1/28. Severe mycoplasma pneumoniae pneumonia.Four cases of severe mycoplasma pneumoniae infection are reported which were treated in a single hospital over the course of 4 years. The difficulties in the diagnosis of M. pneumoniae infections are eminently demonstrated by these cases. Because of the fact that it generally takes 2-o weeks to make this diagnosis, the physician must utilize clues of limited reliability. If gram stains and culture of sputum fail to demonstrate any bacterial pathogen and the patient has a chest X-ray compatible with this diagnosis as well as a white blood count less than 15,000/mm3, M. pneumoniae infection may be present. A good antimicrobial choice in such a situation is erythromycin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/28. public health response to 2 clinical cases of blastomycosis in colorado residents.We summarize the public health response after the identification of 2 cases of pneumonia caused by blastomyces dermatitidis infection in colorado residents. The response to these cases emphasizes the need for physicians to add fungal infection to the list of differential diagnoses for patients who have refractory pneumonia, even those who live in areas of nonendemicity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/28. The use of guidelines for the empirical treatment of hospital-acquired pneumonia.BACKGROUND: Several practice guidelines for the empirical antimicrobial treatment of hospital-acquired pneumonia (HAP) have been developed, but the acceptance and use of such guidelines are unknown. OBJECTIVE: To assess physicians' use of empirical HAP guidelines published by the American Thoracic Society (ATS) and by The University Health Network, Toronto, ontario. DESIGN: A retrospective assembly and chart review. SETTING: A university teaching hospital. patients: One hundred fifteen consecutive patients who had been diagnosed with pneumonia more than 48 h after admission to hospital over a 10-month period. RESULTS: The charts of 115 patients were reviewed. Seventy-five patients (65%) were treated empirically. Forty patients (35%) were treated based on microbiological data that were available before the initiation of antibiotics. patients who received nonempirical treatment for HAP had a significantly greater acuity of illness than the empirically treated group. Thirty-seven patients (49%) who received empirical therapy were treated according to either ATS or hospital guidelines for HAP. The use of guideline-concordant antimicrobial therapy had no measurable effect on in-hospital mortality (eight of 37 patients [21.6%] versus seven of 38 patients [18.4%], P=0.96) or median length of stay (19 days versus 21 days, P=0.30). patients whose treatment did not follow guideline recommendations tended to receive appropriate antimicrobial coverage more often than did those patients whose treatment was guideline concordant (15 of 18 patients [83%] versus six of 11 patients [55%], P=0.49). CONCLUSIONS: Institutional and ATS guidelines for the empirical treatment of HAP are less widely used than would be predicted by chance at The University Health Network. The clinical utility of these guidelines remains to be proven.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/28. rhodococcus equi infection in transplant recipients: a case of mistaken identity and review of the literature.The incidence of rhodococcus equi infection in solid-organ transplant recipients continues to rise throughout the world. Unfortunately, this opportunistic pathogen is still underestimated and potentially disregarded by physicians and microbiology laboratories due to its morphology on Gram staining. Pulmonary involvement is the most common finding in the immunocompromised host. We report a case of a 63-year-old heart-transplant recipient who presented with increasing fatigue and nonproductive cough for 3 weeks. After full evaluation, a lung abscess was demonstrated by thoracic computerized tomography (CT). blood and sputum cultures were remarkable for heavy "diphtheroids." Although the Gram-stain result was initially interpreted as a contaminant, a clinical suspicion for Rhodococcus assisted in further investigation. Broncheoalveolar lavage and CT-guided biopsy of the lung abscess revealed heavy growth of diphtheroids. However, further evaluation by a reference laboratory demonstrated mycolic acid staining consistent with R. equi. Surgical drainage and prolonged antibiotic therapy resulted in complete remission of the pneumonia and abscess. This represents the fourth reported case of R. equi infection in a heart transplant recipient. It is imperative that all physicians and laboratory staff consider R. equi when an immunocompromised patient has any type of pneumonia, especially with abscess formation.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/28. Fulminant clostridium difficile colitis in a patient with spinal cord injury: case report.BACKGROUND: In certain patients with clostridium difficile colitis (CDC), a life-threatening systemic toxicity may develop despite appropriate and timely medical therapy. DESIGN: literature search and case report. FINDINGS: A 39-year-old man with T10 paraplegia presented with a distended, quiet abdomen following recent treatment with antibiotics for pneumonia. diarrhea was not present. Complete blood counts demonstrated a marked leukocytosis. A CT scan of the abdomen demonstrated a state of diffuse pancolonic inflammation with peritoneal fluid. The patient was taken to the operating room and underwent total abdominal colectomy with oversewing of the rectal stump and end ileostomy for treatment of the fulminant CDC. CONCLUSION: patients with spinal cord injury (SCI) often receive antibiotics for infections of the aerodigestive tree and urinary tract and for problems with skin integrity. A heightened awareness of the development of fulminant CDC remains essential in the care of patients with SCI. Any unexplained abdominal illness after recent antibiotic administration should alert the physician to CDC and its potential as a fulminant, potentially fatal illness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/28. Cystic adenomatoid malformation of the lung presenting in adulthood.Cystic adenomatoid malformation is an uncommon embryonic developmental abnormality usually diagnosed in neonates and infants. Its presentation in adulthood is rare, with only 27 cases reported up to now. Due to its rarity, it is seldom suspected and adult physicians are not familiar with its clinical and radiologic features. We report two cases of cystic adenomatoid malformation presenting in adults, one as a recurrent pneumonia, and another as a coincidental finding on a chest roentgenogram. We describe the clinical features, radiologic and computed tomographic findings, and the histopathologic characteristics in this article, along with a review of the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/28. Diffuse pulmonary uptake of indium-111-labeled leukocytes in drug-induced pneumonitis.indium-111-labeled-leukocyte scintigraphy was performed on three febrile patients, two of whom had no signs or symptoms referable to the respiratory tract. The third patient had dyspnea on exertion, unchanged over two months. Their past histories were remarkable in that all three had recently undergone chemotherapy for malignancy (2 lymphoma, 1 malignant thymoma). Diffuse pulmonary uptake of labeled leukocytes was observed in all three individuals. As a direct result of leukocyte imaging, all three underwent fiberoptic bronchoscopy and transbronchial biopsy. The final diagnosis in each of these patients was drug-induced pneumonitis, which responded to treatment with corticosteroids. This entity should be added to the group of conditions, both infectious and noninfectious, that cause diffuse pulmonary uptake on labeled leukocyte images. Moreover, in the appropriate clinical setting, even in the absence of pulmonary signs or symptoms, diffuse pulmonary uptake of labeled leukocytes should alert the physician to the possibility of drug-induced pneumonitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/28. Lipoid pneumonia: a preventable complication.BACKGROUND: Lipoid pneumonia 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. OBJECTIVES: To increase physicians' awareness of LP, its diagnosis and prevention. methods: We present two illustrative cases of LP and review the literature. RESULTS: Two cases of LP were diagnosed within half a year in an internal medicine ward. Both cases were elderly patients, and LP was associated with the use of mineral oil as a laxative agent. Computerized tomography revealed bilateral low attenuation infiltrates, associated with a "crazy paving" pattern in one case. sudan Black staining was diagnostic in both cases--in one on a transbronchial biopsy specimen, and in the other on sputum cytologic examination. Both patients suffered from neurologic diseases and were at risk of aspiration. In both cases clinical symptoms and signs continued for several months prior to diagnosis but resolved after the mineral oil was discontinued. CONCLUSIONS: LP often occurs in elderly patients who are at risk of aspiration. The condition may be underdiagnosed. Since in most cases mineral oil cathartics are the causative agent, an effort at primary prevention is indicated. It is suggested that the licensing of mineral oil for internal use be changed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/28. Retrosternal density: pulmonary underdevelopment or accessory hemidiaphragm.Vertical retrosternal density paralleling the sternum, with haziness of a hemithorax on chest roentgenogram, often challenges the clinical acumen of pediatricians, chest physicians, and pediatric radiologists alike. Its presence has been historically linked to either pulmonary underdevelopment and/or accessory hemidiaphragm. The surgical and radiological pediatric literature has long debated this topic, but unfortunately, it has not received much attention in the general pediatric or in pediatric pulmonology literature. The similar radiologic appearance of these two entities can cause confusion both in diagnostic and the therapeutic approach. Many authors advocate an invasive modality, including thoracotomy, as the only definitive way to differentiate between them. We present two similar cases with retrosternal densities, review the pertinent literature, and propose a rational approach to diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/28. rhodococcus equi causing human pulmonary infection: review of 29 cases.rhodococcus equi is a gram-positive pleomorphic bacillus that has been identified as a life-threatening pulmonary pathogen in the immunocompromised host. infection with R equi may go unrecognized by physicians unacquainted with its presentation and unaware of the organism's ability to mimic diphtheroids and to stain weakly positive with an acid-fast stain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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