PNEUMONIA
(Diagnosis, Diagnostics, Immunodiagnosis,
Immunodiagnostics, Pathogenesis, Vaccines
& Drugs)
ABSTRACTS
1393. Aikio O. Vuopala K. Pokela
ML. Hallman M. Diminished inducible
nitric oxide synthase expression in fulminant
early-onset neonatal pneumonia.
Pediatrics. 105(5):1013-9, 2000
May.
Abstract
OBJECTIVE: Fulminant early-onset neonatal
pneumonia is associated with ascending intrauterine infection (IUI),
prematurity, persistent pulmonary hypertension (PPHN), and septicemia. Nitric
oxide (NO) as an inflammatory mediator is included in antimicrobial
defense and has a role in pathogenesis of septic shock. The aim was to
study the role of inflammatory NO in neonatal pneumonia.
METHODS: Lungs from 36 autopsies were studied: 12 had fulminant early-onset
neonatal pneumonia, 5 pneumonia of later onset, and 19 controls had similar
gestational and postnatal age. In addition, airway specimens from 21
intubated newborns were analyzed: 7 with fulminant early-onset pneumonia, 7
apparently noninfected infants born prematurely attributable
to IUI, and 7
premature infants of similar gestation. Specimens were analyzed for inducible NO synthase (NOS2) and
nitrotyrosine, an indicator of NO toxicity.
The degree of staining was analyzed. RESULTS: In fulminant pneumonia,
alveolar macrophages (AM) showed significantly less NOS2
immunoactivity than the controls. In the airway specimens, the infants with fulminant
pneumonia 0 to 2 days after birth had significantly lower intracellular
NOS2 and nitrotyrosine and significantly lower interleukin-1beta and
surfactant protein-A than apparently noninfected IUI infants. NOS2 and
the other indices increased significantly during the recovery.
CONCLUSIONS: For the first time, we report NOS2 expression by macrophages from
human neonates. In fulminant early-onset neonatal pneumonia, delayed
production rather than excess of pulmonary inflammatory NO is associated with
severe symptoms.
1394. Aurora R. Milite F.
Vander Els NJ. Respiratory emergencies. [Review] [117 refs] Seminars in
Oncology. 27(3):256-69, 2000 Jun.
Abstract
Respiratory emergencies may originate from disease in the airways, thoracic vessels, and pulmonary parenchyma. Airway obstruction may be amenable to bronchoscopic therapies, including laser ablation photodynamic therapy (PDT) and stent placement. Asthma is common, but may be mimicked by endobronchial metastasis. Superior vena cava syndrome (SVCS) is seen most commonly with bronchogenic carcinoma and lymphoma. Emergent treatment need not precede tissue diagnosis in the absence of associated tracheal obstruction. Pulmonary embolism (PE) may now be diagnosed with spiral computed tomography (CT), but ventilation perfusion scintigraphy remains the first-line test. Parenchymal lung disease may result from infections, with neoplastic and iatrogenic etiologies. The incidence of Pneumocystis carinii pneumonia (PCP) is increasing among cancer patients, but it can be prevented by prophylaxis. Attempts to treat adult respiratory distress syndrome (ARDS) through modification of inflammatory mediators have been disappointing, and the prognosis remains poor.
1395. Bandyopadhyay T. Gerardi DA.
Metersky ML. A comparison of induced and expectorated sputum for the
microbiological diagnosis of community
acquired pneumonia. Respiration. 67(2):173-6, 2000.
Abstract
BACKGROUND: Sputum induction has proved
useful in the diagnosis of Pneumocystis carinii pneumonia and
mycobacterial infections but there are scant data on its use in the diagnosis of
community-acquired pneumonia (CAP). OBJECTIVE: To better define the sage
of sputum induction by hypertonic saline in the setting of CAP.
METHODS: A retrospective review of records of patients admitted to a
community teaching hospital in the year 1995 with a diagnosis of CAP. RESULTS:
Of 492 patients admitted with CAP, 71 (14%) had attempted sputum
induction. A group of 66 patients with CAP and attempted sputum collection by
spontaneous expectoration was compared with this group. Sputum induction
failed to yield a sample in 22 patients (31%). Forty-five of 49 patients
(92%) with induced sputum had received prior antibiotics as compared to 23
of 34 patients (68%) with expectorated samples (p < 0.05), due to
sputum induction often being attempted later in the hospital course. The
diagnostic yield of sputum induction was 14 of 71 (20%) compared to 16
out of 66 (24%) for attempted spontaneously expectorated samples.
Antibiotic therapy was changed for 5 of 34 patients (15%) who spontaneously
expectorated samples and for 9 of 49 patients (18%) with successful induction.
CONCLUSIONS: Sputum induction is effective in obtaining sputum in some patients with CAP who fail to
expectorate a sample. Attempting induction
early, preferably before starting antibiotics, may increase its
diagnostic yield. Copyright 2000 S. Karger AG, Basel.
1396. Baughman RP. Protected-specimen
brush technique in the diagnosis of ventilator-associated pneumonia. [Review]
[0 refs] Chest. 117(4 Suppl
2):203S-206S, 2000 Apr.
1398. Carrigan DR. Adenovirus infections
in immunocompromised patients. [Review] [05 refs] American Journal of
Medicine. 102(3A):71-4, 1997 Mar 17.
Abstract
Adenovirus infections have been reported in
as many as one-fifth of bone marrow transplant (BMT) recipients and
patients with acquired immunodeficiency syndrome (AIDS), and in a
lesser, though still prominent, proportion of organ transplant recipients.
The relative contributions of primary infections versus reactivations from
latency in immunocompromised patients remain unclear. Compared with adult
BMT recipients, pediatric BMT recipients appear to be infected by
adenovirus more frequently and earlier in the post-transplant period. The diagnosis
of adenovirus infection is complicated by the existence of > 40
viral serotypes, although certain subgroups are more likely to be involved in
certain patient populations. Adenoviruses are responsible for a broad
range of clinical diseases that may be associated with high mortality,
including pneumonia, hepatitis, encephalitis, hemorrhagic cystitis, and
gastroenteritis. The clinical and histopathologic features of adenovirus
disease may resemble those of cytomegalovirus disease, potentially
complicating the diagnosis. Risk factors for clinical adenovirus disease
include the number of sites from which the virus is cultured and, in BMT
recipients, the presence of moderate to severe acute graft-versus-host
disease.
1399.
Carvalho Neves Forte W. Ferreira
De Carvalho Junior F. Damaceno N. Vidal
Perez F. Gonzales Lopes C. Mastroti RA. Evolution of IgA deficiency to
IgG subclass deficiency and common variable
immunodeficiency. Allergologia et Immunopathologia. 28(1):18-20, 2000 Jan-Feb.
Abstract
FIRST REPORT: male child with repeated
pulmonary infections from the age of 4 months. He was diagnosed as IgA
deficiency (undetectable IgA levels) at the age of 3 years, when he presented
repeated bouts of pneumonia and tonsillitis. Several immunologic evaluations
were made between the ages of 4 months and 8 years. At 8 years and 9
months, the diagnosis of IgA deficiency was confirmed, and associated
IgG2 and IgG4 deficiency (29.0 mg/dl y 0.01 mg/dl) with normal total IgG
serum level was found. With the administration of intravenous gammaglobulin,
the lung infections remitted and the subsequent clinical course has been
uneventful up to now. SECOND REPORT: a boy with repeated infections since
the age of 2 months. IgA deficiency was diagnosed at 1 year 7 months
(undetectable serum IgA levels). At age 51/2 years, his clinical
course worsened and more serious infections appeared. A new immunologic study
revealed IgA deficiency associated with CD4 cell deficiency (432
cells/mm3) and normal CD3, CD19, and CD8 levels. Despite intensive antibiotic
treatment and care, the child died. The findings suggest an association of
IgA deficiency and common variable immunodeficiency.
1400. Chaudhry R. Nazima N. Dhawan B. Kabra SK. Prevalence of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community acquired pneumonia [published erratum appears in Indian J Pediatr 1998 Nov-Dec;65(6):866]. Indian Journal of Pediatrics. 65(5):717-21, 1998 Sep-Oct.
Abstract
A prospective one year study was performed
on 62 children admitted at the All India Institute of Medical Sciences with
community acquired pneumonia (CAP) for the prevalence of Mycoplasma
pneumoniae and Chlamydia pneumoniae. Diagnosis of infection with M.
pneumoniae was based on serological tests viz microparticle
agglutination test for detection of IgM antibodies and indirect
immunofluorescence test for antigen detection from throat swabs (sensitivity 85.7%,
specificity 93.3%). The indirect solid-phase enzyme immunoassay for detection
of IgG antibodies was used to determine the prevalence of C. pneumoniae
(sensitivity 88.8%, specificity 75.8%). Seventeen patients (27.4%) were
found to have serological evidence of M. pneumoniae infection whereas only 4
(6.4%) patients were seropositive for C. pneumoniae. Results of this
study indicate that M. Pneumoniae plays a significant role in CAP
in infants and young children. Thus specialized laboratory testing for
these agents should be more widely used thereby affecting empiric antibiotic
regimens.
1401. Chugh
K. Pneumonia due to unusual organisms in children. [Review] [34 refs] Indian
Journal of Pediatrics. 66(6):929-36,
1999 Nov-Dec.
Abstract
Generally antimicrobials for treatment of pneumonia are chosen to target the usual bacterial etiological agents. Such regimens are unable to cure patients of pneumonia caused by 'unusual organisms' mycoplasma, chlamydia, Pneumocystis carinii and Legionella pneumophilus). Thus, there is a need to anticipate their presence in appropriate cases and to plan the initial antimicrobial therapy accordingly. Studies in Europe as well as India have shown that such infections form a fairly substantial percentage of community acquired pneumonia in children. Mycoplasma pneumoniae and Chlamydia pneumoniae are common in school age children while Chlamydia trachomatis occurs in early infancy. Pneumocystis carinii is an important pathogen in immunocompromised children. Routine laboratory tests and radiological features are not specific enough to give accurate diagnosis of these infections for which one has to depend on sophisticated culture techniques, immunological tests for the antigens or antibodies and polymerase chain reaction. Mycoplasma, chlamydia and legionella infections respond to macrolide antibiotics and for pneumocystis infections, trimethoprim-sulfamethaxozole or pentamidine is the drug of choice. Overall prognosis with appropriate treatment is good except for P. carinii infection in immunocompromised host which carries a high mortality and recurrence rate.
1402. Clark
CE. Coote JM. Silver DA. Halpin DM.
Asthma after childhood pneumonia: six year follow up study. BMJ. 320(7248):1514-6, 2000 Jun 3.
Abstract
OBJECTIVE: To establish the long term
cumulative prevalence of asthma in children admitted to hospital with pneumonia
and to examine the hypothesis that some children admitted to hospital with
pneumonia may be presenting with undiagnosed asthma. DESIGN: Prospective
study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal
questionnaires to their general
practitioners and the children or their parents. SETTING: General practices in
southwest England. PARTICIPANTS: 78 children admitted to the Royal Devon and
Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed
on independent review of x ray films. MAIN OUTCOME MEASURES: Any
diagnosis of asthma, use of any treatment for asthma, and asthma symptom
scores. RESULTS: On the basis of a 100% response rate from general
practitioners and 86% from patients or parents, the cumulative prevalence of asthma
was 45%. A diagnosis of asthma was associated with a family history
of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36;
P=0.0002). Mean symptom scores were higher for all children with asthma (mean
score 2.4; chi(2)=14.88; P=0. 0001) and for children with asthma not being
treated (mean 1.4; chi(2)=6.2; P=0.01) than for those without
asthma (mean 0.2). CONCLUSIONS: A considerable proportion of children
presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high
cumulative prevalence of asthma suggests that careful follow up of such
children is worth while. Asthma is undertreated in these children; a structured
symptom questionnaire may help to identify and reduce morbidity due to
undertreatment.
1403. Craven
DE. Epidemiology of ventilator-associated pneumonia. Chest. 117(4 Suppl 2):186S-187S, 2000 Apr.
Abstract
In summary, the method of diagnosis used for VAP accounts for reported differences in etiology, pathogenesis, and outcomes. Further studies are needed to assess outcomes related to various diagnostic methods rather than to assess the sensitivity and specificity of these methods.
1404. Dudas
V. Hopefl A. Jacobs R. Guglielmo BJ.
Antimicrobial selection for hospitalized patients with presumed
community-acquired pneumonia: a survey of nonteaching US community hospitals.
Annals of Pharmacotherapy.
34(4):446-52, 2000 Apr. Abstract
OBJECTIVE: To describe and evaluate empiric
antimicrobial regimens chosen for hospitalized patients with presumed
community-acquired pneumonia (CAP) in US hospitals, including compliance with the
American Thoracic Society (ATS) guidelines. Secondary outcomes
included length of stay (LOS) and mortality associated with the choice of
therapy. METHODS: A nonrandomized, prospective, observational study was performed in 72 nonteaching hospitals
affiliated with a national group purchasing organization. Patients with an
admission diagnosis of physician-presumed
CAP and an X-ray taken within 72 hours of admission were eligible for the
study. Demographic, antibiotic
selection, and outcomes data were collected
prospectively from patient charts. RESULTS: 3035 patients were
enrolled; 2963 were eligible for analysis. Compliance with the ATS guidelines
was 81% in patients with nonsevere CAP. The most common antibiotic
regimen used for empiric treatment was ceftriaxone alone or in
combination with a macrolide (42%). The overall mortality rate was 5.5%. The
addition of a macrolide to either a second- or third-generation cephalosporin
or a beta-lactam/beta-lactamase inhibitor was
associated with decreased mortality and reduced LOS. CONCLUSIONS: Most
hospitalized patients with CAP receive antimicrobial therapy consistent
with the ATS guidelines. The addition of a macrolide may be associated
with improved patient outcomes.
1405. Easterbrook
PJ. Yu LM. Goetghebeur E. Boag
F. McLean K. Gazzard B. Ten-year
trends in CD4 cell counts at HIV and AIDS diagnosis in a London HIV clinic.
AIDS. 14(5):561-71, 2000 Mar 31.
Abstract
OBJECTIVE: To examine temporal trends
(1986-1996) in the CD4 cell count at first HIV-1 positive test and initial AIDS
diagnosis, and the influence of selected patient characteristics and
treatment factors on these trends. DESIGN: A retrospective clinic-based study.
SETTING: Three hospital-based clinics in West London. PATIENTS: A group of
5921 adult HIV-1-seropositive persons and 2835 reported patients with AIDS
over a 10-year period from 1 January 1986 to 1 October 1996. METHODS: The
CD4 cell count at HIV diagnosis (CD4HIV) was defined as the nearest
CD4 cell count to within 2 months of HIV diagnosis; and the CD4 cell
count at AIDS diagnosis (CD4AIDS) as the last CD4 cell count in the
two months prior to the development of AIDS. Simple and multiple
linear regression analysis were used to examine the influence of selected covariates on CD4HIV and
CD4AIDS. RESULTS: The percentage of patients
with an available CD4HIV and CD4AIDS increased from less than 5% in 1987
to 53% and 40%, respectively, in 1990, and 79% and 48%, respectively, in 1996.
Patients with a missing CD4HIV or CD4AIDS were younger and less
likely to have received antiretroviral therapy or prophylaxis for
Pneumocystis carinii pneumonia (PCP). There was no significant change in
CD4HIV over a 10-year period (median 334 x 10(6) cells/l), but a lower
CD4HIV was associated with older age at presentation and injecting drug use. There was a delay in the onset
of clinical AIDS, with a fall in the median
CD4AIDS value from 99 x 10(6) cells/l prior to 1987, to 58 x 10(6) cells/l
in 1990, 68 x 10(6) cells/l in 1994 and 60 x 10(6) cells/l in 1996; this
decline in onset was seen for PCP as well as for cytomegalovirus and
atypical mycobacterial infections. At all time periods, a lower CD4AIDS was
associated with combined use of antiretroviral therapy and PCP prophylaxis.
After adjustment for use of antiretroviral therapy and PCP prophylaxis
prior to AIDS diagnosis, year of diagnosis was no longer associated with CD4AIDS. There was a
significant trend towards an improved
survival following AIDS diagnosis from 20.1 months prior to 1988, to 20.3
months (1989-1990), 21.0 months (1991-1992) and 22.1 (1993-1994) (P <
0.0005). CONCLUSIONS: The observed decline in CD4AIDS value was related to the
introduction of antiretroviral therapy in 1988, and PCP prophylaxis in
1989. Temporal changes in the CD4 cell count at HIV and AIDS diagnosis among
different demographic groups can provide insights into the changing natural history of the HIV epidemic
and access to medical care. We recommend monitoring of the CD4 cell count
at new HIV and AIDS diagnosis and at
initiation of antiretroviral therapy as additional measures in national HIV/AIDS
surveillance.
1406. Englund JA. Piedra PA. Whimbey E. Prevention and treatment of respiratory syncytial virus and parainfluenza viruses in immunocompromised patients. American Journal of Medicine. 102(3A):61-70; discussion 75-6, 1997 Mar 17.
Abstract
Immunocompromised patients are vulnerable to
severe infections due to respiratory syncytial virus (RSV) and
parainfluenza viruses (PIV), and therefore prevention and treatment
strategies must be considered. The prevention of RSV disease with high-titer RSV-specific immune globulin has
been documented in very young children but
has not been systematically studied in high-risk adults. Vaccines
against RSV and PIV are under development, but their use in
immunocompromised patients is problematic. Ribavirin aerosol therapy is licensed for
the treatment of RSV in pediatric patients and has also been used to
treat RSV disease in adults and PIV disease in severely immunocompromised children and adults.
Uncontrolled trials show that early therapy with ribavirin aerosol may be
beneficial, but treatment of pneumonia in
patients with respiratory failure is rarely successful. Other
potential treatments for RSV or PIV disease include high-dose, short-duration
ribavirin therapy; combined immunoglobulin and ribavirin therapy;
polyclonal and monoclonal antibodies; and, potentially,
immunomodulators.
1407. Franquet
T. Gimenez A. Roson N. Torrubia S. Sabate JM.
Perez C. Aspiration diseases:
findings, pitfalls, and differential diagnosis. Radiographics. 20(3):673-85, 2000 May-Jun.
Abstract
The aspiration of different substances into the airways and lungs may cause a variety of pulmonary complications. These disease entities most commonly involve the posterior segment of the upper lobes and the superior segment of the lower lobes. Esophagography and computed tomography (CT) are especially useful in the evaluation of aspiration disease related to tracheoesophageal or tracheopulmonary fistula. Foreign body aspiration typically occurs in children and manifests as obstructive lobar or segmental overinflation or atelectasis. An extensive, patchy bronchopneumonic pattern may be observed in patients following massive aspiration of gastric acid or water. CT is the modality of choice in establishing the diagnosis of exogenous lipoid pneumonia, which can result from aspiration of hydrocarbons or of mineral oil or a related substance. Aspiration of infectious material manifests as necrotizing consolidation and abscess formation. The relatively low diagnostic accuracy of chest radiography in aspiration diseases can be improved with CT and by being familiar with the clinical settings in which specific complications are likely to occur. Recognition of the varied clinical and radiologic manifestations of these disease entities is imperative for prompt, accurate diagnosis, resulting in decreased morbidity and mortality rates.
1408. Gupta
R. Faridi MM. Gupta P. Neonatal empyema thoracis. Indian Journal of
Pediatrics. 63(5):704-6, 1996 Sep-Oct.
Abstract
Empyema thoracis, a serious complication of pneumonia, fortunately remains a less common cause of respiratory distress in neonates. Only 14 cases of neonatal empyema thoracis have been described in the world literature. The condition is characterized by its rarity, inability to identify any consistent predisposing factors, uncertain pathogenesis, rapid course, lack of consensus on management and a high mortality. We describe here two cases of empyema aged 6 and 8 days caused by E. Coli and Klebsiella respectively. Out of them one survived. A brief review of literature follows the above account.
1409. Hammerschlag
MR. Activity of gemifloxacin and other new quinolones against Chlamydia
pneumoniae: a review. [Review] [33 refs] Journal of Antimicrobial Chemotherapy. 45 Suppl 1:35-9, 2000
Apr.
Abstract
Quinolones are currently used as empirical
therapy for treatment of community-acquired lower respiratory
infections as they are effective against a broad range of conventional
bacterial and 'atypical' pathogens, including Chlamydia pneumoniae. C. pneumoniae is estimated to be
associated with 10-20% of community-acquired
pneumonia in adults, and has recently been suggested to play a role in
several non-respiratory conditions, including atherosclerosis. The
newer, third-generation quinolones have enhanced activity against
Gram-positive bacteria, including Streptococcus pneumoniae, and
prolonged serum half-lives that permit once-daily dosing. Although
gemifloxacin (SB-265805) and other new quinolones have good activity against C.
pneumoniae in vitro, practically all published treatment studies have relied
on serological diagnosis. Consequently, the microbiological efficacy
of these agents in human infection has not been assessed. This paper
reviews what is known to date of the in vivo microbiological efficacy of
the quinolones against C. pneumoniae, and demonstrates the importance
of assessing this parameter when evaluating the clinical utility of
these agents in C. pneumoniae infection.
1410. Hendrickson RC. Douglass JF. Reynolds LD. McNeill PD. Carter D. Reed SG. Houghton RL. Mass spectrometric identification of mtb81, a novel serological marker for tuberculosis. Journal of Clinical Microbiology. 38(6):2354-61, 2000 Jun.
Abstract
We have used serological proteome analysis
in conjunction with tandem mass spectrometry to identify and sequence a
novel protein, Mtb81, which may be useful for the diagnosis of tuberculosis
(TB), especially for patients coinfected with human immunodeficiency virus
(HIV). Recombinant Mtb81 was tested by an enzyme-linked immunosorbent
assay to detect antibodies in 25 of 27 TB patients (92%) seropositive for HIV
as well as in 38 of 67 individuals (57%) who were TB positive
alone. No reactivity was observed in 11 of 11 individuals (100%) who were HIV
seropositive alone. In addition, neither sera from purified protein
derivative (PPD)-negative (0 of 29) nor sera from healthy (0 of 45) blood
donors tested positive with Mtb81. Only 2 of 57 of PPD-positive
individuals tested positive with Mtb81. Sera from individuals with
smear-positive TB and seropositive for HIV but who had tested
negative for TB in the 38-kDa antigen immunodiagnostic assay were also tested for
reactivity against Mtb81, as were sera from individuals with lung cancer
and pneumonia. Mtb81 reacted with 26 of 37 HIV(+) TB(+) sera (70%) in
this group, compared to 2 of 37 (5%) that reacted with the 38-kDa antigen.
Together, these results demonstrate that Mtb81 may be a promising complementary antigen
for the serodiagnosis of TB.
1411. Hwang
JH. Lee KS. Rhee CH. Recent advances in radiology of the interstitial lung disease. [Review] [46 refs] Current
Opinion in Pulmonary Medicine. 4(5):281-7,
1998 Sep.
Abstract
Idiopathic interstitial pneumonias are
currently classified into four categories of disease: usual, desquamative,
and acute interstitial pneumonia, and nonspecific interstitial
pneumonia and fibrosis. Usual interstitial pneumonia appears on high-resolution CT (HRCT) as patchy
subpleural areas of ground-glass opacity, irregular lines, and
honeycombing. Desquamative interstitial
pneumonia presents as patchy subpleural areas of ground-glass opacity in
middle and lower lung zones. Acute interstitial pneumonia presents as
extensive bilateral airspace consolidation and patchy or diffuse
bilateral areas of ground-glass opacity. Nonspecific interstitial pneumonia
and fibrosis appears as patchy or diffuse areas of ground-glass opacity
with associated areas of consolidation and irregular lines. In a
subset of patients with diffuse lung disease (especially in those with
chronic interstitial lung disease), accurate diagnosis can be made with HRCT
findings only, without surgical biopsy. However, HRCT provides a lower level
of confidence in the diagnosis of acute or subacute interstitial
lung disease such as infection, diffuse alveolar damage, drug reaction, or hemorrhage.
Additional expiratory HRCT scans and scans
with patients prone help to narrow the differential diagnosis among
various diseases and help diagnose or exclude subtle disease in the posterior
part of the lung, respectively. HRCT provides a reproducible method for
evaluating the global extent of disease. It also discriminates between
fibrotic and reversible inflammatory diseases. [References: 46]
1412. Jacobs JA. De Brauwer EI. Cornelissen EI. Drent M. Accuracy and precision of quantitative calibrated loops in transfer of bronchoalveolar lavage fluid. Journal of Clinical Microbiology. 38(6):2117-21, 2000 Jun.
Abstract
Quantitative cultures of bronchoalveolar lavage (BAL) fluid are important in the diagnosis of ventilator-associated pneumonia, and calibrated loops are commonly used to set up these cultures. In this study, the performances of calibrated 0.010- and 0.001-ml loops in the transfer of BAL fluid were determined. Five loops of one lot from seven manufacturers were tested. Calibrations were performed by the gravimetric method (0.010-ml loops) and the colorimetric method (0.001-ml loops). Most of the 0.010-ml loops displayed a precision that was less than 10%, but six of them showed very poor accuracies as they transferred a deficiency (nichrome loops) or an excess (disposable loops) of BAL fluid that exceeded +/-10%. The mean maximum and minimum BAL fluid volumes delivered by the 0.010-ml loops differed by a factor 3. The 0.001-ml loops displayed acceptable precision. Five of them showed inaccuracies of </=+/-10%, and mean maximum and minimum BAL fluid volumes had a range of a factor of 2. For all loops, the volumes of BAL fluid sampled were larger than the volumes of reagent-grade water sampled. Results of the colony counting experiments confirmed these findings and revealed a high intra-assay variability for the 0.001-ml loops. We conclude that, when BAL fluid samples are cultured with calibrated loops, (i) proper verification of the calibration of these loops is mandatory, (ii) calibrations should be performed with BAL fluid as the test solution, and (iii) borderline quantitative culture results should be interpreted with knowledge of the inaccuracy values of these loops.
1413. Jasmer RM. Edinburgh KJ. Thompson A. Gotway MB. Creasman JM. Webb WR. Huang L. Clinical and radiographic predictors of the etiology of pulmonary nodules in HIV-infected patients. Chest. 117(4):1023-30, 2000 Apr.
Abstract
STUDY OBJECTIVES: To determine the etiology and the clinical and radiographic predictors of the etiology of pulmonary nodules in a group of HIV-infected patients. DESIGN: Retrospective analysis. SETTING: A large urban hospital in San Francisco, CA. PATIENTS: HIV-infected patients evaluated at San Francisco General Hospital from June 1, 1993, through December 31, 1997, having one or more pulmonary nodules on chest CT. Main outcome measures: Three physicians reviewed medical records for clinical data and final diagnoses. Three chest radiologists blinded to clinical data reviewed chest CTs. Univariate and multivariate analyses were performed to determine clinical and radiographic predictors of having an opportunistic infection and the specific diagnoses of bacterial pneumonia and tuberculosis. RESULTS: Eighty seven of 242 patients (36%) had one or more pulmonary nodules on chest CT. Among these 87 patients, opportunistic infections were the underlying etiology in 57 patients; bacterial pneumonia (30 patients) and tuberculosis (14 patients) were the most common infections identified. Multivariate analysis identified fever, cough, and size of nodules < 1 cm on chest CT as independent predictors of having an opportunistic infection. Furthermore, a history of bacterial pneumonia, symptoms for 1 to 7 days, and size of nodules < 1 cm on CT independently predicted a diagnosis of bacterial pneumonia; a history of homelessness, weight loss, and lymphadenopathy on CT independently predicted a diagnosis of tuberculosis. CONCLUSIONS: In HIV-infected patients having one or more pulmonary nodules on chest CT scan, opportunistic infections are the most common cause. Specific clinical and radiographic features can suggest particular opportunistic infections.
1414. Jha R. Narayan G. Jaleel MA. Sinha S. Bhaskar V. Kashyap G. Rayudu BR. Prasad KN. Pulmonary infections after kidney transplantation. Journal of the Association of Physicians of India. 47(8):779-83, 1999 Aug.
Abstract
OBJECTIVE: To retrospectively analyse the epidemiology, aetiology, temporal profile and outcome of lung infection following kidney transplantation. METHODS: Out of 142 consecutive renal transplant (RT) recipients who underwent live donor transplantation from June, 1990 to May, 1998, 43 (33%) had serious infection requiring hospitalisation of which 27 were pulmonary. All such pneumonia were included for retrospective analysis. All had a minimum follow up of six months (if alive) and were on triple drug immunosuppression. All had detailed and appropriate investigations for definitive diagnosis. RESULTS: The aetiological agents were Gram negative bacterial infection (2), Gram positive bacterial infection (1), nocardia (2), tuberculosis (10), aspergillosis (2), mixed bacterial and fungal infection (4), Pneumocystis (2) and unconfirmed (4). Four patients had pneumonia because of probable nosocomial exposure. Radiologically lobar/segmental pneumonia was observed in five, nodular lesion six, reticulonodular lesion eight, patchy consolidation five and pleural effusion three. Nodular pneumonias were due to aspergillosis or nocardiosis. Four patients developed secondary cavitation. Pulmonary infections were significantly associated with leucopenia (8/27) (p < 0.01) but not with renal dysfunction (creat > 2 mg%), diabetes, old age or additional immunosuppression (p > 0.05). There were 11 deaths. Mortality was related to failure to reach diagnosis (3) and delayed institution of therapy (6 patients). Pneumonia within first six months had a higher mortality (9/16) compared to late pneumonia (2/11). Immunomodulating virus (CMV 4, HEP B 2) was present in six patients of whom four succumbed. CONCLUSION: Pulmonary infection is a common and serious post-transplant infection requiring hospitalisation, is associated with high mortality. Patients with leucopenia are predisposed to these infections. Prophylaxis for Pneumocystis, Nocardia and tuberculosis needs strong consideration to reduce mortality of such infection. Nosocomial exposure risk needs careful consideration in outbreaks of opportunistic infection.
1415. Kabra SK. Kabra M. Ghosh M. Verma IC. Cystic fibrosis--an Indian perspective on recent advances in diagnosis and management. [Review] [49 refs] Indian Journal of Pediatrics. 63(2):189-98, 1996 Mar-Apr.
Abstract
Cystic fibrosis (CF) is a common inherited disorder in caucasians. The estimated incidence of CF in Asians varies from 1:10,000 to 1:12,000. Indian data is restricted to few case reports. The gene for CF is located on the long arm of chromosome 7 at position 7q13. There are more than 300 identified mutations in CF. The basic defect in CF is a mutational change in the gene for chloride conductance channel. Failure of chloride conductance by epithelial cells leads to dehydration of secretions that are too viscid and difficult to clear. The disease is characterized by abnormal secretions in the respiratory, gastrointestinal and reproductive tract and sweat glands. The common clinical manifestations include meconium ileus in neonatal period, recurrent lower respiratory tract infections (pseudomonas pneumonia, bronchiectasis), steatorrhoea, azoospermia, and in late stages hepatobiliary and endocrine pancreatic dysfunctions. The diagnosis of disease is established by clinical criteria and sweat chloride concentration more than 60 mEq/L. Facilities for DNA diagnosis of common CF mutations are now available in India. The treatment of CF includes early diagnosis, daily clearance of respiratory passages, appropriate antibiotic therapy, aerosolised recombinant human DNase and antibiotics, and nutritional supplementation. The latter include changes in diet composition, pancreatic enzyme supplementation and vitamins and trace mineral supplementation. Gene therapy for the pulmonary manifestations is being tried in a number of centres abroad. Other considerations include heart lung transplantation and ameloride inhalation therapy.
1416. Khare MD. Sharland M. Pulmonary manifestations of pediatric HIV infection. [Review] [26 refs] Indian Journal of Pediatrics. 66(6):895-904, 1999 Nov-Dec.
Abstract
Vertically acquired HIV infection is
becoming increasingly common in India. The main clinical manifestations of
HIV in childhood are growth failure, lymphadenopathy, chronic cough and
fever, recurrent pulmonary infections, and persistent diarrhoea. Pulmonary disease is the major cause
of morbidity and mortality in pediatric
AIDS, manifesting itself in more than 80% of cases. The most common causes
are Pneumocystis carinii pneumonia (PCP), lymphocytic interstitial
pneumonitis (LIP), recurrent bacterial infections which include bacterial
pneumonia and tuberculosis. The commonest AIDS diagnosis in infancy is
PCP, presenting in infancy with tachypnea, hypoxia, and bilateral
opacification on chest-X-ray (CXR). Treatment is with
cotrimoxazole. LIP presents with bilateral reticulonodular shadows on CXR. It may be
asymptomatic in the earlier stages, but children develop recurrent
bacterial super infections, and can progress to bronchiectasis. LIP is a good
prognostic sign in children with HIV infection in comparison to PCP. HIV
should be considered in children with recurrent bacterial pneumonia,
particularly with a prolonged or atypical course, or a recurrence after
standard treatment. Pulmonary TB is common in children with HIV, but little data
is available to guide treatment decisions. Much can be done to
prevent PCP and bacterial infections with cotrimoxazole prophylaxis
and appropriate immunisations, which may reduce hospital admissions and
health care costs.
1417. Lakari E. Paakko P. Pietarinen-Runtti P. Kinnula VL. Manganese superoxide dismutase and catalase are coordinately expressed in the alveolar region in chronic interstitial pneumonias and granulomatous diseases of the lung. American Journal of Respiratory & Critical Care Medicine. 161(2 Pt 1):615-21, 2000 Feb.
Abstract
Free radicals have been suggested to play an important role in the pathogenesis of interstitial lung diseases, the most important of which are chronic interstitial pneumonias such as usual interstitial pneumonia (UIP) and desquamative interstitial pneumonia (DIP) and granulomatous lung diseases such as sarcoidosis. Because manganese superoxide dismutase (MnSOD) and catalase are two important intracellular antioxidant enzymes that probably play a central role in lung defense, the localization and intensity of these two enzymes were assessed by immunohistochemistry in biopsies of UIP (n = 9), DIP (n = 11), pulmonary sarcoidosis (n = 14), and extrinsic allergic alveolitis (n = 6). The mRNA of these enzymes in selected samples of bronchoalveolar lavage was assessed by Northern blotting. Catalase, but not MnSOD, was constitutively expressed, especially in type II pneumocytes of the healthy lung of nonsmoking individuals. In contrast, manganese SOD immunoreactivity was markedly upregulated in all of the interstitial lung diseases investigated, whereas no increased expression of catalase could be detected in any case. Both enzymes were expressed, especially in type II pneumocytes and alveolar macrophages of DIP and UIP, in the well-preserved areas of the lung, in the acute fibromyxoid lesions of UIP, and in the granulomas of sarcoidosis and extrinsic allergic alveolitis. The simultaneous expression of MnSOD and catalase in the alveolar region suggests their protective role against the progression of lung disease.
1418. Lange M. Community-acquired pneumonia: an approach to antimicrobial therapy. [Review] [8 refs] Allergy & Asthma Proceedings. 21(1):33-8, 2000 Jan-Feb.
Abstract
Community-acquired pneumonia (CAP), the sixth leading cause of death in the United States, has undergone significant changes in the past 30 years. In addition to the fact that it increasingly is a disease affecting the elderly and those patients with underlying comorbidities, the spectrum of microbiological agents causing pneumonia has greatly expanded and includes in addition to Streptococcus pneumoniae many other agents including Mycoplasma, Chlamydia, and respiratory viruses. A major problem encountered by the clinician facing a patient with CAP derives from the imprecise clinical presentation, which in most instances does not permit a precise diagnosis of the etiological agent. As pneumonia, if untreated, is frequently a rapidly progressive illness, the clinician usually chooses antimicrobial agents on an empirical basis. Careful attention to historical, physical, and laboratory findings, as well as age and presence of comorbidities has led to a categorization of CAP into four groupings that assist in deciding whether the patient should be hospitalized and what empirical antimicrobial regimen should be started. Careful follow-up and familiarity with the clinical pneumonic syndromes associated with different microbial agents is essential to assure a successful outcome.
1419. Leal-Noval SR. Marquez-Vacaro JA.
Garcia-Curiel A. Camacho-Larana
P. Rincon-Ferrari MD. Ordonez-Fernandez A. Flores-Cordero JM. Loscertales-Abril J. Nosocomial pneumonia in patients undergoing
heart surgery. Critical Care Medicine. 28(4):935-40, 2000 Apr.
Abstract
OBJECTIVE: To determine the risk factors
related to the presence of postsurgical nosocomial pneumonia (NP) in
patients who had undergone cardiac surgery. DESIGN: A case-control
study. SETTING: Postcardiac surgical intensive care unit at a university
center. PATIENTS: A total of 45 patients with NP and 90 control patients
collected during a 4-yr period. INTERVENTIONS: Pre-, intra-, and
postoperative factors were collected and compared between two groups of
patients (cases vs. controls) to determine their influence on the
development of NP. The diagnosis of NP was always microbiologically confirmed as
pulmonary specimen brush culture of > or =10(3) colony-forming units/mL or
positive blood culture/pleural fluid culture by the growth of identical
microorganisms isolated at the lung. For each patient diagnosed with NP, we
selected control cases at a ratio of 1:2. MEASUREMENTS AND MAIN RESULTS:
The incidence of NP was 6.5%. Multivariate analysis found a probable
association of the following variables with a greater risk for the development of NP:
reintubation (adjusted odds ratio [AOR], 62.5; 95%
confidence interval [CI], 8.1-480; p = .01); nasogastric tube (AOR, 19.7; 95% CI,
3.5-109; p = .01), transfusion of > or =4 units of blood derivatives
(AOR, 12.8; 95% CI, 2-82; p = .01) and empirical treatment with broad-spectrum antibiotics
(AOR, 6.6; 95% CI, 1.2-36.8; p = .02).
Culture results showed 13.3% of the NP to be of polymicrobial origin, whereas
77.3% of the microorganisms isolated were Gram-negative bacteria. The
mortality (51 vs. 6.7%, p < .01) and the length of stay in the intensive care
unit (25+/-14.8 days vs. 5+/-5 days, p < .01) were both greater in
patients with NP. CONCLUSIONS: We conclude that the surgical risk factors,
except the transfusion of blood derivatives, have little effect on the
development of NP. Reintubation, nasogastric tubing, previous
therapy with broad-spectrum antibiotics, and blood transfusion are
factors most likely associated with NP acquisition.
1420. McCracken GH Jr. Etiology and treatment of pneumonia. [Review] [22 refs] Pediatric Infectious Disease Journal. 19(4):373-7, 2000 Apr.
Abstract
BACKGROUND: Lower respiratory tract
infections are a common cause of morbidity among children. Among these
infections pneumonia is the most serious illness and can be difficult to
diagnose. The etiology of pneumonia is still partly unknown, primarily
because of difficulty in obtaining adequate samples and lack of
reliable diagnostic methods. ETIOLOGY OF PNEUMONIA: Streptococcus
pneumoniae is recognized as an important cause of pediatric pneumonia
regardless of age in both the inpatient and outpatient setting. In
developed countries S. pneumoniae probably accounts for 25 to 30% of cases of
pediatric community-acquired pneumonia. Viruses (mostly respiratory
syncytial virus) are responsible for approximately 20% of cases, and
Chlamydia pneumoniae and Mycoplasma pneumoniae occur commonly in older children.
FUTURE CHALLENGES: Despite the effectiveness of antimicrobial therapy,
the emergence of resistant bacterial pathogens has resulted in
increased interest in developing more effective vaccines. If conjugate pneumococcal vaccines prove effective at
eradicating carriage of pneumococci in the
nasopharynx, immunization may be an important tool against the spread of
pneumococcal disease. Future challenges include implementation of
effective intervention strategies, production of simple diagnostic tools and
development of effective vaccines.
1421. Mesquita
CT. Morandi Junior JL. Perrone FT.
Oliveira C da S. Barreira LJ. Nascimento SS. Pareto Junior
RC. Mesquita ET. Fatal pulmonary
embolism in hospitalized patients. Clinical diagnosis versus pathological
confirmation. Arquivos Brasileiros de
Cardiologia. 73(3):251-8, 1999 Sep.
Abstract
OBJECTIVE: To assess the incidence of fatal
pulmonary embolism (FPE), the accuracy of clinical diagnosis, and the
profile of patients who suffered an FPE in a tertiary University Hospital.
METHODS: Analysis of the records of 3,890 autopsies performed at the
Department of General Pathology from January 1980 to December 1990. RESULTS:
Among the 3,980 autopsies, 109 were cases of clinically suspected FPE; of
these, 28 cases of FPE were confirmed. FPE accounted for 114 deaths,
with clinical suspicion in 28 cases. The incidence of FPE was 2.86%. No
difference in sex distribution was noted. Patients in the 6th decade of
life were most affected. The following conditions-were more commonly
related to FPE: neoplasias (20%) and heart failure (18.5%). The conditions
most commonly misdiagnosed as FPE were pulmonary edema (16%), pneumonia (15%) and myocardial infarction
(10%). The clinical diagnosis of FPE showed
a sensitivity of 25.6%, a specificity of 97.9%, and an accuracy of
95.6%. CONCLUSION: The diagnosis of pulmonary embolism made on clinical
grounds still has considerable limitations.
1422. Meyer CA. White CS. Sherman KE. Diseases of the hepatopulmonary axis. Radiographics. 20(3):687-98, 2000 May-Jun.
Abstract
Hepatopulmonary syndrome is the most widely
recognized of the processes associated with end-stage liver disease.
Chronic liver dysfunction is associated with pulmonary manifestations due
to alterations in the production or clearance of circulating cytokines and other mediators.
Hepatopulmonary syndrome
results in hypoxemia due to pulmonary vasodilatation with significant
arteriovenous shunting and ventilation-perfusion mismatch. Hepatic hydrothorax may develop in
patients with cirrhosis and ascites. Rarely,
pulmonary hypertension occurs in the setting of portal hypertension. A
second group of disorders may primarily affect the lungs and liver (the
hepatopulmonary axis). Among these are the congenital conditions alpha(1)-antitrypsin deficiency and
cystic fibrosis. Autoimmune liver disease
may be associated with lymphocytic interstitial pneumonitis,
fibrosing alveolitis, intrapulmonary granulomas, and bronchiolitis obliterans
with organizing pneumonia. Sarcoidosis affects the lung and liver in up
to 70% of patients. Medications such as amiodarone can result in
a characteristic radiologic appearance of pulmonary and hepatic toxic
effects. Knowledge of these associations will assist the radiologist in forming a meaningful
differential diagnosis and may influence
treatment decisions.
1423. Miller
RF. Howling SJ. Reid AJ.
Shaw PJ. Pleural effusions in patients with AIDS. Sexually Transmitted
Infections. 76(2):122-5, 2000 Apr.
Abstract
OBJECTIVE: To describe the range of pathology causing pleural effusions in HIV infected patients with acute respiratory episodes and to attempt to identify whether any associated radiological abnormalities enabled aetiological discrimination. METHODS: Prospective study of chest radiographs of 58 consecutive HIV infected patients with pleural effusion and their microbiological, cytological, and histopathological diagnoses. RESULTS: A specific diagnosis was made in all cases. Diagnoses were Kaposi's sarcoma, 19 patients; para-pneumonic effusion, 16 patients; tuberculosis, eight patients; Pneumocystis carinii pneumonia, six patients; lymphoma, four patients; pulmonary embolus, two patients; and heart failure, aspergillus/leishmaniasis, and Cryptococcus neoformans, one case each. Most effusions (50/58) were small. Bilateral effusions were commoner in Kaposi's sarcoma (12/19) and lymphoma (3/4) than in para-pneumonic effusion (3/16). Concomitant interstitial parenchymal shadowing did not aid discrimination. A combination of bilateral effusions, focal air space consolidation, intrapulmonary nodules, and/or hilar lymphadenopathy suggests Kaposi's sarcoma. Unilateral effusion with focal air space consolidation suggests para-pneumonic effusion if intrapulmonary nodules are absent: if miliary nodules and/or mediastinal lymphadenopathy are detected, this suggests tuberculosis. CONCLUSIONS: A wide variety of infectious and malignant conditions cause pleural effusions in HIV infected patients, the most common cause in this group was Kaposi's sarcoma. The presence of additional radiological abnormalities such as focal air space consolidation, intrapulmonary nodules, and mediastinal lymphadenopathy aids aetiological discrimination.
1424. Nakajima H. Harigai M. Hara M. Hakoda M. Tokuda H. Sakai F. Kamatani N. Kashiwazaki S. KL-6 as a novel serum marker for interstitial pneumonia associated with collagen diseases. Journal of Rheumatology. 27(5):1164-70, 2000 May.
Abstract
OBJECTIVE: To investigate the diagnostic value of the serum concentrations of KL-6, a mucinous glycoprotein expressed on type II pneumocytes, for interstitial pneumonia (IP) in various collagen diseases. METHODS: Serum KL-6 levels were measured by ELISA. RESULTS: The mean values and the positive rates of serum KL-6 levels for patients with rheumatoid arthritis, systemic sclerosis, or polymyositis/dermatomyositis with IP were significantly higher than those without IP. Sensitivity, specificity, positive and negative predictive values of serum KL-6 level for IP associated with collagen diseases were 60.7, 98.9, 97.4, and 77.1%, respectively. The mean serum KL-6 level of patients with active IP was significantly (p = 0.0001) higher than that of patients with inactive IP. Serum KL-6 levels increased with the deterioration of IP, while the successful treatment of IP resulted in a significant decrease of these levels. CONCLUSION: Serum KL-6 concentration levels are a useful marker for diagnosis and evaluation of the disease activity of IP associated with collagen diseases.
1425. Okano M. Yamada M. Ohtsu M. Kawamura N. Sakiyama Y. Aoi K. Gandoh S. Fujita M. Kobayashi K. Successful treatment with methylprednisolone pulse therapy for a life-threatening pulmonary insufficiency in a patient with chronic granulomatous disease following pulmonary invasive aspergillosis and Burkholderia cepacia infection. Respiration. 66(6):551-4, 1999 Nov-Dec.
Abstract
A 14-year-old boy with X-linked chronic granulomatous disease developed severe invasive pulmonary aspergillosis. He was treated with itraconazole and amphotericin B. owever, he deteriorated with progressive pulmonary lesions. Burkholderia cepacia was isolated from his bronchoalveolar lavage. Finally, he was given granulocyte transfusions. Following this procedure, his condition rapidly worsened leading to respiratory failure. His lung biopsy demonstrated organizing pneumonia at his right middle lobe. Then, a methylprednisolone pulse therapy was initiated together with the administration of appropriate antibiotics and adequate amounts of amphotericin B. Dramatically, his condition improved. Therefore, a methylprednisolone pulse therapy with appropriate antimicrobial drugs seems to be beneficial for severe pulmonary insufficiency in this type of patients. Copyright Copyright 1999 S. Karger AG, Basel
1426. Osann
KE. Lowery JT. Schell MJ. Small cell lung cancer in women:
risk associated with smoking, prior respiratory disease, and occupation. Lung
Cancer. 28(1):1-10, 2000 Apr.
Abstract
Small cell carcinoma of the lung (SCLC)
occurs most frequently in heavy smokers, yet exhibits a lesser predominance
among men than other smoking-associated lung cancers. Incidence
rates have increased more rapidly in women than men and at a faster
rate among women than other cell types. To investigate the importance of
smoking and other risk factors, a case-control study of SCLC in women was
conducted. A total of 98 women with primary SCLC and 204 healthy controls,
identified by random-digit dialing and frequency matched for age,
completed telephone interviews. Data collected include demographics, medical
history, family cancer history, residence history, and lifetime smoking habits. Odds ratios
(ORs) and 95% confidence intervals (95% CI) were calculated using logistic
regression analysis. Risk for small cell
carcinoma in women is strongly associated with current use of cigarettes.
Ninety-seven of 98 cases had smoked cigarettes; 79% of cases were current
smokers and 20% were former smokers at the time of diagnosis compared to
13% current and 34% former smokers among controls. The ORs associated
with smoking are 108.7 (95% CI 14.8-801) for ever-use of cigarettes, 278.9
(95% CI 37.0-2102) for current smoking, and 31.5 (95% CI 4. 1-241) for
former smoking. Risk increases steeply with pack-years of smoking and
decreases with duration of smoking cessation. After adjusting for age,
education, and lifetime smoking history, medical history of
physician-diagnosed respiratory disease including chronic bronchitis, emphysema,
pneumonia, tuberculosis, asthma, and hay fever is not associated with a
significant increase in lung cancer risk. Employment in blue collar, service, or
other high risk occupations is associated with a two to three-fold non-significant increase in risk
for small cell carcinoma after adjusting for
smoking.
1427. Overweg
K. Kerr A. Sluijter M. Jackson
MH. Mitchell TJ. de Jong AP.
de Groot R. Hermans PW. The
putative proteinase maturation protein A of Streptococcus pneumoniae is a
conserved surface protein with potential to elicit protective immune responses. Infection & Immunity. 68(7):4180-8, 2000 Jul.
Abstract
Surface-exposed proteins often play an important role in the interaction between pathogenic bacteria and their host. We isolated a pool of hydrophobic, surface-associated proteins of Streptococcus pneumoniae. The opsonophagocytic activity of hyperimmune serum raised against this protein fraction was high and species specific. Moreover, the opsonophagocytic activity was independent of the capsular type and chromosomal genotype of the pneumococcus. Since the opsonophagocytic activity is presumed to correlate with in vivo protection, these data indicate that the protein fraction has the potential to elicit species-specific immune protection with cross-protection against various pneumococcal strains. Individual proteins in the extract were purified by two-dimensional gel electrophoresis. Antibodies raised against three distinct proteins contributed to the opsonophagocytic activity of the serum. The proteins were identified by mass spectrometry and N-terminal amino acid sequencing. Two proteins were the previously characterized pneumococcal surface protein A and oligopeptide-binding lipoprotein AmiA. The third protein was the recently identified putative proteinase maturation protein A (PpmA), which showed homology to members of the family of peptidyl-prolyl cis/trans isomerases. Immunoelectron microscopy demonstrated that PpmA was associated with the pneumococcal surface. In addition, PpmA was shown to elicit species-specific opsonophagocytic antibodies that were cross-reactive with various pneumococcal strains. This antibody cross-reactivity was in line with the limited sequence variation of ppmA. The importance of PpmA in pneumococcal pathogenesis was demonstrated in a mouse pneumonia model. Pneumococcal ppmA-deficient mutants showed reduced virulence. The properties of PpmA reported here indicate its potential for inclusion in multicomponent protein vaccines.
1428. Reddy TS. Smith D. Roy TM. Primary meningococcal pneumonia in elderly patients. American Journal of the Medical Sciences. 319(4):255-7, 2000 Apr.
Abstract
Neisseria meningitidis infection in humans usually manifests as meningitis and septicemia with skin manifestations. Infections of the respiratory tract with N meningitidis have been documented in the past, but often this organism is not routinely considered in the differential diagnosis of pneumonia. The pathogenic role of N meningitidis in lower respiratory tract infections may be underestimated because its isolation is difficult, particularly when oropharyngeal flora are present. We profile 2 elderly patients with primary meningococcal pneumonia to show the importance of <span style="mso-