreliable when used alone, and misdiagnosis occurs in up to one-third of patients. Chest radiograph has a sensitivity of 46-77%, and biomarkers including white blood cell count, procalcitonin, and C-reactive protein provide little benefit in diagnosis. Biomarkers may assist admitting teams, but require further study for use in the emergency department. Ultrasound has shown utility in correctly identifying pneumonia. Clinical gestalt demonstrates greater ability to diagnose pneumonia. Clinical scores including Pneumonia Severity Index (PSI); Confusion, blood Urea nitrogen, Respiratory rate, Blood pressure, age 65 score (CURB-65); and several others may be helpful for disposition, but should supplement, not replace, clinical judgment. Patient socioeconomic status must be considered in disposition decisions. The diagnosis of pneumonia requires clinical gestalt using a combination of history and physical examination. Chest radiograph may be negative, particularly in patients presenting early in disease course and elderly patients. Clinical scores can supplement clinical gestalt and assist in disposition when used appropriately. Published by Elsevier Inc.

  4. Differential diagnosis of periapical cyst using collagen birefringence pattern of the cyst wall

    OpenAIRE

    Ji, Hyo Jin; Park, Se-Hee; Cho, Kyung-Mo; Lee, Suk Keun; Kim, Jin Woo

    2017-01-01

    Objectives Periapical lesions, including periapical cyst (PC), periapical granuloma (PG), and periapical abscess (PA), are frequently affected by chemical/physical damage during root canal treatment or severe bacterial infection, and thus, the differential diagnosis of periapical lesions may be difficult due to the presence of severe inflammatory reaction. The aim of this study was to make differential diagnosis among PC, PG, and PA under polarizing microscope. Materials and Methods ...

  5. Pneumonia Atipikal

    OpenAIRE

    Budastra I Nyoman; Siadi Purniti Putu; Subanada Ida Bagus

    2016-01-01

    Pneumonia atipikal adalah pneumonia yang disebabkan oleh mikroorganisme yang tidak dapat diidentifikasi dengan teknik diagnostik standar pneumonia pada umumnya dan tidak menunjukkan respon terhadap antibiotik b-laktam. Mikroorganisme patogen penyebab pneumonia atipikal pada umumnya adalah Mycoplasma pneumoniae, Chlamydia pneumoniae, dan Legionella pneumophila. Manifestasi klinik, pemeriksaan laboratorium dan radiologis pneumonia atipikal menunjukkan gambaran tidak spesifik. Man...

  6. Permanent Central Diabetes Insipidus as a Complication of S. pneumoniae Meningitis in the Pediatric Population.

    Science.gov (United States)

    Statz, Hannah; Hsu, Benson S

    2016-05-01

    Diabetes insipidus is a rare but recognized complication of meningitis. The occurrence of diabetes insidipus has been previously attributed to Streptococcus pneumoniae (S. pneumoniae) in a handful of patients and only once within the pediatric subpopulation. We present the clinical course of a previously healthy 2-year, 8-month-old male child ultimately diagnosed with central diabetes insipidus (CDI) secondary to S. pneumoniae meningitis. Permanent CDI following S. pneumoniae meningitis is unique to our case and has not been previously described. Following the case presentation, we describe the etiology, pathophysiology, diagnosis, and treatment of CDI. The mechanism proposed for this clinical outcome is cerebral herniation for a sufficient duration and subsequent ischemia leading to the development of permanent CDI. Providers should be aware of CDI resulting from S. pneumoniae meningitis as prompt diagnosis and management may decrease the risk of permanent hypothalamo-pituitary axis damage. Copyright© South Dakota State Medical Association.

  7. Childhood Pneumonia Screener: a concept

    Directory of Open Access Journals (Sweden)

    Jukka Räsänen

    2014-06-01

    Full Text Available Childhood pneumonia continues to be the number one cause of death in children under five years of age in developing countries. In addition to mortality, pneumonia constitutes an enormous economic and social burden because late diagnosis is associated with high cost of treatment and often leads to chronic health problems. There are several bottlenecks in developing countries in the case flow of a child with lung infection: 1 recognising the symptoms as a reason to seek care, 2 getting the patient to a first-tier health facility, 3 scarcity of trained healthcare personnel who can diagnose the condition and its severity, 4 access to a second-tier facility in severe cases. These factors are commonly present in rural areas but even in more urban settings, access to a physician is often delayed. The Childhood Pneumonia Screener project aims at bridging the diagnostic gap using emerging technology. Mobile “smart” phone communication with several inexpensive dedicated sensors is proposed as a rapid data-collection and transmission unit that is connected to a central location where trained personnel assisted by sophisticated signal processing algorithms, evaluate the data and determine if the child is likely to have pneumonia and what the level and urgency of care should be.

  8. Idiopathic interstitial pneumonias: imaging-pathology correlation

    International Nuclear Information System (INIS)

    Ellis, Stephen M.; Hansell, David M.

    2002-01-01

    The terminology related to idiopathic interstitial pneumonia (IIP) remains confusing and in some cases wholly inaccurate. In addition, a greater understanding of the correlation between high-resolution computed tomography (HRCT) appearances and the corresponding histopathological changes found in the interstitial pneumonias has resulted in a crucial role for HRCT in the investigation of IIPs. The role of the radiologist is becoming increasingly important with a strong emphasis on establishing a diagnosis without resorting to lung biopsy. We aim to clarify the current classification of the IIPs highlighting their clinical, pathological and imaging characteristics in order to assist the radiologist in performing their increasingly important diagnostic role. (orig.)

  9. Value of ultrasonography in the differential diagnosis of appendicitis

    International Nuclear Information System (INIS)

    Alonso, J.M.; Sandoval, E.

    1998-01-01

    To determine the utility of ultrasound in the diagnosis of diseases that can be confused with appendicitis or presenting with atypical clinical signs of appendiceal inflammation. Graded-compression ultrasound was performed in 226 patients presenting with pain in right iliac fossa. Twenty-three patients were excluded because of inconclusive examination. Appendicitis was confirmed intraoperatively in 98 cases. There was no appendiceal inflammation in 105 patients. A final diagnosis could not be reached in 26 cases (4.7%) and was considered to represent abdominal pain of unknown origin. Ultrasound provided the correct diagnosis in 72 of the 79 patients in whom a definitive diagnosis was reached (91.1%). A wide spectrum of pathologies was identified by ultrasound, including gastrointestinal complaints (n=51), gynecological disorders (n=10), bioliopancreatic abnormalities (n=4), urological diseases (n=3) and others (n=3). Ultrasound is useful in the differential diagnosis of patients with confusing clinical signs of appendicitis. (Author) 34 refs

  10. Differential diagnosis of nongap metabolic acidosis: value of a systematic approach.

    Science.gov (United States)

    Kraut, Jeffrey A; Madias, Nicolaos E

    2012-04-01

    Nongap metabolic acidosis is a common form of both acute and chronic metabolic acidosis. Because derangements in renal acid-base regulation are a common cause of nongap metabolic acidosis, studies to evaluate renal acidification often serve as the mainstay of differential diagnosis. However, in many cases, information obtained from the history and physical examination, evaluation of the electrolyte pattern (to determine if a nongap acidosis alone or a combined nongap and high anion gap metabolic acidosis is present), and examination of the serum potassium concentration (to characterize the disorder as hyperkalemic or hypokalemic in nature) is sufficient to make a presumptive diagnosis without more sophisticated studies. If this information proves insufficient, indirect estimates or direct measurement of urinary NH(4)(+) concentration, measurement of urine pH, and assessment of urinary HCO(3)(-) excretion can help in establishing the diagnosis. This review summarizes current information concerning the pathophysiology of this electrolyte pattern and the value and limitations of all of the diagnostic studies available. It also provides a systematic and cost-effective approach to the differential diagnosis of nongap metabolic acidosis.

  11. Community-acquired pneumonia management and outcomes in the era of health information technology.

    Science.gov (United States)

    Mecham, Ian D; Vines, Caroline; Dean, Nathan C

    2017-11-01

    Pneumonia continues to be a leading cause of hospitalization and mortality. Implementation of health information technology (HIT) can lead to cost savings and improved care. In this review, we examine the literature on the use of HIT in the management of community-acquired pneumonia. We also discuss barriers to adoption of technology in managing pneumonia, the reliability and quality of electronic health data in pneumonia research, how technology has assisted pneumonia diagnosis and outcomes research. The goal of using HIT is to develop and deploy generalizable, real-time, computerized clinical decision support integrated into usual pneumonia care. A friendly user interface that does not disrupt efficiency and demonstrates improved clinical outcomes should result in widespread adoption. © 2017 Asian Pacific Society of Respirology.

  12. Ultrasonography and prostate-specific antigen (PSA) in differential diagnosis of prostate cancer and benign prostatic hyperplasia

    International Nuclear Information System (INIS)

    Mechev, D.S.; Shcherbyina, O.V.; Yatsik, V.Yi.; Gladka, L.Yu.

    2003-01-01

    The purpose of the work is analysis of diagnostic possibilities of transrectal ultrasonography and PSA in differential diagnosis of prostate cancer and benign prostatic hyperplasia. 142 patients have been investigated by transrectal ultrasonography. he transrectal ultrasonography and PSA are sensible tests in diagnosis of prostate cancer and in differential diagnosis of benign prostatic hyperplasia and prostate cancer

  13. [Desmoplastic fibroma. Differential diagnosis of a periapical lesion from endodontic failure].

    Science.gov (United States)

    Zabalegui, B; Gil, J; Zabalegui, I

    1989-01-01

    Treatment of endodontically involved teeth requires accurate diagnosis of the clinical pulpal condition to determine the primary cause of pathosis. The case presented shows the differential diagnosis between a desmoplastic fibroma and a failure of a misdiagnosed endodontic treatment. The initial direction of treatment should had never been the endodontic therapy but local surgical curettage of the lesion.

  14. Hypertrophic pachymeningitis: Current criteria for diagnosis and differentiation (Clinical case and review of literature

    Directory of Open Access Journals (Sweden)

    E. G. Mendelevich

    2015-01-01

    Full Text Available The paper describes a 44-year-old male patient with an about 6-year history of hypertrophic pachymeningitis. The major clinical symptoms were characterized by headache, exophthalmos, and blindness in one eye. The data for differential diagnosis of the disease are given. The current literature on the clinical manifestations of hypertrophic pachymeningitis, its differential diagnosis, and the results of magnetic resonance imaging (MRI is reviewed. Diagnostic difficulties at the stage of a clinical observation are due to the nonspecificity of neurological manifestations and the need for a comprehensive examination to detect a somatic disease. MRI can diagnose the disease-specific phenomenon of damage to the meninges, which calls for further careful differentiation. Clinicians must be familiar with alternative differential diagnosis, as a rapid specific therapeutic approach will help avoid long-term or irreversible neurological complications.

  15. RAPID DETECTION OF PNEUMOCOCCAL ANTIGEN IN PLEURAL FLUID OF PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

    NARCIS (Netherlands)

    BOERSMA, WG; LOWENBERG, A; HOLLOWAY, Y; KUTTSCHRUTTER, H; SNIJDER, JAM; KOETER, GH

    Background Detection of pneumococcal antigen may help to increase the rate of diagnosis of pneumococcal pneumonia. This study was designed to determine the value of rapid detection of pneumococcal antigen in pleural fluid from patients with community acquired pneumonia. Methods Thoracentesis was

  16. Case Report of Necrotizing Fasciitis Associated with Streptococcus pneumoniae

    Directory of Open Access Journals (Sweden)

    Lei Jiao

    2016-01-01

    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.

  17. [Contribution of urinary pneumococcal antigen detection combined with the research of legionella antigen for diagnosis of pneumonia in hospitalized patients].

    Science.gov (United States)

    Honoré, S; Trillard, M; Ould-Hocine, Z; Lesprit, P; Deforges, L; Legrand, P

    2004-10-01

    Bacteriological confirmation of pneumonia (PNM) in hospitalized patients is often erratic or belated. Because of importance of prognosis, early adaptation of treatment requires an empirical antimicrobial therapy (generally aminopenicillin and macrolide combination). The starting therapeutic strategy should profit by a fast and reliable test asserting a pneumococcal etiology. The Binax Now S. pneumoniae (BNP) test allows an urinary pneumococcal antigen (UPA) detection using an immunochromatographic membrane assay within 15 minutes. We first evaluated the BNP test for 28 patients with pneumococcal PNM proved by culture, and 118 negative control patients without PNM. The BNP test was then evaluated by testing urine from 158 hospitalized patients with a clinical picture of PNM (community-acquired: 90, nosocomial: 68) for whom a research of urinary Legionella antigen (Binax Now) was prescribed and was positive for only two cases. 57 patients (36.1%) were hospitalized in ICU. The sensitivity was 71.4% (85.7% for the 21 bacteriemic PNM), and the specificity was 98.3%; that is consistent with previous published data. Among the 158 patients with PNM, UPA was detected in 17 cases (10.8%): 15 within the community-acquired PNM (16.7%) and 2 (2.9%) within the nosocomial cases. The pneumococcal etiology was confirmed by bacteriological samples in 7/17 patients (6 by blood cultures). The 10 others showed clinical and radiological features in agreement with a pneumococcal PNM. Among the 141 patients with negative AUP, S. pneumoniae was isolated from 6 of them (2 in blood cultures). The Binax Now S. pneumoniae test allowed a fast and reliable etiological diagnosis in 10.8% of hospitalized PNM (16.7% of the community-acquired cases) having a research of urinary Legionella antigen (conceiving with severity factors). So it could conduce to an improved adjustment of the starting antimicrobial therapy of hospitalized adult patients with PNM.

  18. The CT diagnosis and differential diagnosis of malignant tumours of the paranasal sinuses

    International Nuclear Information System (INIS)

    Graber, H.R.; Zaunbauer, W.; Haertel, M.

    1986-01-01

    The CT appearances of malignant tumours of the paranasal sinuses are illustrated on the basis of 15 patients, and the differential diagnosis discussed. Malignant soft tissue tumours in the paranasal sinuses are characterised on CT by their non-homogeneous structure; they may destroy the bony margins of the sinus and infiltrate neighbouring regions in certain preferred directions, and they may enhance following the administration of contrast. Precise definition of the malignant tumour by CT permits their exact staging, may help to determine therapy and is valuable for serial observation. It remains to be seen, however, whether the improved radiological diagnosis results in improved prognosis of malignant tumours of the paranasal sinuses. (orig.) [de

  19. Cryptogenic organizing pneumonia%隐源性机化性肺炎

    Institute of Scientific and Technical Information of China (English)

    迟磊; 黄燕; 崔振泽

    2015-01-01

    The diagnosis of cryptogenic organizing pneumonia is derived from the pathology of organizing pneumonia.The causes of organizing pneumonia include:infection,iatrogenic,factors such as drugs,bone marrow transplantation,lung transplantation,radiation and chemotherapy.High correlation disease such as connective tissue disease,malignant tumor and other conditions,are collectively referred to as secondary organizing pneumonia.But there are some clinical case's causes can not be found or causes can not be determined.Cryptogenic organizing pneumonia is refered to these kinds of pneumonia.In this paper,the pathogenesis,clinical manifestation,auxiliary examination,diagnosis and treatment of cryptogenic organizing pneumonia are reviewed.%隐源性机化性肺炎(COP)的诊断源自于病理学上的机化性肺炎.机化性肺炎明确的致病原因包括:感染因素;医源性因素如药物、骨髓移植、肺移植、放化疗术;高相关性疾病如结缔组织疾病、恶性肿瘤及其他情况等,统称为继发性机化性肺炎.但临床上有一些病例难以找到病因或者病因不能确定,COP就是指这些没有明确致病原或其他临床伴随疾病的机化性肺炎.本文对COP的发病机制、临床表现、辅助检查、诊断及治疗加以综述.

  20. Acute fibrinous and organising pneumonia.

    Science.gov (United States)

    Gonçalves, João Rocha; Marques, Ricardo; Serra, Paula; Cardoso, Leila

    2017-09-07

    Acute fibrinous and organising pneumonia (AFOP) is a rare histological pattern of interstitial lung disease. The authors describe a 60-year-old woman admitted to the hospital for sustained fever, presenting with an alveolar opacity on chest X-ray, with the presumed diagnosis of community-acquired pneumonia and the onset of antibiotics. Since serological results suggested that Legionella pneumophila was the infectious agent, she was discharged on levofloxacin. A week later, she was again admitted with fever. CT scan showed opacities with crescentic morphology and a central ground-glass area suggestive of cryptogenic organising pneumonia. Microbiological, serological and autoimmunity tests were negative. She underwent surgical lung biopsy that revealed inflammatory infiltrate, macrophage desquamation, fibroblasts proliferation and fibrin deposition in the alveolar spaces, consistent with AFOP. She started corticotherapy with good response. Disease relapsed after prednisolone discontinuation, 10 months later. Currently, the patient is on prednisolone 5 mg/day without clinical and radiological recurrence. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Screening and identification of APOC1 as a novel potential biomarker for differentiate of mycoplasma pneumoniae in children

    Directory of Open Access Journals (Sweden)

    Jieqiong Li

    2016-12-01

    Full Text Available Background: Although mycoplasma pneumoniae (MP is a common cause of community-acquired pneumonia in children, the currently used diagnostic methods are not optimal. Proteomics is increasingly being used to study the biomarkers of infectious diseases. Methods: Label-free quantitative proteomics and liquid chromatography-mass/mass spectrometry were used to analyze the fold change of protein expression in plasma of children with MP pneumonia (MPP, infectious disease control (IDC, and healthy control (HC groups. Selected proteins that can distinguish MPP from HC and IDC were further validated by enzyme-linked immunosorbent assay (ELISA.Results: After multivariate analyses, 27 potential plasma biomarkers were identified to be expressed differently among child MPP, HC, and IDC groups. Among these proteins, SERPINA3, APOC1, ANXA6, KNTC1, and CFLAR were selected for ELISA verification. SERPINA3, APOC1, and CFLAR levels were significantly different among the three groups and the ratios were consistent with the trends of proteomics results. A comparison of MPP patients and HC showed APOC1 had the largest area under the curve (AUC of 0.853, with 77.6% sensitivity and 81.1% specificity. When APOC1 levels were compared between MPP and IDC patients, it also showed a relatively high AUC of 0.882, with 77.6% sensitivity and 88.3% specificity. Conclusion: APOC1 is a potential biomarker for the rapid and noninvasive diagnosis of MPP in children. The present finding may offer new insights into the pathogenesis and biomarker selection of MPP in children.

  2. Understanding Pneumonia

    Science.gov (United States)

    ... and Diseases > Lung Disease Lookup > Pneumonia Learn About Pneumonia Pneumonia is a common lung infection caused by ... vaccinated and practicing good health habits What Is Pneumonia? Pneumonia is an infection in one or both ...

  3. Infective endocarditis: the specific features of its course, the criteria for diagnosis, differential diagnosis (part II

    Directory of Open Access Journals (Sweden)

    B S Belov

    2008-01-01

    Full Text Available Infective endocarditis (IE is today characterized by polyetiology due to a wide range of pathogens. The paper describes the specific features of the clinical picture of the disease in relation to the etiological agent, which have, in some cases, a crucial role in the choice of empiric antibiotic therapy. Significant clinical polymorphism, obscure symptoms, and monosyndromic onset as guises all enhance the importance of the differential diagnosis of IE, at its early stages in particular. Basic approaches to differentiating IE from the diseases in which differentially diagnostic problems arise to the utmost are outlined.

  4. Molecular Mechanisms of Mild and Severe Pneumonia: Insights from RNA Sequencing.

    Science.gov (United States)

    Huang, Sai; Feng, Cong; Chen, Li; Huang, Zhi; Zhou, Xuan; Li, Bei; Wang, Li-Li; Chen, Wei; Lv, Fa-Qin; Li, Tan-Shi

    2017-04-06

    BACKGROUND This study aimed to uncover the molecular mechanisms underlying mild and severe pneumonia by use of mRNA sequencing (RNA-seq). MATERIAL AND METHODS RNA was extracted from the peripheral blood of patients with mild pneumonia, severe pneumonia, and healthy controls. Sequencing was performed on the HiSeq4000 platform. After filtering, clean reads were mapped to the human reference genome hg19. Differentially expressed genes (DEGs) were identified between the control group and the mild or severe group. A transcription factor-gene network was constructed for each group. Biological process (BP) terms enriched by DEGs in the network were analyzed and these genes were also mapped to the Connectivity map to search for small-molecule drugs. RESULTS A total of 199 and 560 DEGs were identified from the mild group and severe group, respectively. A transcription factor-gene network consisting of 215 nodes and another network consisting of 451 nodes were constructed in the mild group and severe group, respectively, and 54 DEGs (e.g., S100A9 and S100A12) were found to be common, with consistent differential expression changes in the 2 groups. Genes in the transcription factor-gene network for the mild group were mainly enriched in 13 BP terms, especially defense and inflammatory response (e.g., S100A8) and spermatogenesis, while the top BP terms enriched by genes in the severe group include response to oxidative stress (CCL5), wound healing, and regulation of cell differentiation (CCL5), and of the cellular protein metabolic process. CONCLUSIONS S100A9 and S100A12 may have a role in the pathogenesis of pneumonia: S100A9 and CXCL1 may contribute solely in mild pneumonia, and CCL5 and CXCL11 may contribute in severe pneumonia.

  5. Infectious diseases of brain parenchyma in adults: imaging and differential diagnosis

    International Nuclear Information System (INIS)

    Haehnel, S.; Kress, B.; Stippich, C.; Sartor, K.; Seitz, A.; Storch-Hagenlocher, B.; Forsting, M.; Jansen, O.

    2005-01-01

    Infectious diseases of the central nervous system have often to be considered in differential diagnosis, particularly in immunocompromised persons. Neuroimaging, specifically advanced techniques such as diffusion-weighted MRI and perfusion MRI contribute much to the differentiation of various brain infections and to delineation of brain infections from other, for instance, neoplastic diseases. In this review we present the imaging criteria for the most important brain infections in adults and discuss in detail differential diagnostic aspects. (orig.)

  6. mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings.

    Directory of Open Access Journals (Sweden)

    Amy Sarah Ginsburg

    Full Text Available Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings--using the World Health Organization Integrated Management of Childhood Illness (IMCI paper-based protocols and relying on a health care provider's ability to manually count respiratory rate--has proven inadequate. Furthermore, hypoxemia--a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death--is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers' ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop "mPneumonia," an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing

  7. Pneumocystis Pneumonia Presenting as an Enlarging Solitary Pulmonary Nodule

    Directory of Open Access Journals (Sweden)

    Krunal Bharat Patel

    2016-01-01

    Full Text Available Pneumocystis pneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatous Pneumocystis pneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatous Pneumocystis pneumonia infection. This case is the third documented report of Pneumocystis pneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. Although Pneumocystis pneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present.

  8. Anaerobic antibiotic usage for pneumonia in the medical intensive care unit.

    Science.gov (United States)

    Kioka, Mutsumi J; DiGiovine, Bruno; Rezik, Mohamed; Jennings, Jeffrey H

    2017-11-01

    Pneumonia is a common admitting diagnosis in the intensive care unit (ICU). When aspiration is suspected, antibiotics to cover anaerobes are frequently used, but in the absence of clear risk factors, current guidelines have questioned their role. It is unknown how frequently these guidelines are followed. We conducted a single-centre observational study on practice patterns of anaerobic antibiotic use in consecutive patients admitted to the ICU with aspiration pneumonia (Asp), community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). A total of 192 patients were studied (Asp: 20, HCAP: 107, CAP: 65). Overall, 59 patients received anaerobic antibiotics (Asp: 90%, HCAP: 28%, CAP 17%) but a significant proportion of these patients did not meet criteria to receive them. Inappropriate anaerobic antibiotic use was 12/20 for Asp, 27/107 for HCAP and 9/65 for CAP. Mortality probability model III at zero hours (MPM0) score and a diagnosis of Asp were predictors of receiving inappropriate anaerobic antibiotics. Receiving inappropriate anaerobic antibiotics was associated with a longer ICU length of stay (LOS; 7 days (interquartile range (IQR): 7-21) vs 4 days (IQR:2-9), P = 0.017). For patients in the ICU admitted with pneumonia, there is a high occurrence of inappropriately prescribed anaerobic antibiotics, the use of which was associated with a longer ICU LOS. © 2017 Asian Pacific Society of Respirology.

  9. Utility of 67Ga scintigraphy and bronchial washings in the diagnosis and treatment of Pneumocystis carinii pneumonia in patients with the acquired immune deficiency syndrome

    International Nuclear Information System (INIS)

    Tuazon, C.U.; Delaney, M.D.; Simon, G.L.; Witorsch, P.; Varma, V.M.

    1985-01-01

    Twenty patients with the acquired immune deficiency syndrome (AIDS) and suspected Pneumocystis carinii pneumonia were evaluated by 67 Ga scintigraphy and fiberoptic bronchoscopy for initial diagnosis and response to therapy. Lung uptake of 67 Ga was demonstrated in 100% of AIDS patients with P. carinii pneumonia, including those with subclinical infection. Fiberoptic bronchoscopy identified P. carinii in the bronchial washings of 100% of cases (19 patients), whereas only 13 of 16 (81%) patients had P. carinii in lung tissue obtained by transbronchial biopsy. Repeat fiberoptic bronchoscopy was performed in 16 of 20 patients. After 2 to 4 wk of therapy, P. carinii was identified in bronchial washings in 8 of 16 (50%) patients and in transbronchial biopsy in 1 of 10 (10%) patients examined. Bronchial washing has a higher yield than transbronchial biopsy in demonstrating P. carinii in patients with AIDS and may evolve as the procedure of choice in such patients. Based on the clinical course and results of 67 Ga scintigraphy and fiberoptic bronchoscopy in AIDS patients with P. carinii pneumonia, optimal therapy may require at least 3 wk of treatment

  10. Non-HIV Pneumocystis pneumonia: do conventional community-acquired pneumonia guidelines under estimate its severity?

    Science.gov (United States)

    Asai, Nobuhiro; Motojima, Shinji; Ohkuni, Yoshihiro; Matsunuma, Ryo; Nakasima, Kei; Iwasaki, Takuya; Nakashita, Tamao; Otsuka, Yoshihito; Kaneko, Norihiro

    2012-06-11

    Non-HIV Pneumocystis pneumonia (PCP) can occur in immunosuppressed patients having malignancy or on immunosuppressive agents. To classify severity, the A-DROP scale proposed by the Japanese Respiratory Society (JRS), the CURB-65 score of the British Respiratory Society (BTS) and the Pneumonia Severity Index (PSI) of the Infectious Diseases Society of America (IDSA) are widely used in patients with community-acquired pneumonia (CAP) in Japan. To evaluate how correctly these conventional prognostic guidelines for CAP reflect the severity of non-HIV PCP, we retrospectively analyzed 21 patients with non-HIV PCP. A total of 21 patients were diagnosed by conventional staining and polymerase chain reaction (PCR) for respiratory samples with chest x-ray and computed tomography (CT) findings. We compared the severity of 21 patients with PCP classified by A-DROP, CURB-65, and PSI. Also, patients' characteristics, clinical pictures, laboratory results at first visit or admission and intervals from diagnosis to start of specific-PCP therapy were evaluated in both survivor and non-survivor groups. Based on A-DROP, 18 patients were classified as mild or moderate; respiratory failure developed in 15 of these 18 (83.3%), and 7/15 (46.7%) died. Based on CURB-65, 19 patients were classified as mild or moderate; respiratory failure developed in 16/19 (84.2%), and 8 of the 16 (50%) died. In contrast, PSI classified 14 as severe or extremely severe; all of the 14 (100%) developed respiratory failure and 8/14 (57.1%) died. There were no significant differences in laboratory results in these groups. The time between the initial visit and diagnosis, and the time between the initial visit and starting of specific-PCP therapy were statistically shorter in the survivor group than in the non-survivor group. Conventional prognostic guidelines for CAP could underestimate the severity of non-HIV PCP, resulting in a therapeutic delay resulting in high mortality. The most important factor to

  11. Comparative analysis of the results of echo- and roentgenography in children with pleuritides and pneumonia

    International Nuclear Information System (INIS)

    Zagorodskaya, M.M.; Antonova, R.A.; Kareva, E.A.; Gonchar, A.A.

    1988-01-01

    The methods of echography and roentgenography were used for examination of 170 children (74 with acute pneumonia, 52 with pneumonia and pleuritis and 44 with clinical suspicion of acute pneumonia) in order to study the potentialities of echocardography as a screening method for diagnosis of pneumonia. The results indicated that roentgenography was the chief and more reliable method thatechography, however the latter can substitute for it at some stages of investigation of patients over time decreasing total-body radiation exposure of patients

  12. 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

    Directory of Open Access Journals (Sweden)

    Adriell Ramalho Santana

    2012-12-01

    suggestive. Organizing pneumonia may be idiopathic or linked to collagen diseases, drugs and cancer and usually responds to corticosteroid therapy. The diagnosis was anatomopathological, but the patient's clinical condition precluded performing a lung biopsy. Organizing pneumonia should be a differential diagnosis in patients with apparent pneumonia and a progression that is unfavorable to antimicrobial treatment.

  13. The neuromuscular differential diagnosis of joint hypermobility.

    Science.gov (United States)

    Donkervoort, S; Bonnemann, C G; Loeys, B; Jungbluth, H; Voermans, N C

    2015-03-01

    Joint hypermobility is the defining feature of various inherited connective tissue disorders such as Marfan syndrome and various types of Ehlers-Danlos syndrome and these will generally be the first conditions to be considered by geneticists and pediatricians in the differential diagnosis of a patient presenting with such findings. However, several congenital and adult-onset inherited myopathies also present with joint hypermobility in the context of often only mild-to-moderate muscle weakness and should, therefore, be included in the differential diagnosis of joint hypermobility. In fact, on the molecular level disorders within both groups represent different ends of the same spectrum of inherited extracellular matrix (ECM) disorders. In this review we will summarize the measures of joint hypermobility, illustrate molecular mechanisms these groups of disorders have in common, and subsequently discuss the clinical features of: 1) the most common connective tissue disorders with myopathic or other neuromuscular features: Ehlers-Danlos syndrome, Marfan syndrome and Loeys-Dietz syndrome; 2) myopathy and connective tissue overlap disorders (muscle extracellular matrix (ECM) disorders), including collagen VI related dystrophies and FKBP14 related kyphoscoliotic type of Ehlers-Danlos syndrome; and 3) various (congenital) myopathies with prominent joint hypermobility including RYR1- and SEPN1-related myopathy. The aim of this review is to assist clinical geneticists and other clinicians with recognition of these disorders. © 2015 Wiley Periodicals, Inc.

  14. Psoriasis: epidemiology, natural history, and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Basko-Plluska JL

    2012-09-01

    Full Text Available Juliana L Basko-Plluska, Vesna Petronic-RosicDepartment of Medicine, Section of Dermatology, University of Chicago, Chicago, IL, USAAbstract: Psoriasis is a chronic, immune-mediated, inflammatory disease which affects primarily the skin and joints. It occurs worldwide, but its prevalence varies considerably between different regions of the world. Genetic susceptibility as well as environmental factors play an important role in determining the development and prognosis of psoriasis. Genome-wide association studies have identified many genetic loci as potential psoriasis susceptibility regions, including PSORS1 through PSORS7. Histocompatibility antigen (HLA studies have also identified several HLA antigens, with HLA-Cw6 being the most frequently associated antigen. Epidemiological studies identified several modifiable risk factors that may predispose individuals to developing psoriasis or exacerbate pre-existing disease. These include smoking, obesity, alcohol consumption, diet, infections, medications and stressful life events. The exact mechanism by which they trigger psoriasis remains to be elucidated; however, existing data suggest that they are linked through Th1-mediated immunological pathways. The natural history of psoriasis varies depending on the clinical subtype as well as special circumstances, including pregnancy and HIV infection. In general, psoriasis is a chronic disease with intermittent remissions and exacerbations. The differential diagnosis is vast and includes many other immune-mediated, inflammatory disorders.Keywords: psoriasis, epidemiology, natural history, differential diagnosis

  15. Etiology of community-acquired pneumonia in hospitalized patients in Jordan

    International Nuclear Information System (INIS)

    Al-Ali, Musa K.; Batchoun, R. G.; Al-Nour, Tariq M.

    2006-01-01

    To ascertain the causative organisms of community acquired pneumonia (Cap) in Jordanian patients requiring hospital admission. A prospective study of both adults and children admitted to Princess Basma and Princess Rahma Teaching Hospitals in Irbid, Jordan with a diagnosis of CAP over a 6-month period from April to October 2002. A total of 35 adult patients were admitted with a mean age of 47 years, and 63 children with a mean age of 3 years. A pathogen was isolated from 25 (71%) adults, and from 17 (27%) children, and sputum cultures gave the best diagnostic yield. In adults Streptococcus pneumoniae was the most common isolate (26%), followed by Chlamydia pneumoniae (23%), Haemophilus influenzae (17%), Mycoplasma pneumoniae (9%), and Legionella pneumophila and Klebsiella pneumoniae (6%) each. Seven of the 9 gram negative isolates were from patients with some co morbid illness. While in children, Chlamydia pneumoniae was the most common (14%), followed by Mycoplasma pneumoniae (6%), and Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa (3%) each. Streptococcus pneumoniae and atypical microorganisms are the most common cause of CAP in previously healthy adults; while in those with associated co morbid illness, gram negative organisms are the likely cause. In children, the overall detection rate of causative organisms was low with atypical microorganisms being the most common. (author)

  16. Predictors of pneumonia in acute stroke in patients in an emergency unit

    Directory of Open Access Journals (Sweden)

    Sara R. M. Almeida

    2015-05-01

    Full Text Available Objective To evaluate the risk factors and comorbid conditions associated with the development of pneumonia in patients with acute stroke. To determine the independent predictors of pneumonia. Method Retrospective study from July to December 2011. We reviewed all medical charts with diagnosis of stroke. Results 159 patients (18-90 years were admitted. Prevalence of pneumonia was 32%. Pneumonia was more frequent in patients with hemorrhagic stroke (OR: 4.36; 95%CI: 1.9-10.01, p < 0.001, higher National Institute of Health Stroke Scale (NIHSS (p = 0.047 and, lower Glasgow Coma Score (GCS (p < 0.0001. Patients with pneumonia had longer hospitalization (p < 0.0001. Multivariable logistic regression analysis identified NIHSS as an independent predictor of pneumonia (95%CI: 1.049-1.246, p = 0.002. Conclusion Pneumonia was associated with severity and type of stroke and length of hospital stay. The severity of the deficit as evaluated by the NIHSS was shown to be the only independent risk factor for pneumonia in acute stroke patients.

  17. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

    Science.gov (United States)

    Farooqui, Habib; Jit, Mark; Heymann, David L.; Zodpey, Sanjay

    2015-01-01

    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

  18. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates.

    Science.gov (United States)

    Farooqui, Habib; Jit, Mark; Heymann, David L; Zodpey, Sanjay

    2015-01-01

    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

  19. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates.

    Directory of Open Access Journals (Sweden)

    Habib Farooqui

    Full Text Available 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

  20. Differential diagnosis and clinical management of periapical radiopaque/hyperdense jaw lesions

    Directory of Open Access Journals (Sweden)

    Brunno Santos Freitas SILVA

    2017-07-01

    Full Text Available Abstract Great attention has been given to the study of radiolucent periapical lesions to avert possible misdiagnosis of apical periodontitis associated with certain radiolucent non-endodontic lesions. However, there are a significant number of radiopaque lesions found in the periapical region, which could be equally relevant to endodontic practice. The diagnosis and management of these radiopaque/hyperdense lesions could be challenging to the endodontist. These bone alterations could be neoplastic, dysplastic or of metabolic origin. In the context of the more widespread use of cone-beam CT, a detailed review of radiopaque inflammatory and non-inflammatory lesions is timely and may aid clinicians perform a differential diagnosis of these lesions. Distinguishing between inflammatory and non-inflammatory lesions simplifies diagnosis and consequently aids in choosing the correct therapeutic regimen. This review discusses the literature regarding the clinical, radiographic, histological and management aspects of radiopaque/hyperdense lesions, and illustrates the differential diagnoses of these lesions.

  1. Ultrasonographic diagnosis of an endocarditis valvularis in a Burmese python (Python molurus bivittatus) with pneumonia.

    Science.gov (United States)

    Schroff, Sandra; Schmidt, Volker; Kiefer, Ingmar; Krautwald-Junghanns, Maria-Elisabeth; Pees, Michael

    2010-12-01

    An 11-yr-old Burmese python (Python molurus bivittatus) was presented with a history of respiratory symptoms. Computed tomography and an endoscopic examination of the left lung were performed and revealed severe pneumonia. Microbiologic examination of a tracheal wash sample and an endoscopy-guided sample from the lung confirmed infection with Salmonella enterica ssp. IV, Enterobacter cloacae, and Klebsiella pneumoniae. Computed tomographic examination demonstrated a hyperattenuated structure within the heart. Echocardiographic examination revealed a hyperechoic mass at the pulmonic valve as well as a dilated truncus pulmonalis. As therapy for pneumonia was ineffective, the snake was euthanized. Postmortem examination confirmed pneumonia and infective endocarditis of the pulmonic valve caused by septicemia with Salmonella enterica ssp. IV. Focal arteriosclerosis of the pulmonary trunk was also diagnosed. The case presented here demonstrates the possible connection between respiratory and cardiovascular diseases in snakes.

  2. Lymphoma and broncho-pneumonia in a calf

    International Nuclear Information System (INIS)

    Lallemand, M.; Francoz, D.; Latouche, J.S.

    2005-01-01

    A one and a half month old Holstein calf was presented with a chronic respiratory condition. Clinical examination revealed cachexia and lymphadenopathy and wheezes and crepitations on auscultation. Blood cell count indicated a non-regenerative microcytic anaemia and marked lymphopenia. Broncho-pneumonia due to Mycoplasma bovis was diagnosed after radiography and cytobacteriology of transtracheal lavage. A large cell lymphoma was suspected after finding a high proportion of large lymphocytes in a lymph node puncture aspirate. Serology for bovine leukosis was negative. A diagnosis of juvenile lymphoma associated with M. bovis broncho-pneumonia was established. The diagnosis was confirmed on post-mortem. Juvenile lymphoma is rare. Affected animals are aged between two and six months and systematically present generalised lymphadenopathy. This disease is always fatal. When an animal is presented with generalised lymphadenopathy, this condition should be eliminated by lymph node puncture of a moderately hypertrophied lymph node before other tests are performed [it

  3. Radiological possibilities in differential diagnosis of hypertension

    International Nuclear Information System (INIS)

    Hoetzinger, H.

    1982-01-01

    The radiological methods have their definite place within the pattern of differential diagnosis of hypertension. To detect renal hypertension, urography and radionuclide techniques with separate clearance are employed. Morphological proof of arterial stenoses is effected by means of angiography. Changes in the adrenal causing hypertension are covered by sonography and computerized tomography which are supplemented mainly by adrenal phlebography and selctive withdrawal of blood for hormonal determination. The chest x-ray film yields information on cardiac adaptation to enhanced pressure load. (orig.) [de

  4. Differential diagnosis of calf pain by ultrasonography

    Directory of Open Access Journals (Sweden)

    Luciano Augusto Botter

    2008-03-01

    Full Text Available This paper aims to evaluate the recent and numerous applications of ultrasonography in the differential diagnosis of conditions that affect the popliteal fossa and lower limbs, resulting in calf pain. Popliteal cysts and their ruptures, aneurysms, hematomas, cellulitis, abscesses, soft tissue tumors and other fluid collections are easily identified by this technique. Moreover, post-trauma and inflammatory conditions affecting muscles and tendons, muscle necrosis, deep venous thrombosis and superficial thrombophlebitis are very well demonstrated by the ultrasonographic screening.

  5. Dementia and Depression: A Process Model for Differential Diagnosis.

    Science.gov (United States)

    Hill, Carrie L.; Spengler, Paul M.

    1997-01-01

    Delineates a process model for mental-health counselors to follow in formulating a differential diagnosis of dementia and depression in adults 65 years and older. The model is derived from empirical, theoretical, and clinical sources of evidence. Explores components of the clinical interview, of hypothesis formation, and of hypothesis testing.…

  6. Extramedullary plasmacytoma in the carotid space: Expanding the differential diagnosis

    International Nuclear Information System (INIS)

    Deshpande, Sneha Satish; Kane, Shubhada; Arya, Supreeta

    2014-01-01

    Plasma cell neoplasms have been classified into various types, with a range of clinical and radiological presentations. Extramedullary plasmacytoma (EMP) is a subset of plasma cell neoplasms which presents as an isolated non-osseous soft tissue mass. Though carotid space neoplasms are commonly encountered, EMP in the carotid space is rare and seldom considered in the initial differential diagnosis of a carotid space mass. These tumors can be treated by surgery or radiotherapy. On the other hand, the commonly encountered tumors in the carotid space are treated surgically. Also, it is mandatory to exclude multiple myeloma in the patients presenting with EMP. Hence, accurate and early diagnosis has therapeutic and prognostic implications. We report a rare case of EMP of the carotid space, describing the imaging features and the differential diagnoses with clues pointing to this rare entity

  7. Clinical features and differential diagnosis of type 2 diabetes mellitus in children

    Directory of Open Access Journals (Sweden)

    Tamara Leonidovna Kuraeva

    2009-09-01

    Full Text Available This review was designed to evaluate prevalence, specific clinical features, and differential diagnosis of type 2 diabetes mellitus (DM2 in childrenand adolescents. Special emphasis is laid on the importance of immunological and molecular-genetic studies for the verification of diagnosis and activecase detection in h groups.

  8. Diabetes insipidus: Differential diagnosis and management.

    Science.gov (United States)

    Robertson, Gary L

    2016-03-01

    Diabetes insipidus (DI) is a syndrome characterized by the excretion of abnormally large volumes of dilute urine. It can be caused by any of 4 fundamentally different defects that must be distinguished for safe and effective management. They are: (1) pituitary DI, due to inadequate production and secretion of antidiuretic hormone, arginine-vasopressin (AVP); (2) gestational DI due to degradation of AVP by an enzyme made in placenta; (3) primary polydipsia, due to suppression of AVP secretion by excessive fluid intake; and (4) nephrogenic DI due to renal insensitivity to the antidiuretic effect of AVP. This review describes several methods of differential diagnosis, indicates the advantages and disadvantages of each and presents a new approach that is simpler and less costly but just as reliable as the best of the older methods. The various treatments for the different types of DI and recent findings on the genetic basis of the familial forms of DI are also discussed with emphasis on their contributions to improved diagnosis and management. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Diagnóstico da pneumonia enzoótica suína pela técnica da imunoperoxidase Immunoperoxidase technique for diagnosis of enzootic pnemonia in swine

    Directory of Open Access Journals (Sweden)

    F.C. Ribeiro

    2004-12-01

    Full Text Available Avaliou-se a técnica da imunoperoxidase como método auxiliar para a detecção de Mycoplasma hyopneumoniae em suínos naturalmente infectados. Foram colhidos 80 fragmentos de pulmões de 40 animais provenientes de granjas consideradas negativas e 40 de granjas com diagnóstico positivo de pneumonia enzoótica. Com a utilização de soro policlonal específico (IgG de coelho anti- M. hyopneumoniae observou-se correlação positiva de 77% entre os diagnósticos microscópicos e imunoistoquímicos, enquanto que a correlação entre os diagnósticos macroscópico e imunoistoquímico foi de 49%. Nas granjas consideradas negativas observou-se presença de discreta imunorreação em 22,5% dos casos, o que poderia indicar a existência de reação cruzada com outros microrganismos. Nas granjas com diagnóstico positivo para pneumonia enzoótica a técnica da peroxidase-anti-peroxidase (PAP revelou diferentes graus de intensidade, variando de fraca imunomarcação até espesso depósito amarronzado no epitélio ou na luz das vias aéreas, ou ainda no interior de macrófagos, com relação direta entre a intensidade das lesões e da imunorreação. A técnica imunoistoquímica possui sensibilidade de 95% e especificidade de 77,5%, podendo ser recomendada como ferramenta auxiliar, rápida e de baixo custo para o diagnóstico de pneumonia enzoótica suína em laboratórios de rotina em histopatologia.The immunoperoxidase technique as an auxiliary method for the detection of Mycoplasma hyopneumoniae in naturally infected pigs was evaluated. Eighty lung fragments of which 40 from animals of farms considered negatives and 40 of farms with positive diagnosis of enzootic pneumonia were collected. The results obtained with polyclonal specific serum (IgG of rabbit anti - M. hyopneumoniae evidentiated a positive correlation of 77% between microscopic and immunohistochemical diagnoses, while the correlation between the macroscopic and immunohistochemical diagnoses

  10. Pneumonia Nosokomial

    OpenAIRE

    Keliat, E.N; Abidin, Alwinsyah; Lubis, Nursyamsiah

    2017-01-01

    Pada masa yang lalu pneumonia diklasifikasikan sebagai pneumonia tipikal yang disebabkan oleh Str. Pneumonia daan atipikal yang disebabkan kuman atipik seperti halnya M. pneumonia. Kemudian ternyata manifestasi dari patogen lain seperti H. influenza, S. aureus dan bakteri Gram negatif memberikan sindrom klinik yang identik dengan pneumonia oleh Str E.N Keliat

  11. Acute fibrinous and organising pneumonia: a case report and review of the literature.

    Science.gov (United States)

    Tzouvelekis, Argyris; Koutsopoulos, Anastasios; Oikonomou, Anastasia; Froudarakis, Marios; Zarogoulidis, Pavlos; Steiropoulos, Paschalis; Mikroulis, Dimitrios; Antoniades, Antonis; Bouros, Demosthenes

    2009-10-12

    Organising pneumonia is a distinct histopathological entity characterized by intra-alveolar buds of granulation tissue, called Masson bodies, which mainly comprise of activated fibroblasts and loose connective tissue. This histopathologic pattern has been described in idiopathic cases, characterizing cryptogenic organising pneumonia as well as in the context of pulmonary infection, drug-induced pneumonitis and following lung transplantation. Although distinct as a clinical and pathological entity, community organising pneumonia may present with atypical clinical and pathological features, such as intra-alveolar fillings of fibrin balls and organising tissue that resembles acute respiratory distress syndrome or diffuse alveolar damage. The latter characteristics constitute a recently described anatomoclinical entity called acute fibrinous and organising pneumonia. Here, we describe a rare case of acute fibrinous and organising pneumonia, in an otherwise healthy 65-year-old Greek woman who complained of dry cough, fever, weight loss and progressive dyspnoea. She had never been a smoker. Her clinical symptoms showed a rapid deterioration in the two weeks before admission, despite a course of oral antibiotics. After excluding infection and malignancy with routine laboratory tests and flexible bronchoscopy, high resolution computed tomography and video assisted thoracoscopic lung biopsy were performed. Diagnosis was based on radiological features typical of community organising pneumonia coupled with pathologic features characteristic of acute fibrinous and organising pneumonia. The patient was treated with corticosteroids and showed excellent clinical and radiological response three months after treatment initiation. Acute fibrinous and organising pneumonia is an extremely rare pathologic entity, often misdiagnosed as typical community organising pneumonia. To our knowledge, this is the seventh case of acute fibrinous and organising pneumonia in the literature, with no

  12. Mycoplasma pneumoniae pneumonia: CT features in 16 patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Inho; Kim, Tae Sung; Yoon, Hye-Kyung [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2006-03-15

    The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F=9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age <18 years) and the adult (age {>=}18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. (orig.)

  13. Mycoplasma pneumoniae pneumonia: CT features in 16 patients

    International Nuclear Information System (INIS)

    Lee, Inho; Kim, Tae Sung; Yoon, Hye-Kyung

    2006-01-01

    The objective of this study was to assess the computed tomography (CT) features of Mycoplasma pneumoniae pneumonia. We retrospectively reviewed CT findings of 16 patients (M:F=9:7, age range 1-74 years, median 9 years) with serologically proven Mycoplasma pneumoniae pneumonia and with chest CT scan available. Two distinctive patterns of CT features of M. pneumoniae pneumonia were noted between the paediatric (age <18 years) and the adult (age ≥18 years) groups. The pediatric group (n=11) showed lobar or segmental consolidation (100%) with frequent pleural effusion (82%) and regional lymphadenopathy (82%) and mild volume decrease of the involved lobe (73%), while four of the five adult patients showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation (80%) with a lobular distribution, and frequent thickening of interlobular septa (60%) and the bronchial walls (40%) were also detected at high-resolution CT. The CT finding of a lobar or segmental consolidation with a parapneumonic effusion seen in our children with M. pneumoniae pneumonia was similar to that of bacterial lobar pneumonia. In contrast, the CT findings noted in our adult patients consisted of a mixture of a bacterial bronchopneumonia pattern and a viral interstitial pneumonia pattern. (orig.)

  14. Differential diagnosis of pancreas cancer and chronic pancreatitis in computed tomography

    International Nuclear Information System (INIS)

    Fujita, Nobuyuki; Saitou, Hiroya; Hiromura, Tadao; Takahashi, Hiromichi; Shinohara, Masahiro; Morita, Yutaka; Irie, Goro

    1987-01-01

    Differential diagnosis of pancreas cancer and chronic pancreatitis in Computed Tomography. CT pictures of 46 cases of pancreas cancer and 16 cases of chronic pancreatitis were reviewed to clarify a way of differential diagnosis of these two disorders. The conclusion obtained in this study is as below. 1) Well-defined cystic central low density is a sign of chronic pancreatitis, and in the other hand, the solid central low density is a sign of pancreas cancer. 2) Effect of contrast enhancement was greater in chronic pancreatitis than in pancreas cancer. 3) Possibility of pancreas cancer is high in a case which has a sign of vascular involvement but no definite sign of tumor. 4) Sensitivity, specificity, total accuracy is 76.7 %, 87.5 %, 75.8 % respectively. (author)

  15. Differential diagnosis of benign intrahepatic tumours

    International Nuclear Information System (INIS)

    Koenig, R.; Herter, M.; Deutsches Krebsforschungszentrum, Heidelberg

    1983-01-01

    Differential diagnosis of benign intrahepatic tumours can be very difficult despite numerous non-invasive diagnostic approaches, as is evident from two case reports presented here. The problem appears particularly intricate if two or more masses or space-occupying growths are present at the same time, the diagnostic aspects being different. In the first case, echinococcus alveolaris occurred simultaneously with a cavernous haemangioma and a focal nodular hyperplasia (FNH). In the second case, FNH as a pendulating tumour was combined with a second focus in the superior part of the liver. These two examples are used as basis for discussing various diagnostic approaches, such as sonography, computed tomography and scintiscanning. (orig.) [de

  16. Differential diagnosis of benign intrahepatic tumours

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, R.; Herter, M.

    1983-01-01

    Differential diagnosis of benign intrahepatic tumours can be very difficult despite numerous non-invasive diagnostic approaches, as is evident from two case reports presented here. The problem appears particularly intricate if two or more masses or space-occupying growths are present at the same time, the diagnostic aspects being different. In the first case, echinococcus alveolaris occurred simultaneously with a cavernous haemangioma and a focal nodular hyperplasia (FNH). In the second case, FNH as a pendulating tumour was combined with a second focus in the superior part of the liver. These two examples are used as basis for discussing various diagnostic approaches, such as sonography, computed tomography and scintiscanning.

  17. Aspiration pneumonia. Pathophysiological aspects, prevention and management. A review.

    Science.gov (United States)

    Petroianni, A; Ceccarelli, D; Conti, V; Terzano, C

    2006-12-01

    Aspiration pneumonias occur more frequently than reported and, in many cases, the disease is not recognised. In hospitalised and institutionalised patients with predisposing diseases prompt diagnosis of this complication and correct preventive measures can drastically reduce the worsening of clinical conditions and the deaths due to aspiration pneumonia. Normal airway structure, effective defence mechanisms, and preventive measures are decisive in reducing aspiration episodes. An increased aspiration risk for food, fluids, medications, or secretions may lead to the development of pneumonia. Pneumonia is the most common respiratory complication in all stroke deaths and in mechanical ventilation patients. In addition, the increased incidence of aspiration pneumonia with aging may be a consequence of impairment of swallowing and the cough reflex. Dysphagia, compromised consciousness, invasive procedures, anaesthesia, insufficient oral care, sleep disorders, and vomiting are all risk factors. Aspiration pneumonia includes different characteristic syndromes based on the amount (massive, acute, chronic) and physical character of the aspirated material (acid, infected, lipoid), needing a different therapeutic approach. Chronic patients education and correct health care practices are the keys for preventing the events of aspiration. In patients at risk a clinical and instrumental assessment of dysphagia should be evaluated. Management includes the removal of etiologic factors (drugs, tubes, mobilisation, oral hygiene), supportive care, and in bacterial pneumonias a specific antibiotic therapy for community-acquired or nosocomial events.

  18. [DIFFERENTIAL DIAGNOSIS OF TUMOROID-LIKE ABSCESS AND LUNG CANCER].

    Science.gov (United States)

    Churylin, R

    2015-01-01

    The purpose of work is development and clarification of roentgenology displays of tumoroidea variant of abscess of lungs for differential diagnostics him with the cancer of lungs. Practically in most cases abscess of lungs there is a necessity of leadthrough of differential diagnostics with in a number of nosology forms, including with the cavernous form of peripheral cancer of lungs. The features of flow of roentgenologic picture of tumoroidea variant are resulted, alike symptoms, differ ences and signs which allow to set a correct diagnosis, are resulted, the value of follow-up of roent genologic research and use of computed tomography is underlined.

  19. Distant metastases in differentiated thyroid carcinoma: diagnosis and treatment

    International Nuclear Information System (INIS)

    Schmidt, A.; Cross, G.; Pitoia, F.

    2017-01-01

    Distant metastases occur in less than 10% of patients with differentiated thyroid carcinoma. In these patients, overall survival at 10 years is considerably reduced. Whereas cure is the initial goal of treatment, stabilisation of the disease and management of symptoms have become the primary objective in many patients with persistent radio-iodine refractory progressive disease. In the last decade, several targeted therapies have shown encouraging results in patients with advanced disease. The objective of this review is to describe the characteristics, diagnosis, overall survival, and the local and systemic available treatments for patients with distant metastases from differentiated thyroid cancer. (authors) [es

  20. Dificuldades no diagnóstico da pneumonia associada ao ventilador

    Directory of Open Access Journals (Sweden)

    Maria Augusta Machado

    2003-11-01

    Full Text Available RESUMO: A pneumonia associada ao ventilador é uma doença que apresenta elevada morbilidade e mortalidade. Por isso é importante um diagnóstico correcto, de modo a orientar a antibioterapia da forma mais adequada. No entanto, o seu diagnóstico é difícil, pois o quadro clínico e radiológico são inespecíficos, e critérios de diagnóstico estandardizados, que permitem a sua confirmação, são muito invasivos ou pouco frequentes. O desenvolvimento de técnicas de colheita com protecção das amostras e de culturas quantitativas tem tentado contornar o problema da contaminação das amostras obtidas por métodos de rotina e permitir a distinção entre colonização e infecção. A autora faz uma revisão sobre os diferentes métodos de diagnóstico desta entidade clínica.REV PORT PNEUMOL 2003; IX (6: 503-514 ABSTRACT: Ventilator associated pneumonia is associated with high morbidity and mortality. It is important a correct diagnosis in way to guide the antibiotic therapy in the most appropriate way. However, its diagnosis is difficult, because clinical and radiologic features are not specific and approaches to standard diagnosis, that allow its confirmation, are very invasive or not very frequent. Protected techniques and quantitative cultures have been trying to outline the problem of the contamination of the samples obtained by routine methods and to allow the distinction between colonization and infection. The author makes a revision on the different methods of diagnosis of this clinical entity.REV PORT PNEUMOL 2003; IX (6: 503-514 Palavras-chave: Pneumonia, ventilação mecânica, diagnóstico, Key-words: Pneumonia, mechanical ventilation, diagnosis

  1. Computational Psychosomatics and Computational Psychiatry: Toward a Joint Framework for Differential Diagnosis.

    Science.gov (United States)

    Petzschner, Frederike H; Weber, Lilian A E; Gard, Tim; Stephan, Klaas E

    2017-09-15

    This article outlines how a core concept from theories of homeostasis and cybernetics, the inference-control loop, may be used to guide differential diagnosis in computational psychiatry and computational psychosomatics. In particular, we discuss 1) how conceptualizing perception and action as inference-control loops yields a joint computational perspective on brain-world and brain-body interactions and 2) how the concrete formulation of this loop as a hierarchical Bayesian model points to key computational quantities that inform a taxonomy of potential disease mechanisms. We consider the utility of this perspective for differential diagnosis in concrete clinical applications. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. sup(99m)Tc-MDP bone scintigraphy: kinetics of captation and differential diagnosis

    International Nuclear Information System (INIS)

    Slosman, D.; Frey, P.; Donath, A.

    1983-01-01

    The differential diagnosis of bone pathology is approached by the study of local MDP kinetics during the first two hours after intravenous injection. The value of the ratio between the pathological and the contralateral side is constant in normal cases (flat curve), it decreases in infectious bone diseases, it passes through a maximum after 1 to 1 1/2 hour in inflammatory non-infectious involvement of bone and it keeps increasing in primary bone pathological conditions. This technique has become a very useful tool in approaching differential diagnosis

  3. Lichen planus-like keratosis: Another differential diagnosis for kaposi sarcoma

    Directory of Open Access Journals (Sweden)

    Marcela Clavellina-Miller

    2015-01-01

    Full Text Available Epidemic Kaposi sarcoma is a common finding among HIV/AIDS patients that are not under antiretroviral treatment, and sometimes it is the first sign of the disease. However, it can be seen even in patients with undetectable viral load and high CD 4 cell count. Under these circumstances, the clinical presentation can be atypical in location or number. For this reason, the number of differential diagnosis is increased and biopsy of the suspicious lesions is essential for an accurate diagnosis and further apropiate treatment.

  4. Differential diagnosis of scintigraphic brain centres by 75Se selenite

    International Nuclear Information System (INIS)

    Bestagno, M.; Garraffa, V.; Rembado, R.; Guerra, U.

    1975-01-01

    Since standard brain scintigraphy with sup(99m)Tc is not always adequate for a satisfactory differential diagnosis of the radioactive foci detected, the possibilities of 75 Se sodium selenite were investigated. It was observed that in centres due to a vascular lesion the selenite concentration is always low, rising steeply in neoplasmic foci. The 75 Se-selenite scintigraphic method is considered highly valid, complementing that of sup(99m)Tc when this latter is unsuitable for diagnosis of the nature of cerebral foci [fr

  5. Bilateral pulmonary nodules in an adult patient with bronchiolitis obliterans-organising pneumonia.

    Science.gov (United States)

    Kopanakis, Antonios; Golias, Christos; Pantentalakis, George; Patentalakis, Michalis; Mermigkis, Charalampos; Mermigkis, Christos; Charalabopoulos, Alexandros; Peschos, Dimitrios; Batistatou, Anna; Charalabopoulos, Konstantinos

    2009-01-01

    A 58-year-old male ex-smoker was admitted to hospital because of nodular infiltrates on chest x rays. He was complaining of fatigue, dyspnoea with exertion, low grade fever and weight loss. Physical examination was unremarkable. Bronchoscopy was inconclusive but revealed endobronchial lesions of chronic active inflammation. The diagnosis of cryptogenic organising pneumonitis bronchiolitis obliterans-organising pneumonia (COP-BOOP) was established by open lung biopsy. Proliferative bronchiolitis with regions of organising pneumonia is the characteristic feature of COP. The radiological picture of bilateral pulmonary nodules is an infrequent manifestation of COP. Lung biopsy, open or with video assistance thoracic surgery, is recommended to confirm the diagnosis.

  6. SARS - Diagnosis

    Indian Academy of Sciences (India)

    SARS - Diagnosis. Mainly by exclusion of known causes of atypical pneumonia; * X ray Chest; * PCR on body fluids- primers defined by WHO centres available from website.-ve result does not exclude SARS. * Sequencing of amplicons; * Viral Cultures – demanding; * Antibody tests.

  7. [The clinical value of urinary antigen detection of Legionella pneumonia].

    Science.gov (United States)

    Jiang, Luxi; Chen, Yu; Xia, Shuyue; Ma, Jiangwei; Zhao, Hongwen; Lu, Ye; Tao, Sixu; Zhao, Li

    2015-01-01

    To investigate the clinical value of urinary antigen detection of Legionella, and to describe the clinical characteristics of Legionella pneumonia. Patients with suspected Legionella pneumonia were enrolled from the Respiratory departments of 3 tertiary hospitals in Shenyang during May 2011 to November 2013. Urinary Legionella antigen was detected for all the enrolled patients. Bacterial culture, polymerase chain reaction (PCR) for Legionella, and double Legionella antibody detection in sera were performed for each patient whose urinary antigen was positive. Patients confirmed to have Legionella pneumonia were pooled and analyzed. Totally 13 cases presenting with pneumonia were positive for Legionella by the urinary antigen method, and in one of them Legionella strain was isolated from the secretion of lower respiratory tract. PCR detection was performed in 8 patients, and 4 of them were positive. Legionella antibody detection was performed in 12 patients, and 7 of them were positive. Nine patients had a history of exposure to Legionella high-risk environments. The characteristics of the cases with Legionella pneumonia were as follows: characteristic orange sputum in 4 patients, digestive symptoms in 6, neurologic disorders in 8, hyponatremia in 10, hypoxia with oxygenation index 130) in 8 patients . Chest CT scan showed bilateral involvement in 6, ground-glass opacity combined with consolidation in 11, and moderate pleural effusion in 11 patients. Cavity and reversed halo sign were found in one case, respectively. All of the patients received fluoroquinolone treatment, and 11 patients recovered completely while 2 died of multiple organ dysfunction syndrome, one of them was complicated with secondary infection. Detection of urinary antigen of Legionella is very useful in the diagnosis of Legionella pneumonia. Attention should be paid to exposure history to the high-risk environments and multiple organ impairment when Legionella infection is suspected. Orange sputum

  8. Differential diagnosis of granulomatous lung disease: clues and pitfalls

    Directory of Open Access Journals (Sweden)

    Shinichiro Ohshimo

    2017-09-01

    Full Text Available Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis. Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis.

  9. Role of imaging procedures in clarification of complications of pneumonia

    International Nuclear Information System (INIS)

    Lampichler, K.

    2017-01-01

    Despite a considerable number of antimicrobial agents and interdisciplinary treatment options, lower respiratory tract infections are still associated with high morbidity and mortality rates. Infections of the respiratory tract can lead to severe complications, such as empyema, lung abscesses and acute respiratory distress syndrome (ARDS). Besides intrapulmonary complications pneumonia can also impair other organs due to a systemic inflammatory response. Underlying cardiovascular diseases, such as chronic heart failure, arteriosclerosis and dysrhythmia can either deteriorate due to infections or be newly manifested as a result of pneumonia. Early diagnosis and therapy of these sometimes life-threatening complications are crucial and can have a severe impact on disease outcome. The most important imaging techniques include chest X-ray and computed tomography (CT) of the chest. Although a definite diagnosis is sometimes difficult or even impossible to establish using chest X-ray or CT, there are several findings indicative of intrapulmonary or extrapulmonary complications of pneumonia. Another useful and portable tool is thoracic ultrasound directly on the patient, which can be used to further define the underlying disease or as guidance during procedures. The chest X-ray is useful in initial diagnosis and follow-up. If complications or disease progression are suspected or the clinical course differs from the X-ray interpretation, a subsequent CT of the chest should be performed. (orig.) [de

  10. Do you really know precise radiologic–pathologic correlation of usual interstitial pneumonia?

    Energy Technology Data Exchange (ETDEWEB)

    Johkoh, Takeshi, E-mail: johkoht@aol.com [Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami (Japan); Sumikawa, Hiromotsu [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Fukuoka, Junya; Tanaka, Tomonori [Department of Pathology, Nagasaki University Graduate School of Medicine, Toyama (Japan); Fujimoto, Kiminori [Department of Radiology and Center for Diagnostic Imaging, Kurume University School of Medicine, Kurume (Japan); Takahashi, Masashi [Department of Radiology, Shiga Medical University, Otsu (Japan); Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduate School of Medicine, Suita (Japan); Kondo, Yasuhiro; Taniguchi, Hiroyuki [Department of Respiratory and Allergic Medicine, Tosei General Hospital, Seto (Japan)

    2014-01-15

    Although usual interstitial pneumonia (UIP) is the most common chronic interstitial pneumonia, understanding of pathologic backgrounds of CT findings has still not been enough. Since honeycombing on either scanning microgram or CT is essential for diagnosis of UIP in 2010 ATS-ERS-JRS-ALAT guide line, the role of radiologists has become much more important. We will summarize common and uncommon CT findings with radiologic–pathological correlation.

  11. Do you really know precise radiologic–pathologic correlation of usual interstitial pneumonia?

    International Nuclear Information System (INIS)

    Johkoh, Takeshi; Sumikawa, Hiromotsu; Fukuoka, Junya; Tanaka, Tomonori; Fujimoto, Kiminori; Takahashi, Masashi; Tomiyama, Noriyuki; Kondo, Yasuhiro; Taniguchi, Hiroyuki

    2014-01-01

    Although usual interstitial pneumonia (UIP) is the most common chronic interstitial pneumonia, understanding of pathologic backgrounds of CT findings has still not been enough. Since honeycombing on either scanning microgram or CT is essential for diagnosis of UIP in 2010 ATS-ERS-JRS-ALAT guide line, the role of radiologists has become much more important. We will summarize common and uncommon CT findings with radiologic–pathological correlation.

  12. Actualización del diagnóstico de la neumonía adquirida en la comunidad Updating of the diagnosis of the community acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Iván Sergio Reyes Salazar

    2011-07-01

    Full Text Available Se revisaron numerosos documentos publicados sobre el diagnóstico de la neumonía adquirida en la comunidad, con vistas a su actualización, sobre todo respecto a las características clínicas de esa inflamación aguda del parénquima en los ancianos, que les diferencia de otros adultos. En el artículo se aborda no solo la patogénesis de esa infección extrahospitalaria, sino lo relacionado con diversos métodos para confirmar su existencia, valorar el estado general de quienes la padecen y decidir la mejor conducta terapéutica en cada caso.Several published documents on the diagnosis of the pneumonia acquired in the community were reviewed, for their updating, mainly regarding the clinical characteristics of that acute inflammation of parenchyma in the aged people that differentiate them from other adults. In the work not only the pathogenesis of that community acquired infection is discussed but also what is related to diverse methods to confirm its occurrence, to value the general state of those who suffer from it and to decide the best therapeutic behavior in each case.

  13. Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care

    Directory of Open Access Journals (Sweden)

    Vincent Q. Trinh

    2016-01-01

    Full Text Available Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS. Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS, a Healthcare Cost and Utilization Project (HCUP subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P<0.001; the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P=0.01. Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.

  14. Ultrasound in differential diagnosis of periapical radiolucencies: A radiohistopathological study

    Science.gov (United States)

    Khambete, Neha; Kumar, Rahul

    2015-01-01

    Objectives: To evaluate the efficacy of ultrasound in differential diagnosis of periapical radiolucencies. Materials and Methods: Ten patients aged between 19 years and 40 years with periapical lesions associated with anterior maxillary or mandibular teeth were selected and consented for the study. Pre-operative periapical radiographs were obtained. Measurements and provisional diagnoses of the apical areas were made by two specialist observers on two separate occasions. Preoperative ultrasound examinations with Doppler flowmetry were then performed and the images assessed by two specialist observers for the size, contents, vascular supply and a provisional diagnosis made as to whether the lesion was a cyst or granuloma. Endodontic surgery was performed including curettage of the apical tissues to enable histopathological investigation, which provided the gold standard diagnosis. All measurements and findings were compared and statistically analyzed. Results: Total 10 lesions were identified in 10 patients. On periapical radiographs, lesions were readily identified but observers were unable to differentiate granuloma from cyst using either modality. Where sufficient buccal cortical bone had been resorbed, ultrasound imaging was simple but underestimated the size of the lesions compared with periapical radiographs. In all cases, the ultrasound diagnosis agreed with the histopathological gold standard. Conclusion: Ultrasonography (USG) can provide accurate information about the nature of intraosseous lesions of the jaws before any surgical procedure. It is proposed that USG with Doppler flowmetry can provide an additional diagnostic tool without invasive surgery, where treatment option is nonsurgical. PMID:25657525

  15. Organizing pneumonia: what is it? A conceptual approach and pictorial review.

    Science.gov (United States)

    Baque-Juston, M; Pellegrin, A; Leroy, S; Marquette, C H; Padovani, B

    2014-09-01

    Organizing pneumonia (formerly named bronchiolitis obliterans with organizing pneumonia or BOOP) is a clinical, radiological and histological entity that is classified as an Interstitial Lung Disease. The understanding of this family of diseases has seen great progress over the past twenty years. CT presentation of organizing pneumonia is polymorphous but a few patterns have been recently recognized as being more specific to this diagnosis. The aim of this work is to summarize new understandings of the clinical and histological presentation of the disease and to review the most relevant CT features. Copyright © 2014 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  16. Pneumonia in HIV-infected persons: increased risk with cigarette smoking and treatment interruption

    DEFF Research Database (Denmark)

    Gordin, Fred M; Roediger, Mollie P; Girard, Pierre-Marie

    2008-01-01

    RATIONALE: Bacterial pneumonia is a major cause of morbidity for HIV-infected persons and contributes to excess mortality in this population. OBJECTIVES: To evaluate the frequency and risk factors for occurrence of bacterial pneumonia in the present era of potent antiretroviral therapy. METHODS: We...... evaluated data from a randomized trial of episodic antiretroviral therapy. The study, Strategies for Management of Antiretroviral Therapy, enrolled 5,472 participants at 318 sites in 33 countries. Study patients had more than 350 CD4 cells at baseline. Diagnosis of bacterial pneumonia was confirmed...... by a blinded clinical-events committee. MEASUREMENTS AND MAIN RESULTS: During a mean follow-up of 16 months, 116 participants (2.2%) developed at least one episode of bacterial pneumonia. Patients randomized to receive episodic antiretroviral therapy were significantly more likely to develop pneumonia than...

  17. Necrotizing pneumonia: CT findings and its clinical significance

    International Nuclear Information System (INIS)

    Park, Hong Suk; Im, Jung Gi; Ryoo, Jae Wook; Yeon, Kyung Mo; Han, Man Chung

    1995-01-01

    To analyze CT and follow-up chest radiographic findings in patients with necrotizing pneumonia and to evaluate clinical significance of the extent of necrosis. We reviewed medical records and retrospectively analysed CT scans and follow-up chest radiographs of 22 patients with necrotizing pneumonia, confirmed by biopsy (n = 7) and culture (n = 15). Inclusion criteria for necrotizing pneumonia was necrotic low attenuation, with or without cavitation on postcontrast enhanced CT scan. The study group included 15 men and seven women, aged 11-66 years (average: 47 years). The pathogens of necrotizing pneumonia were Klebsiella spp (n = 7), Enterobacter spp (n = 5), Actinomyces spp (n = 4), Pseudomonas spp (n = 4), Nocardia spp (n = 4), and others (n = 5). Average duration of pneumonia was 4.1 months. On CT scan, pneumonic consolidations were well-marginated in 14 patients and there were cavities on initial CT scan in 16 cases. Margins of the necrotic portion on CT scan were well-demarcated in majority of the patients (16/22). Low attenuation areas on initial CT scan resulted in cavitation, fibrosis and volume loss as shown on follow-up chest radiographs. The larger the necrotic areas on CT, the more the volume loss was. CT findings of necrotizing pneumonia were well-marginated air-space consolidation with low attenuation area, with or without cavity. The extent of necrotic area was closely related with the degree of fibrotic change later on. CT is important tool for diagnosis and prediction of parenchymal damage in necrotizing pneumonia

  18. Indirect Enzyme-Linked Immunosorbent Assay for Detection of Immunoglobulin G Reactive with a Recombinant Protein Expressed from the Gene Encoding the 116-Kilodalton Protein of Mycoplasma pneumoniae

    OpenAIRE

    Duffy, Michael F.; Whithear, Kevin G.; Noormohammadi, Amir H.; Markham, Philip F.; Catton, Michael; Leydon, Jennie; Browning, Glenn F.

    1999-01-01

    Serology remains the method of choice for laboratory diagnosis of Mycoplasma pneumoniae infection. Currently available serological tests employ complex cellular fractions of M. pneumoniae as antigen. To improve the specificity of M. pneumoniae diagnosis, a recombinant protein was assessed as a serodiagnostic reagent. A panel of recombinant proteins were expressed from a cloned M. pneumoniae gene that encodes a 116-kDa surface protein antigen. The recombinant proteins were assessed for reactiv...

  19. Contribution to differential diagnosis of lumbar spine disc hernia by computerized tomography

    International Nuclear Information System (INIS)

    Dolansky, J.

    1989-01-01

    The significance is discussed of computerized tomography in differential diagnosis of disc hernias of the lumbar spine. A simple technique is described that allows to differentiate disc hernias from epidural vein varices. It mostly includes repeat imaging of the same body section and/or the application of a contrast medium. (L.O.). 2 figs., 4 refs

  20. Application of 18F-FDG PET for the diagnosis and differential diagnosis of Alzheimer's disease and Lewy body dementia

    International Nuclear Information System (INIS)

    Klisarova, A.; Bochev, P.; Deleva, N.; Dimitrov, I.; Ivanov, B.

    2010-01-01

    Alzheimer's disease and Lewy body dementia are the two most frequent disorders among degenerative dementias. Their clinical identification and differential diagnosis are often difficult in the early stages when, on the other hand treatment is most effective. FDG-PET assessment of region brain metabolism is a proven method and its application demented patients ensures a higher diagnostic accuracy even at the preclinical stage. It helps resolving cases with difficult differential diagnosis as well. In this paper we discuss the application of the method in Alzheimer's disease and Lev body dementia; we present typical cases of both disorder which were assessed by FDG-PET for the first time in Bulgaria highlighting the methodology and the characteristic imaging findings

  1. Radiation doses and image quality in pediatric chest X-ray for the diagnosis of pneumonia in selected Latin American countries

    International Nuclear Information System (INIS)

    Jimenez, P.; Fleitas, I.; Cotelo, E.; Estevan, M.

    2008-01-01

    the first stage of the process for early diagnosis of children pneumonia, as well as the implementation of the radiation protection principle of optimization in medical exposures. (author)

  2. Pneumonia

    OpenAIRE

    Coelho, Liana Sousa [UNESP; Tanni, Suzana Erico; Godoy, Irma de [UNESP

    2009-01-01

    Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). In this paper will be presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

  3. Etiology of childhood community acquired pneumonia and its implications for vaccination

    Directory of Open Access Journals (Sweden)

    Nascimento-Carvalho Cristiana M.C.

    2001-01-01

    Full Text Available Pneumonia is an important cause of morbidity and mortality among children throughout the world. Vaccines are available for some organisms, but they are underutilized and/or still in development. To evaluate the potential impact of vaccines, we review studies in which the etiology of childhood community-acquired pneumonia was recorded. In North America and Europe (9 studies, the etiology of pneumonia was established in 62% of studied children (range 43%-88% by use of noninvasive specific methods for microbiologic diagnosis. The most often identified agents were S. pneumoniae (22%, respiratory syncytial virus (RSV (20%, Haemophilus influenzae (7%, and Mycoplasma pneumoniae (15%. In Africa and South America (8 studies, bacteria were recovered from 56% (range 32%-68% of severely ill children studied by lung aspirate. The most often isolated bacteria were Streptococcus pneumoniae (33% and Haemophilus influenzae (21%. A high percentage of H. influenzae strains were not serotype b. Throughout the world, children requiring hospitalization were most likely to have infection caused by pneumococcus H. influenzae or RSV. Out patients also had Mycoplasma pneumoniae. Countries in Africa and Asia recorded 2 to 10 times more children with pneumonia (7 to 40/100 annually than in the USA. Widespread use of pneumococcal and H. influenzae type b conjugate vaccines could reduce the frequency of childhood pneumonia by one-third. Further reduction will require development of non-type b H. influenzae, RSV and M. pneumoniae vaccines. This could result in a > 50% reduction of pneumonia in children. This goal should be sought and achieved as soon as possible.

  4. Detection of immunoglobulin M and immunoglobulin G antibodies to Mycoplasma pneumoniae in children with community-acquired lower respiratory tract infections

    Directory of Open Access Journals (Sweden)

    Surinder Kumar

    2018-01-01

    Full Text Available Context: Mycoplasma pneumoniae (M. pneumoniae causes up to 40% of community-acquired pneumonia in children. It is impossible to identify M. pneumoniae infection on the basis of clinical signs, symptoms, and radiological features. Therefore, correct etiological diagnosis strongly depends on laboratory diagnosis. Aims: This study aims to investigate the role of M. pneumonia e in pediatric lower respiratory tract infections (LRTIs employing enzyme-linked immunosorbent assays (ELISA and particle agglutination (PA test. Settings and Design: Two hundred and eighty children, age 6 months to 12 years with community-acquired LRTIs were investigated for M. pneumoniae etiology. Materials and Methods: We investigated 280 children hospitalized for community-acquired LRTIs, using ELISA and PA test for detecting M. pneumoniae immunoglobulin M (IgM and immunoglobulin G antibodies. Statistical Analysis Used: The difference of proportion between the qualitative variables was tested using the Chi-square test and Fischer exact test. P ≤ 0.05 was considered as statistically significant. Kappa value was used to assess agreement between ELISA and PA test. Results: M. pneumoniae was positive in 51 (23.2% 5 years of age.

  5. Pneumonia

    OpenAIRE

    Coelho, Liana Sousa [UNESP; Do Vale, Simone Alves [UNESP; Godoy, Irma de [UNESP; Tanni, Suzana Erico [UNESP

    2012-01-01

    Pneumonia is an infectious disease with great morbidity and mortality worldwide. According to the current guidelines recommendations the authors reviewed the treatment of community-acquired pneumonia (CAP) and health care-associated pneumonia (HCAP). In this paper will be also presented data about etiology, clinics and diagnostic tools. © Copyright Moreira Jr. Editora.

  6. Management of severe childhood pneumonia by day care approach in developing countries

    Directory of Open Access Journals (Sweden)

    Yasmin Jahan

    2018-01-01

    Full Text Available Background: Background: Pneumonia is a major cause of child mortality among children under 5 years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by the World Health Organization(WHO in September (2013, pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia.Methods: Disease management of severe childhood pneumonia requires early identification,prompt referral and the availability of intensive quality care. Under 5 years old children with severe pneumonia should receive day care, with antibiotic treatment, feeding, and supportive care with similar 24-hour hospital treatment.Discussion: Considering that difficulties, International Centre for Diarrheal Disease Research,Bangladesh (ICDDR, B initiated Day Care Approach (DCA model, as an innovative, safe,effective and less expensive alternative to hospital management of severe childhood pneumonia.A 24 months old girl came to the health care center with severe breathing difficulty, cough,history of fever and head nodding. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall in drawing, no danger signs, no rales on auscultation, and no hypoxemia. Conclusion: Considering the WHO case management protocol for severe pneumonia, DCA recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at daycare clinics including for children with hypoxemia who is required prolong (4-6 hours oxygen therapy.

  7. Dyrkningsnegativ Streptococcus pneumoniae endokarditis diagnosticeret med polymerasekaedereaktion

    DEFF Research Database (Denmark)

    Rasmussen, Rasmus Vedby; Kemp, Michael; Bangsborg, Jette Marie

    2008-01-01

    A 60-year old man was admitted with sepsis and meningitis of unknown aetiology. Underlying aortic valve endocarditis was diagnosed by echocardiography and severe insufficiency led to aortic valve replacement. Application of broad-range PCR to cusp tissue revealed a DNA product, and a diagnosis of...... of Streptococcus pneumoniae endocarditis was obtained by DNA sequencing....

  8. Clinical Value of Thyrotropin Receptor Antibodies for the Differential Diagnosis of Interferon Induced Thyroiditis.

    Science.gov (United States)

    Benaiges, D; Garcia-Retortillo, M; Mas, A; Cañete, N; Broquetas, T; Puigvehi, M; Chillarón, J J; Flores-Le Roux, J A; Sagarra, E; Cabrero, B; Zaffalon, D; Solà, R; Pedro-Botet, J; Carrión, J A

    2016-01-01

    The clinical value of thyrotropin receptor antibodies for the differential diagnosis of thyrotoxicosis induced by pegylated interferon-alpha remains unknown. We analyzed the diagnostic accuracy of thyrotropin receptor antibodies in the differential diagnosis of thyrotoxicosis in patients with chronic hepatitis C (CHC) receiving pegylated interferon-alpha plus ribavirin. Retrospective analysis of 274 patients with CHC receiving pegylated interferon-alpha plus ribavirin. Interferon-induced thyrotoxicosis was classified according to clinical guidelines as Graves disease, autoimmune and non- autoimmune destructive thyroiditis. 48 (17.5%) patients developed hypothyroidism, 17 (6.2%) thyrotoxicosis (6 non- autoimmune destructive thyroiditis, 8 autoimmune destructive thyroiditis and 3 Graves disease) and 22 "de novo" thyrotropin receptor antibodies (all Graves disease, 2 of the 8 autoimmune destructive thyroiditis and 17 with normal thyroid function). The sensitivity and specificity of thyrotropin receptor antibodies for Graves disease diagnosis in patients with thyrotoxicosis were 100 and 85%, respectively. Patients with destructive thyroiditis developed hypothyroidism in 87.5% of autoimmune cases and in none of those with a non- autoimmune etiology (pthyroid scintigraphy for the differential diagnosis of thyrotoxicosis in CHC patients treated with pegylated interferon. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Differential Diagnosis of Parotid Lipoma in a Breast Ca Patient

    Directory of Open Access Journals (Sweden)

    Melda Misirlioglu

    2017-01-01

    Full Text Available Lipomas are common benign tumors usually detected on the torso, neck, upper thighs, and upper arms. However, they are rarely found in the parotid gland region. Because of their rarity at this site, they are not often considered in the differential diagnosis of parotid tumors. This report describes a rare case of a lipoma in the superficial lobe of parotid gland. A 71-year-old female patient admitted to our department complaining about swelling and pain in the posterior area of the left mandibular region since one month. Her medical history included mastectomy after breast CA fifteen years ago. Clinical examination revealed a smooth-surfaced, soft, and painful mass, with well-defined margins in the left mandibular region. Differential diagnosis of metastasis, inflammatory neck swellings, and benign salivary gland tumors were considered for the patient. Advanced imaging methods such as ultrasonography and contrast tomography revealed that the lesion was a lipoma of parotid gland. A surgical intervention under general anesthesia was planned for the removal of the mass; however patient refused the surgical treatment. Patient was placed on six-month periodic recall. This article reviews the radiographic appearance and differential diagnoses of lipoma in this rare location.

  10. Non-HIV Pneumocystis pneumonia: do conventional community-acquired pneumonia guidelines under estimate its severity?

    Directory of Open Access Journals (Sweden)

    Asai Nobuhiro

    2012-06-01

    Full Text Available Abstract Background Non-HIV Pneumocystis pneumonia (PCP can occur in immunosuppressed patients having malignancy or on immunosuppressive agents. To classify severity, the A-DROP scale proposed by the Japanese Respiratory Society (JRS, the CURB-65 score of the British Respiratory Society (BTS and the Pneumonia Severity Index (PSI of the Infectious Diseases Society of America (IDSA are widely used in patients with community-acquired pneumonia (CAP in Japan. To evaluate how correctly these conventional prognostic guidelines for CAP reflect the severity of non-HIV PCP, we retrospectively analyzed 21 patients with non-HIV PCP. Methods A total of 21 patients were diagnosed by conventional staining and polymerase chain reaction (PCR for respiratory samples with chest x-ray and computed tomography (CT findings. We compared the severity of 21 patients with PCP classified by A-DROP, CURB-65, and PSI. Also, patients’ characteristics, clinical pictures, laboratory results at first visit or admission and intervals from diagnosis to start of specific-PCP therapy were evaluated in both survivor and non-survivor groups. Results Based on A-DROP, 18 patients were classified as mild or moderate; respiratory failure developed in 15 of these 18 (83.3%, and 7/15 (46.7% died. Based on CURB-65, 19 patients were classified as mild or moderate; respiratory failure developed in 16/19 (84.2%, and 8 of the 16 (50% died. In contrast, PSI classified 14 as severe or extremely severe; all of the 14 (100% developed respiratory failure and 8/14 (57.1% died. There were no significant differences in laboratory results in these groups. The time between the initial visit and diagnosis, and the time between the initial visit and starting of specific-PCP therapy were statistically shorter in the survivor group than in the non-survivor group. Conclusions Conventional prognostic guidelines for CAP could underestimate the severity of non-HIV PCP, resulting in a therapeutic delay

  11. Usual interstitial pneumonia and nonspecific interstitial pneumonia: Correlation between CT findings at the site of biopsy with pathological diagnoses

    Energy Technology Data Exchange (ETDEWEB)

    Sumikawa, Hiromitsu, E-mail: h-sumikawa@radiol.med.osaka-u.ac.jp [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0825 (Japan); Johkoh, Takeshi [Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public Health Teachers, 3-1 Kurumazuka, Itami, Hyougo 664-8533 (Japan); Fujimoto, Kiminori [Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, 830-0011 (Japan); Ichikado, Kazuya [Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, 5-3-1 Tikami, Kumamoto, 861-4193 (Japan); Colby, Thomas V. [Department of Pathology, Mayo Clinic, Scottsdale, AZ (United States); Fukuoka, Junya [Laboratory of Pathology, Toyama University Hospital, Toyama (Japan); Taniguchi, Hiroyuki; Kondoh, Yasuhiro; Kataoka, Kensuke [Department of Respiratory Medicine, Tosei General Hospital, 160 Nishioiwake-cho, Seto City, Aichi (Japan); Yanagawa, Masahiro; Koyama, Mitsuhiro; Honda, Osamu; Tomiyama, Noriyuki [Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0825 (Japan)

    2012-10-15

    Objectives: The aim of this study was to correlate high-resolution CT (HRCT) findings at the site of biopsy with the whole lung CT and pathologic diagnoses in usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP). Methods: The study included 35 patients (25 UIP and 10 NSIP) diagnosed both pathologically and clinically. 81 surgical biopsy specimens (54 UIP, and 27 NSIP) and extracted areas corresponding to biopsy sites on HRCT were analyzed. CT interpretations were compared with pathological diagnoses in both extracted images and the whole lung. Concordant and discordant cases in multiple extracted images were divided and analyzed. Then the whole cases were categorized by including or not at least one UIP diagnosis of extracted images and evaluated. Results: The diagnoses in extracted sites significantly correlated with pathological diagnoses (p = 0.047). There were significant differences in the concordances of extracted images compared with the diagnosis of whole lung and pathology (p = 0.008, 0.003, respectively). All 7 cases that were not concordant were diagnosed as radiological UIP with whole lung CT. The cases with at least one UIP diagnosis of extracted CT images were diagnosed as UIP in pathology more frequently (18 in 25) (p = 0.007). Conclusions: Radiological UIP in whole CT had more frequently discordant diagnoses from multiple extracted images than NSIP. And there were more cases in pathological UIP that included at least one UIP diagnosis of extracted images compared with pathological NSIP.

  12. Added Diagnostic Value of Cerebrospinal Fluid Biomarkers for Differential Dementia Diagnosis in an Autopsy-Confirmed Cohort.

    Science.gov (United States)

    Niemantsverdriet, Ellis; Feyen, Bart F E; Le Bastard, Nathalie; Martin, Jean-Jacques; Goeman, Johan; De Deyn, Peter Paul; Bjerke, Maria; Engelborghs, Sebastiaan

    2018-01-01

    Differential dementia diagnosis remains a challenge due to overlap of clinical profiles, which often results in diagnostic doubt. Determine the added diagnostic value of cerebrospinal fluid (CSF) biomarkers for differential dementia diagnosis as compared to autopsy-confirmed diagnosis. Seventy-one dementia patients with autopsy-confirmed diagnoses were included in this study. All neuropathological diagnoses were established according to standard neuropathological criteria and consisted of Alzheimer's disease (AD) or other dementias (NONAD). CSF levels of Aβ1 - 42, T-tau, and P-tau181 were determined and interpreted based on the IWG-2 and NIA-AA criteria, separately. A panel of three neurologists experienced with dementia made clinical consensus dementia diagnoses. Clinical and CSF biomarker diagnoses were compared to the autopsy-confirmed diagnoses. Forty-two patients (59%) had autopsy-confirmed AD, whereas 29 patients (41%) had autopsy-confirmed NONAD. Of the 24 patients with an ambiguous clinical dementia diagnosis, a correct diagnosis would have been established in 67% of the cases applying CSF biomarkers in the context of the IWG-2 or the NIA-AA criteria respectively. AD CSF biomarkers have an added diagnostic value in differential dementia diagnosis and can help establishing a correct dementia diagnosis in case of ambiguous clinical dementia diagnoses.

  13. CT of jejunal diverticulitis: imaging findings, differential diagnosis, and clinical management

    International Nuclear Information System (INIS)

    Macari, M.; Faust, M.; Liang, H.; Pachter, H.L.

    2007-01-01

    Aim: To describe the imaging findings of jejunal diverticulitis as depicted at contrast-enhanced computed tomography (CT) and review the differential diagnosis and clinical management. Materials and Methods: CT and pathology databases were searched for the diagnosis of jejunal diverticulitis. Three cases were identified and the imaging and clinical findings correlated. Results: Jejunal diverticulitis presents as a focal inflammatory mass involving the proximal small bowel. A trial of medical management with antibiotics may be attempted. Surgical resection may be required if medical management is unsuccessful. Conclusion: The imaging findings at MDCT may allow a specific diagnosis of jejunal diverticulitis to be considered and may affect the clinical management of the patient

  14. Inflammatory Mediators Associated With Pressure Ulcer Development in Individuals With Pneumonia After Traumatic Spinal Cord Injury: A Pilot Study.

    Science.gov (United States)

    Krishnan, Shilpa; Vodovotz, Yoram; Karg, Patricia E; Constantine, Gregory; Sowa, Gwendolyn A; Constantine, Florica J; Brienza, David M

    2017-09-01

    To identify the inflammatory mediators around the time of pneumonia onset associated with concurrent or later onset of pressure ulcers (PUs). Retrospective. Acute hospitalization and inpatient rehabilitation unit of a university medical center. Individuals (N=86) with traumatic spinal cord injury (SCI) were included in the initial analyses. Fifteen of the 86 developed pneumonia and had inflammatory mediator data available. Of these 15, 7 developed PUs and 8 did not. Not applicable. Twenty-three inflammatory mediators in plasma and urine were assayed. The differences in concentrations of plasma and urine inflammatory mediators between the closest time point before and after the diagnosis of pneumonia were calculated. Initial chi-square analysis revealed a significant (P=.02) association between pneumonia and PUs. Individuals with SCI and diagnosed pneumonia had nearly double the risk for developing PUs compared with those with no pneumonia. In individuals with pneumonia, Mann-Whitney U exact tests suggested an association (Ppneumonia. These findings suggest that a relatively small increase in plasma TNF-α, and decreases in urine TNF-α, GM-CSF, and IL-15 from just before to just after the diagnosis of pneumonia could be markers for an increased risk of PUs in individuals with pneumonia after traumatic SCI. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  15. Differential diagnosis of CNS angiostrongyliasis: a short review.

    Science.gov (United States)

    Senthong, Vichai; Chindaprasirt, Jarin; Sawanyawisuth, Kittisak

    2013-06-01

    The diagnostic criterion for eosinophilic meningitis (EOM) is the identification of an absolute count of 10 eosinophils per ml or more than 10% of the total white blood cells in the cerebrospinal fluid (CSF) in the proper clinical context. The most common cause of EOM is Angiostrongylus cantonensis infection, termed meningitic angiostrongyliasis (MA). Neurognathostomiasis (NG) is the main parasitic disease in the differential diagnosis of meningitic angiostrongyliasis. This short review is based on articles published on Medline between 2000 and 2012 related to EOM. There are three main approaches that can be used to differentiate between MA and NG, involving clinical factors, history of larval exposure, and serological tests. MA patients presented with acute severe headache but without neurological deficit, combined with a history of eating uncooked snails or slugs. NG patients always presented with motor weakness, migratory swelling, radicular pain and had history of eating uncooked poultry or fish. Specific antigenic bands in immunoblot tests are helpful tools to differentiate the two diseases. Other causes of eosinophilic meningitis are neurocysticercosis, cerebral paragonimiasis, Toxoplasma canis, Baylisascaris, tuberculous meningitis, and cryptococcal meningitis.

  16. Plain X-ray diagnosis of the acute abdomen: A surgical handbook with notes on clinical presentation and differential diagnosis

    International Nuclear Information System (INIS)

    Gough, M.H.; Gear, M.W.; Daar, A.S.

    1985-01-01

    Taken in conjunction with a history and clinical examination, the plain X-ray film may provide invaluable help in reaching or confirming a diagnosis in the patient with an acute abdomen. Designed for the casualty officer or trainee surgeon, this clinical handbook is a practical guide to the interpretation of the plain abdominal X-ray. The format of the first edition has been retained, providing typical examples of X-rays of the conditions which present as abdominal emergencies. Each X-ray is accompanied by a legend in four sections: the characteristic radiological signs demonstrated in the film; the differential diagnosis suggested by the X-ray; the presenting signs and symptoms of the condition under discussion; and a list of possible clinical differential diagnoses

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

    Science.gov (United States)

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

    2016-08-12

    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. A 57-year-old Hispanic woman, a nonsmoker with a history of controlled asthma, presented to the hospital with unresolving pneumonia despite three rounds of antibiotics over a 2-month period. She was later diagnosed with chronic eosinophilic pneumonia based on the presence of peripheral blood eosinophilia, the peripheral distribution of alveolar infiltrates on chest radiograph, and a lung parenchymal biopsy with infiltrates of eosinophils. Upon presentation, our patient had a right-sided moderate-sized pleural effusion. The pleural fluid profile was consistent with a transudative effusion with eosinophil predominance. Our patient responded promptly to oral corticosteroid treatment in a few days. The pulmonary infiltrates and pleural effusion subsided on a 1-month follow-up chest radiograph after starting corticosteroid treatment. We report the first case of chronic eosinophilic pneumonia presenting with pneumonia with ipsilateral transudative eosinophilic pleural effusion. Like other cases of chronic eosinophilic pneumonia, early recognition and diagnosis is essential and prompt treatment with corticosteroids is the mainstay of therapy. Pleural effusion resolved without the further need for therapeutic thoracentesis.

  18. Differential diagnosis of small solid pancreatic lesions

    DEFF Research Database (Denmark)

    Dietrich, Christoph Frank; Sahai, Anand Vasante; D'Onofrio, Mirko

    2016-01-01

    BACKGROUND AND AIMS: Pancreatic ductal adenocarcinoma (PDAC) is typically diagnosed at a late stage. Little is known about the incidental finding of early-stage PDAC. The aim of the current study was to determine the etiology of small solid pancreatic lesions (≤15 mm) to optimize clinical......-enhanced US allowed differential diagnosis of PDAC and non-PDAC in 189 of 219 patients (86%). CONCLUSIONS: Approximately 40% of patients with small solid pancreatic lesions had very early stage PDAC. Approximately 60% of small solid pancreatic lesions ≤15 mm are not PDAC and, therefore, do not require radical...

  19. Age specific fast breathing in under-five diarrheal children in an urban hospital: Acidosis or pneumonia?

    Science.gov (United States)

    Nuzhat, Sharika; Ahmed, Tahmeed; Kawser, Chowdhury Ali; Khan, Azharul Islam; Islam, S M Rafiqul; Shahrin, Lubaba; Shahunja, K M; Shahid, Abu S M S B; Al Imran, Abdullah; Chisti, Mohammod Jobayer

    2017-01-01

    Children with diarrhea often present with fast breathing due to metabolic acidosis from dehydration. On the other hand, age specific fast breathing is the cornerstone for the diagnosis of pneumonia following classification of pneumonia recommended by the World Health Organization (WHO). Correction of metabolic acidosis by rehydrating the diarrheal children requires time, which delays early initiation of appropriate antimicrobials for pneumonia and thereby increases the risk of deaths. We need to further investigate the simple clinical features other than fast breathing which might help us in earliest diagnosis of pneumonia in children with diarrhea Thus, the objective of our study was to identify other contributing clinical features that may independently help for early diagnosis of pneumonia in diarrheal children who present with age specific fast breathing. This was an unmatched case-control study. Diarrheal children aged 0-59 months, admitted to Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) during January 2014 to December 2014 having age specific fast breathing (11-59 months ≥40 breaths/min) were studied. The study children with clinical and radiological pneumonia constituted the cases (n = 276) and those without pneumonia constituted the controls (n = 446). Comparison of clinical features and outcomes between the cases and the controls was made. The distribution of acidosis among the cases and the controls was comparable (35% vs. 41%, p = 0.12). The cases had proportionately higher deaths compared to the controls, however, the difference was not statistically significant (3% vs. 1%; p = 0.23). In logistic regression analysis after adjusting for potential confounders, the cases were independently associated with cough (OR = 62.19, 95% CI = 27.79-139.19; ppneumonia. The results underscore the importance of early identification of these simple clinical features that may help to minimize potential delay due to

  20. Pathogenic Link Between Postextubation Pneumonia and Ventilator-Associated Pneumonia: An Experimental Study.

    Science.gov (United States)

    Rezoagli, Emanuele; Zanella, Alberto; Cressoni, Massimo; De Marchi, Lorenzo; Kolobow, Theodor; Berra, Lorenzo

    2017-04-01

    The presence of an endotracheal tube is the main cause for developing ventilator-associated pneumonia (VAP), but pneumonia can still develop in hospitalized patients after endotracheal tube removal (postextubation pneumonia [PEP]). We hypothesized that short-term intubation (24 hours) can play a role in the pathogenesis of PEP. To test such hypothesis, we initially evaluated the occurrence of lung colonization and VAP in sheep that were intubated and mechanically ventilated for 24 hours. Subsequently, we assessed the incidence of lung colonization and PEP at 48 hours after extubation in sheep previously ventilated for 24 hours. To simulate intubated intensive care unit patients placed in semirecumbent position, 14 sheep were intubated and mechanically ventilated with the head elevated 30° above horizontal. Seven of them were euthanized after 24 hours (Control Group), whereas the remaining were euthanized after being awaken, extubated, and left spontaneously breathing for 48 hours after extubation (Awake Group). Criteria of clinical diagnosis of pneumonia were tested. Microbiological evaluation was performed on autopsy in all sheep. Only 1 sheep in the Control Group met the criteria of VAP after 24 hours of mechanical ventilation. However, heavy pathogenic bacteria colonization of trachea, bronchi, and lungs (range, 10-10 colony-forming unit [CFU]/g) was reported in 4 of 7 sheep (57%). In the Awake Group, 1 sheep was diagnosed with VAP and 3 developed PEP within 48 hours after extubation (42%), with 1 euthanized at 30 hours because of respiratory failure. On autopsy, 5 sheep (71%) confirmed pathogenic bacterial growth in the lower respiratory tract (range, 10-10 CFU/g). Twenty-four hours of intubation and mechanical ventilation in semirecumbent position leads to significant pathogenic colonization of the lower airways, which can promote the development of PEP. Strategies directed to prevent pathogenic microbiological colonization before and after mechanical

  1. Differential diagnosis of pelvic pain in women: acute and chronic forms

    International Nuclear Information System (INIS)

    Speiser, P. . paul.speiser@univie.ac.at

    2001-01-01

    Acute and chronic forms of pelvic pain are symptoms of various gynaecological entities with a difficult clinical differential diagnosis. Acute pains are generally intensive attacks with a sudden onset, rapid progression, and normally short duration. Chronic pelvic pain is a continuous non-cyclic condition. Transvaginal sonography is an efficient tool to document morphologic abnormalities. Other imaging modalities, especially magnetic resonance imaging (MRI) and computed tomography (CT) are valuable to differentiate gynaecological from other abdominal causes pain. (author)

  2. CT diagnosis and differential diagnosis of the masses in lateral district of neck

    International Nuclear Information System (INIS)

    Cai Wenchong; Wei Zengcai; Li Huajie

    2006-01-01

    Objective: To analyze the CT findings and the corresponding anatomic basis of the masses arising in the lateral district of neck, and improve the diagnosis. Methods: CT findings in 52 patients with tumours in lateral district of neck, pathologically proved, were retrospectively studied on the size of the masses, morphology, density, margin, contrast enhanced characteristics, location and relationship with adjacent vessels and spaces. Results: Among the 52 cases, masses were located in the prestyloid space in 8 cases, in the parotid in 8, within the masticator space in 2, and in the carotid space in 31. In most of the cases, CT revealed the pathologic nature of the masses and adjacent anatomic structure. According to the displacement of the adjacent spaces muscles and vessels caused by the masses, the origin of the masses could be predicted. The origin of the masses was spatially related to the internal carotid artery and the jugular vein. Conclusion: CT is an effective modality for the positional diagnosis of the masses arising lateral district of neck. Considering the anatomical position and contrast enhanced characteristics and the involvement of the adjacent structure, the qualitative and differential diagnosis can be improved. (authors)

  3. Headache and facial pain: differential diagnosis and treatment.

    Science.gov (United States)

    Bernstein, Jonathan A; Fox, Roger W; Martin, Vincent T; Lockey, Richard F

    2013-01-01

    Headaches affect 90% of the population sometime during their life. Most are benign and fleeting, some are serious and life-threatening, and others require ongoing medical consultation and treatment. A careful history and physical is necessary to establish a differential diagnosis and to guide the choice of testing to make an accurate diagnosis. The most common types of headaches are discussed in this review. They are divided into primary and secondary headache disorders as classified by the International Headache Society. Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Secondary headaches are those that occur as a result of some other disorder and include brain tumors, rhinosinusitis, diseases of intracranial and extracranial vasculature, and temporomandibular joint disease. Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  4. Antenatal Hydronephrosis: Differential Diagnosis, Evaluation, and Treatment Options

    Science.gov (United States)

    Herndon, C.D. Anthony

    2006-01-01

    The diagnosis, evaluation and management of antenatal hydronephrosis has undergone a two stage paradigm shift since the advent of prenatal ultrasonography in the early 1980s. Initially the identification of a large number of asymptomatic infants appeared to afford the surgeon the opportunity for preemptive intervention. However, it has now become apparent that antenatal hydronephrosis (AH) is far more difficult to interpret thanoriginally perceived. The initial enthusiasm for surgery has now been replaced by a much more conservative approach to ureteropelvic junction(UPJ) obstruction, multi-cystic dysplastic kidney(MCDK), vesicoureteral reflux and the non-refluxing megaureter. This review will highlight the postnatal evaluation of AH and include an overview of the Society for Fetal Urology grading system for hydronephrosis. The differential diagnosis and treatment options for UPJ obstruction, vesicoureteral reflux, MCDK, duplication anomalies, megaureter, and posterior urethral valves will be discussed. PMID:17619702

  5. Differential diagnosis of mesiotemporal lesions: case report of neurosyphilis

    International Nuclear Information System (INIS)

    Vieira Santos, A.; Matias, S.; Saraiva, P.; Goulao, A.

    2005-01-01

    We report a clinical and imaging case of suspected herpes simplex encephalitis subsequently diagnosed as neurosyphilis based on positive antibodies in the CSF. MRI of the brain showed cortical and subcortical lesions in the mesial temporal region, septal area, insula and cingulated gyrus of the right cerebral hemisphere. Neurosyphilis should be included in the differential diagnosis of mesial temporal region lesions on MRI. (orig.)

  6. MassTag Polymerase Chain Reaction for Differential Diagnosis of Viral Hemorrhagic Fevers

    National Research Council Canada - National Science Library

    Palacios, Gustavo; Briese, Thomas; Kapoor, Vishal; Jabado, Omar; Liu, Zhiqiang; Venter, Marietjie; Zhai, Junhui; Renwick, Neil; Grolla, Allen; Geisbert, Thomas W; Drosten, Christian; Towner, Johnathan; Ju, Jingyue; Paweska, Janusz; Nichol, Stuart T; Swanepel, Robert; Feldmann, Heinz; Jahrling, Peter B; Lipkin, W. I

    2006-01-01

    Viral hemorrhagic fevers are associated with high rates of illness and death. Although therapeutic options are limited, early differential diagnosis has implications for containment and may aid in clinical management...

  7. 028. Migratory pneumonia—cryptogenic organizing pneumonia (COP)

    Science.gov (United States)

    Lagoudi, Kalliopi; Ioannidou, Despoina; Papadaki, Elena; Organtzis, Ioannis; Kostanta, Soultana; Papaioannou, Antonis; Moumtzi, Despoina; Porpodis, Konstantinos; Fouka, Evaggelia

    2015-01-01

    In this study were presented the clinical and laboratory findings of eight patients with migratory pneumonia, who were hospitalised in our clinic. It is about eight women with average age of 58±13 years with fever, weakness, dry cough, shortness of breath and who already had received antibiotics. Crackles were the most frequent evidence by the auscultation. All patients showed consolidation in chest radiography which resolved completely from the initial area and migrated in different areas. The chest HRCT showed opacity with air bronchogram and ground glass in places. Regarding to the respiratory function, patients showed mild restriction disorder (average values ± SD: FEV1% 83±24, FVC% 86±21, TLC% 82±16, DLco% 74±15). The average price of pO2 was 68+7 mmHg. The findings of BAL were: macrophages 51%±20%, lymphocytes 33.5%±14%, neutrophils 7.5%±3%, eosinophils 7%±8%. From diagnosis, we excluded eosinophilic pneumonia, infectious causes, collagen diseases and vasculitis. The findings of physical examination, chest radiography and the results of the BAL of all of the patients argued for Bronchiolitis obliterans organizing pneumonia (BOOP), the cause of which was not found (cryptogenic organizing pneumonia-COP). All patients responded directly to corticosteroids.

  8. Clinical case review: a method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia.

    Science.gov (United States)

    Puumalainen, Taneli; Quiambao, Beatriz; Abucejo-Ladesma, Erma; Lupisan, Socorro; Heiskanen-Kosma, Tarja; Ruutu, Petri; Lucero, Marilla G; Nohynek, Hanna; Simoes, Eric A F; Riley, Ian

    2008-07-21

    The World Health Organization's (WHO) case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies. A group of paediatricians conducted a retrospective review of clinical and laboratory data including C-reactive protein concentration and chest radiograph findings among Filipino children hospitalised in the Bohol Regional Hospital who were enrolled in a pneumococcal vaccine efficacy study and had an episode of respiratory disease fulfilling the WHO case definition for clinical pneumonia. Our aim was to evaluate which disease entities the WHO definition actually captures and what is the probable aetiology of respiratory infections among these episodes diagnosed in this population. Among the 12,194 children enrolled to the vaccine study we recorded 1,195 disease episodes leading to hospitalisation which fulfilled the WHO criteria for pneumonia. In total, 34% of these episodes showed radiographic evidence of pneumonia and 11% were classified as definitive or probable bacterial pneumonia. Over 95% of episodes of WHO-defined severe pneumonia (with chest indrawing) had an acute lower respiratory infection as final diagnosis whereas 34% of those with non-severe clinical pneumonia had gastroenteritis or other non-respiratory infection as main cause of hospitalisation. The WHO definition for severe pneumonia shows high specificity for acute lower respiratory infection and provides a tool to compare the total burden of lower respiratory infections in different settings. ISRCTN62323832.

  9. Pneumonia is an independent risk factor for pyogenic liver abscess: A population-based, nested, case-control study.

    Science.gov (United States)

    Ho, Sai-Wai; Yeh, Chao-Bin; Yang, Shun-Fa; Yeh, Han-Wei; Huang, Jing-Yang; Teng, Ying-Hock

    2017-01-01

    Bacteremic pneumonia is considered a potential cause of distal organ abscess formation. Therefore, we hypothesize that pneumonia is a risk factor for pyogenic liver abscess (PLA).The aim of this study is to explore the association between pneumonia and PLA. A nationwide, population-based, nested, case-control study was conducted using data from the Taiwan National Health Insurance Research Database. In total, 494 patients with PLA and 1,976 propensity score matched controls were enrolled. Conditional logistic regression was used to estimate adjusted odds ratios (aORs) in patients with exposure to pneumonia before PLA. After matched and adjusted for confounding factors including age, sex, urbanization, income, chronic liver disease, alcohol-related disease, biliary stone, chronic kidney disease, diabetes mellitus, chronic liver disease, and cancer, hospitalization for pneumonia remained an independent risk factor for PLA with an aORs of 2.104 [95% confidence interval (CI) = 1.309-3.379, p = 0.0021]. Moreover, the aORs were significantly higher among patients hospitalized for pneumonia within 30 days (aORs = 10.73, 95% CI = 3.381-34.054), 30-90 days (aORs = 4.698, 95% CI = 1.541-14.327) and 90-180 (aORs = 4.000, 95% CI = 1.158-13.817) days before PLA diagnosis. Pneumonia is an independent risk factor for subsequent PLA. Moreover, hospitalization for pneumonia within 180 days before PLA diagnosis was associated with an increased risk of PLA.

  10. mPneumonia, an Innovation for Diagnosing and Treating Childhood Pneumonia in Low-Resource Settings: A Feasibility, Usability and Acceptability Study in Ghana.

    Science.gov (United States)

    Ginsburg, Amy Sarah; Tawiah Agyemang, Charlotte; Ambler, Gwen; Delarosa, Jaclyn; Brunette, Waylon; Levari, Shahar; Larson, Clarice; Sundt, Mitch; Newton, Sam; Borriello, Gaetano; Anderson, Richard

    2016-01-01

    Pneumonia is the leading cause of infectious disease mortality in children. Currently, health care providers (HCPs) are trained to use World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and manually assess respiratory rate to diagnose pneumonia in low-resource settings (LRS). However, this approach of relying on clinical signs alone has proven problematic. Hypoxemia, a diagnostic indicator of pneumonia severity associated with an increased risk of death, is not assessed because pulse oximetry is often not available in LRS. To improve HCPs' ability to diagnose, classify, and manage pneumonia and other childhood illnesses, "mPneumonia" was developed. mPneumonia is a mobile health application that integrates a digital version of the IMCI algorithm with a software-based breath counter and a pulse oximeter. A design-stage qualitative pilot study was conducted to assess feasibility, usability, and acceptability of mPneumonia in six health centers and five community-based health planning and services centers in Ghana. Nine health administrators, 30 HCPs, and 30 caregivers were interviewed. Transcribed interview audio recordings were coded and analyzed for common themes. Health administrators reported mPneumonia would be feasible to implement with approval and buy-in from national and regional decision makers. HCPs felt using the mPneumonia application would be feasible to integrate into their work with the potential to improve accurate patient care. They reported it was "easy to use" and provided confidence in diagnosis and treatment recommendations. HCPs and caregivers viewed the pulse oximeter and breath counter favorably. Challenges included electricity requirements for charging and the time needed to complete the application. Some caregivers saw mPneumonia as a sign of modernity, increasing their trust in the care received. Other caregivers were hesitant or confused about the new technology. Overall, this technology was

  11. Carriage of Mycoplasma pneumoniae in the Upper Respiratory Tract of Symptomatic and Asymptomatic Children : An Observational Study

    NARCIS (Netherlands)

    Spuesens, Emiel B. M.; Fraaij, Pieter L. A.; Visser, Eline G.; Hoogenboezem, Theo; Hop, Wim C. J.; van Adrichem, Leon N. A.; Weber, Frank; Moll, Henriette A.; Broekman, Berth; Berger, Marjolein Y.; van Rijsoort-Vos, Tineke; van Belkum, Alex; Schutten, Martin; Pas, Suzan D.; Osterhaus, Albert D. M. E.; Hartwig, Nico G.; Vink, Cornelis; van Rossum, Annemarie M. C.

    Background: Mycoplasma pneumoniae is thought to be a common cause of respiratory tract infections (RTIs) in children. The diagnosis of M. pneumoniae RTIs currently relies on serological methods and/or the detection of bacterial DNA in the upper respiratory tract (URT). It is conceivable, however,

  12. Rainfall is a risk factor for sporadic cases of Legionella pneumophila pneumonia.

    Directory of Open Access Journals (Sweden)

    Carolina Garcia-Vidal

    Full Text Available It is not known whether rainfall increases the risk of sporadic cases of Legionella pneumonia. We sought to test this hypothesis in a prospective observational cohort study of non-immunosuppressed adults hospitalized for community-acquired pneumonia (1995-2011. Cases with Legionella pneumonia were compared with those with non-Legionella pneumonia. Using daily rainfall data obtained from the regional meteorological service we examined patterns of rainfall over the days prior to admission in each study group. Of 4168 patients, 231 (5.5% had Legionella pneumonia. The diagnosis was based on one or more of the following: sputum (41 cases, antigenuria (206 and serology (98. Daily rainfall average was 0.556 liters/m(2 in the Legionella pneumonia group vs. 0.328 liters/m(2 for non-Legionella pneumonia cases (p = 0.04. A ROC curve was plotted to compare the incidence of Legionella pneumonia and the weighted median rainfall. The cut-off point was 0.42 (AUC 0.54. Patients who were admitted to hospital with a prior weighted median rainfall higher than 0.42 were more likely to have Legionella pneumonia (OR 1.35; 95% CI 1.02-1.78; p = .03. Spearman Rho correlations revealed a relationship between Legionella pneumonia and rainfall average during each two-week reporting period (0.14; p = 0.003. No relationship was found between rainfall average and non-Legionella pneumonia cases (-0.06; p = 0.24. As a conclusion, rainfall is a significant risk factor for sporadic Legionella pneumonia. Physicians should carefully consider Legionella pneumonia when selecting diagnostic tests and antimicrobial therapy for patients presenting with CAP after periods of rainfall.

  13. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care

    DEFF Research Database (Denmark)

    Holm, Anette; Nexoe, Joergen; Bistrup, Lene A

    2007-01-01

    of Infectious Diseases, Odense University Hospital, Denmark. METHOD: A total of 364 adults diagnosed with community-acquired LRTI by their GP were studied with chest radiography, vital signs, biochemical markers of inflammation (C-reactive protein [CRP] and leukocyte count), and microbiological examinations......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......; this emphasises the importance of coverage of S. pneumoniae when treatment is indicated. CRP should not be introduced for diagnosis of radiographic pneumonia in general practice before its use has been investigated in prospective, controlled intervention trials using CRP-guided treatment algorithms....

  14. Significance of X-ray examination in the diagnosis of contralateral pneumonia in closed chest trauma

    International Nuclear Information System (INIS)

    Anan'ina, G.V.; Parizhskij, Z.M.; Abramova, T.T.

    1986-01-01

    It is shown that after unilateral closed chest traumas X-ray examination of both lungs should be conducted to except traumatic pneumonia as at the side of the trauma as in contralateral lung and to exclude pneumonia complications. Special attention must be paid to the patients with traumatic rib fractures and to those who has chromic nonspecific diseases of lungs and abused with alcochol

  15. [Seroprevalence of Mycoplasma pneumoniae in Poland in 2008-2013].

    Science.gov (United States)

    Kałużewski, Stanisław; Rastawicki, Waldemar

    2014-01-01

    Mycoplasma pneumoniae is a common causative agent of tracheobronchitis and atypical pneumonia, mainly in children and adolescents. The infections are often seen as epidemics occurring in autumn-winter seasons at intervals of 4-7 years. Epidemiological studies showed that M. pneumoniae is responsible for 30% to 40% of all cases of bacterial respiratory infections in Poland. The aim of the study was estimate the seroprevalence of M. pneumoniae in Poland in 2008-2013 in comparing to results obtained in other European countries. The results of diagnostic serological tests (ELISA) in particular immunoglobulin classes for infection with M. pneumoniae performed in 16.825 persons were retrospectively analyzed. The patients were mostly children at the preschool and school age with clinical symptoms of respiratory tract infection. The data were obtained from Bacteriology Department of National Institute of Public Health-National Institute of Hygiene in Warsaw and from 13 Sanitary and Epidemiological Stations through the country which send quarterly or monthly reports. The serological results showed that in autumn-winter seasons of 2011-2012 the "early antibodies" (IgA and/or IgM) for M. pneumoniae were twice more often diagnosed in sera of patients with respiratory tract infection than in analogous seasons of 2008-2010. The antibodies were detected in 34% and 42% of patients, respectively in third quarter of 2011 and 2012. Epidemic increase of M. pneumoniae infections in Poland in autumn-winter seasons of 2011-2012 was mainly observed due to diagnosis of the IgA and/or IgM antibodies in serological tests.

  16. Common recessive limb girdle muscular dystrophies differential diagnosis: why and how?

    Directory of Open Access Journals (Sweden)

    Ana Cotta

    2014-09-01

    Full Text Available Limb girdle muscular dystrophies are heterogeneous autosomal hereditary neuromuscular disorders. They produce dystrophic changes on muscle biopsy and they are associated with mutations in several genes involved in muscular structure and function. Detailed clinical, laboratorial, imaging, diagnostic flowchart, photographs, tables, and illustrated diagrams are presented for the differential diagnosis of common autosomal recessive limb girdle muscular dystrophy subtypes diagnosed nowadays at one reference center in Brazil. Preoperative image studies guide muscle biopsy site selection. Muscle involvement image pattern differs depending on the limb girdle muscular dystrophy subtype. Muscle involvement is conspicuous at the posterior thigh in calpainopathy and fukutin-related proteinopathy; anterior thigh in sarcoglycanopathy; whole thigh in dysferlinopathy, and telethoninopathy. The precise differential diagnosis of limb girdle muscular dystrophies is important for genetic counseling, prognostic orientation, cardiac and respiratory management. Besides that, it may probably, in the future, provide specific genetic therapies for each subtype.

  17. Thallium 201 thyroid scan: differential diagnosis of benign and malignant nodules

    International Nuclear Information System (INIS)

    Oh, Jong Sub; Kim, Byong Geun; Park, Byung Ran; Kim, Se Jong; Ko, Kang Seok; Kim, Min Joong; Ji, Joo Yun

    1995-01-01

    To evaluate useful findings and diagnostic value of TI-201 thyroid scan in differentiating benign from malignant nodules. We studied 77 cold thyroid nodules proven histologically(27 malignant and 50 benign). Early (5-15 min) and delayed images(3-5 hours) were obtained after intravenous injection of thallium 201. In these nodules, we retrospectively analyzed the degree of TI-201 uptake in early and delayed images, histopathologic type, size, and presence or absence of cystic change in the sonograms of 22 malignant nodules. Useful finding for diagnosis of malignant nodules was strong uptake of TI-201 in early and delayed images(specificity: 98%, sensitivity: 63%, positive predictive value: 94.4%). Useful finding for benign nodules was no uptake of TI-201 in delayed image(specificity: 88.9%, sensitivity: 68%, positive predictive value: 91.9%). The accuracy of TI-201 thyroid scan in differentiating benign from malignant nodules was 66.2%. The nodules with strong TI-201 uptake in early image and low TI-201 uptake in delayed image were malignant in 29.4%. Cystic changes were found in 40% of malignant nodules with atypical TI-201 uptake. TI-201 thyroid scan showed high specificity in follicular neoplasm and adenomatous goiter in which differentiation of benignancy and malignancy is difficult with only cytologic examination. We consider that TI-201 thyroid scan is valuable in differentiating benign from malignant nodules and when combined with fine needle aspiration and ultrasound examination, it will enable more accurate differential diagnosis between benign and malignant thyroid nodules

  18. Pneumocystis carinii pneumonia in systemic lupus erythematosus: a report of two cases.

    Science.gov (United States)

    Tsai, H C; Lee, S S; Lin, H H; Lu, L Y; Liu, Y C

    2001-10-01

    Patients with systemic lupus erythematosus (SLE) have increased susceptibility to infection by Pneumocystis carinii, but this condition has rarely been reported in Taiwan. Here, we describe two cases of patients with SLE who developed Pneumocystis carinii pneumonia (PCP). The first patient was a 39-year-old woman presenting with fever and dyspnea that had lasted 2 weeks. Chest roentgenography disclosed bilateral interstitial and alveolar infiltrates. The second patient was a 22-year-old woman presenting with a 4-day history of malaise, cough, dyspnea, and fever. She had concomitant Mycobacterium tuberculosis infection. Both patients had been treated with varying doses of corticosteroids and/or cytotoxic drugs within 4 months before presentation. Diagnosis was established based on the findings of bronchoalveolar lavage (BAL) and transbronchial lung biopsy (TBLB). Both patients received trimethoprim-sulfamethoxazole (20 mg.kg-1.d-1 trimethoprim), but finally died of nosocomial septicemia (Acinetobacter baumanni and Pseudomonas aeruginosa bacteremia in one, P. aeruginosa bacteremia in the other). These two cases demonstrate that PCP should be included in the differential diagnosis of patients with SLE presenting with pneumonic processes. In addition, a second opportunistic pathogen should be suspected. Bronchoscopic examination should be performed if the diagnosis is not clear and should include TBLB and BAL.

  19. Differential Diagnosis of the pancreatic disease : significance of perivascular changes at celiac trunk and superior mesenteric artery on CT

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Ryang; Kim, Ki Whang; Yu, Jeong Sik; Kim, Ji Hyung; Kim, Dong Guk; Lee, Sung Il; Ahn, Chang Soo; Oh, Sei Jung [Yonsei Univ., Seoul (Korea, Republic of). Coll. of Medicine; Kim, Young Hwan [Sanggye Paik Hospital, Seoul (Korea, Republic of)

    1998-03-01

    The purpose of this paper is to classify perivascular change in the celiac trunk and SMA occurring in pancreatic disease and to evaluate its significance in differential diagnosis. In 73 patients with pancreatic disease (42, acute pancreatitis; 14, chronic pancreatitis; 17, pancreatic cancer) abdominal CT findings were retrospectively reviewed. We defined infiltration as linear or irregular density and thickening as presence of a soft tissue mantle surrounding the vessel, and statistically evaluated the usefulness of these factors for the differential diagnosis of pancreatic diseases. Thickening of the celiac trunk and SMA is a valuable finding in the differential diagnosis of pancreatic inflammatory disease and pancreatic cancer. When applied to the differential diagnosis of pancreatic disease, perivascular change should be classified as either infiltration or thickening. (author). 10 refs., 1 tab., 2 figs.

  20. Differential Diagnosis of the pancreatic disease : significance of perivascular changes at celiac trunk and superior mesenteric artery on CT

    International Nuclear Information System (INIS)

    Kwon, Ryang; Kim, Ki Whang; Yu, Jeong Sik; Kim, Ji Hyung; Kim, Dong Guk; Lee, Sung Il; Ahn, Chang Soo; Oh, Sei Jung

    1998-01-01

    The purpose of this paper is to classify perivascular change in the celiac trunk and SMA occurring in pancreatic disease and to evaluate its significance in differential diagnosis. In 73 patients with pancreatic disease (42, acute pancreatitis; 14, chronic pancreatitis; 17, pancreatic cancer) abdominal CT findings were retrospectively reviewed. We defined infiltration as linear or irregular density and thickening as presence of a soft tissue mantle surrounding the vessel, and statistically evaluated the usefulness of these factors for the differential diagnosis of pancreatic diseases. Thickening of the celiac trunk and SMA is a valuable finding in the differential diagnosis of pancreatic inflammatory disease and pancreatic cancer. When applied to the differential diagnosis of pancreatic disease, perivascular change should be classified as either infiltration or thickening. (author). 10 refs., 1 tab., 2 figs

  1. Gram staining of protected pulmonary specimens in the early diagnosis of ventilator-associated pneumonia.

    Science.gov (United States)

    Mimoz, O; Karim, A; Mazoit, J X; Edouard, A; Leprince, S; Nordmann, P

    2000-11-01

    We evaluated prospectively the use of Gram staining of protected pulmonary specimens to allow the early diagnosis of ventilator-associated pneumonia (VAP), compared with the use of 60 bronchoscopic protected specimen brushes (PSB) and 126 blinded plugged telescopic catheters (PTC) obtained from 134 patients. Gram stains were from Cytospin slides; they were studied for the presence of microorganisms in 10 and 50 fields by two independent observers and classified according to their Gram stain morphology. Quantitative cultures were performed after serial dilution and plating on appropriate culture medium. A final diagnosis of VAP, based on a culture of > or = 10(3) c.f.u. ml-1, was established after 81 (44%) samplings. When 10 fields were analysed, a strong relationship was found between the presence of bacteria on Gram staining and the final diagnosis of VAP (for PSB and PTC respectively: sensitivity 74 and 81%, specificity 94 and 100%, positive predictive value 91 and 100%, negative predictive value 82 and 88%). The correlation was less when we compared the morphology of microorganisms observed on Gram staining with those of bacteria obtained from quantitative cultures (for PSB and PTC respectively: sensitivity 54 and 69%, specificity 86 and 89%, positive predictive value 72 and 78%, negative predictive value 74 and 84%). Increasing the number of fields read to 50 was associated with a slight decrease in specificity and positive predictive value of Gram staining, but with a small increase in its sensitivity and negative predictive value. The results obtained by the two observers were similar to each other for both numbers of fields analysed. Gram staining of protected pulmonary specimens performed on 10 fields predicted the presence of VAP and partially identified (using Gram stain morphology) the microorganisms growing at significant concentrations, and could help in the early choice of the treatment of VAP. Increasing the number of fields read or having the Gram

  2. [Differential diagnosis in potency disorders].

    Science.gov (United States)

    Kockott, G; Dittmar, F

    1976-12-02

    Disorders of sexual libido are seldom organic, in general they are of psychological origin. It is, however, difficult to obtain a differential diagnosis. One of the first diagnostic considerations must be the establishment of primary or secondary libidinal dificit, or indeed, whether there is no libido at all. In cases of libido disorders with primary libido dificit, depression, organic disease, or side effects of pharmaca may be the cause. Libido disorders in the presence of functional libido, however, must be regarded as primarily psychologically caused. An exception are libido problems in the presence of diabetes mellitus and peripheral vasculatory defeciencies. In these cases libido is either totally absent or appears only secondarily. The symptomatology of libido disorders in the presence of depression, diabetes melitus, and peripheral vasculatory disturbancies, as well as psychologically caused erectile and ejaculatory difficulties are discussed in detail. These groups are compared with respect to libido and behavior involving erection, ejaculation, anxiety and avoidance.

  3. Differential diagnosis of radiation injury

    Energy Technology Data Exchange (ETDEWEB)

    Wendt, F

    1971-04-01

    A single haematological alteration is not sufficient to diagnose whether it is a radiation-induced change or not. For the differential diagnosis of possibly radiation-induced changes in the peripheral blood and blood-forming organs, information on the radiation exposure in terms of time, quality, quantity and localization, and the clinical symptoms have to be taken into account. Ionizing radiation within the dosage range considered here produces cell division delay, mitotic inhibition, chromosomal damage or interphase cell death; it thereby interferes with the steady-state equilibria in the cell-renewal systems of the organism (Bond et al., 1965; Little, 1968). The cause of haematological changes appearing immediately after a short-term, external whole-body radiation exposure has been described and analysed elsewhere in this Manual. The critical cell component is the 'stem cell compartment' which is highly radiosensitive and suffers damage but, because stem cells cannot be identified morphologically, a direct study of stem cell injury is not possible.

  4. Laser Raman detection of platelet as a non-invasive approach for early and differential diagnosis of Alzheimer's disease

    International Nuclear Information System (INIS)

    Chen, P; Wang, X H; Cheng, Y; Peng, J; Shen, A G; Hu, J M; Tian, Q; Shang, X L; Liu, Z C; Yao, X Q; Wang, J Z; Baek, S J; Park, A

    2011-01-01

    Early and differential diagnosis of Alzheimer's disease (AD) is a problem that puzzled many doctors. Reliable markers in easy-assembling samples are of considerable clinical diagnostic value. In this work, laser Raman spectroscopy (LRS) was developed a new method that potentially allows early and differential diagnosis of AD from the platelet sample. Raman spectra of platelets isolated from different ages of AD transgenic mice and non-transgenic controls were collected and analyzed. Multilayer perceptron networks (MLP) classification method was used to classify spectra and establish the diagnostic models. For differential diagnosis, spectra of platelets isolated from AD, Parkinson's disease (PD) and vascular dementia (VD) mice were also discriminated. Two notable spectral differences at 740 and 1654 cm -1 were revealed in the mean spectrum of platelets isolated from AD transgenic mice and the controls. MLP displayed a powerful ability in the classifying of early, advanced AD and the control group, and in differential diagnosis of PD and advanced AD, as well as VD and advanced AD. The results suggest that platelet detecting by LRS coupled with MLP analysis appears to be an easy and accurate method for early and differential diagnosis of AD. This technique could be rapidly promoted from laboratory to the hospital

  5. Pneumomediastinum and Pneumothorax Associated with Herpes Simplex Virus (HSV) Pneumonia.

    Science.gov (United States)

    López-Rivera, Fermín; Colón Rivera, Xavier; González Monroig, Hernán A; Garcia Puebla, Juan

    2018-01-30

    BACKGROUND Pneumonia is one of the most common causes of death from infectious disease in the United States (US). Although most cases of community-acquired pneumonia (CAP) are secondary to bacterial infection, up to one-third of cases are secondary to viral infection, most commonly due to rhinovirus and influenza virus. Pneumonia due to herpes simplex virus (HSV) is rare, and there is limited knowledge of the pathogenesis and clinical complications. This report is of a fatal case of HSV pneumonia associated with bilateral pneumothorax and pneumomediastinum. CASE REPORT A 36-year-old homeless male Hispanic patient, who was a chronic smoker, with a history of intravenous drug abuse and a medical history of chronic hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, not on highly active antiretroviral therapy (HAART), was admitted to hospital as an emergency with a seven-day history of productive purulent cough. The patient was admitted to the medical intensive care unit (MICU) with a diagnosis of CAP, with intubation and mechanical ventilation. Broncho-alveolar lavage (BAL) was performed and was positive for HSV. The patient developed bilateral pneumothorax with pneumomediastinum, which was fatal, despite aggressive clinical management. CONCLUSIONS Pneumonia due to HSV infection is uncommon but has a high mortality. Although HSV pneumonia has been described in immunocompromised patients, further studies are required to determine the pathogenesis, early detection, identification of patients who are at risk and to determine the most effective approaches to prophylaxis and treatment for HSV pneumonia.

  6. Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings

    International Nuclear Information System (INIS)

    Laurent, F.; Philippe, J.C.; Vergier, B.; Granger-Veron, B.; Darpeix, B.; Vergeret, J.; Blanc, P.; Velly, J.F.

    1999-01-01

    The objective of this study was to describe high-resolution CT (HRCT) and MR findings of exogenous lipoid pneumonia and to correlate them with pathologic findings. A retrospective review of the medical records of our institution revealed seven patients with a diagnosis of lipoid pneumonia based on clinical data, chest films, bronchoalveolar lavage, and follow-up. Both HRCT and MR imaging were reviewed by two readers. Pathologic examination of the resected specimen or surgical biopsies were also reviewed in the four available cases. The HRCT findings were pulmonary consolidations (n = 6) with fatty (n = 3) or unspecific but low attenuation values (n = 3), areas of ground-glass opacities (n = 5), septal lines, and centrilobular interstitial thickening (n = 5). In five of the seven cases, a crazy-paving pattern of various spread was also present, either isolated (n = 1) or surrounding a pulmonary consolidation. In two cases traction bronchiectasis and cystic changes consistent with fibrosis were seen. At MR imaging (n = 2) a pulmonary consolidation of high signal intensity on T1-weighted image consistent with lipid content was present in one case. Pathologic examination (n = 4) showed the coexistence of lobules with lesions of various ages, sometimes in contiguous lobules, within the same patient. Recent lesions were those with alveolar fill-in by spumous macrophages and almost normal alveolar walls and septae. In more advanced lesions, lobules were filled in with larger vacuoles often surrounded by inflammatory infiltrates of alveolar walls, bronchiolar walls, and septa. The oldest lesions were characterized by fibrosis and parenchymal distortion around large lipid-containing vacuoles. The HRCT findings reflect pathologic findings in exogenous lipoid pneumonia. Although non-specific, consolidation areas of low attenuation values and crazy-paving pattern are frequently associated in exogenous lipoid pneumonia and are indicative of the diagnosis. (orig.)

  7. Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia.

    Science.gov (United States)

    Claessens, Yann-Erick; Debray, Marie-Pierre; Tubach, Florence; Brun, Anne-Laure; Rammaert, Blandine; Hausfater, Pierre; Naccache, Jean-Marc; Ray, Patrick; Choquet, Christophe; Carette, Marie-France; Mayaud, Charles; Leport, Catherine; Duval, Xavier

    2015-10-15

    Clinical decision making relative to community-acquired pneumonia (CAP) diagnosis is difficult. Chest radiograph is key in establishing parenchymal lung involvement. However, radiologic performance may lead to misdiagnosis, rendering questionable the use of chest computed tomography (CT) scan in patients with clinically suspected CAP. To assess whether early multidetector chest CT scan affects diagnosis and management of patients visiting the emergency department with suspected CAP. A total of 319 prospectively enrolled patients with clinically suspected CAP underwent multidetector chest CT scan within 4 hours. CAP diagnosis probability (definite, probable, possible, or excluded) and therapeutic plans (antibiotic initiation/discontinuation, hospitalization/discharge) were established by emergency physicians before and after CT scan results. The adjudication committee established the final CAP classification on Day 28. Chest radiograph revealed a parenchymal infiltrate in 188 patients. CAP was initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), and excluded in 4 (1.2%). CT scan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest radiograph and excluded CAP in 56 (29.8%) of the 188 with parenchymal infiltrate on radiograph. CT scan modified classification in 187 (58.6%; 95% confidence interval, 53.2-64.0), leading to 50.8% definite CAP and 28.8% excluded CAP, and 80% of modifications were in accordance with adjudication committee classification. Because of CT scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalization was decided in 22 and discharge in 23. In CAP-suspected patients visiting the emergency unit, early CT scan findings complementary to chest radiograph markedly affect both diagnosis and clinical management. Clinical trial registered with www.clinicaltrials.gov (NCT 01574066).

  8. Pneumonia pada Anak Balita di Indonesia

    Directory of Open Access Journals (Sweden)

    Athena Anwar

    2014-05-01

    Full Text Available Pneumonia adalah penyakit infeksi yang merupakan penyebab utama kematian pada balita di dunia. Riset Kesehatan Dasar (Riskesdas tahun 2007 melaporkan bahwa kematian balita di Indonesia mencapai 15,5%. Penelitian ini bertujuan untuk mengidentifikasi faktor determinan terjadinya pneumonia pada balita di Indonesia. Desain penelitian ini adalah potong lintang dengan menggunakan data Riskesdas 2013. Kriteria sampel adalah balita (0 – 59 bulan yang menjadi responden Riskesdas 2013. Variabel dependen adalah kejadian pneumonia balita, sedangkan variabel independennya adalah karakteristik individu, lingkungan fisik rumah, perilaku penggunaan bahan bakar, dan kebiasaan merokok. Penetapan kejadian pneumonia berdasarkan hasil wawancara, dengan batasan operasional diagnosis pneumonia oleh tenaga kesehatan dan/atau dengan gejala pneumonia dalam periode 12 bulan terakhir. Jumlah sampel yang memenuhi kriteria adalah 82.666 orang. Hasil menunjukkan bahwa faktor risiko yang paling berperan dalam kejadian pneumonia balita adalah jenis kelamin balita (OR = 1,10; 95% CI = 1,02 - 1,18, tipe tempat tinggal (OR = 1,15; 95% CI = 1,06 – 1,25, pendidikan ibu (OR = 1,20; 95% CI = 1,11 – 1,30, tingkat ekonomi keluarga/kuintil indeks kepemilikan (OR = 1,19; 95% CI = 1,10 – 1,30, pemisahan dapur dari ruangan lain (OR = 1,19; 95% CI = 1,05 – 1,34, keberadan/kebiasaan membuka jendela kamar (OR = 1,17; 95% CI = 1,04 – 1,31, dan ventilasi kamar yang cukup (OR = 1,16; 95% CI = 1,04 – 1,30. Disimpulkan bahwa faktor sosial, demografi, ekonomi dan kondisi lingkungan fisik rumah secara bersama-sama berperan terhadap kejadian pneumonia pada balita di Indonesia. Pneumonia is an infectious disease which is a major cause of mortality in children under five years of age in the world. National Basic Health Research 2007 reported that infant mortality in Indonesia has reached 15.5%. The objective of the study was to identify the determinant factors related to the incidence of

  9. Clinical case review: A method to improve identification of true clinical and radiographic pneumonia in children meeting the World Health Organization definition for pneumonia

    Directory of Open Access Journals (Sweden)

    Ruutu Petri

    2008-07-01

    Full Text Available Abstract Background The World Health Organization's (WHO case definition for childhood pneumonia, composed of simple clinical signs of cough, difficult breathing and fast breathing, is widely used in resource poor settings to guide management of acute respiratory infections. The definition is also commonly used as an entry criteria or endpoint in different intervention and disease burden studies. Methods A group of paediatricians conducted a retrospective review of clinical and laboratory data including C-reactive protein concentration and chest radiograph findings among Filipino children hospitalised in the Bohol Regional Hospital who were enrolled in a pneumococcal vaccine efficacy study and had an episode of respiratory disease fulfilling the WHO case definition for clinical pneumonia. Our aim was to evaluate which disease entities the WHO definition actually captures and what is the probable aetiology of respiratory infections among these episodes diagnosed in this population. Results Among the 12,194 children enrolled to the vaccine study we recorded 1,195 disease episodes leading to hospitalisation which fulfilled the WHO criteria for pneumonia. In total, 34% of these episodes showed radiographic evidence of pneumonia and 11% were classified as definitive or probable bacterial pneumonia. Over 95% of episodes of WHO-defined severe pneumonia (with chest indrawing had an acute lower respiratory infection as final diagnosis whereas 34% of those with non-severe clinical pneumonia had gastroenteritis or other non-respiratory infection as main cause of hospitalisation. Conclusion The WHO definition for severe pneumonia shows high specificity for acute lower respiratory infection and provides a tool to compare the total burden of lower respiratory infections in different settings. Trial registration ISRCTN62323832

  10. Postoperative pneumonia among patients with and without COPD in Spain from 2001 to 2015.

    Science.gov (United States)

    de Miguel-Díez, Javier; López-de-Andrés, Ana; Hernández-Barrera, Valentín; Jiménez-Trujillo, Isabel; Méndez-Bailón, Manuel; de Miguel-Yanes, José María; Jiménez-García, Rodrigo

    2018-02-13

    To describe and compare incidence, characteristics and outcomes of postoperative pneumonia among patients with or without COPD. We included hospitalized patients aged ≥40 years whose medical diagnosis included pneumonia and ventilator-associated pneumonia in the secondary's diagnosis field and who were discharged from Spanish hospitals from 2001 to 2015. Irrespectively of the position at the procedures coding list, we retrieved data about the type of surgical procedures using the enhanced ICD-9-CM codes. We grouped admissions by COPD status. The data were collected from the National Hospital Discharge Database. We included 117,665 hospitalizations of patients that developed postoperative pneumonia (18.06% of them had COPD). The incidence of postoperative pneumonia was significantly higher in COPD patients than in those without COPD (IRR 1.93, 95%CI 1.68-2.24). In hospital-mortality (IHM) was significantly lower in the first group of patients (29.79% vs 31.43%, p patients, were older age, more comorbidities, mechanical ventilation, pleural drainage tube, red blood cell transfusion, dialysis and emergency room admission. Time trend analysis showed a significant decrease in IHM from 2001 to 2015. COPD was associated with lower IHM (OR 0.91, 95%CI 0.88-0.95). The incidence of postoperative pneumonia was higher in COPD patients than in those without this disease. However, IHM was lower among COPD patients. IHM decreased over time, regardless of the existence or not of COPD. Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  11. Climate variability and nonstationary dynamics of Mycoplasma pneumoniae pneumonia in Japan.

    Science.gov (United States)

    Onozuka, Daisuke; Chaves, Luis Fernando

    2014-01-01

    A stationary association between climate factors and epidemics of Mycoplasma pneumoniae (M. pneumoniae) pneumonia has been widely assumed. However, it is unclear whether elements of the local climate that are relevant to M. pneumoniae pneumonia transmission have stationary signatures of climate factors on their dynamics over different time scales. We performed a cross-wavelet coherency analysis to assess the patterns of association between monthly M. pneumoniae cases in Fukuoka, Japan, from 2000 to 2012 and indices for the Indian Ocean Dipole (IOD) and El Niño Southern Oscillation (ENSO). Monthly M. pneumoniae cases were strongly associated with the dynamics of both the IOD and ENSO for the 1-2-year periodic mode in 2005-2007 and 2010-2011. This association was non-stationary and appeared to have a major influence on the synchrony of M. pneumoniae epidemics. Our results call for the consideration of non-stationary, possibly non-linear, patterns of association between M. pneumoniae cases and climatic factors in early warning systems.

  12. Pneumonia (For Parents)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Pneumonia KidsHealth / For Parents / Pneumonia What's in this article? ... the Doctor? Print en español Neumonía What Is Pneumonia? Pneumonia is an infection of the lungs . The ...

  13. Hepatobiliary gammagraphy and its importance for differential diagnosis of mechanic and hepatocellular jaundice

    International Nuclear Information System (INIS)

    Takacs, J.

    1983-01-01

    The reliability of hepatobiliary gammagraphy following sup(99m)Tc-EHIDA administration and its variations with the concentration of the total plasma bilirubin were assessed in 155 hepatitis patients in whom differential diagnosis was performed for mechanical or hepatocellular jaundice. In mechanical jaundice (28 patients), sensitivity of the method was 75.8%, specificity 95.9%, diagnostic accuracy 90.9%. In hepatocellular jaundice (127 patients) the respective values were 95.9%, 90.3%, 94.8%. The differential diagnosis reliability was found to decrease with the increasing level of total bilirubin. For a level of up to 21.5 μmol/l, diagnostic accuracy was 93.6%, for a level between 21.6 and 85.5 μmol/l it was 91.0%, from 85.6 to 171.0 μmol/l it was 66.6%, from 171.1 to 242.0 μmol/l it was 50.0%, and above 242.0 μmol/l, diagnostic accuracy was 28.5%. At the same time, the sensitivity and specificity of examination decreased with increasing bilirubin level. In respect of differential diagnosis of jaundice, a concentration of the total plasma bilirubin of 242.O μmol/l is considered to be the limit concentration. (author)

  14. Radiation-Induced Organizing Pneumonia: A Characteristic Disease that Requires Symptom-Oriented Management.

    Science.gov (United States)

    Otani, Keisuke; Seo, Yuji; Ogawa, Kazuhiko

    2017-01-27

    Radiation-induced organizing pneumonia (RIOP) is an inflammatory lung disease that is occasionally observed after irradiation to the breast. It is a type of secondary organizing pneumonia that is characterized by infiltrates outside the irradiated volume that are sometimes migratory. Corticosteroids work acutely, but relapse of pneumonia is often experienced. Management of RIOP should simply be symptom-oriented, and the use of corticosteroids should be limited to severe symptoms from the perspective not only of cost-effectiveness but also of cancer treatment. Once steroid therapy is started, it takes a long time to stop it due to frequent relapses. We review RIOP from the perspective of its diagnosis, epidemiology, molecular pathogenesis, and patient management.

  15. Radiological findings and differential diagnosis in childhood asthma

    International Nuclear Information System (INIS)

    Faerber, D.; Bauer, C.P.; Hahn, H.

    1990-01-01

    In children with asthma, routine chest X-ray typically shows bilaterally increased air volume, low diaphragms, wide diaphragmatic angles, and often a slender cardiac silhouette with a prominent pulmonic arch. Such an X-ray is not diagnostic of asthma itself, however, but rather of its complications: pneumonitis (particularly in toddlers with infectious asthma), atelectasis due to mucus obstruction, and, rarely, extra-alveolar air trapping (pneumomediastinum with or without cutaneous emphysema more often than pneumothorax). The differential diagnosis has to rule out 'pseudoasthma' due to cystic fibrosis, alveolitis, achalasia, and foreign body aspiration. (orig.) [de

  16. Advances in the causes and management of community acquired pneumonia in adults.

    Science.gov (United States)

    Wunderink, Richard G; Waterer, Grant

    2017-07-10

    Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of what causes community acquired pneumonia, especially the role of viral pathogens and the frequent finding of multiple pathogens. The past decade has seen increasing overuse of empiric coverage of meticillin resistant Staphylococcus aureus and antibiotic resistant Gram negative pathogens owing to inappropriate application of guidelines for healthcare associated pneumonia. Optimal treatment remains a matter for debate, especially in very sick patients, including the role of combination antibiotic therapy and corticosteroids. Pneumonia care bundles are being defined to improve outcomes. Increased recognition of both acute and long term cardiac complications is shifting our concept of pneumonia from an acute lung disease to a multisystem problem with adverse chronic health consequences. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Radiographic and HRCT findings of pneumocystis carinii pneumonia

    International Nuclear Information System (INIS)

    Heo, Jin Sam; Kim, Kun Il; Kim, Chang Won; Park, Soon Kew; Cho, Goon Jae

    1999-01-01

    (n=4), and consolidation(n=3). Although ground-glass opacity in both pure Pneumocystis carinii pneumonia and this same condition combined with other lung diseases is a common radiologic findings, the possibility of variable radiologic findings in cases of Pneumocystis carinii pneumonia and other lung diseases with which it frequently combines is essential for approximate diagnosis of Pneumocystis carinii pneumonia

  18. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients.

    Science.gov (United States)

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, P<0.0005). Highly similar differences were observed between microbiota profiles of young adult pneumonia patients and their healthy controls. Clustering resulted in 11 (sub)clusters including 95% (386/405) of samples. We observed three microbiota profiles strongly associated with pneumonia (P<0.05) and either dominated by lactobacilli (n=11), Rothia (n=51) or Streptococcus (pseudo)pneumoniae (n=42). In contrast, three other microbiota clusters (in total n=183) were correlated with health (P<0.05) and were all characterized by more diverse profiles containing higher abundances of especially Prevotella melaninogenica, Veillonella and Leptotrichia. For the remaining clusters (n=99), the association with health or disease was less clear. A decision tree model based on the relative abundance of five bacterial community members in URT microbiota showed high specificity of 95% and sensitivity of 84% (89% and 73%, respectively, after cross-validation) for differentiating pneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with

  19. Extragastrointestinal Stromal Tumor: A Differential Diagnosis of Compressive Upper Abdominal Tumor

    Directory of Open Access Journals (Sweden)

    Clara Kimie Miyahira

    2018-01-01

    Full Text Available Introduction. Extragastrointestinal stromal tumors (EGIST are rare mesenchymal tumor lesions located outside the gastrointestinal tract. A rare compressing tumor with difficult diagnosis is reported. Presentation of the Case. A male patient, 63 years old, was admitted in the emergency room complaining of stretching and continuous abdominal pain for one day. He took Hyoscine, with partial improvement of symptoms, but got worse due to hyporexia, and the abdominal pain persisted. The patient also reported early satiety and ten-pound weight loss over the last month. Discussion. EGIST could be assessed by CT-guided biopsy, leading to diagnosis and proper treatment with surgical resection or Imatinib. Conclusion. This case report highlights the importance of considering EGIST an important differential diagnosis of compressing upper abdominal tumors.

  20. MR findings of lipoid pneumonia: report of two cases

    International Nuclear Information System (INIS)

    Seo, Jung Wook; Cho, Eun Ok; Kim, Joung Sook; Hur, Gham

    1995-01-01

    Exogenous lipoid pneumonia is an unusual disease resulting from aspiration of oil particles. A history of oil ingestion strongly suggests the diagnosis, but the radiological presentation varies from mild perihilar consolidation to diffuse and extensive bilateral involvement, particularly of the posterior basal segment of both lower lung. Since magnetic resonance (MR) provides greater contrast resolution than CT, it offers the potential for tissue characterization. In particular, fatty tissue and lipid containing substances are known to have high signal intensities on T1-and T2-weighted spin-echo (SE) images. We report MR findings in two case of exogenous lipoid pneumonia caused by ingestion of shark liver oil (Squalene)

  1. Rocking pneumonia

    OpenAIRE

    Rijkers, Ger T.; Rodriguez Gomez, Maria

    2017-01-01

    Ever since Chuck Berry coined the term “rocking pneumonia” in his 1956 song “Roll over Beethoven”, pneumonia has been mentioned frequently in modern blues and rock songs. We analyzed the lyrics of these songs to examine how various elements of pneumonia have been represented in popular music, specifically the cause of pneumonia, the risk groups, comorbidity (such as the boogie woogie flu), the clinical symptoms, and treatment and outcome. Up to this day, songwriters suggest that pneumonia is ...

  2. Pneumonia and wheezing in the first year: An international perspective.

    Science.gov (United States)

    Garcia-Marcos, Luis; Mallol, Javier; Solé, Dirceu; Brand, Paul L P; Martinez-Torres, Antonela; Sanchez-Solis, Manuel

    2015-12-01

    The relationship between pneumonia and recurrent wheezing (RW) and the factors associated to pneumonia in wheezing and non-wheezing infants have not been compared between affluent and non-affluent populations. The International Study of Wheezing in Infants (EISL) is a large population-based cross-sectional study carried out in Latin America (LA) and Europe (EU). We used a validated questionnaire for identifying wheeze in the first year of life. The questionnaire also inquired about pneumonia diagnosis, together with other potentially related factors. Associations between both conditions and between potential risk/protective factors for pneumonia were tested by random-effects logit model and adjusting for all factors found previously associated to RW in this cohort. Pneumonia and RW were strongly associated to each other in LA and EU (aOR 5.42; 95%CI: 4.87-6.04 and aOR 13.99; 95%CI: 9.61-20.36, respectively). Infant eczema was the most consistent risk factor of pneumonia in both continents, in the whole population and also among wheezers and non-wheezers (aOR ranging from 1.30; 95%CI: 1.11-1.52 to 2.65; 95%CI: 1.68-4.18); while breast feeding for at least 3 months was the most consistent protective factor (aOR ranging from 0.60; 95%CI: 0.51-0.71 to 0.76; 95%CI: 0.69-0.84). Factors associated to pneumonia were similar between continents among wheezers, but differed considerably among non-wheezers. Pneumonia and RW are associated conditions sharing many risk/protective factors in EU and LA among wheezing infants, but not among non-wheezing infants. The association between pneumonia and RW could be due to shared pathophysiology or by diagnostic confusion between the two conditions. © 2015 Wiley Periodicals, Inc.

  3. Signs and symptoms indicative of community-acquired pneumonia in infants under six months

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Bazhuni Pombo March

    Full Text Available OBJECTIVE: Evaluation of the clinical signs and symptoms predicting bacterial and viral pneumonia, in accordance with the Brazilian National Control Program for Acute Respiratory (ARI. METHODS: Observational prospective study. Seventy-six children from birth to six months of age who had pneumonia were studied in the emergency room. The patients were subdivided into two groups, based on radiological findings (gold-standard: 47 had bacterial pneumonia, and 29 had viral pneumonia. The frequencies, sensitivities, and specificities of the signs and symptoms were evaluated. RESULTS: The sensibilities and sensitivities of general findings in bacterial pneumonia were, respectively: fever 53.2%/40.0%; hypoactivity 68.4%/55.6% and prostration detected by the doctor 72.7%/55.0%. The same findings in viral pneumonias showed, respectively: 37.9%/40.0%, 66.7%/55.6% and 66.7%/55.6%. The sensibilities and sensitivities of respiratory findings in bacterial pneumonia were, respectively: coughing 66.0/38.1%, Respiratory rate = 50 ripm 76.6%/38.1%, altered respiratory auscultation 91.3%/10.5%, and chest indrawing 46.7%/80.0%. The same findings in viral pneumonias were, respectively: 69.0%/38.1%, 86.2%/38.1%, 85.7%/10.5% and 44.8%/80.0%. CONCLUSION: Analysis of signs and symptoms in each group did not distinguish bacterial from viral pneumonia. Our findings reinforce the adequacy of the ARI program in Brazil, which gives an early diagnosis of pneumonia, independent of its etiology.

  4. Ulno-volar bayonet hand: Its differential diagnosis from Madelung's deformity

    International Nuclear Information System (INIS)

    Christ, F.

    1981-01-01

    The ulno-volar bayonet hand related to the mostly hereditary multiple exostoses is compared to Madelung's forearm deformity under clinical and roentgenological view in differential diagnosis. The ulno-volar bayonet hand is considerably more seldom, basing upon dysplasia of the lower part of the ulna, less inconvenient in function, and hardly tending to the development of early arthrosis. (orig.) [de

  5. Basic pattern in CT of the lung and differential diagnosis

    International Nuclear Information System (INIS)

    Jacobi, V.; Thalhammer, A.

    2006-01-01

    Infectious, physical, chemical or other noxae elicit a limited number of reactions in lung tissue. As in the case of other organs and tissues, lung tissue has specific reactions that are often more indicative of the particular organ than the harmful agent. The resulting radiological features are usually ambiguous and therefore prevent definitive diagnosis. This complicates etiological categorization of the disease. Pathognomonic findings are rare. The same noxa can yield different radiographic features and clinical pictures for different patients. A diagnosis is generally not comprised of a single radiographic feature, but rather of a combination of a plurality of features. Although the number of possible diagnoses can be limited via radiological means, a final diagnosis is determined in conjunction with the medical history, the clinical picture, as well as lab and histopathological values. This article defines the most common pulmonary changes and also discusses differential diagnostic criteria. (orig.)

  6. Climate variability and nonstationary dynamics of Mycoplasma pneumoniae pneumonia in Japan.

    Directory of Open Access Journals (Sweden)

    Daisuke Onozuka

    Full Text Available BACKGROUND: A stationary association between climate factors and epidemics of Mycoplasma pneumoniae (M. pneumoniae pneumonia has been widely assumed. However, it is unclear whether elements of the local climate that are relevant to M. pneumoniae pneumonia transmission have stationary signatures of climate factors on their dynamics over different time scales. METHODS: We performed a cross-wavelet coherency analysis to assess the patterns of association between monthly M. pneumoniae cases in Fukuoka, Japan, from 2000 to 2012 and indices for the Indian Ocean Dipole (IOD and El Niño Southern Oscillation (ENSO. RESULTS: Monthly M. pneumoniae cases were strongly associated with the dynamics of both the IOD and ENSO for the 1-2-year periodic mode in 2005-2007 and 2010-2011. This association was non-stationary and appeared to have a major influence on the synchrony of M. pneumoniae epidemics. CONCLUSIONS: Our results call for the consideration of non-stationary, possibly non-linear, patterns of association between M. pneumoniae cases and climatic factors in early warning systems.

  7. Prognostic value of vitamin D in patients with pneumonia: A ...

    African Journals Online (AJOL)

    1Management Office of Hospital Infection, 2Department of Tuberculosis Internal Medicine, The Chest Hospital of Linyi, Linyi. City, Shandong Province .... Retrospective cohort. Ethiopia. 521 children younger than 5 years with a diagnosis of pneumonia. None. Low level. Leow (2011) [25]. Prospective cohort. New Zealand.

  8. Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Kazunori, E-mail: kazokada@sfsu.edu [Department of Computer Science, San Francisco State University, San Francisco, California 94132 (United States); Rysavy, Steven [Biomedical and Health Informatics Program, University of Washington, Seattle, Washington 98195 (United States); Flores, Arturo [Computer Science and Engineering, University of California, San Diego, California 92093 (United States); Linguraru, Marius George [Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Medical Center, Washington, DC 20010 and Departments of Radiology and Pediatrics, George Washington University, Washington, DC 20037 (United States)

    2015-04-15

    Purpose: This paper proposes a novel application of computer-aided diagnosis (CAD) to an everyday clinical dental challenge: the noninvasive differential diagnosis of periapical lesions between periapical cysts and granulomas. A histological biopsy is the most reliable method currently available for this differential diagnosis; however, this invasive procedure prevents the lesions from healing noninvasively despite a report that they may heal without surgical treatment. A CAD using cone-beam computed tomography (CBCT) offers an alternative noninvasive diagnostic tool which helps to avoid potentially unnecessary surgery and to investigate the unknown healing process and rate for the lesions. Methods: The proposed semiautomatic solution combines graph-based random walks segmentation with machine learning-based boosted classifiers and offers a robust clinical tool with minimal user interaction. As part of this CAD framework, the authors provide two novel technical contributions: (1) probabilistic extension of the random walks segmentation with likelihood ratio test and (2) LDA-AdaBoost: a new integration of weighted linear discriminant analysis to AdaBoost. Results: A dataset of 28 CBCT scans is used to validate the approach and compare it with other popular segmentation and classification methods. The results show the effectiveness of the proposed method with 94.1% correct classification rate and an improvement of the performance by comparison with the Simon’s state-of-the-art method by 17.6%. The authors also compare classification performances with two independent ground-truth sets from the histopathology and CBCT diagnoses provided by endodontic experts. Conclusions: Experimental results of the authors show that the proposed CAD system behaves in clearer agreement with the CBCT ground-truth than with histopathology, supporting the Simon’s conjecture that CBCT diagnosis can be as accurate as histopathology for differentiating the periapical lesions.

  9. Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans

    International Nuclear Information System (INIS)

    Okada, Kazunori; Rysavy, Steven; Flores, Arturo; Linguraru, Marius George

    2015-01-01

    Purpose: This paper proposes a novel application of computer-aided diagnosis (CAD) to an everyday clinical dental challenge: the noninvasive differential diagnosis of periapical lesions between periapical cysts and granulomas. A histological biopsy is the most reliable method currently available for this differential diagnosis; however, this invasive procedure prevents the lesions from healing noninvasively despite a report that they may heal without surgical treatment. A CAD using cone-beam computed tomography (CBCT) offers an alternative noninvasive diagnostic tool which helps to avoid potentially unnecessary surgery and to investigate the unknown healing process and rate for the lesions. Methods: The proposed semiautomatic solution combines graph-based random walks segmentation with machine learning-based boosted classifiers and offers a robust clinical tool with minimal user interaction. As part of this CAD framework, the authors provide two novel technical contributions: (1) probabilistic extension of the random walks segmentation with likelihood ratio test and (2) LDA-AdaBoost: a new integration of weighted linear discriminant analysis to AdaBoost. Results: A dataset of 28 CBCT scans is used to validate the approach and compare it with other popular segmentation and classification methods. The results show the effectiveness of the proposed method with 94.1% correct classification rate and an improvement of the performance by comparison with the Simon’s state-of-the-art method by 17.6%. The authors also compare classification performances with two independent ground-truth sets from the histopathology and CBCT diagnoses provided by endodontic experts. Conclusions: Experimental results of the authors show that the proposed CAD system behaves in clearer agreement with the CBCT ground-truth than with histopathology, supporting the Simon’s conjecture that CBCT diagnosis can be as accurate as histopathology for differentiating the periapical lesions

  10. Noninvasive differential diagnosis of dental periapical lesions in cone-beam CT scans.

    Science.gov (United States)

    Okada, Kazunori; Rysavy, Steven; Flores, Arturo; Linguraru, Marius George

    2015-04-01

    This paper proposes a novel application of computer-aided diagnosis (CAD) to an everyday clinical dental challenge: the noninvasive differential diagnosis of periapical lesions between periapical cysts and granulomas. A histological biopsy is the most reliable method currently available for this differential diagnosis; however, this invasive procedure prevents the lesions from healing noninvasively despite a report that they may heal without surgical treatment. A CAD using cone-beam computed tomography (CBCT) offers an alternative noninvasive diagnostic tool which helps to avoid potentially unnecessary surgery and to investigate the unknown healing process and rate for the lesions. The proposed semiautomatic solution combines graph-based random walks segmentation with machine learning-based boosted classifiers and offers a robust clinical tool with minimal user interaction. As part of this CAD framework, the authors provide two novel technical contributions: (1) probabilistic extension of the random walks segmentation with likelihood ratio test and (2) LDA-AdaBoost: a new integration of weighted linear discriminant analysis to AdaBoost. A dataset of 28 CBCT scans is used to validate the approach and compare it with other popular segmentation and classification methods. The results show the effectiveness of the proposed method with 94.1% correct classification rate and an improvement of the performance by comparison with the Simon's state-of-the-art method by 17.6%. The authors also compare classification performances with two independent ground-truth sets from the histopathology and CBCT diagnoses provided by endodontic experts. Experimental results of the authors show that the proposed CAD system behaves in clearer agreement with the CBCT ground-truth than with histopathology, supporting the Simon's conjecture that CBCT diagnosis can be as accurate as histopathology for differentiating the periapical lesions.

  11. Differential diagnosis of neurodegenerative dementias with nuclear medicine methods

    International Nuclear Information System (INIS)

    Kluge, R.

    2015-01-01

    Full text: Neurodegenerative dementias (NDD) are characterized by insidious onset and gradual progression of cognitive dysfunction, initially relatively focal with respect to cognitive domains and brain regions involved. Nuclear medicine techniques help to clarify differential diagnoses of syndromes such as Alzheimer’s disease (AD), dementia with Lewy bodies (DlB), posterior cortical atrophy (PCA), logopenic primary progressive aphasia (PPA), agrammatic PPA, semantic dementia (SD), behavioral variant frontotemporal dementia (bvFTD) and progressive supranuclear palsy syndrome (PSPS). The process of pathologic changes in the brain may start decades before first clinical symptoms become evident. An early diagnosis already in the pre-clinical phase of the diseases will be of immense importance when expected effective therapeutic options have been introduced. NDDs are histopathologically characterized by accumulation of pathological proteins in the brain like beta amyloid or protein tau. While radiotracers for labeling of protein tau are in preclinical evaluation, different radiotracers labeling amyloid plaques ([11C]PIB, [18F]Florbetapir (Amyvid, Fa. EliLilly), [18F]Florbetaben (Neuraceq, Fa. Piramal), [18F]Flutemetamol (vVzamyl, Fa. Ge) have already been established in clinical use during the last years. In AD these tracers are intensively accumulated in the whole cortical brain. Even an early disease can be excluded in case of a negative amyloid PET. The method is, however, not highly specific since amyloid plaques may also be present in DlB (70 – 80%), FTD (30%) orlogopenicPPA (100%). Neuronal dysfunction goes along with decreased glucose consumption. Different diseases are characterized by different topographical zones of reduced [18F]FDG uptake. In AD the posterior cingular, temporopariatal and (later) frontal cortex are affected, in DlB the pattern is similar, including the occipital cortex, in FTD the frontal cortex is affected, in nonfluent PPA the

  12. High pneumonia lifetime-ever incidence in Beijing children compared with locations in other countries, and implications for national PCV and Hib vaccination

    Science.gov (United States)

    Qu, Fang; Sun, Yuexia; Sundell, Jan

    2017-01-01

    Objectives To compare the proportion of Beijing children who have ever had pneumonia (%Pneumonia) to those in other locations, and to estimate by how much national vaccine coverage with Pneumococcal Conjugate Vaccine (PCV) and Haemophilus Influenzae Type b (Hib) could reduce Beijing %Pneumonia. Methods %Pneumonia was obtained for each age group from 1 to 8 years inclusive from 5,876 responses to a cross-sectional questionnaire. Literature searches were conducted for world-wide reports of %Pneumonia. Previous vaccine trials conducted worldwide were used to estimate the pneumococcal (S. pneumoniae) and Hib (H. influenzae) burdens and %Pneumonia as well as the potential for PCV and Hib vaccines to reduce Beijing children’s %Pneumonia. Findings The majority of pneumonia cases occurred by the age of three. The cumulative %Pneumonia for 3–8 year-old Beijing children, 26.9%, was only slightly higher than the 25.4% for the discrete 3 year-old age group, similar to trends for Tianjin (China) and Texas (USA). Beijing’s %Pneumonia is disproportionally high relative to its Gross National Income (GNI) per capita, and markedly higher than %Pneumonia in the US and other high GNI per capita countries. Chinese diagnostic guidelines recommend chest X-ray confirmation while most other countries discourage it in favor of clinical diagnosis. Literature review shows that chest X-ray confirmation returns far fewer pneumonia diagnoses than clinical diagnosis. Accordingly, Beijing’s %Pneumonia is likely higher than indicated by raw numbers. Vaccine trials suggest that national PCV and Hib vaccination could reduce Beijing’s %Pneumonia from 26.9% to 19.7% and 24.9% respectively. Conclusion National PCV and Hib vaccination programs would substantially reduce Beijing children’s pneumonia incidence. PMID:28166256

  13. Causes of recurrent pneumonia in children in a general hospital.

    Science.gov (United States)

    Hoving, M F Paulien; Brand, Paul L P

    2013-03-01

    Because the few previous studies on underlying causes of recurrent pneumonia in children have come from tertiary care referral centres where selection bias may be important, the aim of this study was to examine underlying causes of recurrent pneumonia in children in a general hospital. We performed a retrospective chart review in a general hospital of 62 children with recurrent pneumonia over a 7.5 years period. In 19 patients (30.6%), no cause was identified, commonly because favourable natural history obviated the need for a full and invasive diagnostic work-up. Other underlying causes included recurrent aspiration in 16 patients (25.7%), lung disease (airway stenosis, bronchiectasis, middle lobe syndrome or tracheooesophageal fistula) in 10 patients (16.1%) and immune deficiency in 10 patients (16.1%). In contrast to previous studies, asthma was never diagnosed as an underlying cause, but diagnostic confusion between asthma (or recurrent upper respiratory tract infections) and recurrent pneumonia was common. The cause of recurrent pneumonia in children remains elusive in almost a third of patients, partly because the favourable natural history consistent with immune system maturation eliminates the need for further diagnostic procedures. Asthma is more likely a differential diagnostic consideration than an underlying cause of recurrent pneumonia in children. A standardised diagnostic guideline is needed to improve knowledge on causes of recurrent pneumonia in children. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  14. Plasmodium species differentiation by non-expert on-line volunteers for remote malaria field diagnosis.

    Science.gov (United States)

    Ortiz-Ruiz, Alejandra; Postigo, María; Gil-Casanova, Sara; Cuadrado, Daniel; Bautista, José M; Rubio, José Miguel; Luengo-Oroz, Miguel; Linares, María

    2018-01-30

    Routine field diagnosis of malaria is a considerable challenge in rural and low resources endemic areas mainly due to lack of personnel, training and sample processing capacity. In addition, differential diagnosis of Plasmodium species has a high level of misdiagnosis. Real time remote microscopical diagnosis through on-line crowdsourcing platforms could be converted into an agile network to support diagnosis-based treatment and malaria control in low resources areas. This study explores whether accurate Plasmodium species identification-a critical step during the diagnosis protocol in order to choose the appropriate medication-is possible through the information provided by non-trained on-line volunteers. 88 volunteers have performed a series of questionnaires over 110 images to differentiate species (Plasmodium falciparum, Plasmodium ovale, Plasmodium vivax, Plasmodium malariae, Plasmodium knowlesi) and parasite staging from thin blood smear images digitalized with a smartphone camera adapted to the ocular of a conventional light microscope. Visual cues evaluated in the surveys include texture and colour, parasite shape and red blood size. On-line volunteers are able to discriminate Plasmodium species (P. falciparum, P. malariae, P. vivax, P. ovale, P. knowlesi) and stages in thin-blood smears according to visual cues observed on digitalized images of parasitized red blood cells. Friendly textual descriptions of the visual cues and specialized malaria terminology is key for volunteers learning and efficiency. On-line volunteers with short-training are able to differentiate malaria parasite species and parasite stages from digitalized thin smears based on simple visual cues (shape, size, texture and colour). While the accuracy of a single on-line expert is far from perfect, a single parasite classification obtained by combining the opinions of multiple on-line volunteers over the same smear, could improve accuracy and reliability of Plasmodium species

  15. Discrimination method of large log-likelihood study in differential diagnosis of pulmonary diffuse mild micro-nodule

    International Nuclear Information System (INIS)

    Chen Budong; Ma Daqing; He Wen; Tang Hongqu; Qian Linxue; Zhou Ronglin

    2001-01-01

    Objective: To analyze HRCT and thin-slice CT scan findings in 150 patients with pulmonary diffuse mild micro-nodule, and to find the features with the purpose of identifying random micro-nodule, peri-lymphatic micro-nodule, and centrilobular micro-nodule. Methods: The useful features i 150 patients with pulmonary diffuse mild micro-nodule were translated into scores by means of discrimination method of large log-likelihood to identify the micro-nodular category. Results: The accuracy of diagnosis was 94.0% for random micro-nodule, 76.0% for peri-lymphatic micro-nodule, and 90.0% for centrilobular micro-nodule. Conclusion: HRCT and thin-slice CT scans were helpful in differential diagnosis of pulmonary diffuse mild micro-nodule. The discrimination method of large log-likelihood was propitious to diagnosis and differential diagnosis

  16. Pneumonia caused by Pittsburgh pneumonia agent: radiologic manifestations

    International Nuclear Information System (INIS)

    Muder, R.R.; Reddy, S.C.; Yu, V.L.; Kroboth, F.J.

    1984-01-01

    Using an objective scoring system, chest radiographs were reviewed in 23 cases of pneumonia due to the Pittsburgh pneumonia agent (PPA, Tatlockia micdadei, Legionella micdadei), including six cases of pneumonia with simultaneous isolation of PPA and L pneumophila (Legionnaires' disease). Infiltrates were typically segmental to lobar; nodular infiltrates were noted in three cases. Spread to additional lobes after presentation occurred in four of 17 PPA infections. Pneumonia caused by both PPA and L pneumophila was unusually severe, with involvement of all lobes occurring in four of six cases, compared with one of 17 cases of PPA infection (p>0.02). Radiographic severity did not correlate with underlying disease, immune status, or outcome. The majority of patients receiving erythromycin demonstrated objective radiologic improvement. In a patients, population that included nonimmunosuppressed patient, nodule formation and rapid radiologic progression were not found to be characteristic of PPA pneumonia

  17. Pigmented Nodular Basal Cell Carcinomas in Differential Diagnosis with Nodular Melanomas: Confocal Microscopy as a Reliable Tool for In Vivo Histologic Diagnosis

    International Nuclear Information System (INIS)

    Casari, A.; Pellacani, G.; Seidenari, S.; Pepe, P.; Longo, C.; Cesinaro, A. M.; Beretti, F.

    2011-01-01

    Nodular basal cell carcinoma, especially when pigmented, can be in differential diagnosis with nodular melanomas, clinically and dermoscopically. Reflectance confocal microscopy is a relatively new imaging technique that permits to evaluate in vivo skin tumors with a nearly histological resolution. Here, we present four cases of challenging nodular lesions where confocal microscopy was able to clarify the diagnosis.

  18. Ventilator-associated pneumonia: clinical significance and implications for nursing.

    Science.gov (United States)

    Grap, M J; Munro, C L

    1997-01-01

    Pneumonia is the second most common nosocomial infection in the United States and the leading cause of death from nosocomial infections. Intubation and mechanical ventilation greatly increase the risk of bacterial pneumonia. Ventilator-associated pneumonia (VAP) occurs in a patient treated with mechanical ventilation, and it is neither present nor developing at the time of intubation; it is a serious problem--with significant morbidity and mortality rates. Aspiration of bacteria from the oropharynx, leakage of contaminated secretions around the endotracheal tube, patient position, and cross-contamination from respiratory equipment and health care providers are important factors in the development of VAP. Nurses caring for patients treated with mechanical ventilation must recognize risk factors and include strategies for reducing these factors as part of their nursing care. This article summarizes the literature related to VAP: its incidence, associated factors, diagnosis, and current therapies, with an emphasis on nursing implications in the care of these patients.

  19. Assessment and Differential Diagnosis of Comorbid Conditions in Adolescents and Adults with Autism Spectrum Disorders

    Science.gov (United States)

    Trammell, Beth; Wilczynski, Susan M.; Dale, Brittany; Mcintosh, David E.

    2013-01-01

    Successful treatment of individuals with autism spectrum disorders (ASD) is entirely contingent on an accurate diagnosis. Although many resources exist to help the clinician with differential diagnosis of children, particularly in early childhood, the resources available for evaluating adolescents and adults is far less prevalent. Clinicians often…

  20. Ventilação mecânica não-invasiva em paciente com provável pneumonia por pneumocystis jirovecii: relato de caso Noninvasive mechanical ventilation in patient with pneumocystis jirovecii pneumonia: case report

    Directory of Open Access Journals (Sweden)

    Élida Mara Carneiro

    2008-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A pneumonia por Pneumocystis jirovecii tem sido uma das doenças mais comuns e uma complicação infecciosa fatal em pacientes com síndrome da imunodeficiência adquirida. O objetivo deste estudo foi apresentar uma paciente com provável diagnóstico de pneumonia por Pneumocystis jirovecii que recebeu ventilação não-invasiva com pressão positiva. RELATO DO CASO: Paciente do sexo feminino, 25 anos, com diagnóstico provável de pneumonia por Pneumocystis jirovecii grave, recebeu ventilação mecânica não-invasiva com pressão positiva. CONCLUSÕES: Todos os parâmetros melhoraram progressivamente nos primeiros cinco dias. Os resultados sugeriram a eficácia desta medida para otimizar a oxigenação, reverter a hipoxemia e prevenir a intubação traqueal.BACKGROUND AND OBJECTIVES: Pneumocystis jirovecii pneumonia has been one of the most common diseases and life-threatening infectious complications in acquired immunodeficiency syndrome patients. The objective of the case report was to present a patient with probable diagnosis of Pneumocystis jirovecii pneumonia who received noninvasive positive pressure ventilation. CASE REPORT: A female patient, 25 years old, with probable diagnosis of Pneumocystis jirovecii pneumonia received noninvasive positive pressure ventilation. CONCLUSIONS: All respiratory parameters progressively improved in the first five days. Results suggest the efficacy of this support to improve oxygenation, to revert hypoxemia and to prevent orotracheal intubation.

  1. Costal chondrosarcoma requiring differential diagnosis from metastatic tumor.

    Science.gov (United States)

    Matsuoka, Katsunari; Ueda, Mitsuhiro; Miyamoto, Yoshihiro

    2017-02-01

    Although chondrosarcoma is a common malignant bone tumor, cases arising in the rib are relatively rare. We experienced a case of chondrosarcoma arising in the right 10th rib during follow-up after lung cancer surgery. Although the finding of an osteolytic mass suggested a metastatic bone tumor, 18F-fluorodeoxyglucose positron-emission tomography demonstrated low fluorodeoxyglucose uptake, and a primary bone tumor was suspected. The bone tumor was resected and diagnosed as chondrosarcoma. Four years after resection, there has been no recurrence or metastasis. Positron-emission tomography was useful for differential diagnosis between a chondrosarcoma and a metastatic bone tumor.

  2. Angelman Syndrome. Part 3 (Differential Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    O.Ye. Abaturov

    2015-10-01

    Full Text Available The article discusses the problem of differential diagnosis and treatment of patients with Angelman syndrome (AS. It provides the most common syndromes with similar to AS phenotypes, the main differences between AS-like syndromes, indicating the causative gene. Much attention is given to the basic directions of treating patients with Angelman syndrome: organization of regime, syndromic treatment, providing psychological, speech therapy, orthopedic services, occupational therapy, activities aimed at social adaptation. This article contains the latest information about modern progressive directions of AS medical management. To optimize the diagnostic and therapeutic process, data about international Angelman syndrome foundations are shown.

  3. Differential diagnosis of Raynaud’s phenomenon based on modeling of finger thermoregulation

    International Nuclear Information System (INIS)

    Ismail, E; Romani, G L; Merla, A; Orlando, G; Corradini, M L; Amerio, P

    2014-01-01

    Raynaud's phenomenon (RP) is a vasospastic disorder of small arteries, pre-capillary arteries, and cutaneous arteriovenous shunts of the extremities, typically induced by cold exposure and emotional stress. RP is either primary (PRP) or secondary to connective tissue diseases such as systemic sclerosis (SSc). Early differential diagnosis is crucial in order to set the proper therapeutic strategy. To this goal, thermal infrared imaging data from 18 healthy controls (HCs) and 48 RP patients (20 PRP, 28 SSc) were processed through a model for a second-order time-invariant system with exponential critically damped dynamic response. Subject classification on the basis of the model parameters provides 100% true-positive discrimination for RP patients (PRP and SSc) and healthy, and 90% of correct classification within the group of patients. The proposed method may provide useful hints for early differential diagnosis in the assessment of RP disease. (paper)

  4. A case report for differential diagnosis: Integrative medicine vs child abuse.

    Science.gov (United States)

    Ribeiro, Cristina Silveira; Rodrigues, Fernanda; Ribeiro, Catarina; Magalhães, Teresa

    2010-11-01

    The authors present the case of a ten-year-old Chinese boy who was taken to a hospital due to the presence of suspicious bruises on his body. The child was examined in the National Institute of Legal Medicine by forensic doctors and a forensic psychologist. Clinical characteristics of the case are summarized stressing that a better understanding of some kinds of integrative medicine (IM) may help to differentiate injuries resulting from those practices. This is the only and unique case diagnosed by the medico-legal services in Portugal. In fact a great range of IM practice has the potential to create confusion in the diagnosis of physical child abuse. This study focuses on the differential diagnosis of one specific kind of frequent skin injury usually seen in situations of both child abuse and IM (in this case TuiNa) - bruises. As the number of people who practice Traditional Chinese Medicine and other forms of IM increases in the Western world, the child protection community would benefit from familiarizing itselves with these practices to prevent social and/or legal conflicts that may arise from mistaken diagnoses of abuse. The objective of this case report is to emphasize the relevance of comprehensive and interdisciplinary evaluation of child abuse cases taking into account the specifics of each case, to achieve a proper diagnosis. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  5. Rapid assessment of agents of biological terrorism: defining the differential diagnosis of inhalational anthrax using electronic communication in a practice-based research network.

    Science.gov (United States)

    Temte, Jonathan L; Anderson, Anna Lisa

    2004-01-01

    Early detection of bioterrorism requires assessment of diagnoses assigned to cases of rare diseases with which clinicians have little experience. In this study, we evaluated the process of defining the differential diagnosis for inhalational anthrax using electronic communication within a practice-based research network (PBRN) and compared the results with those obtained from a nationwide random sample of family physicians with a mailed instrument. We distributed survey instruments by e-mail to 55 physician members of the Wisconsin Research Network (WReN), a regional PBRN. The instruments consisted of 3 case vignettes randomly drawn from a set describing 11 patients with inhalational anthrax, 2 with influenza A, and 1 with Legionella pneumonia. Physicians provided their most likely nonanthrax diagnosis, along with their responses to 4 yes-or-no management questions for each case. Physicians who had not responded at 1 week received a second e-mail with the survey instrument. The comparison group consisted of the nationwide sample of physicians who completed mailed survey instruments. Primary outcome measures were response rate, median response time, and frequencies of diagnostic categories assigned to cases of inhalational anthrax. The PBRN response rate compared favorably with that of the national sample (47.3% vs 37.0%; P = not significant). The median response time for the PBRN was significantly shorter than that for the national sample (2 vs 28 days; P < .001). No significant differences were found between the PBRN and the Midwest subset of the national sample in the frequencies of major diagnostic categories or in case management. Electronic means of creating differential diagnoses for rare infectious diseases of national significance is feasible within PBRNs. Information is much more rapidly acquired and is consistent with that obtained by conventional methods.

  6. Fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation in a patient with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Ho Min-Po

    2009-01-01

    Full Text Available Bacterial meningitis remains a major cause of death and long-term neurologic sequelae worldwide. We present a case of fatal Klebsiella pneumoniae meningitis and concomitant disseminated intravascular coagulation (DIC in a 72-year-old woman with diabetes mellitus (DM. Both blood and cerebrospinal fluid cultures grew Klebsiella pneumoniae . Due to advanced age, newly recognized DM, K. pneumoniae bacteremia, and DIC, the prognosis of our patient was poor. Eight hours after arrival to the emergency department, cardiopulmonary resuscitation was necessary in this patient, but she died despite an early diagnosis and appropriate antibiotic therapy.

  7. Prenatal Diagnosis of Cloacal Exstrophy: A Case Report and Differential Diagnosis with a Simple Omphalocele

    Directory of Open Access Journals (Sweden)

    Ching-Yu Chou

    2015-03-01

    Full Text Available Cloacal exstrophy is a rare congenital disorder that may lead to mortality and morbidity. Although the prenatal diagnosis of cloacal exstrophy can be made by a midtrimester ultrasound, it is difficult to differentiate it from a simple omphalocele that can be corrected completely by surgery without morbidity. We reported a case with cloacal exstrophy and reviewed previous literature on differentiating it from an omphalocele. A 33-year-old, pregnant female visited our outpatient center for prenatal care at the 22nd gestational week. The midtrimester ultrasound showed fetal anomalies including a protruding mass from umbilicus, absence of bladder, ambiguous genitalia, and bilateral renal hydronephrosis. The parents received prenatal genetic counseling and decided to continue the pregnancy. A female baby was delivered at the 37th gestational week via vaginal delivery, and cloacal exstrophy without omphalocele was diagnosed. Cloacal exstrophy is a complicated congenital disorder that should be differentiated from a simple omphalocele. Prenatal counseling and postnatal care in a tertiary medical center are important for parents and the fetus, respectively.

  8. Infectious diseases of the brain: imaging and differential diagnosis; Infektioese Hirnerkrankungen: Bildgebung und differenzialdiagnostische Aspekte

    Energy Technology Data Exchange (ETDEWEB)

    Haehnel, S.; Seitz, A. [Abt. Neuroradiologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany); Storch-Hagenlocher, B. [Abt. Neurologie, Neurologische Klinik, Universitaetsklinikum Heidelberg (Germany)

    2006-09-15

    Infectious diseases of the central nervous system have to be considered in differential diagnosis particularly in immunocompromised persons. Neuro-imaging, specifically advanced techniques such as diffusion weighted MRI and perfusion MRI contribute much to the differentiation of brain infections and for differentiating brain infections from other, for instance, neoplastic diseases. In this review we present the imaging criteria of the most important brains infections in adults and in pediatric patients and discuss differential diagnostic aspects in detail. (orig.)

  9. Nuclear medicine and MRI in differential diagnosis of doubtful spinal disorders

    International Nuclear Information System (INIS)

    Szilvasi, J.; Mester, A.R.; Kaposi, P.N.; Gyorke, T.; Karlinger, K.; Mako, E.K.

    2004-01-01

    Full text: Purpose of presentation is a retrospective analysis and pictorial assay of MRI in differential diagnosis of spinal diseases with increased Tc-99m-MDP uptake on the whole body bone scan. A retrospective analysis of 200 spine cases was carried out in respect of metastatic, osteoporotic and degenerative bony lesions with similar appearance of bone scan. Referring diagnoses were either spinal pain syndromes or tumour staging. Double headed gamma camera (ADAC) and a low field whole body (0.3 T, Hitachi) scanner were used. Bone scan, SPECT and routine SE T1 and SE T2 sequences were completed with STIR and Gd contrast administration in selected complicated cases. Recently additional opposed phase GRE sequences were used as well. In doubtful whole body scintigraphic cases, SPECT study was performed. Cases with uncertain diagnosis were sent for MRI study. Increased T2 signal and decreased T1 signal, if diffusely distributed in the vertebral body, is characteristic to recent osteoporotic compressions. In cases of non-compressed (metastatic) vertebral bodies with diffuse increased T2 signal increase this appearance had predictive value of imminent compression fracture. Increased T2 signal with decreased T1 signal in adjacent vertebral bodies accompanied by irregularity of contours and of signal intensity involving the inter-vertebral disc, and Gd enhancement were symptoms of infection, in particularly spondylodiscitis. Opposed phase GRE sequences seems to be optimal in differentiation of metastatic lesions versus porotic lesions. We conclude that routine bone scan, and MRI in selected patients suffering from back pain syndrome can help differentiation of osteoporotic versus metastatic and degenerative vertebral lesions. Additional STIR sequence, Gd administration and opposed phase GRE imaging make the diagnosis more specific. (author)

  10. HE4 in the Differential Diagnosis of a Pelvic Mass: A Case Report

    Directory of Open Access Journals (Sweden)

    Luigi Frati

    2011-01-01

    Full Text Available Neoplasms of the ovary present an increasing challenge to the physician. Neoplastic ovarian cysts can resemble endometriomas in ultrasound imaging and need to be carefully considered in the differential diagnosis. We report the case of a woman with a strong family history of hereditary breast and ovarian cancer, who presented with a pelvic mass. The young girl refused oncogenetic counseling and genetic testing, even though she had a 50% a priori probability of being a BRCA1 mutation carrier. Pelvic magnetic resonance imaging (MRI and a comparative analysis of the serum concentration of HE-4 and CA125 biomarkers provided accuracy and sensitivity in the diagnosis of a benign ovarian pathology. Based on this experience, we propose that the sensitivity of a screening program based on a HE4 and CA125 assay and MRI in high risk patients with mutations in the BRCA1 and BRCA2 genes may be considered a useful pre-operative tool for the differential diagnosis of pelvic masses.

  11. Multiple organ dysfunction syndrome associated with Mycoplasma pneumoniae infection

    Directory of Open Access Journals (Sweden)

    Shu-Bo Zhai

    2012-03-01

    Full Text Available In this study, we report one case of a three-year-old boy infected with Mycoplasma pneumonia (MP and presenting concomitant multiple organ damage of the heart, kidney, lung and liver, among others, together with a brief review for the diagnosis and treatment of MP infection with multiple organ dysfunction syndrome (MODS.

  12. Differential Diagnosis of Erythmato-Squamous Diseases Using Classification and Regression Tree.

    Science.gov (United States)

    Maghooli, Keivan; Langarizadeh, Mostafa; Shahmoradi, Leila; Habibi-Koolaee, Mahdi; Jebraeily, Mohamad; Bouraghi, Hamid

    2016-10-01

    Differential diagnosis of Erythmato-Squamous Diseases (ESD) is a major challenge in the field of dermatology. The ESD diseases are placed into six different classes. Data mining is the process for detection of hidden patterns. In the case of ESD, data mining help us to predict the diseases. Different algorithms were developed for this purpose. we aimed to use the Classification and Regression Tree (CART) to predict differential diagnosis of ESD. we used the Cross Industry Standard Process for Data Mining (CRISP-DM) methodology. For this purpose, the dermatology data set from machine learning repository, UCI was obtained. The Clementine 12.0 software from IBM Company was used for modelling. In order to evaluation of the model we calculate the accuracy, sensitivity and specificity of the model. The proposed model had an accuracy of 94.84% (. 24.42) in order to correct prediction of the ESD disease. Results indicated that using of this classifier could be useful. But, it would be strongly recommended that the combination of machine learning methods could be more useful in terms of prediction of ESD.

  13. Imaging of cavitary necrosis in complicated childhood pneumonia

    International Nuclear Information System (INIS)

    Hodina, M.; Schnyder, P.; Gudinchet, F.; Hanquinet, S.; Cotting, J.

    2002-01-01

    The aim of this study was to illustrate the chest radiographs (CR) and CT imaging features and sequential findings of cavitary necrosis in complicated childhood pneumonia. Among 30 children admitted in the Pediatric Intensive Care Unit for persistent or progressive pneumonia, respiratory distress or sepsis despite adequate antibiotic therapy, a study group of 9 children (5 girls and 4 boys; mean age 4 years) who had the radiographic features and CT criteria for cavitary necrosis complicated pneumonia was identified. The pathogens identified were Streptococcus pneumoniae (n=4), Aspergillus (n=2), Legionella (n=1), and Staphylococcus aureus (n=1). Sequential CR and CT scans were retrospectively reviewed. Follow-up CR and CT were evaluated for persistent abnormalities. Chest radiographs showed consolidations in 8 of the 9 patients. On CT examination, cavitary necrosis was localized to 1 lobe in 2 patients and 7 patients showed multilobar or bilateral areas of cavitary necrosis. In 3 patients of 9, the cavitary necrosis was initially shown on CT and visualization by CR was delayed by a time span varying from 5 to 9 days. In all patients with cavities, a mean number of five cavities were seen on antero-posterior CR, contrasting with the multiple cavities seen on CT. Parapneumonic effusions were shown by CR in 3 patients and in 5 patients by CT. Bronchopleural fistulae were demonstrated by CT alone (n=3). No purulent pericarditis was demonstrated. The CT scan displayed persistent residual pneumatoceles of the left lower lobe in 2 patients. Computed tomography is able to define a more specific pattern of abnormalities than conventional CR in children with necrotizing pneumonia and allows an earlier diagnosis of this rapidly progressing condition. Lung necrosis and cavitation may also be associated with Aspergillus or Legionella pneumonia in the pediatric population. (orig.)

  14. Differential diagnosis of gigantic pulmonary abscesses

    International Nuclear Information System (INIS)

    Vinner, M.G.; Khachatryan, M.A.; Abelyan, A.M.

    1985-01-01

    The paper is concerned with an analysis of the clinical X-ray picture in 100 patients with gigantic pulmonary abscesses (the diameter over 6 cm) and in 102 patients with retrostenotic abscesses in central lung cancer, gigantic peripheral cancer with disintegration, tuberculous infiltrate with dissociation, an echinococcal cyst with suppuration and rupture in the bronchus. The reliable clinical differential diagnostic symptoms were not revealed. The chief method of X-ray examination is tomography. In addition to examination of the gigantic focus of lesion in the lung, tomography of the major bronchi should be also performed. The difference between a gigantic pulmonary abscess and peripheral lung cancer is in the nature of the walls and contours; of particular importance is the symptom of nodularity and radiance of the outlines of the pathological shadow which is more distinctive in peripheral cancer. Correct diagnosis was established in 96.6% of the patients

  15. Differential diagnosis of perirenal cyctic or non-cyctic fluid collections

    International Nuclear Information System (INIS)

    Stoker, J.; Lameris, J.S.

    1989-01-01

    A perirenal fluid collection, which is fluid located between the renal capcule and renal fasciae, is not a frequent diagnostic finding. When seen, either cystic, pseuod-cystic, several diagnostic possibilities must be kept in mind. The differential diagnosis of perirenal fluid, except for adrenal fluid, and the perirenal anatomy are described on the basis of three illustrative cases. Emphasis is on the radiological aspects. (Author). 15 refs.; 7 figs.; 1 tab

  16. Review of differential diagnosis and management of spasmodic dysphonia.

    Science.gov (United States)

    Whurr, Renata; Lorch, Marjorie

    2016-06-01

    The recent literature on spasmodic dysphonia is reviewed with regard to pathogenesis, differential diagnosis, treatment options, audits, and current methods of management. Advances in technology have enabled clinicians to better understand the connection between brain and laryngeal function and dysfunction. Refinements in imaging and genetic investigation techniques have led to advances in the understanding of the underlying mechanism of this neurolaryngeal disorder. Development of diagnostic assessment tools and measures of quality of life hold the potential to improve treatment and care. Fifty articles published between 2014 and 2015 were selected for this review. The sources were drawn from several clinical specialties: 54% come under the scope of laryngology, 32% from neurology, and 14% from other areas. It remains poorly understood, misdiagnosed, and underdiagnosed. Its identification, diagnosis, treatment selection, and coordination of care require an expert specialist multidisciplinary team. More training is required to help people who have this chronic and psychosocially disabling voice disorder, which impinges on all aspects of their lives. Spasmodic dysphonia is now classified as a 'rare' disease in the United States. This designation will assist in international standards of diagnosis, assessment, treatment, and management.

  17. Acquired pneumonias in the community in adults: An etiologic prospective study with emphasis in the diagnosis

    International Nuclear Information System (INIS)

    Robledo, J; Sierra, P; Bedoya, F; Londono, A; Porras, A; Lujan, M; Correa, N; Mejia, GI; Realpe, T; Trujillo, H

    2003-01-01

    Is defined prospectively in adults the etiology of acquired pneumonia in the community (NAC) in three hospitals of the city of Medellin. The etiology of NAC in the studied group does not vary of the one reported in other countries, the pneumococo frequency and M. pneumoniae, suggests that the empiric therapies should contemplate these two pathologies, the resource toasted by the microbiology laboratory allows to define the etiology and the specific treatment

  18. Unusual Features of Extraarticular Skeletal Tuberculosis: New Classification and Differential Diagnosis

    International Nuclear Information System (INIS)

    Kim, Kun Sang; Park, Soo Soung

    1983-01-01

    Twenty two cases of extra articular skeletal tuberculosis which showed unusual radiological features are reported and classified into several categories with discussion on the differential diagnosis. Radiological patterns of skeletal tuberculosis is so variable that with any kind of skeletal changes the possibility of the skeletal tuberculosis should not be excluded between of lack of its classical patterns.

  19. Characteristics and Management of Community-Acquired Pneumonia in the Era of Global Aging

    Directory of Open Access Journals (Sweden)

    Catia Cillóniz

    2018-04-01

    Full Text Available Community-acquired pneumonia (CAP can occur at any time of life, but its incidence and risk of death are linked to increasing age. CAP in the elderly is a major health problem associated with high rates of readmission, morbidity, and mortality. Since the clinical presentation of pneumonia in the elderly may be atypical, clinicians should suspect pneumonia in older patients presenting symptoms such as falls and altered mental status, fatigue, lethargy, delirium, anorexia, in order to avoid the complications associated with delayed diagnosis and therapy. Streptococcus pneumoniae remains the most frequently reported pathogen in this population. However, particular attention should be paid to patients with risk factors for multidrug resistant pathogens, because a large proportion of elderly persons present multimorbidity. Vaccination is one of the most important preventive approaches for CAP in the elderly. In addition, lifestyle-tailored interventions for different modifiable risk factors will help to reduce the risk of pneumonia in elderly persons. Surveillance of etiological pathogens may improve vaccination policies in this population.

  20. Correlations between computed tomography findings and clinical manifestations of Streptococcus pneumoniae pneumonia

    International Nuclear Information System (INIS)

    Yagihashi, Kunihiro; Kurihara, Yasuyuki; Fujikawa, Atsuko; Matsuoka, Shin; Nakajima, Yasuo

    2011-01-01

    The aim of this study was to characterize the imaging features and compare computed tomography (CT) findings with clinical features of patients with Streptococcus pneumoniae pneumonia. We retrospectively reviewed 75 patients (44 men, 31 women; mean age 67 years) diagnosed with S. pneumoniae pneumonia who underwent chest CT scanning at our institution between January 2007 and August 2008. Diagnoses were based on detection of the S. pneumoniae antigen in urine. Chest CT scans revealed abnormalities in all patients. The predominant opacity patterns were an airspace pneumonia pattern (48%) and a bronchopneumonia pattern (48%), followed by an interstitial pneumonia pattern (4%). Consolidation was observed most frequently (84%) followed by ground glass opacity (82.7%), bronchial wall thickening (61.3%), and centrilobular nodules (49.3%). Airway dilatation (21.6%), pleural effusion (33.3%), lymphadenopathy (34.8%), and pulmonary emphysema (21.3%) were also observed. Pulmonary emphysema was significantly less frequent in patients with the bronchopneumonia pattern than in those without (p=0.007). The clinical features and CT findings did not differ significantly. CT image analysis showed that patients with S. pneumoniae pneumonia exhibited the bronchopneumonia and airspace pneumonia patterns with equal frequency. Bronchopneumonia pattern was less common in patients with preexisting emphysema. (author)

  1. Validity of bacterial pneumonia score for predicting bacteremia in children with pneumonia

    Directory of Open Access Journals (Sweden)

    Rosalia Theodosia Daten Beyeng

    2011-12-01

    Full Text Available Background Bacteremia in children with pneumonia reflects a severe condition, with longer duration of hospital care and potentially lethal complications. Early detection of bacteremia in patients with pneumonia may reduce serious complications. Few bacteremia screening tools have been widely used in chidren with pneumonia. One of those tools is the bacterial pneumonia score (BPS. Objective To assess the validity of the bacterial pneumonia score for predicting bacteremia in pediatric patients with pneumonia. Methods A diagnostic test was conducted on children aged 1 to 60 months hospitalized with pneumonia from December 2009 to August 2010. Subjects were collected consecutively. Pneumonia was diagnosed using the World Healt Organization (WHO criteria. Subjects underwent complete blood counts and blood culture examinations at admission. Statistical analyses included sensitivity, specificity, positive and negative predictive value (PPV/NPV, positive and negative likelihood ratio (PLR/NLR, and post-test probability. Results Our study included 229 children. Based on BPS with a cut-off score of ≥ 4, the sensitivity was 83.3%, specificity 49.7%, PPV 8.4%, NPV 98.2%, PLR 1.66, NLR 0.31, and post-test probability 8.4% for detecting bacteremia in pediatric pneumonia patients. Conclusion BPS can not be used for predicting bacteremia in pediatric patients with pneumonia.

  2. CT findings of focal organizing pneumonia: correlation with pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yang Soo; Kim, Young Goo; Park, Un Sup [College of Medicine, Chungang University, Seoul (Korea, Republic of)

    1994-11-15

    To evaluate the CT findings of focal organizing pneumonia and to correlate them with pathologic findings to help differentiating from lung cancer. We evaluated radiologic and pathologic findings of five patients with solitary pulmonary nodule which were confirmed as focal organizing pneumonia pathologically. On CT scan, focal organizing pneumonia had irregular margin contacting the pleura in all five cases. The shape of the nodules were spherical to wedge or elliptical and the size from 3.5cm to 5.5cm(average 4.2 cm) in largest diameter. On postcontrast CT scan, all nodules showed enhancement and four cases showed central low density components. Two nodules contained air within the nodule. In four cases, pleural changes such as effusion and/or focal thickening were noted. No lymphadenopathy was found in all cases. Pathologically, the enhancing portion on CT showed findings of organizing pneumonia such as granulation tissue with fibroblast proliferation in alveolar space and interstitial thickening. The central low density areas on CT were due to ischemic necrosis, abscess and exudate, transudate and infiltration of foamy histiocyte. The possibility of focal organizing pneumonia should be considered when peripherally located solitary pulmonary nodule had enhancing component with no combined lymphadenopathy on CT scan.

  3. CT findings of focal organizing pneumonia: correlation with pathologic findings

    International Nuclear Information System (INIS)

    Kim, Yang Soo; Kim, Young Goo; Park, Un Sup

    1994-01-01

    To evaluate the CT findings of focal organizing pneumonia and to correlate them with pathologic findings to help differentiating from lung cancer. We evaluated radiologic and pathologic findings of five patients with solitary pulmonary nodule which were confirmed as focal organizing pneumonia pathologically. On CT scan, focal organizing pneumonia had irregular margin contacting the pleura in all five cases. The shape of the nodules were spherical to wedge or elliptical and the size from 3.5cm to 5.5cm(average 4.2 cm) in largest diameter. On postcontrast CT scan, all nodules showed enhancement and four cases showed central low density components. Two nodules contained air within the nodule. In four cases, pleural changes such as effusion and/or focal thickening were noted. No lymphadenopathy was found in all cases. Pathologically, the enhancing portion on CT showed findings of organizing pneumonia such as granulation tissue with fibroblast proliferation in alveolar space and interstitial thickening. The central low density areas on CT were due to ischemic necrosis, abscess and exudate, transudate and infiltration of foamy histiocyte. The possibility of focal organizing pneumonia should be considered when peripherally located solitary pulmonary nodule had enhancing component with no combined lymphadenopathy on CT scan

  4. Neuropsychological assessment and differential diagnosis in young-onset dementias.

    Science.gov (United States)

    Sitek, Emilia J; Barczak, Anna; Harciarek, Michał

    2015-06-01

    Although Alzheimer's disease is the most common cause of dementia in the elderly, there are several conditions (ie, frontotemporal dementia or Huntington's disease) associated with a relatively earlier onset. This article provides arguments in favor of a comprehensive neuropsychological assessment in the differential diagnosis of young-onset dementia, as episodic memory impairment is not observed early in the course of most types of young-onset dementia that predominantly affect the domains of behavior, executive, language, and/or motor function. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Exogenous lipoid pneumonia caused by paraffin in an amateur fire breather.

    Science.gov (United States)

    Weinberg, I; Fridlender, Z G

    2010-05-01

    Paraffin has characteristics that make it popular among fire breathers. To describe a case of paraffin-induced lipoid pneumonia in a fire breather. The patient was evaluated clinically in relation to his occupational history. A 32-year-old man presented with dyspnoea, tachypnoea and non-productive cough of 2 h duration that started immediately following an attempt to blow fire using paraffin as the volatile substance. He was discharged from the emergency ward but returned the next day presenting again with dyspnoea accompanied by mid-sternal pain, fever (38.1 degrees C) and leucocytosis. Chest radiography showed perihilar punctuate infiltrations. A diagnosis of exogenous lipoid pneumonia caused by paraffin was made, and the patient was treated, with full recovery within a week. Fire breathers must be viewed as a population at risk of paraffin-induced lipoid pneumonia.

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

    International Nuclear Information System (INIS)

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

    2009-01-01

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    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)

    2009-04-15

    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.)

  8. Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia

    Directory of Open Access Journals (Sweden)

    Érica Maria Lima Pimentel

    Full Text Available Abstract The prevalence of dementia increases significantly from the age of 65 years, doubling every five years thereafter. Alzheimer's disease (AD and vascular dementia (VaD constitute the two main dementia types. Differentiating them encompasses anamnesis, neurological examination, laboratory and neuroimaging exams and neuropsychological assessment. Neuropsychological assessment produces different findings for each dementia type, and reveals those areas most impaired as well as those most preserved. The aim of the present article was to describe the role of neuropsychology in diagnosing dementia and achieving a differential diagnosis between AD and VaD. A general overview follows of the most widely known instruments used to assess cognitive function in dementia, and the cognitive changes seen in AD and VaD. The conclusion drawn was that there is significant overlap in cognitive changes between both these dementia types, while each type has its own specific characteristics which are identifiable and quantifiable on neuropsychological assessments and provide the basis for reaching a differential diagnosis.

  9. Multivariable Discriminant Analysis for the Differential Diagnosis of Microcytic Anemia

    Directory of Open Access Journals (Sweden)

    Eloísa Urrechaga

    2013-01-01

    Full Text Available Introduction. Iron deficiency anemia and thalassemia are the most common causes of microcytic anemia. Powerful statistical computer programming enables sensitive discriminant analyses to aid in the diagnosis. We aimed at investigating the performance of the multiple discriminant analysis (MDA to the differential diagnosis of microcytic anemia. Methods. The training group was composed of 200 β-thalassemia carriers, 65 α-thalassemia carriers, 170 iron deficiency anemia (IDA, and 45 mixed cases of thalassemia and acute phase response or iron deficiency. A set of potential predictor parameters that could detect differences among groups were selected: Red Blood Cells (RBC, hemoglobin (Hb, mean cell volume (MCV, mean cell hemoglobin (MCH, and RBC distribution width (RDW. The functions obtained with MDA analysis were applied to a set of 628 consecutive patients with microcytic anemia. Results. For classifying patients into two groups (genetic anemia and acquired anemia, only one function was needed; 87.9% β-thalassemia carriers, and 83.3% α-thalassemia carriers, and 72.1% in the mixed group were correctly classified. Conclusion. Linear discriminant functions based on hemogram data can aid in differentiating between IDA and thalassemia, so samples can be efficiently selected for further analysis to confirm the presence of genetic anemia.

  10. Association of pneumonia and lung cancer: the value of convalescent chest radiography and follow-up

    International Nuclear Information System (INIS)

    Holmberg, H.; Kragsbjerg, P.

    1993-01-01

    A retrospective study of 1011 hospitalized patients with pneumonia was undertaken to assess the value of routine convalescent chest radiography for detection of underlying lung cancer. To investigate the mode of clinical onset of pulmonary carcinoma, 232 inpatients with this diagnosis were also studied. The findings may be summarized as follows: 1. 13/1011 pneumonia patients were found to have previously undiagnosed pulmonary carcinoma; 2. many of these carcinomas (8/13) were disclosed by an acute chest X-ray; 3. pulmonary carcinoma was found by convalescent chest X-ray in 2/88 patients not feeling well and in 2/524 patients feeling well at follow-up, and non of these 4 patients benefitted from the carcinoma diagnosis; 4. ESR was of no value in detecting underlying pulmonary carcinoma at follow-up in patients with pneumonia; 5. of the 232 patients with pulmonary carcinoma, 29 (12.5%) presented with an acute respiratory tract infection; 6. most of these latter patients did not recover as expected and their correct diagnosis was made based on a chest X-ray performed because of persistent symptoms. We suggest that patients with radiologically verified pneumonia undergo clinical examination or are interviewed 4-5 weeks after the onset. If signs or symptoms of respiratory disease persist, chest X-ray should be performed. We consider, however, that routine convalescent chest radiography with the aim of detecting any underlying pulmonary tumour could be omitted if the patient has completely recovered 1 month after the acute onset of illness. (9 refs.)

  11. Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS).

    Science.gov (United States)

    Schwarz, Norbert G; Sarpong, Nimako; Hünger, Frank; Marks, Florian; Acquah, Samuel Ek; Agyekum, Alex; Nkrumah, Bernard; Loag, Wibke; Hagen, Ralf M; Evans, Jennifer A; Dekker, Denise; Fobil, Julius N; Meyer, Christian G; May, Jürgen; Adu-Sarkodie, Yaw

    2010-11-04

    The diagnosis and antimicrobial treatment of pneumonia in African children in the absence of diagnostic means such as x-ray facilities or microbiological laboratories relies primarily on clinical symptoms presented by the patients. In order to assess the spectrum of bacterial pathogens, blood cultures were performed in children fulfilling the clinical criteria of pneumonia. In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia"). The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin. In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment.

  12. Clinical application and progress of PET and PET-CT for differential diagnosis of the benign or malignant pulmonary nodules

    International Nuclear Information System (INIS)

    Wang Xuemei; Wang Meiling; Wang Xiangcheng

    2010-01-01

    To differential diagnosis the benign or malignant of pulmonary nodules is a medical difficult problem. As the development of medical imaging equipment and technology, PET-CT can identified benign or malignant lesions of pulmonary nodules though changes of metabolism. Researches about PET-CT for differential diagnosis pulmonary nodules benign or malignant are reviewed. (authors)

  13. CT scan findings of fungal pneumonia; Diagnose der Pilzpneumonie in der Thorax-CT

    Energy Technology Data Exchange (ETDEWEB)

    Heckmann, M.; Uder, M.; Bautz, W.; Heinrich, M. [Erlangen-Nuernberg Univ., Erlangen (Germany). Inst. fuer Diagnostische Radiologie

    2008-07-01

    The importance of fungal infection of the lung in immunocompromised patients has increased substantially during the last decades. Numerically the most patients are those with neutropenia, e.g. patients with malignancies or solid organ and stem cell transplantation, chemotherapy, corticosteroid use and HIV infection. Although fungal infections can occur in immunocompetent patients, their frequency in this population is rare. The clinical symptoms such as fever accompanied with non-productive cough are unspecific. In some patients progression to hypoxemia and dyspnea may occur rapidly. In spite of improved antifungal therapy morbidity and mortality of these infections are still high. Therefore an early and non-invasive diagnosis is very important. That is why CT and even better High-Resolution-CT (HR-CT) is a very important modality in examining immunocompromised patients with a probability of fungal infection. CT is everywhere available and, as a non-invasive method, able to give the relevant diagnose efficiently. This paper should give an overview about the radiologic findings and possible differential diagnosis of diverse pulmonary fungal infections in CT. Pneumonias caused by Aspergillus, Cryptococcus, Candida, Histoplasma, Mucor and Geotrichum capitatum are illustrated. (orig.)

  14. CT diagnosis and differential diagnosis of masses located in the junctional space adjacent to stomach, spleen and pancreas

    International Nuclear Information System (INIS)

    Hu Xueling

    2006-01-01

    Objective: To study the CT diagnosis and differential diagnosis of masses located in the junctional space adjacent to stomach, spleen and pancreas, with analysis of cases in which misdiagnosis was made. Methods: CT manifestations were retrospectively investigated in 20 cases of masses located in the junctional space adjacent to stomach, spleen and pancreas. Lesions had been located with the images and then qualitative diagnosis had been made. All the cases were eventually confirmed by pathology. Results: The lesions were in round shape in 6 cases out of 20 irregular masses were revealed in 14 showed, unclear demarcated lesions were showed in 16 cases. Inhomogeneous enhancement of the masses was visualized when the contrast agent was given. The central spot and maximum plain of the mass were different among different pathology types of the masses. 6 of 20 were original from stomach, 7 of 20 from pancreas, 3 from spleen and 4 from peritoneal cavity. 6 of 20 were wrong located (30%), 8 of 20 (40%)were wrong pathological diagnosis. Conclusion: Location is more important than pathological character diagnosis. It is valuable to locate the maximum plain of the masses and shape changed of organs nearby. (authors)

  15. [(99)Tc(m)N-NOET dual-phase SPECT in differential diagnosis of benign and malignant lung tumors].

    Science.gov (United States)

    Liu, Haiyan; Li, Sijin; Yang, Suyun; Wu, Zhifang

    2014-01-01

    To investigate the value of (99)Tc(m)N-NOET dual-phase SPECT in differential diagnosis of benign and malignant lung tumors. CT scan, early (20 to 30 min) and delayed (2 h) imaging of NOET SPECT were performed on 61 patients suspected of lung lesions before operation. The results were compared with the pathological findings. All cases were not treated with radiotherapy, chemotherapy or surgery before checks. Moreover, all patients had pathological diagnosis. To determine the value in differential diagnosis of tumors by analyzing the tumor uptake and excretion of (99)Tc(m)N-NOET, and the results were compared with that of CT. The value of early T/N ratio (ER) in the malignant (G1) and benign (G2) groups was 1.25 ± 0.15 and 1.09 ± 0.11 (P 0.05). The ER, DR and RI of NOET SPECT in the malignant patients were not significantly correlated with TNM staging, pathological types, tumor diameter, cavity in the lung tumor mass, history of smoking, tumor size and patient gender (P > 0.05). The sensitivity of NOET dual-phase SPECT and CT in the differential diagnosis of benign and malignant lung tumors was 94.1% vs. 90.2%, specificity was 70.0% vs. 80.0% , positive predictive value (PPV) was 94.1% vs. 95.8%, negative predictive value (NPV) was 70.0% vs. 61.5 %, and accuracy was 90.2%. vs. 88.5% (P > 0.05 for all). (99)Tc(m)N- NOET dual-phase SPECT could be used in differential diagnosis of benign and malignant lung tumors, with no significant differences compared with the efficacy of CT imaging. The semiquantitative indexes (ER, DR and RI) of NOET SPECT can also be used in differential diagnosis of benign and malignant lung tumors, and are not significantly correlated with TNM staging, pathological types, tumor diameter, cavity of the lung tumor mass, history of smoking, tumor size and patient gender.

  16. [The significance of a 4,183 Da peptide of dermcidin protein in the early diagnosis and differential diagnosis of acute coronary syndrome].

    Science.gov (United States)

    Kai, Feng; Lifeng, Liu; Haijing, Song; Xianhua, Liu; Hu, Xia

    2015-12-01

    To investigate the predictive value of 4,183 Da peptide of dermcidin protein in the early diagnosis and differential diagnosis of ischemic heart disease. A prospective controlled study was conducted. Serum samples were drawn from 161 patients with acute coronary'syndrome [ACS, including 46 patients with unstable angina (UA), 23 with acute non-ST elevation myocardial infarction, and 92 with acute ST segment elevation myocardial infarction], 111 subjects for routine physical examination, including 45 patients with hypertension history, 42 with coronary heart disease, 22 with diabetes, and 54 patients with non-ACS (including pulmonary embolism, aortic dissection, aneurysm, arrhythmia, myocarditis, coronary myocardial bridge, pleurisy, pneumothorax pneumomediastinum, rib fracture, reflux esophagitis, peptic ulcer, and pancreatitis) to serve as controls. 4 183 Da peptide of dermcidin protein was assessed with matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS) technology, and myeloperoxidase [MPO, determined by point-of-care testing (POCT) and enzyme linked immunosorbent assay (ELISA), respectively], high sensitive C-reactive protein (hs-CRP), heart type fatty acid binding protein (H-FABP), myoglobin (MYO), cardiac troponin I (cTnI), and MB isoenzyme of creatine kinase (CK-MB) were quantitated with biochemical analysis. The power of the biomarkers above for early diagnosis and differential diagnosis for ischemic heart disease were judged by comparison of their sensitivity and specificity. (1) It was showed by one-way ANOVA that 4,183 Da peptide was higher in ACS group than that in control group (relative abundance: 22.05 ± 16.97 vs. 15.52 ± 14.09, P = 0.001), but no difference was found between ACS group and non-ACS group (relative abundance: 22.05 ± 16.97 vs. 19.99 ± 17.63, P = 0.416). (2) The specificity and sensitivity of the 4 183 Da polypeptide and MPO for predicting ACS and UA were compared with the receiver operating

  17. Detection of Streptococcus pneumoniae in whole blood by PCR.

    Science.gov (United States)

    Zhang, Y; Isaacman, D J; Wadowsky, R M; Rydquist-White, J; Post, J C; Ehrlich, G D

    1995-03-01

    Streptococcus pneumoniae is a major cause of bacteremia in both children and adults. Currently, the diagnosis of pneumococcal bacteremia relies on the isolation and identification of the bacteria from blood cultures. We have developed a sensitive assay for the detection of S. pneumoniae in whole blood by the PCR. A specific primer-probe set (JM201 and JM202 primers with JM204 probe) designed from the penicillin-binding protein 2B gene was demonstrated to reproducibly detect between 10 and 100 fg of input purified S. pneumoniae DNA. This assay system was shown to be inclusive for all strains of S. pneumoniae evaluated, including 15 different serotypes and a battery of penicillin-resistant and -sensitive strains. The specificity of this PCR-based assay was demonstrated by its inability to support amplification from a series of human, bacterial, and yeast genomic DNAs. A general specimen preparation method which should be suitable for the purification of DNA from any pathogens in whole blood was developed. With this protocol it was possible to detect S. pneumoniae-specific DNA from whole blood specimens inoculated with as little as 4 CFU/ml. Copurified human blood DNA, ranging from 0 to 4.5 micrograms per PCR, did not affect the sensitivity of S. pneumoniae detection by PCR. A blinded clinical trial was used to compare the PCR-based assay with standard microbiological blood culture for the detection of S. pneumoniae bacteremia in 36 specimens obtained from pediatric patients seen in the emergency room of Children's Hospital of Pittsburgh. With culture as the "gold standard," the PCR-based assay had a sensitivity of 80% (4 of 5 culture-positive specimens were PCR positive) and a specificity of 84% (26 of 31 culture-negative specimens were PCR negative). However, three patients whose specimens were PCR positive and culture negative had histories suggestive of bacteremia, including recent positive blood cultures, treatment with antibiotics, cellulitis, and multiple

  18. Association between presence of pneumonia and pressure ulcer formation following traumatic spinal cord injury.

    Science.gov (United States)

    Krishnan, Shilpa; Karg, Patricia E; Boninger, Michael L; Brienza, David M

    2017-07-01

    To determine if the presence of pneumonia and pressure ulcers are associated in individuals with an acute spinal cord injury during acute care and rehabilitation hospitalizations. Retrospective, secondary analyses of data obtained from the Spinal Cord Injury Model Systems enrolled from 1993 until 2006 Setting: Acute care hospitalization and inpatient rehabilitation facilities Participants: A cohort of individuals hospitalized in acute care (n = 3,098) and inpatient rehabilitation (n = 1,768) was included in the analysis. Frequencies of pressure ulcer formation and episodes of pneumonia were noted in both settings. Not applicable. Pressure ulcer formation and diagnosis of pneumonia Results: The development of pressure ulcers, including stage I, was 20.3% acute care and 21.1% during in inpatient rehabilitation. Multivariate logistic regression analyses revealed a significant association of pneumonia with occurrence of pressure ulcers (P ≤ 0.001, OR = 2.3 and 2.2 respectively), the American Spinal Injury Association Impairment Scale grades (P pneumonia, after adjusting for injury severity, age, sex, and utilization of mechanical ventilation. Impaired inflammatory response and decreased mobility in individuals with pneumonia may predispose these individuals to develop pressure ulcers. Surveillance and preventive measures for pressure ulcers should be rigorous in individuals with SCI and pneumonia.

  19. Understanding MIH: definition, epidemiology, differential diagnosis and new treatment guidelines.

    Science.gov (United States)

    Mast, P; Rodrigueztapia, M T; Daeniker, L; Krejci, I

    2013-09-01

    Molar-Incisor Hypomineralisation (MIH) is a congenital disease which increases in prevalence. It affects permanent first molars and, often to a lesser degree, permanent incisors with variable severity. The aetiology is unknown, but different hypotheses have been advanced. Differential diagnosis is mandatory not to confound MIH with other diseases. Treatment consists in a minimally invasive approach by reinforcing and protecting the existing dental structure. In more severe cases, restorative treatment may be indicated.

  20. [ERG diagnosis and differential diagnosis: results of examination over 6 years].

    Science.gov (United States)

    Stemeyer, G; Stähli, P

    1996-05-01

    This study reviews the patient material first from the point of view of referral diagnosis. Secondly, we focus on difficulties in selective differential diagnoses. 1501 patients underwent electroretinographic (ERG) testing from 1989 to 1994, amounting to 1815 ERG recordings, including follow-up examinations. The technique applied is full-field, single flash ERG with selective stimulation of the rod- and of the cone-systems. In 3.8% (57 cases) the ERG was performed under general anesthesia in outpatients. Tapetoretinal degenerations, toxic retinal side effects, inflammatory disease and ocular trauma represented, in this order, the major groups of referral diagnoses aside from unclear visual loss. The documentation or the exclusion of tapetoretinal degeneration represented the largest share (57%) of the application of the diagnostic procedure. 171 cases of isolated retinitis pigmentosa (RP) and 33 cases of syndromic RP were identified. Frequent and rare diagnostic entities and their differential diagnoses within this group are discussed. Inevitably, a number of diagnostic decisions remain problematic, in particular at the first examination. These diagnostic difficulties are addressed also and include the differentiation between RP sine pigmento and congenital amaurosis Leber in infants, RP with macular involvement vs. cone-rod degeneration, unilateral RP vs. postinflammatory conditions, and progressive cone dystrophy vs. achromatopsia, cone-rod degeneration or Stargardt's disease. Frequent and meaningful indications for ERG recording and difficult diagnostic decisions arise from this review of a relatively large group of patients. A number of diagnoses can hardly, if not at all be established without ERG testing. These include retinal cause of visual loss in infants, congenital amaurosis Leber, RP sine pigmento, early stages of RP, carrier status in XL RP and in choroideremia, progressive cone dystrophy, toxic retinopathy without fundus changes, retinal involvement

  1. Age specific fast breathing in under-five diarrheal children in an urban hospital: Acidosis or pneumonia?

    Directory of Open Access Journals (Sweden)

    Sharika Nuzhat

    Full Text Available Children with diarrhea often present with fast breathing due to metabolic acidosis from dehydration. On the other hand, age specific fast breathing is the cornerstone for the diagnosis of pneumonia following classification of pneumonia recommended by the World Health Organization (WHO. Correction of metabolic acidosis by rehydrating the diarrheal children requires time, which delays early initiation of appropriate antimicrobials for pneumonia and thereby increases the risk of deaths. We need to further investigate the simple clinical features other than fast breathing which might help us in earliest diagnosis of pneumonia in children with diarrhea Thus, the objective of our study was to identify other contributing clinical features that may independently help for early diagnosis of pneumonia in diarrheal children who present with age specific fast breathing.This was an unmatched case-control study. Diarrheal children aged 0-59 months, admitted to Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b during January 2014 to December 2014 having age specific fast breathing (11-59 months ≥40 breaths/min were studied. The study children with clinical and radiological pneumonia constituted the cases (n = 276 and those without pneumonia constituted the controls (n = 446. Comparison of clinical features and outcomes between the cases and the controls was made.The distribution of acidosis among the cases and the controls was comparable (35% vs. 41%, p = 0.12. The cases had proportionately higher deaths compared to the controls, however, the difference was not statistically significant (3% vs. 1%; p = 0.23. In logistic regression analysis after adjusting for potential confounders, the cases were independently associated with cough (OR = 62.19, 95% CI = 27.79-139.19; p<0.01 and chest wall indrawing (OR = 31.05, 95%CI = 13.43-71.82; p<0.01 and less often had severe acute malnutrition (OR = 0.33, 95%CI = 0

  2. Sublethal Concentrations of Carbapenems Alter Cell Morphology and Genomic Expression of Klebsiella pneumoniae Biofilms

    Science.gov (United States)

    Van Laar, Tricia A.; Chen, Tsute; You, Tao

    2015-01-01

    Klebsiella pneumoniae, a Gram-negative bacterium, is normally associated with pneumonia in patients with weakened immune systems. However, it is also a prevalent nosocomial infectious agent that can be found in infected surgical sites and combat wounds. Many of these clinical strains display multidrug resistance. We have worked with a clinical strain of K. pneumoniae that was initially isolated from a wound of an injured soldier. This strain demonstrated resistance to many commonly used antibiotics but sensitivity to carbapenems. This isolate was capable of forming biofilms in vitro, contributing to its increased antibiotic resistance and impaired clearance. We were interested in determining how sublethal concentrations of carbapenem treatment specifically affect K. pneumoniae biofilms both in morphology and in genomic expression. Scanning electron microscopy showed striking morphological differences between untreated and treated biofilms, including rounding, blebbing, and dimpling of treated cells. Comparative transcriptome analysis using RNA sequencing (RNA-Seq) technology identified a large number of open reading frames (ORFs) differentially regulated in response to carbapenem treatment at 2 and 24 h. ORFs upregulated with carbapenem treatment included genes involved in resistance, as well as those coding for antiporters and autoinducers. ORFs downregulated included those coding for metal transporters, membrane biosynthesis proteins, and motility proteins. Quantitative real-time PCR validated the general trend of some of these differentially regulated ORFs. Treatment of K. pneumoniae biofilms with sublethal concentrations of carbapenems induced a wide range of phenotypic and gene expression changes. This study reveals some of the mechanisms underlying how sublethal amounts of carbapenems could affect the overall fitness and pathogenic potential of K. pneumoniae biofilm cells. PMID:25583711

  3. Severe rhinovirus pneumonia in a young woman taking performance-enhancing drugs.

    Science.gov (United States)

    Mayer, Kristina Nadine; Wyder, Daniel; Spasic, Danijela; Herren, Thomas

    2016-01-06

    A 22-year-old woman presented to the emergency room of a local hospital with pleuritic chest pain. She regularly worked out and admitted to taking performance-enhancing drugs (PEDs). Clinical findings and further diagnostic work up revealed a diagnosis of perimyocarditis, and adequate therapy was initiated. During the course of the first day, the patient had to be intubated and mechanically ventilated. A diagnosis of bilateral pneumonia and acute respiratory distress syndrome (ARDS) due to an infection by rhinovirus spp was made. A smoking habit, the intense physical training and the use of PED's may have exacerbated the course of the viral pneumonia. After 12 days the patient could be extubated. The length of stay in the intensive care unit was 16 days. After hospital discharge, the patient went to a pulmonary rehabilitation facility for 2 weeks. The outcome was favourable and the patient resumed her strength and endurance training. 2016 BMJ Publishing Group Ltd.

  4. Daptomycin-Induced Acute Eosinophilic Pneumonia: Late Onset and Quick Recovery

    Directory of Open Access Journals (Sweden)

    Mohamad Rachid

    2017-01-01

    Full Text Available Background. Daptomycin is a cyclic lipopeptide antibiotic that provides great coverage for gram positive cocci. From the early years of daptomycin use, concerns were raised regarding the pulmonary side effects of daptomycin and potential development of acute eosinophilic pneumonia (AEP secondary to daptomycin therapy. Discussion. AEP could be idiopathic or induced by drugs or toxins. It is a distinct entity from atopic diseases and autoimmune, parasitic, or fungal infections that can also cause pulmonary eosinophilia. Multiple medications are associated with acute eosinophilic pneumonia. Multiple cases of daptomycin-induced AEP have been reported in the literature. Diagnosis of AEP is based on clinical history, laboratory tests, and radiographic studies. Obtaining bronchoalveolar lavage or lung biopsy is needed to confirm the diagnosis. Timing of the drug use and clinical presentation is crucial in the diagnosis of drug-induced AEP. Discontinuation of the offending drug and systemic corticosteroids are the mainstay treatment with great outcomes and recovery. Conclusion. We present a case of AEP caused by daptomycin, with complete recovery after discontinuation of daptomycin and administration of steroids. The patient had AEP after almost 6 weeks of daptomycin therapy which has never been reported in literature and our patient achieved complete recovery with appropriate management.

  5. Does Magnetization Transfer Ratio (MTR) contribute to the diagnosis and differential diagnosis of the dementias?

    International Nuclear Information System (INIS)

    Hentschel, F.; Kreis, M.; Damian, M.; Krumm, B.

    2004-01-01

    Purpose: The magnetization transfer ratio (MTR) is a MR-based neuroimaging procedure aiming at the quantification of the structural integrity of brain tissue. Its contribution to the differential diagnosis of dementias was examined and discussed in relation to the pathogenesis of age-related dementias. Materials and Methods: Sixty-one patients from a memory clinic were diagnosed by general physical and neuropsychiatric examination, and underwent neuropsychologic testing and neuroimaging using MRI. Their clinical diagnoses were based on standard operational research criteria. Additionally, the MTR in 10 defined regions of interest (ROI) was determined. This investigation was performed using a T1-weighted SE sequence. Average MTR values were determined in the individual ROI and their combinations and correlated with the age gender, cognitive impairment and clinical diagnosis. Sensitivity, specificity, positive and negative predictive value were determined, as well as the rate of correct classifications. Results: For cognitive healthy subjects, the MRT values correlate only mildly, though significantly, with age in the hippocampus and with gender in the dorsal corpus callosum. In contrast, the MTR in the frontal white matter correlates strongly and highly significantly with cognitive impairment in patients with dementia. The differential diagnostic assignment of Alzheimer's disease versus vascular dementia by MTR provides a correct classification of approximately 50% to 70%. PPV for no dementia vs. vascular dementia or the NPV for vascular vs. Alzheimer's disease are considerably higher exceeding 80%. For no dementia vs. Alzheimer's disease, the NPV was over 90%. (orig.)

  6. Comparison of high-resolution computed tomography findings between Pseudomonas aeruginosa pneumonia and Cytomegalovirus pneumonia

    International Nuclear Information System (INIS)

    Omeri, Ahmad Khalid; Okada, Fumito; Takata, Shoko; Ono, Asami; Sato, Haruka; Mori, Hiromu; Nakayama, Tomoko; Ando, Yumiko; Hiramatsu, Kazufumi

    2014-01-01

    To compare pulmonary high-resolution CT (HRCT) findings in patients with Pseudomonas aeruginosa pneumonia to HRCT findings in patients with Cytomegalovirus (CMV) pneumonia. We studied 124 patients (77 men, 47 women; age range, 20-89 years; mean age, 65.4 years) with P. aeruginosa pneumonia and 44 patients (22 men, 22 women; age range, 36-86 years; mean age, 63.2 years) with CMV pneumonia. CT findings of consolidation (p < 0.005), bronchial wall thickening (p < 0.001), cavity (p < 0.05), and pleural effusion (p < 0.001) were significantly more frequent in patients with P. aeruginosa pneumonia than in those with CMV pneumonia. Centrilobular nodules, a crazy-paving appearance, and nodules were significantly more frequent in patients with CMV pneumonia than in those with P. aeruginosa pneumonia (all p < 0.001). Pulmonary HRCT findings, such as bronchial wall thickening, crazy-paving appearance, and nodules may be useful in distinguishing between P. aeruginosa pneumonia and CMV pneumonia. (orig.)

  7. Comparison of high-resolution computed tomography findings between Pseudomonas aeruginosa pneumonia and Cytomegalovirus pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Omeri, Ahmad Khalid; Okada, Fumito; Takata, Shoko; Ono, Asami; Sato, Haruka; Mori, Hiromu [Oita University Faculty of Medicine, Department of Radiology, Yufu, Oita (Japan); Nakayama, Tomoko [Oita Red Cross Hospital, Department of Radiology, Oita (Japan); Ando, Yumiko [Oita Nishibeppu National Hospital, Department of Radiology, Oita (Japan); Hiramatsu, Kazufumi [Oita University Hospital, Hospital Infection Control Center, Oita (Japan)

    2014-12-15

    To compare pulmonary high-resolution CT (HRCT) findings in patients with Pseudomonas aeruginosa pneumonia to HRCT findings in patients with Cytomegalovirus (CMV) pneumonia. We studied 124 patients (77 men, 47 women; age range, 20-89 years; mean age, 65.4 years) with P. aeruginosa pneumonia and 44 patients (22 men, 22 women; age range, 36-86 years; mean age, 63.2 years) with CMV pneumonia. CT findings of consolidation (p < 0.005), bronchial wall thickening (p < 0.001), cavity (p < 0.05), and pleural effusion (p < 0.001) were significantly more frequent in patients with P. aeruginosa pneumonia than in those with CMV pneumonia. Centrilobular nodules, a crazy-paving appearance, and nodules were significantly more frequent in patients with CMV pneumonia than in those with P. aeruginosa pneumonia (all p < 0.001). Pulmonary HRCT findings, such as bronchial wall thickening, crazy-paving appearance, and nodules may be useful in distinguishing between P. aeruginosa pneumonia and CMV pneumonia. (orig.)

  8. C-reactive protein, procalcitonin, clinical pulmonary infection score, and pneumonia severity scores in nursing home acquired pneumonia.

    Science.gov (United States)

    Porfyridis, Ilias; Georgiadis, Georgios; Vogazianos, Paris; Mitis, Georgios; Georgiou, Andreas

    2014-04-01

    Patients with nursing home acquired pneumonia (NHAP) present a distinct group of lower respiratory track infections with different risk factors, clinical presentation, and mortality rates. To evaluate the diagnostic value of clinical pulmonary infection score (CPIS), C-reactive protein, and procalcitonin and to compare the accuracy of pneumonia severity scores (confusion, urea nitrogen, breathing frequency, blood pressure, ≥ 65 y of age [CURB-65]; pneumonia severity index; NHAP index; systolic blood pressure, multilobar involvement, albumin, breathing frequency, tachycardia, confusion, oxygen, arterial pH [SMART-COP]; and systolic blood pressure, oxygen, age > 65 y, breathing frequency [SOAR]) in predicting in-patient mortality from NHAP. Nursing home residents admitted to the hospital with acute respiratory illness were enrolled in the study. Subjects were classified as having NHAP (Group A) or other pulmonary disorders (Group B). Clinical, imaging, and laboratory data were assessed to compute CPIS and severity scores. C-reactive protein and procalcitonin were measured by immunonephelometry and immunoassay, respectively. Fifty-eight subjects were diagnosed with NHAP (Group A) and 29 with other pulmonary disorders (Group B). The mean C-reactive protein ± SD was 16.38 ± 8.6 mg/dL in Group A and 5.2 ± 5.6 mg/dL in Group B (P 1.1 ng/mL was an independent predictor of in-patient mortality. Of the pneumonia severity scores, CURB-65 showed greater accuracy in predicting in-patient mortality (area under the curve of 0.68, 95% CI 0.53-0.84, P = .06). CPIS, procalcitonin, and C-reactive protein are reliable for the diagnosis of NHAP. Procalcitonin and CURB-65 are accurate in predicting in-patient mortality in NHAP.

  9. Klebsiella pneumoniae necrotizing fasciitis of the leg in an elderly French woman

    Directory of Open Access Journals (Sweden)

    Monié M

    2014-07-01

    of K. pneumoniae occurred in a hospitalized elderly woman without risk factors. Clinicians and geriatricians in particular should be aware of this important albeit unusual differential diagnosis. Keywords: necrotizing fasciitis, Klebsiella pneumoniae, elderly

  10. Mycoplasmal pneumonia in children

    Energy Technology Data Exchange (ETDEWEB)

    Schmidt, H.; Lengerke, H.J. v.

    1987-10-01

    Roentgenographic findings of bilateral interstitial pneumonia without segmental consolidation and with regional lymphadenitis, which occurs after infancy, are always suggestive of pneumonia from Mycoplasma pneumoniae, as this is one of the most frequent types of pneumonia in children. M. pneumonia can be presumed by the discrepancy between the extensive roentgenographic findings and the generally good condition of the patient. Before therapy is decided upon it is important to know what the etiology is.

  11. Pneumonia (image)

    Science.gov (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 ...

  12. Correlation of levels of alpha-defensins determined by HPLC-ESI-MS in bronchoalveolar lavage fluid with the diagnosis of pneumonia in premature neonates.

    Science.gov (United States)

    Tirone, Chiara; Boccacci, Simona; Inzitari, Rosanna; Tana, Milena; Aurilia, Claudia; Fanali, Chiara; Cabras, Tiziana; Messana, Irene; Castagnola, Massimo; Romagnoli, Costantino; Vento, Giovanni

    2010-08-01

    The presence of alpha-defensins in bronchoalveolar lavage fluid (BALF) was investigated in a cohort of preterm newborns with gestational age (GA) groups: pneumonia group of nine neonates suffering from pulmonary infection (GA: 26.1 +/- 2.1 wk; birth weight: 787.4 +/- 309.9 g), with or without associated bloodstream infection, and nonpneumonia group of 15 neonates (GA: 27.7 +/- 2.0 wk; birth weight: 1019.0 +/- 319.8 g). BALF culture was positive for CONS (n = 5), Staphylococcus aureus (n = 1), and Candida spp (n = 3). BALF samples were analyzed by HPLC-electrospray Ionization-mass spectrometer. The alpha-defensins 1-4 concentration, absolute and differential white cells count were measured. Relative amounts of alpha-defensins 1-4 and the absolute number of neutrophils were found significantly higher in the pneumonia group with respect to the nonpneumonia group (p < 0.05). Moreover, positive significant correlations between the number of neutrophils and the alpha-defensins 1-3 levels were observed. In conclusion, our data show that preterm newborns, also at the lower GA, are able to produce alpha-defensins, underlining that their innate defense system is already active before the at-term delivery date.

  13. Ventilator-associated pneumonia.

    Science.gov (United States)

    Shaw, Michael Jan

    2005-05-01

    This review summarises some of the notable papers on ventilator-associated pneumonia (VAP) from January 2003 to October 2004. Ventilator-associated pneumonia remains an important drain on hospital resources. All population groups are affected, but patients with VAP are more likely to be older, sicker, and male, with invasive medical devices in situ. Early VAP diagnosis is desirable to reduce VAP mortality and to retard emergence of multidrug-resistant microbes. This may be possible using preliminary culture results or intracellular organism in polymorphonuclear cells. In most intensive care units, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii are the commonest organisms isolated in VAP. However, causative organisms vary between and within hospitals. Consequently, individual intensive care units should develop empirical antibiotic policies to target the pathogenic bacteria prevalent in their patient populations. Preventative strategies aimed at reducing aerodigestive tract colonisation by pathogenic organisms, and also their subsequent aspiration, are becoming increasingly important. Educating medical staff about these simple measures is therefore pertinent. To reduce the occurrence of multidrug-resistant organisms, limiting the duration of antibiotic treatment to 8 days and antimicrobial rotation should be contemplated. Empirical therapy with antipseudomonal penicillins plus beta-lactamase inhibitors should be considered. If methicillin-resistant Staphylococcus aureus VAP is a possibility, linezolid may be better than vancomycin. Prevention remains the key to reducing VAP prevalence.

  14. [The influence of Chlamydia pneumoniae infection on acute coronary syndromes].

    Science.gov (United States)

    Gajek, Jacek; Choroszy-Król, Irena; Zyśko, Dorota; Teryks-Wołyniec, Dorota; Halawa, Bogumił

    2003-07-01

    Chlamydia pneumoniae is one of the infectious factors the role of which is considered in the process of atherosclerosis and its complications. Of the study was to assess the incidence of Ch. pneumoniae infection in the patients with acute coronary events. The study was carried out in 36 patients, mean age 61.2 +/- 13.4 years, 27 men and 9 women hospitalised in our Department with the diagnosis of previous or recent acute myocardial infarction. The control group consisted of 19 subjects, aged 61.1 +/- 14.3 years, 10 men and 9 women hospitalised due to other reasons. In all studied patients during the first 24 hours venous blood was taken for the assessment of fibrinogen and C-reactive protein (CRP) concentrations and titres of IgA and IgG anti-Ch. pneumoniae antibodies, and pharyngeal swabs were done for Ch. pneumoniae assessment. Positive swab tests were found in 19% of the patients, positive IgG titres in 80% and IgA in 64% of the patients. In the control group the corresponding values were 11, 79, 42%, respectively. In the patients with positive IgG titres, negative IgA titre result was observed in 21% and in the control group in 53% (p < 0.05). The CRP level was significantly higher in the studied patients than in the control group (24.2 vs 4.2 mg/l; p < 0.05). 1. The high percentage of positive serologic tests and rare positive results of pharyngeal swabs indicate a frequent contact with Ch. pneumoniae in human population. 2. Ch. pneumoniae infection exerts no significant influence on the unspecific markers of inflammation. 3. The higher frequency of seroconversion-positive IgG and negative IgA titres--in the control group indicates the role of prolonged or acute Ch. pneumoniae infection in the development or progression of coronary atherosclerosis and its complications.

  15. [Algorithm for the differential diagnosis of precancerous and regenerative changes in the cervix uteri].

    Science.gov (United States)

    Sazonova, V Iu; Fedorova, V E; Danilova, N V

    2013-01-01

    Pretumoral changes in the epithelium of the cervix uteri include cervical intraepithelial neoplasia (CIN). CIN III should be differentiated with regenerative changes during epidermization of endocervicoses. Epidermization is proliferation of undifferentiated reserve cells that differentiate towards the squamous epithelium, by superseding the ectopic endocervical glandular epithelium. This process was called immature squamous metaplasia (ISM). The objective of the investigation was to define the significance of different morphological signs in the differential diagnosis of CIN III and ISM. One hundred and twelve cervical, CIN III, and immature squamous metaplasia biopsies were selected for examination. The selected cervical specimens were divided into 2 groups according to the presence or absence of p16 and CK17 expression. The p16+, CK17- cases were taken as true CIN III and the pl 6-, CK17+ as a regenerative process. The basis for this investigation is the signs included by O.K. Khmelnitsky into an algorithm for the differential diagnosis of epidermizing pseudoerosion and intraepithelial cancer of the cervix uteri. The algorithm was reconsidered to objectify. The investigation established great differences in the number of significant mitoses in the study groups. A clear trend was found for differences in the number of acanthotic strands. A new differential diagnostic algorithm for CIN III and ISM, which included the number of significant mitoses and acanthotic strands and p16 and CK17 expression, was proposed.

  16. Evaluation of tumor markers for the differential diagnosis of benign and malignant ascites.

    Science.gov (United States)

    Liu, Fang; Kong, Xinjuan; Dou, Qian; Ye, Jin; Xu, Dong; Shang, Haitao; Xu, Keshu; Song, Yuhu

    2014-01-01

    The diagnosis of malignant ascites is a challenging problem in clinical practice, non-invasive techniques should be developed to improve diagnostic accuracy. The diagnostic performances of tumor markers in malignant ascites remained unsettled. Our aim was to evaluate diagnostic performance of tumor markers in differential diagnosis of benign and malignant ascites. A total of 437 patients were enrolled, and the relevant parameters of the patients were analyzed for the differentiation of benign ascites from malignant ascites. At the predetermined cutoff values of tumor makers, tumor markers in ascitic fluid showed better diagnostic performance than those in serum. Combined use of tumor markers and the cytology increased the diagnostic yield of the latter by 37%. In cytologically negative malignant ascites, tumor markers provided assistance in differentiating malignant ascites from benign ascites, and the combination of ascitic tumor markers yielded 86% sensitivity, 97% specificity. Use of a panel of tumor markers exhibited excellent diagnostic performance in diagnosing malignant ascites, which indicated the detection of tumor markers may represent a beneficial adjunct to cytology, thus guiding the selection of patients who might benefit from further invasive procedures.

  17. Differentiated thyroid carcinoma in a scintigraphically hot nodule: diagnosis and interdisciplinary therapeutical approach

    International Nuclear Information System (INIS)

    Stahl, A.; Hess, U.; Langhammer, H.; Harms, J.; Zwicknagl, M.

    2002-01-01

    A hyperfunctioning differentiated thyroid carcinoma is a rare occurrence. Nevertheless, this diagnosis must be considered in a scintigraphically hot nodule if there is a clinical or sonographic suggestion of malignancy. The case of a 57-year old patient with hyperthyreosis and a scintigraphically hot thyroid nodule is presented. Further evaluation led to the diagnosis of a differentiated thyroid carcinoma with extensive lymph node and pulmonary metastases (pT2b, pN1b, pM1). The scintigraphically hot nodule corresponded to the primary tumor, whereas scintigraphic detection of the lymph node metastases was only possible postoperatively. Extensive resection of the lymph node metastases was achieved by the intraoperative application of a gamma probe (2nd operation). This allowed sufficient uptake of radioiodine in the pulmonary metastases for their detection and subsequent devitalization by radioiodine therapy. Complete elimination of all tumor tissue was documented at a control follow-up after six months. Gamma probe-guided surgery may allow for additional removement of non-palpable lymph node metastases. In selected cases this may optimize the surgical results and thereby facilitate the subsequent radioiodine elimination of advanced differentiated thyroid carcinomas. (author)

  18. Traditional Chinese medicine therapy decreases the pneumonia risk in patients with dementia

    Science.gov (United States)

    Lin, Shun-Ku; Tsai, Yueh-Ting; Lo, Pei-Chia; Lai, Jung-Nien

    2016-01-01

    Abstract Pneumonia is a frequent complication in dementia patients and is associated with high mortality rates. The aim of this retrospective cohort study was to determine whether traditional Chinese medicine (TCM) therapy can decrease pneumonia risk in dementia patients. The cohort dataset was obtained from the Longitudinal Health Insurance Database 2005, a sublibrary of the National Health Insurance Research Database, containing all medical data of 1 million beneficiaries, randomly selected from the all Insurers in year 2005. Newly diagnosed dementia patients (n = 9712) without pneumonia were analyzed from January 1997 to December 2003. After matching by sex, age, urban level, Charlson comorbidity index, insured amount, and comorbidities, 1376 pairs (1:1) of TCM and non-TCM users were acquired. Every dementia patient was individually recorded from 1997 to 2012 to identify pneumonia incidence (onset after 3 months of dementia diagnosis). Demographic characteristics, Charlson comorbidity index, comorbidities, behavioral and psychological symptoms of dementia, and psychotropic drugs were also investigated. Cox proportional regression was used to compute hazard ratios and 95% confidence intervals (CIs) after adjustment for the above-mentioned variables. There were 419 (30.5%) and 762 (55.4%) pneumonia cases in the TCM and non-TCM cohorts during a mean follow-up period of 7.6 years. The adjusted hazard ratios (95% CI) for pneumonia admission was 0.62 (0.55–0.70) for the TCM group. Patients who received TCM therapy at higher cumulative doses or for longer periods experienced increased protection from pneumonia admission. Ma-Xing-Gan-Shi-Tang, Yin-Qiao-San, and Xiao-Qing-Long-Tang might represent possible formulae reducing the incidence of pneumonia. TCM might be associated with a lower risk of pneumonia in dementia patients. PMID:27631269

  19. [Comorbid psychiatric disorders and differential diagnosis of patients with autism spectrum disorder without intellectual disability].

    Science.gov (United States)

    Strunz, Sandra; Dziobek, Isabel; Roepke, Stefan

    2014-06-01

    Autism spectrum conditions (ASC) without intellectual disability are often diagnosed late in life. Little is known about co-occurring psychiatric disorders and differential diagnosis of ASC in adulthood, particularly with regard to personality disorders. What kind of comorbid psychiatric disorders occur in ASC? Which are the most prevalent differential diagnoses in a sample of patients who seek autism specific clinical diagnostics? 118 adults who were referred with a presumed diagnosis of autistic disorder, were diagnosed with autism specific instruments and the prevalence of further psychiatric disorders was investigated. 59 (50%) fulfilled the criteria of ASC. 36% of the individuals with ASC fulfilled also criteria for a DSM-IV axis-I psychiatric disorder. Affective disorders (24%) and social phobia (14%) were the most prevalent comorbid disorders. The most frequent differential diagnoses were depression, social phobia, paranoid, avoidant and narcissistic personality disorder. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Fault detection and diagnosis in nonlinear systems a differential and algebraic viewpoint

    CERN Document Server

    Martinez-Guerra, Rafael

    2014-01-01

    The high reliability required in industrial processes has created the necessity of detecting abnormal conditions, called faults, while processes are operating. The term fault generically refers to any type of process degradation, or degradation in equipment performance because of changes in the process's physical characteristics, process inputs or environmental conditions. This book is about the fundamentals of fault detection and diagnosis in a variety of nonlinear systems which are represented by ordinary differential equations. The fault detection problem is approached from a differential algebraic viewpoint, using residual generators based upon high-gain nonlinear auxiliary systems (‘observers’). A prominent role is played by the type of mathematical tools that will be used, requiring knowledge of differential algebra and differential equations. Specific theorems tailored to the needs of the problem-solving procedures are developed and proved. Applications to real-world problems, both with constant an...

  1. A Multivariate Analytic Approach to the Differential Diagnosis of Apraxia of Speech

    Science.gov (United States)

    Basilakos, Alexandra; Yourganov, Grigori; den Ouden, Dirk-Bart; Fogerty, Daniel; Rorden, Chris; Feenaughty, Lynda; Fridriksson, Julius

    2017-01-01

    Purpose: Apraxia of speech (AOS) is a consequence of stroke that frequently co-occurs with aphasia. Its study is limited by difficulties with its perceptual evaluation and dissociation from co-occurring impairments. This study examined the classification accuracy of several acoustic measures for the differential diagnosis of AOS in a sample of…

  2. Pharmacoeconomic Analysis of Drugs Used in the Treatment of Pneumonia in Paediatric Population in a Tertiary Care Hospital in India-A Cost-of-Illness Study.

    Science.gov (United States)

    Saha, Lekha; Kaur, Sharonjeet; Khosla, Pratibha; Kumari, Sweta; Rani, Alka

    2017-12-11

    The cost of antibiotic therapy for the treatment of pneumonia in the inpatient paediatric population can have a major impact on the healthcare expenditure. We planned to assess the direct and indirect costs of diagnosis and medical treatment of paediatric patients with community acquired pneumonia who are hospitalized in a tertiary care hospital in India. 125 children with a diagnosis of pneumonia who were admitted to the inpatient department of a paediatric hospital receiving antibiotic treatment were observed. Data on clinical presentation and resources consumed were collected and the costs of pneumonia treatment were calculated. Descriptive statistics (mean ± standard deviation (SD)) were used to evaluate data regarding demographics, drugs prescribed and cost (direct and indirect cost). Multivariate regression analysis was used to find out predictors of direct and indirect cost. Among all pneumonia admissions, mild-to-moderate pneumonia constitutes 76.8%, and 23.2% children were admitted with severe pneumonia; 105 children out of 125 (84%) were suffering from associated disorders along with pneumonia. The majority of antibiotics prescribed belonged to beta lactams (52%) followed by aminoglycosides (19%), macrolides (13%) and peptides (11%). Parenteral routes of administration were used in a majority of patients as compared to oral. The average cost per patient in management of pneumonia was 12245 ± 593 INR ($187.34 ± 9.07).

  3. Pharmacoeconomic Analysis of Drugs Used in the Treatment of Pneumonia in Paediatric Population in a Tertiary Care Hospital in India—A Cost-of-Illness Study

    Directory of Open Access Journals (Sweden)

    Lekha Saha

    2017-12-01

    Full Text Available Aims and objectives: The cost of antibiotic therapy for the treatment of pneumonia in the inpatient paediatric population can have a major impact on the healthcare expenditure. We planned to assess the direct and indirect costs of diagnosis and medical treatment of paediatric patients with community acquired pneumonia who are hospitalized in a tertiary care hospital in India. Methods: 125 children with a diagnosis of pneumonia who were admitted to the inpatient department of a paediatric hospital receiving antibiotic treatment were observed. Data on clinical presentation and resources consumed were collected and the costs of pneumonia treatment were calculated. Descriptive statistics (mean ± standard deviation (SD were used to evaluate data regarding demographics, drugs prescribed and cost (direct and indirect cost. Multivariate regression analysis was used to find out predictors of direct and indirect cost. Results: Among all pneumonia admissions, mild-to-moderate pneumonia constitutes 76.8%, and 23.2% children were admitted with severe pneumonia; 105 children out of 125 (84% were suffering from associated disorders along with pneumonia. The majority of antibiotics prescribed belonged to beta lactams (52% followed by aminoglycosides (19%, macrolides (13% and peptides (11%. Parenteral routes of administration were used in a majority of patients as compared to oral. The average cost per patient in management of pneumonia was 12245 ± 593 INR ($187.34 ± 9.07.

  4. Neurocognitive differential diagnosis of dementing diseases: Alzheimer's Dementia, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder.

    Science.gov (United States)

    Braaten, Alyssa J; Parsons, Thomas D; McCue, Robert; Sellers, Alfred; Burns, William J

    2006-11-01

    Similarities in presentation of Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder, pose differential diagnosis challenges. The current study identifies specific neuropsychological patterns of scores for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. Neuropsychological domains directly assessed in the study included: immediate memory, delayed memory, confrontational naming, verbal fluency, attention, concentration, and executive functioning. The results reveal specific neuropsychological comparative profiles for Dementia of Alzheimer's Type, Vascular Dementia, Frontotemporal Dementia, and Major Depressive Disorder. The identification of these profiles will assist in the differential diagnosis of these disorders and aid in patient treatment.

  5. [A rare cause of pneumonia: Shewanella putrefaciens].

    Science.gov (United States)

    Durdu, Bülent; Durdu, Yasemin; Güleç, Nuray; Islim, Filiz; Biçer, Mualla

    2012-01-01

    Shewanella putrefaciens is a gram-negative, non-fermentative, oxidase positive, motile bacillus that produces hydrogen sulphide. It is found widely in the nature especially in marine environments. Although it is accepted as saprophytic, different clinical syndromes, most commonly skin or soft tissue infections, have been associated with S.putrefaciens, mainly in immunocompromised cases and patients with underlying diseases. However, pneumonia cases due to S.putrefaciens are quite limited in the literature. In this report, a case of pneumonia caused by S.putrefaciens was presented. A 43-year-old female patient was admitted to our hospital with the complaints of fever, cough, sputum and weakness. The patient has had brochiectasis since childhood and has used periodical antibiotic therapies due to pneumoniae episodes. She was diagnosed to have pneumonia based on the clinical, radiological and laboratory findings, and empirical antibiotic treatment with ciprofloxacin and ceftazidime combination was initiated. Gram-stained smear of sputum yielded abundant leucocytes and gram-negative bacteria, and the isolate grown in the sputum culture was identified as S.putrefaciens by conventional methods and API 20 NE (BioMerieux, France) system. The isolate was found susceptible to ceftriaxone, ceftazidime, cefepime, ciprofloxacin, piperacillin-tazobactam, cephoperazon-sulbactam, imipenem, amikacin, gentamicin and trimethoprime-sulphametoxazole; whereas resistant to ampicillin, amoxycillin-clavulanate, cefazolin and cefuroxime, by Kirby-Bauer disk diffusion method. According to the antibiogram results, the therapy was changed to ceftriaxone (1 x 2 g, intravenous). The patient was discharged with complete cure after 14 days of therapy. In conclusion, S.putrefaciens should be considered in patients with predisposing factors as an unusual cause of pneumonia and the characteristics such as H2S production and sensitivity to third generation cephalosporins and penicillins should be used

  6. [Organising Pneumonia - a review and results from Icelandic studies].

    Science.gov (United States)

    Sveinsson, Olafur A; Isaksson, Helgi J; Gudmundsson, Gunnar

    2008-01-01

    Organising pneumonia (OP) is a relatively rare interstitial lung disease. It s definition is based on a characteristic histological pattern in the presence of certain clinical and radiological features. Organising pneumonia represents also what has been called Bronchiolitis Obliterans Organising Pneumonia (BOOP). Recently it has been recommended to call OP cryptogenic organising pneumonia (COP) when no definite cause or characteristic clinical context is found and secondary organising pneumonia (SOP) when causes can be identified such as infection or it occurs in a characteristic clinical context such as connective tissue disorder. The most common clinical symptoms are dyspnea, cough, fever and general malaise. It is common that symptoms have been present for some weeks before the diagnosis is made. Patients commonly have lowered PO2 and a mildly restrictive spirometry. Radiographic features are most often patchy bilateral airspace opacities but an interstitial pattern or focal opacities can also be seen. Most of patients respond well to steroids but relapses are quite common. The aim of this paper is to present an overview of the disease and the main results from studies on OP in Iceland. The mean annual incidence for OP in Iceland was 1.97/100,000 inhabitants. Annual incidence for COP was 1.10/100,000 and 0.87/100,000 for SOP. This is higher than in most other studies. In Iceland patients with OP had a higher standardized mortality ratio than the general population despite good clinical responses. No clinical symptoms could separate between SOP and COP.

  7. CT differential diagnosis of primary pelvic osteosarcoma, chondrosarcoma and Ewing's sarcoma

    International Nuclear Information System (INIS)

    Heller, M.; Heyer, D.; Spielmann, R.P.; Buecheler, E.

    1990-01-01

    The value of CT for the differential diagnosis of primary malignant tumours in the pelvis was investigated in the case of three types of tumour: Osteosarcomas, chondrosarcomas and Ewing's sarcomas. A total of 78 CT examinations in 29 patients was used. The results show that CT, using suitable techniques (high resolution etc.) constitutes a valuable diagnostic method for differentiating these bone tumours. This applies not only for the localisation of the tumour and for defining its extent, but also for showing the morphology of intra- and extra-osseous soft tissue components and their patterns of calcification. It is possible to recognise patterns of growth and of tissue destruction that are typical of individual tumours. (orig.) [de

  8. Analysis of the effectiveness of physical rehabilitation according spirographic indicators in community-acquired pneumonia during convalescence

    Directory of Open Access Journals (Sweden)

    Y. S. Kalmykova

    2014-09-01

    Full Text Available Purpose : to make a program of physical rehabilitation for convalescents after community-acquired pneumonia, promotes normalization of respiratory function. The objectives of the study was to evaluate the dynamics spirographic indicators during convalescence community-acquired pneumonia. Material: the study involved 28 women aged 19 to 24 years with a diagnosis of community-acquired pneumonia after convalescent. Results: the positive influence of physiotherapy based dance aerobics; morning hygienic gymnastics; therapeutic massage and physical therapy on indicators of lung volumes, ventilation and bronchial patency according spirographic research. Conclusion: in community-acquired pneumonia during the convalescence period recommended physical rehabilitation, which includes curative gymnastics based on dance aerobics, morning hygienic gymnastics, massage therapy, physiotherapy. It improves the functionality of the cardiorespiratory system, nonspecific immunity and overall physical performance level.

  9. The need to improve the diagnosis, clinical care and outcomes of children with pneumonia: where are the gaps?

    Directory of Open Access Journals (Sweden)

    Anne B Chang

    2013-10-01

    Full Text Available Pneumonia is the greatest contributor to childhood mortality and morbidity in resource-poor regions, while in high-income countries it is one of the most common reasons for clinic attendance and hospitalization in this age group. Furthermore, pneumonia in children increases the risk of developing chronic pulmonary disorders in later adult life. While substantial advances in managing childhood pneumonia have been made, many issues remain, some of which are highlighted in this perspective. Multiple studies are required as many factors that influence outcomes, such as etiology, patient characteristics and prevention strategies can vary between and within countries and regions. Also, outside of vaccine studies, most randomized controlled trials (RCTs on pneumonia have been based in resource-poor countries where the primary aim is usually prevention of mortality. Few RCTs have focused on medium to long-term outcomes or prevention. We propose different tiers of primary outcomes, where in resource-rich countries medium to long-term sequelae should also be included and not just the length of hospitalization and readmission rates.

  10. Differential diagnosis of neuromyelitis optica spectrum disorders

    Science.gov (United States)

    Kim, Sung-Min; Kim, Seong-Joon; Lee, Haeng Jin; Kuroda, Hiroshi; Palace, Jacqueline; Fujihara, Kazuo

    2017-01-01

    Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system (CNS) mostly manifesting as optic neuritis and/or myelitis, which are frequently recurrent/bilateral or longitudinally extensive, respectively. As the autoantibody to aquaporin-4 (AQP4-Ab) can mediate the pathogenesis of NMOSD, testing for the AQP4-Ab in serum of patients can play a crucial role in diagnosing NMOSD. Nevertheless, the differential diagnosis of NMOSD in clinical practice is often challenging despite the phenotypical and serological characteristics of the disease because: (1) diverse diseases with autoimmune, vascular, infectious, or neoplastic etiologies can mimic these phenotypes of NMOSD; (2) patients with NMOSD may only have limited clinical manifestations, especially in their early disease stages; (3) test results for AQP4-Ab can be affected by several factors such as assay methods, serologic status, disease stages, or types of treatment; (4) some patients with NMOSD do not have AQP4-Ab; and (5) test results for the AQP4-Ab may not be readily available for the acute management of patients. Despite some similarity in their phenotypes, these NMOSD and NMOSD-mimics are distinct from each other in their pathogenesis, prognosis, and most importantly treatment. Understanding the detailed clinical, serological, radiological, and prognostic differences of these diseases will improve the proper management as well as diagnosis of patients. PMID:28670343

  11. Predictors of viral pneumonia in patients with community-acquired pneumonia.

    Directory of Open Access Journals (Sweden)

    Ji Eun Kim

    Full Text Available BACKGROUND: Viruses are increasingly recognized as major causes of community-acquired pneumonia (CAP. Few studies have investigated the clinical predictors of viral pneumonia, and the results have been inconsistent. In this study, the clinical predictors of viral pneumonia were investigated in terms of their utility as indicators for viral pneumonia in patients with CAP. METHODS: Adult patients (≥ 18 years old with CAP, tested by polymerase chain reaction (PCR for respiratory virus, at two teaching hospitals between October 2010 and May 2013, were identified retrospectively. Demographic and clinical data were collected by reviewing the hospital electronic medical records. RESULTS: During the study period, 456 patients with CAP were identified who met the definition, and 327 (72% patients were tested using the respiratory virus PCR detection test. Viral pneumonia (n = 60 was associated with rhinorrhea, a higher lymphocyte fraction in the white blood cells, lower serum creatinine and ground-glass opacity (GGO in radiology results, compared to non-viral pneumonia (n = 250 (p < 0.05, each. In a multivariate analysis, rhinorrhea (Odd ratio (OR 3.52; 95% Confidence interval (CI, 1.58-7.87 and GGO (OR 4.68; 95% CI, 2.48-8.89 were revealed as independent risk factors for viral pneumonia in patients with CAP. The sensitivity, specificity, positive- and negative-predictive values (PPV and NPV of rhinorrhea were 22, 91, 36 and 83%: the sensitivity, specificity, PPV and NPV of GGO were and 43, 84, 40 and 86%, respectively. CONCLUSION: Symptom of rhinorrhea and GGO predicted viral pneumonia in patients with CAP. The high specificity of rhinorrhea and GGO suggested that these could be useful indicators for empirical antiviral therapy.

  12. Persistent severe hypokalemia: Gitelman syndrome and differential diagnosis

    Directory of Open Access Journals (Sweden)

    Christine Zomer Dal Molin

    Full Text Available Abstract The main causes of hypokalemia are usually evident in the clinical history of patients, with previous episodes of vomiting, diarrhea or diuretic use. However, in some patients the cause of hypokalemia can become a challenge. In such cases, two major components of the investigation must be performed: assessment of urinary excretion potassium and the acid-base status. This article presents a case report of a patient with severe persistent hypokalemia, complementary laboratory tests indicated that's it was hypomagnesaemia and hypocalciuria associated with metabolic alkalosis, and increase of thyroid hormones. Thyrotoxic periodic paralysis was included in the differential diagnosis, but evolved into euthyroid state, persisting with severe hypokalemia, which led to be diagnosed as Gitelman syndrome.

  13. The use of computed tomography in the differential diagnosis of late epilepsy

    International Nuclear Information System (INIS)

    Annewanter, B.

    1981-01-01

    The report refers to 299 patients suffering from late epilepsies who were examined both clinically and by computed tomography. The cases were classified according to clinical tentative diagnoses and types of attacks. The objective was to find out how useful computerized tomography is in differential diagnosis concerning the aetiology of late epilepsies. (orig./MG) [de

  14. Isolated Cataplexy in the Differential Diagnosis of Drop Attacks: A Case of Successful Clinical Diagnosis and Treatment

    Directory of Open Access Journals (Sweden)

    Robert T. Egel

    2012-01-01

    Full Text Available Drop attacks are sudden spontaneous falls that are not accompanied by alteration of consciousness and are followed by immediate recovery. Cataplexy, which is usually associated with narcolepsy, is one of the causes of drop attacks. We report a patient with the rare condition of cataplexy without associated narcolepsy (isolated cataplexy. Isolated cataplexy should be included in the differential diagnosis when a patient presents with recurrent drop attacks and normal diagnostic test results.

  15. Severe community-acquired pneumonia caused by Mycoplasma pneumoniae in young female patient

    Directory of Open Access Journals (Sweden)

    Milačić Nena

    2015-07-01

    Full Text Available Mycoplasma pneumonia is common agent causing community acquired pneumonia in younger population. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a 27 years old female patient with unilateral pneumonia followed by pleural effusion and adhesions on the same side. This potential source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.

  16. Evaluation of a Hospital-Based Pneumonia Nurse Navigator Program.

    Science.gov (United States)

    Seldon, Lisa E; McDonough, Kelly; Turner, Barbara; Simmons, Leigh Ann

    2016-12-01

    The aim of this study is to evaluate the effectiveness of a hospital-based pneumonia nurse navigator program. This study used a retrospective, formative evaluation. Data of patients admitted from January 2012 through December 2014 to a large community hospital with a primary or secondary diagnosis of pneumonia, excluding aspiration pneumonia, were used. Data included patient demographics, diagnoses, insurance coverage, core measures, average length of stay (ALOS), disposition, readmission rate, financial outcomes, and patient barriers to care were collected. Descriptive statistics and parametric testing were used to analyze data. Core measure performance was sustained at the 90th percentile 2 years after the implementation of the navigator program. The ALOS did not decrease to established benchmarks; however, the SD for ALOS decreased by nearly half after implementation of the navigator program, suggesting the program decreased the number and length of extended stays. Charges per case decreased by 21% from 2012 to 2014. Variable costs decreased by 4% over a 2-year period, which increased net profit per case by 5%. Average readmission payments increased by 8% from 2012 to 2014, and the net revenue per case increased by 8.3%. The pneumonia nurse navigator program may improve core measures, reduce ALOS, and increase net revenue. Future evaluations are necessary to substantiate these findings and optimize the cost and quality performance of navigator programs.

  17. CT findings of pleural lesions: differential diagnosis between malignant benign diseases

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Seung Yon; Lim, Tae Hwan; Kim, Woo Sun; Park, Kwang Gil [Asan Medical Center, University of Ulsan, College of Medicine, Seoul (Korea, Republic of)

    1991-05-15

    A number of benign and malignant diseases may cause pleural abnormalities. Since the resolution of computed tomography (CT) has been improved, the detailed anatomy of pleura can now be well delineated in various pleural diseases. We reviewed retrospectively the CT findings of 60 patients with pathologically proved pleural diseases in order to find out the differential points between benign and malignant diseases. Thirty-six patients had malignant diseases (20 adenocarcinoma, 8 squamous cell carcinoma, 4 small cell carcinoma, 2 lung metastasis, 1 large cell carcinoma, 1 small and large cell carcinoma), and 24 patients had benign diseases (16 tuberculosis including empyema, 3 bacterial empyema, 3 pneumonia, 1 lung abscess, 1 lung contusion). The CT features that suggested malignant pleural diseases were high-grade mediastinal involvement (57.9%, {rho} < 0.1), thick and irregular thickening with nodularity and mass formations (38.5%, {rho} < 0.1), Circumferential pleural thickening 132.1%, {rho} < 0.01), and aggressive pleural effusion 122.2%, {rho} < 0.05). Benign pleural lesions were typically represented by pleural calcification (50%) and extrapleural fat accumulation (45.8%)

  18. Application of dual phase imaging of 11C-acetate positron emission tomography on differential diagnosis of small hepatic lesions.

    Directory of Open Access Journals (Sweden)

    Li Huo

    Full Text Available OBJECTIVE: Previously we observed that dual phase 11C-acetate positron emission tomography (AC-PET could be employed for differential diagnosis of liver malignancies. In this study, we prospectively evaluated the effect of dual phase AC-PET on differential diagnosis of primary hepatic lesions of 1-3 cm in size. METHODS: 33 patients having primary hepatic lesions with size of 1-3 cm in diameter undertook dual phase AC-PET scans. Procedure included an early upper-abdomen scan immediately after tracer injection and a conventional scan in 11-18 min. The standardized uptake value (SUV was calculated for tumor (SUVT and normal tissue (SUVB, from which 11C-acetate uptake ratio (as lesion against normal liver tissue, SUVT/SUVB in early imaging (R1, conventional imaging (R2, and variance between R2 and R1 (ΔR were derived. Diagnoses based on AC-PET data and histology were compared. Statistical analysis was performed with SPSS 19.0. RESULTS: 20 patients were found to have HCC and 13 patients had benign tumors. Using ΔR>0 as criterion for malignancy, the accuracy and specificity were significantly increased comparing with conventional method. The area under ROC curve (AUC for R1, R2, and ΔR were 0.417, 0.683 and 0.831 respectively. Differential diagnosis between well-differentiated HCCs and benign lesions of FNHs and hemangiomas achieved 100% correct. Strong positive correlation was also found between R1 and R2 in HCC (r2 = 0.55, P<0.001. CONCLUSIONS: Dual phase AC-PET scan is a useful procedure for differential diagnosis of well-differentiated hepatocellular carcinoma and benign lesions. The dynamic changes of 11C-acetate uptake in dual phase imaging provided key information for final diagnosis.

  19. Brain MR Contribution to the Differential Diagnosis of Parkinsonian Syndromes: An Update

    Directory of Open Access Journals (Sweden)

    Giovanni Rizzo

    2016-01-01

    Full Text Available Brain magnetic resonance (MR represents a useful and feasible tool for the differential diagnosis of Parkinson’s disease. Conventional MR may reveal secondary forms of parkinsonism and may show peculiar brain alterations of atypical parkinsonian syndromes. Furthermore, advanced MR techniques, such as morphometric-volumetric analyses, diffusion-weighted imaging, diffusion tensor imaging, tractography, proton MR spectroscopy, and iron-content sensitive imaging, have been used to obtain quantitative parameters useful to increase the diagnostic accuracy. Currently, many MR studies have provided both qualitative and quantitative findings, reflecting the underlying neuropathological pattern of the different degenerative parkinsonian syndromes. Although the variability in the methods and results across the studies limits the conclusion about which technique is the best, specific radiologic phenotypes may be identified. Qualitative/quantitative MR changes in the substantia nigra do not discriminate between different parkinsonisms. In the absence of extranigral abnormalities, the diagnosis of PD is more probable, whereas basal ganglia changes (mainly in the putamen suggest the diagnosis of an atypical parkinsonian syndrome. In this context, changes in pons, middle cerebellar peduncles, and cerebellum suggest the diagnosis of MSA, in midbrain and superior cerebellar peduncles the diagnosis of PSP, and in whole cerebral hemispheres (mainly in frontoparietal cortex with asymmetric distribution the diagnosis of Corticobasal Syndrome.

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

    Directory of Open Access Journals (Sweden)

    Vučinić Slavica

    2005-01-01

    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