1/62. Fulminant lethal tuberculous pneumonia (sepsis tuberculosis gravissima) with ARDS in a non-immunocompromised western European middle-aged man.We report the case of a 42 years old, non-immunocompromised native Austrian living in Vienna. He presented at home with severe dyspnea and had to be intubated immediately. Shortly after hospital admission, he developed severe adult respiratory distress syndrome (ARDS) and septic shock with massive, bilobar patchy to confluent infiltrations and a need for norepinephrine. A CT-scan revealed severe loss of functional lung tissue with areas of consolidation and multiple communicating cystic spaces. air leaking into the mediastinum through fistulas produced pneumomediastinum, pneumoperitoneum, and a massive soft tissue emphysema. bronchoalveolar lavage performed within the first 24 hours of admission revealed of acid-fast bacilli. Even though appropriate tuberculostatic medication was started immediately, the patient succumbed the next day to ARDS due to massive tuberculous pneumonia and miliary disease (sepsis tuberculosis gravissima).- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
2/62. Developing bronchial fistulas as a late complication of extraperiosteal plombage.A 65-year-old male, who underwent extraperiosteal plombage for pulmonary tuberculosis 46 years ago, was referred to our hospital due to relapsing hemosputa and pneumonia. A chest computed tomography scan revealed a bronchial fistula and a fluid collection in one Lucite ball. On May 20, 1996, a right-anterior thoracotomy was performed in a supine position. Five Lucite balls were removed, and the empyema space was tightly filled with an omental pedicle flap. Although the bronchial fistulas were not sutured directly, the air leakage from the drainage tube ceased 12 days later. Two years postoperatively the patient has remained well. Our simple approach of combining an anterior thoracotomy and replacement of an empyema space with an omental pedicle flap in the same posture, without closing bronchial fistulas, would be an easy procedure, and therefore exploitable in patients who have a similar problem.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
3/62. Successful treatment of pulmonary mycobacterium xenopi infection in a natural killer cell-deficient patient with clarithromycin, rifabutin, and sparfloxacin.Isolation of mycobacterium xenopi from the respiratory tract may indicate pneumonia, often clinically indistinguishable from tuberculosis. Resistance to the classic antituberculous drugs renders the treatment of these infections problematic. We report on a case of cavernous pneumonia caused by M. xenopi in a 36-year-old male with natural killer cell deficiency but without severe immunodeficiency. He was successfully treated with a novel triple-drug combination comprising clarithromycin, sparfloxacin, and rifabutin. An impressive subsequent regression of pathological pulmonary changes was observed, and mycobacteria could no longer be detected. The therapeutic potential of clarithromycin and sparfloxacin in the treatment of M. xenopi infections is discussed.- - - - - - - - - - ranking = 0.4keywords = pneumonia (Clic here for more details about this article) |
4/62. Acute respiratory distress syndrome due to tuberculosis in a child after allogeneic bone marrow transplantation for acute lymphoblastic leukemia.We report the occurrence of tuberculosis in a 10-year-old Taiwanese boy, approximately 4 months after he received a matched-related bone marrow transplantation from his sister for acute T-cell lymphoblastic leukemia. After transplantation, grade III acute graft-versus-host disease developed and the patient was treated with prednisolone and cyclosporine. Marrow failure was noted on day 77 post-transplantation, however, after an episode of herpes zoster infection. Interstitial pneumonia, diagnosed on the basis of chest x-ray and computed tomography findings, occurred on day 120. Histologic examination of an open-lung biopsy specimen showed caseating granulomas and a few acid-fast bacilli. The patient died of acute respiratory distress syndrome, despite immediate implementation of antituberculosis therapy. sputum cultures grew mycobacterium tuberculosis 5 weeks later. This report demonstrates that the possibility of tuberculosis needs to be considered in immunocompromised patients, and that appropriate prophylaxis should be instituted in areas where tuberculosis is endemic.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
5/62. pneumocystis carinii pneumonia (PCP) at Ga-Rankuwa Hospital.pneumocystis carinii is recognized as one of the leading causes of death in AIDS patients in developed countries but its role in this regard in developing countries appears to be less prominent. Sub-Saharan African countries, in spite of their high hiv prevalence, have hardly recorded any cases. We report the first microbiologically proven case of PCP in an adult patient at Ga-Rankuwa Hospital. A 37 year old African woman was referred to Ga-Rankuwa Hospital from the local clinic for chest infection with a non productive cough that had not responded to conventional treatment. On admission, she was febrile, emaciated and in respiratory distress with oral thrush. Chest radiography showed diffuse bilateral infiltrations and a preliminary diagnosis of atypical pneumonia and tuberculosis was made. The patient was begun on penicillin, gentamicin, contrimoxazole and anti-tuberculosis therapy. Laboratory investigations revealed a low haemoglobin, positive hiv test (after counselling) and pneumocystis carinii trophozoites and cytes in the bronchoalveolar larvage specimen. In spite of appropriate treatment the patient died within three days. One wonders whether the outcome for this middle aged woman with advanced hiv infection would have been different had appropriate cotrimoxazole therapy been administered at the primary health care centre. It must be noted that PCP may no longer be a rare disease in sub-Saharan countries and intensive investigations should be carried out to avoid losing patients with treatable infectious diseases.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
6/62. Discrepancy between Ga-67 citrate and F-18 fluorodeoxyglucose positron emission tomographic scans in pulmonary infection.The authors describe a patient with the acquired immunodeficiency syndrome who had active pulmonary tuberculosis and was receiving anti-tuberculosis treatment. High-grade fever and a right-sided pleural effusion had recently developed. Results of a Ga-67 scan were negative for any focal infection in the chest. fluorine-18 fluorodeoxyglucose positron emission tomography showed increased uptake in the right lower lung field, which correlated with the diagnosis of concomitant bacterial pneumonia. Anti-tuberculosis treatment can decrease the sensitivity of the Ga-67 scan and could have contributed to this discrepancy. The authors predict that the fluorine-18 fluorodeoxyglucose positron emission tomographic scan will play an important diagnostic role in the management of such a selected group of patients.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
7/62. Tuberculous pneumonia complicating lung transplantation: case report and review of the literature.Although tuberculosis is more common in transplant recipients than in the general population, most centres report that mycobacterial infection is very rare in comparison with the extreme variety of transplant-associated infections. Only 18 previous cases of tuberculosis-complicated lung or heart-lung transplants have been published. An unusual case is reported of mycobacterium tuberculosis infection in a double-lung recipient who presented a radiographic feature of segmental pneumonia, mimicking a bacterial infection. bronchoalveolar lavage revealed lymphocytosis (> 30% of isolated cells). Data regarding optimal treatment for tuberculosis in lung transplant recipients are limited. Nevertheless, therapy should not be different from that in other immunocompromised patients and should include an aggressive initial four-drug regimen (until the sputum cultures become negative) or a 6-month conventional therapy with two agents to which the organism is susceptible. Close follow-up is required to confirm the bacteriological response and minimize the likelihood of relapse. In this patient, treatment with a four-drug antituberculous regimen for 3 months followed by isoniazide and rifampicin for an additional 9 months was curative.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
8/62. Cavitary lung disease in AIDS: etiologies and correlation with immune status.To investigate the etiology and differential features of cavitary lung disease in patients with acquired immune deficiency syndrome (AIDS), chest computed tomography (CT) records from a 2-year period were reviewed to identify all human immunodeficiency virus (hiv)-positive patients with cavitary lung disease. medical records were reviewed for the documentation of specific causes of lung cavitation and the CD4 count at the time of imaging. Of 25 hiv-positive patients with cavitary lung disease, 20 had specific diagnoses. Infection was the etiology in all the cases. Polymicrobial infection was found in 17 patients (85%) and unimicrobial in 3 (15%). Seventeen patients (85%) had bacterial organisms, 10 of whom had other pathogens as well. Mycobacteria were isolated in 8 patients (40%), fungi in 3 (15%), cytomegalovirus (CMV) in 3 (15%), and pneumocystis carinii pneumonia (PCP) in 1 (5%). Mediastinal or hilar lymphadenopathy and additional noncavitary ill-defined nodular opacities were found more frequently in patients with mycobacterial pathogens. Mean CD4 count in patients with cavitary disease because of bacterial pathogens alone was significantly higher than in patients with nonbacterial pathogens (alone or combined with bacterial pathogens) (203 vs. 42, p < 0.05). Four patients expired during the diagnostic hospital admission; 2 of them had pulmonary cavitary disease associated with nocardia asteroides. Cavitary lung disease in patients with AIDS undergoing chest CT should be assumed infectious and is generally polymicrobial.- - - - - - - - - - ranking = 0.2keywords = pneumonia (Clic here for more details about this article) |
9/62. TB or not TB: cavitary bronchiolitis obliterans organizing pneumonia mimicking pulmonary tuberculosis.Two patients with subacute symptoms and signs compatible with pulmonary tuberculosis (TB) had right upper lobe cavitary infiltrates shown on chest radiography. In both patients, purified protein derivative and microbiologic testing excluded TB, and tissue examination yielded typical histologic changes of bronchiolitis obliterans organizing pneumonia (BOOP). Glucocorticoid therapy led to clinical and radiologic resolution. Though probably rare in this situation, BOOP should be considered in the differential diagnosis of patients presenting with clinical and radiologic features of pulmonary TB.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
10/62. pneumocystis carinii pneumonia, pulmonary tuberculosis and visceral leishmaniasis in an adult hiv negative patient.This is a case report of a 29 year old male with pneumocystis pneumonia and tuberculosis, and who was initially suspected of having hiv infection, based on risk factor analyses, but was subsequently shown to be hiv negative. The patient arrived at the hospital with fever, cough, weight loss, loss of appetite, pallor, and arthralgia. In addition, he was jaundiced and had cervical lymphadenopathy and mild heptosplenomegaly. He had interstitial infiltrates of the lung, sputum smears positive for mycobacterium tuberculosis and pneumocystis carinii, and stool tests were positive for strongyloides stercoralis and schistosoma mansoni. He was diagnosed as having AIDS, and was treated for tuberculosis, pneumocystosis, and strongyloidiasis with a good response. The patient did not receive anti-retroviral therapy, pending outcome of the hiv tests. A month later, he was re-examined and found to have worsening hepatosplenomegaly, pancytopenia, fever, and continued weight loss. At this time, it was determined that his hiv ELISA antibody tests were negative. A bone marrow aspirate was done and revealed amastigotes of leishmania, and a bone marrow culture was positive for Leishmania species. He was treated with pentavalent antimony, 20 mg daily for 20 days, with complete remission of symptoms and weight gain. This case demonstrates that immunosuppression from leishmaniasis and tuberculosis may lead to pneumocystosis, and be misdiagnosed as hiv infection. The occurrence of opportunistic infections in severely ill patients without hiv must always be considered and alternate causes of immunosuppression sought.- - - - - - - - - - ranking = 1keywords = pneumonia (Clic here for more details about this article) |
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