A Community-acquired Lung Abscess Attributable to Streptococcus pneumoniae which Extended Directly into the Chest Wall.

We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy.

The clinical features of respiratory infections caused by the Streptococcus anginosus group.

BACKGROUND: The Streptococcus anginosus group (SAG) play important roles in respiratory infections. It is ordinarily difficult to distinguish them from contaminations as the causative pathogens of respiratory infections because they are often cultured in respiratory specimens. Therefore, it is important to understand the clinical characteristics and laboratory findings of respiratory infections caused by the SAG members. The aim of this study is to clarify the role of the SAG bacteria in respiratory infections. METHODS: A total of 30 patients who were diagnosed with respiratory infections which were caused by the SAG bacteria between January 2005 and February 2015 were retrospectively evaluated. RESULTS: Respiratory infections caused by the SAG were mostly seen in male patients with comorbid diseases and were typically complicated with pleural effusion. Pleural effusion was observed in 22 (73.3%) patients. Empyema was observed in half of the 22 patients with pleural effusion. S. intermedius, S. constellatus and S. anginosus were detected in 16 (53.3 %), 11 (36.7 %) and 3 (10.0 %) patients, respectively. Six patients had mixed-infections. The duration from the onset of symptoms to the hospital visit was significantly longer in "lung abscess" patients than in "pneumonia" patients among the 24 patients with single infections, but not among the six patients with mixed-infection. The peripheral white blood cell counts of the "pneumonia" patients were higher than those of the "lung abscess" patients and S. intermedius was identified significantly more frequently in patients with pulmonary and pleural infections (pneumonia and lung abscess) than in patients with bacterial pleurisy only. In addition, the patients in whom S. intermedius was cultured were significantly older than those in whom S. constellatus was cultured. CONCLUSIONS: Respiratory infections caused by the SAG bacteria tended to be observed more frequently in male patients with comorbid diseases and to more frequently involve purulent formation. In addition, S. intermedius was mainly identified in elderly patients with having pulmonary infection complicated with pleural effusion, and the aspiration of oral secretions may be a risk factor in the formation of empyema thoracis associated with pneumonia due to S. intermedius.

[The use of Timalin in the treatment of the acute lung abscess].

The study was aimed to research levels of main acute inflammation phase peptides, coagulative and fibrinolitic plasma activity on the background of traditional treatment and with addition of Timalin in patients with acute lung abscess. The study demonstrated that induction of bioregulative therapy leads to faster normalization of main indicators of SIRS and plasma fibrinolitic activity and eliminates hypercoagulation.

Mycobacterium abscessus lung disease in a patient with previous pulmonary tuberculosis.

Patients with pre-existing lung damage, such as due to pulmonary tuberculosis (PTB), are susceptible to nontuberculous mycobacteria (NTM) infections. For patients with previous PTB, it is difficult to differentiate NTM lung disease from PTB, especially in tuberculosis (TB) high-burdened countries. Here, we report a case of Mycobacterium abscessus lung disease with a previous history of PTB. The patient underwent a right upper lobe lobectomy due to disappointing treatment response with anti-tuberculosis therapy. However, the disease worsened after the surgery. Five years later, she was diagnosed with M. abscessus lung disease. Successive computed tomography (CT) scans showed the progressing features of M. abscessus lung disease. This patient had multiple micronodules adjacent to the pleura with a positive culture for NTM. Bilateral bronchiectasis without lobar predominance are valuable features for distinguishing M. abscessus lung disease from other mycobacterial lung disease.

Acute subepicardial infarction associated with severe septic shock--insight in myocardial perfusion.

Isolated infarctions of the subepicardial myocardium without changes in subendocardium are extremely rare. We present an autoptic case with an acute subepicardial infarction of the right- and left-ventricular myocardium. A 53-year-old male was admitted to hospital with acute upper abdominal pain. Clinical examination revealed an acute infero-lateral myocardial infarction. The patient succumbed to acute heart failure a few hours later. Autopsy revealed numerous pulmonary abscesses due to suppurative lobular pneumonia with consecutive pericardial effusion. Furthermore, we diagnosed an acute myocardial infarct encompassing the entire right and left ventricles but limited to the subepicardial myocardium only. Microscopically, we observed fibrin microemboli in the subepicardial microvessels. The existence of an isolated subepicardial myocardial infarct challenges our understanding of myocardial perfusion.

Eight cases of lower respiratory tract infection caused by Stomatococcus mucilaginosus.

Stomatococcus mucilaginosus was isolated from 8 patients suffering from lower respiratory tract infections over a 4-y period (1999-2003). The infections ranged from mild cases of pneumonia to a life-threatening case of recurrent lung abscesses in a neutropenic patient. The various strains were cultured from specimens obtained by bronchoscopy, blood, and sputum specimens. All strains were fully susceptible to rifampicin, vancomycin and gentamicin. They showed variable susceptibility to penicillin and ciprofloxacin. S. mucilaginosus is likely to be under-reported as a pathogen due to difficulties in obtaining samples for culture as well as misidentification due to its biochemical characteristics.

Lung abscess caused by Clostridium ramosum.

A 49-year-old male presented with weight loss and fever. Further evaluation revealed lung abscesses and Clostridium ramosum bacteremia. This is an unusual cause of infection. There have only been seven reports of infections caused by C. ramosum.

[Radionuclide examination of functional disorders in patients with acute abscess of lung]. / Radionuklidnye metody issledovaniia funktsional'nykh narushenii u bol'nykh s ostrym abstsessom legkogo.

Potential of radionuclide examination for study of external respiratory function is discussed. Results of examination of 42 patients with lung abscess are analyzed. Procedure of perfusion and ventilating aerosol pulmonoscintigraphy with (99m)Tc-pentatex is described in detail. This procedure permits to examine alveolar-capillary diffusion. Variants of synchronous and asynchronous variations of indices of ventilating-perfusion correlations are demonstrated. These methods are safe and non-invasive. They may be recommended for functional assessment of regional and total characteristics of external respiration of each lung separately, and also for diagnosis of predominance of ventilating or perfusion dysfunction. Clearence of pentatex excretion from right and left lung characterizes integrity of epithelium and alveolar-capillary membrane. It is the index of alveolar-capillary permeability.

Pediatric lung abscess: a retrospective review of 23 cases.

Pulmonary abscess is a rare but critical problem in childhood. We did a retrospective review of 23 children with documented lung abscess who had been admitted and treated at the Taipei Veterans General Hospital over a 20-year period from April 1982 to April 2002. Among the 23 children, 11 cases were primary lung abscess, and 12 were secondary lung abscess. The pathogens were isolated in 16 patients (69.6%), and blood cultures yielded in only 3 patients (13.0%). The most common microorganism isolated in this series was Streptococcus pneumoniae. The 2 patients (8.7%) that died in our series had secondary lung abscess. We herein report the presenting symptoms, bacteriology, clinical management, and outcome of these 23 cases.

Effects of pulmonary abscesses on racing performance of horses treated at referral veterinary medical teaching hospitals: 45 cases (1985-1997).

OBJECTIVE: To determine whether results of physical or radiographic examination or biochemical analyses in adult racehorses with primary lung abscesses were associated with ability to race following treatment. DESIGN: Multiple-center retrospective study. ANIMALS: 25 Standardbreds and 20 Thoroughbreds. PROCEDURE: Medical records of horses with a primary lung abscess that were admitted to any of 4 veterinary teaching hospitals were reviewed. Results of physical examination, laboratory testing, and thoracic radiography were reviewed. Racing performance after treatment was compared with performance before illness and with performance of the general population of racehorses of similar age, sex, and breed. RESULTS: 23 of 25 Standardbreds and 13 of 20 Thoroughbreds raced after diagnosis and treatment of a lung abscess. Most horses had a solitary abscess in the dorsal to caudodorsal lung fields. Results of initial physical examination, biochemical analyses, and culture and identification of the microbial isolate were not associated with whether a horse returned to racing. For horses that had raced prior to the illness, race performance after treatment of the lung abscess was not significantly different from performance before the illness. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of racing performance in those horses that resumed racing after treatment, long-term residual lung damage did not develop in horses with primary lung abscesses that were treated appropriately. It is not known whether horses that recovered would be more likely to bleed from the site of a prior infection when resuming strenuous exercise and whether lung abscesses contributed to a failure to resume racing.

Absceso pulmonar en niños

Introducción: El absceso pulmonar es poco frecuente en lactantes y niños; sin embrago, esta unidad es responsable de gran morbimortalidad según lo reporta la bibliografía internacional. Objetivos: Describir la experiencia del Hospital Napoleón Franco Pareja entre 1992 y 1995, en relación con el absceso pulmonar en niños. Pacientes y Métodos: Fueron revisadas de manera retrospectiva 16 historias clínicas de niños con diagnósticos comprobado de absceso pulmonar, quienes fueron hospitalizados y tratados en el Hospital Infantil Napoleón Franco en la Ciudad de Cartagena (Colombia), entre los meses de enero de 1992 y diciembre de 1995. Resultados: Reportamos las características clínicas de la enfermedad, comprendiendo la signo/sintomatología más frecuente, las localizaciones patológicas, sus estudios radiológicos, tratamiento y evolución. Destacamos la presencia de desnutrición severa como un factor condicionante importante del absceso pulmonar (absceso secundario). El tratamiento médico conservador se constituyó en el método único de manejo más utilizado. Sólo un paciente ameritó abordaje quirúrgico abierto (lobectomía). Conclusión: El absceso pulmonar es una patología de alta frecuencia en nuestro medio, lo que se corrobora con la casuística encontrada en nuestra institución (2,37/1.000), que es una de las mayores incidencias reportadas a nivel mundial. El tratamiento antibiótico empírico es útil como único manejo en la mayoría de los casos.

Lung abscess in patients with AIDS.

We identified 31 patients with human immunodeficiency virus (HIV) infection and lung abscess. All patients had advanced HIV disease, and the mean CD4 cell count was 17/mm3 (range, 2-50/mm3). Twenty-two patients (71%) had previous opportunistic infections, and 24 (77%) had previous pulmonary infections. Symptoms at the time of presentation included fever (90% of patients), cough (87%), dyspnea (35%), pleuritic chest pain (26%), and hemoptysis (10%). The microbiological etiology was established for 28 patients, and the pathogens recovered were bacteria (65%), Pneumocystis carinii (6%), fungi (3%), and mixed microorganisms (16%). The pathogens included Pseudomonas aeruginosa (11), Streptococcus pneumoniae (6), P. carinii (5), Klebsiella pneumoniae (5), Staphylococcus aureus (4), Aspergillus species (3), viridans streptococcus (2), Haemophilus influenzae (1), Streptococcus milleri (1), Proteus mirabilis (1), and Cryptococcus neoformans (1). Mycobacterium tuberculosis was not isolated; two patients for whom a microbiological etiology was not established responded to antituberculous therapy. Patients were treated for 2-12 weeks; 25% of the patients received > 4 weeks of therapy. The outcome was poor: 36% of the patients had recurrences, and 19% died. In patients with AIDS, lung abscess is associated with advanced HIV infection, is due to a broad spectrum of pathogens, responds poorly to antibiotics, and has a poor prognosis.

Transbronchial regional electroplethysmography of the lungs.

OBJECTIVE: The objective of this study was to describe a method of transbronchial regional electroplethysmography of the lungs. METHODS: The electrical resistance of a division of a lung, such as a segment or subsegment, as well as its pulsatile oscillation, were measured using a two-part process: A catheter-transducer was wedged into a small bronchus and the electrical resistance of a blood sample obtained from the same patient was measured. The electroplethysmograph (EPG) was developed for this purpose. The theory behind our method is based on a model of the lung as a three-component structure (blood-tissue-air). We performed experiments on isolated lung lobes of animals, using simultaneous electrometric and direct determination of physiologic indices for regional lung function. RESULTS: Equations have been proposed to calculate blood volume, Vb (+/- 10%); air volume, Va (+/- 11%); pulsatile increment of the blood volume, delta V (+/- 10%); and regional stroke volume, RSV (+/- 20%) per 100 cm3 of the lung. The proposed formulas yield an accuracy that is adequate for the clinical range of variations in Vb and Va, as well as delta V and RSV. Experiments on lung lobes indicate that the conductivity of lung tissue (gamma t) is not large. This allows one to calculate the above indices without our having obtained accurate values for conductivity. CONCLUSIONS: The method of Transbronchial regional electroplethysmography of the lungs is described and cases in which this method was used for clinical investigation are presented.

Acute phase protein response, food intake, liveweight change and lesions following intrathoracic injection of yeast in sheep.

Acute phase protein concentrations in blood, food intake and liveweight changes were compared in 10 sheep given intrathoracic injections of yeast and 10 control sheep over a period of 61 days. The yeast injections caused acute pleuritis and limited necrotising lung lesions which progressed to fibrous pleural adhesions and walled-off abscesses. The responses of ceruloplasmin, fibrinogen and haptoglobin were closely correlated (r = 0.87 to 0.91) in the yeast-injected sheep with peaks on days 5 or 7 after treatment (4, 4.6 and over 130 times control, respectively). Albumin concentration fell to a nadir of 89 per cent of control on day 12 after treatment. Depression of food intake was temporally related to the 'positive' acute phase protein responses with a nadir on day 5 after treatment (30 per cent of control). Liveweight showed a pronounced fall to five days after treatment and thereafter remained depressed relative to the controls for most of the experimental period. The data suggest that the 'positive' acute phase proteins may be useful indicators of production losses due to inflammatory diseases in sheep.