Seminars in respiratory infections
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Pediatric fungal pulmonary infections are being seen with increasing frequency. The dimorphic fungi Histoplasma capsulatum. Blastomyces dermatitidis, Coccidioides immitis, and Cryptococcus neoformans frequently cause infections that are asymptomatic. ⋯ Diagnosis can be made definitively by isolation of the causative organism, but serology or skin testing is often necessary when this is not successful. Severe or life threatening infections are treated with amphotericin B. Recently, new oral azole antifungals are being used more frequently for mild to moderate disease with good success.
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Semin Respir Infect · Jun 1996
ReviewDifferential diagnosis of fever and pulmonary densities in mechanically ventilated patients.
Sepsis continues to represent a major threat to the recovery of mechanically ventilated patients and a serious challenge to physicians in charge of their care. Diagnosis of pneumonia is made difficult by numerous infectious and noninfectious conditions that may present in a clinically similar fashion. ⋯ A thorough understanding of the various causes of fever and pulmonary densities, other than pneumonia, is necessary to avoid misdiagnosis and inappropriate treatment. This understanding then allows a systematic approach to diagnosis using the most appropriate tests.
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Semin Respir Infect · Mar 1996
ReviewNosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996.
Mechanically ventilated patients have a higher incidence of pneumonia and mortality than do nonventilated patients. Ventilator-associated pneumonia (VAP) is diagnosed clinically, by bronchoscopy or "blind" bronchoalveolar lavage (BAL) or protected specimen brush (PSB), and by quantitative endobronchial aspirates (QEA). VAP is usually caused by bacteria, but Legionella pneumophila, Mycobacterium tuberculosis, viruses, and fungi are also potential pathogens. ⋯ Aspiration appears to be the major route for the entry of bacteria into the lower respiratory tract. Host factors, oropharyngeal and gastric colonization, cross-infection, and complications from the use of antibiotics and nasogastric and endotracheal tubes increases the risk of bacterial VAP. A working knowledge of the epidemiology and strategies for prevention of VAP should reduce infection rates, morbidity, and mortality in critically ill patients.
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Semin Respir Infect · Dec 1995
ReviewRespiratory syncytial virus and parainfluenza virus infections in the immunocompromised host.
Respiratory syncytial virus (RSV) and parainfluenza virus (PIV) are common causes of respiratory infections in immunocompetent children under the age of 6 years. These viruses belong to a family of enveloped single-stranded RNA viruses, the paramyxoviruses. The clinical manifestations in the normal host range from mild illness to severe croup, bronchiolitis, and pneumonia. ⋯ Clinical trials have shown ribavirin to be of benefit in treating infants infected with RSV. However, clinical trials in immunocompromised patients infected with RSV or PIV have not been carried out. Since infection with RSV and PIV can be severe and life-threatening and treatment with ribavirin is relatively benign, it seems warranted to treat immunocompromised patients infected with RSV or PIV with ribavirin until otherwise proven unwarranted.
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Semin Respir Infect · Sep 1995
ReviewThe fibroproliferative phase of late adult respiratory distress syndrome.
Tissue response to insults is similar regardless of the tissue involved, and occurs in two sequential and interconnected steps, inflammation and fibroproliferation. Adult respiratory distress syndrome (ARDS) is a disease characterized by acute onset of diffuse and severe inflammatory reaction of the lung parenchyma with loss of compartmentalization, resulting in protein rich exudative edema. ⋯ We will review recent observations indicating that an exaggerated pulmonary inflammatory response plays a key role in the progression of ARDS. We will provide a unifying pathogenetic model of ARDS, showing how the evolution from acute to chronic inflammation explains the progression of histological, laboratory, clinical, and physiological findings seen during the course of unresolving ARDS.