Seminars in respiratory infections
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Bronchiolitis obliterans organizing pneumonia (BOOP) is increasingly recognized as an important cause of diffuse infiltrative lung disease. It is a diagnostic consideration in patients with a febrile flu-like illness of a few weeks' duration and a roentgenogram showing bilateral patchy infiltrates that are not responsive to a typical course of antibiotics. It is defined as granulated tissue plugs within lumens of small airways that extend into alveolar ducts and alveoli. ⋯ This type of therapy is often effective in patients with associated systemic disorders or in other clinical settings, but there may be limited or no response in patients with dermatomyositis, immunosuppression, or interstitial opacities at the lung bases. Respiratory failure leading to death may occur in 5% of patients. It is important to add BOOP to the differential diagnosis of febrile, noninfectious illnesses that are mimics of pneumonia.
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Hypersensitivity pneumonitis or extrinsic allergic alveolitis is an immunologically mediated lung disease caused by repeated inhalations of organic antigens. The basic histological lesion consists of a diffuse mononuclear cell infiltration of alveolar wall, alveoli, terminal bronchioles, and neighboring interstitium. The inflammation is often followed by granulomas, which then may progress to fibrosis. ⋯ Once the diagnosis is suspected, the presence of serum precipitating antibodies (immunoglobulin [lg] G), suppressor cytotoxic lymphocytosis in bronchoalveolar lavage (BAL) fluid, and granulomatous alveolitis in lung biopsy specimens is extremely helpful in confirming the diagnosis. For patients in whom the diagnosis is confirmed, avoidance of the causative antigen is the best therapy, although corticosteroids are used to suppress inflammation. Once the fibrosis has developed, the patient may gradually develop respiratory failure or cor pulmonale, possibly resulting in death.
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Semin Respir Infect · Mar 1995
ReviewRecognition and emergency management of infectious causes of upper airway obstruction in children.
Infections represent one of the most common causes of upper airway obstruction in the pediatric age group. Because obstructive processes may lead to respiratory failure and subsequent cardiopulmonary arrest, prompt recognition is crucial. This discussion provides a brief review of the unique anatomic and physiological characteristics of the child's airway, which may contribute to obstructive processes, followed by basic principles of pediatric airway management. Finally, we review many of the infectious causes of upper respiratory obstruction, with emphasis on early recognition and acute management.
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Semin Respir Infect · Dec 1994
ReviewEffect of manipulating dietary constituents on the incidence of infection in critically ill patients.
Nutrition status has major implications for the incidence of infectious complications in critically ill patients. Providing macronutrients and micronutrients in appropriate amounts consistent with the metabolism present during the inflammatory response can significantly reduce the incidence of infectious complications. Current data would indicate that the enteral route of nutrition is more effective in this regard when it is used within 3 to 4 days after injury. ⋯ Despite these effects, infectious complications remain a common problem in critically ill patients. Based on the anti-inflammatory and lymphoproliferative properties of specific nutrients, enteral products have been formulated with increased amounts of these nutrients. The results of current studies with these products indicate a further reduction in infectious complications and length of hospital stay.
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Semin Respir Infect · Sep 1994
ReviewMethicillin-resistant Staphylococcus aureus as a cause of community-acquired pneumonia--a critical review.
Methicillin-resistant Staphylococcus aureus (MRSA) has been recognized as a nosocomial pathogen in Europe and North America for 3 decades. More recently it has emerged as a problem in long-term care facilities. It is less frequently considered a pathogen in nonfacility, community-acquired infections, where it is most often seen in intravenous drug users. ⋯ In addition, these isolates are frequently resistant to a number of other antibiotics, with vancomycin and only antibiotic to have consistently shown activity against MRSA. Therefore, vancomycin remains the treatment of choice for infections caused by MRSA, although treatment failures have been reported. The use of alternative antibiotics should be based on results of susceptibility testing of the strain isolated from the patient.