A pneumonia lipóide (PL) é de difícil diagnóstico porque apresenta características clínicas, laboratoriais e radiológicas semelhante às da pneumonia bacteriana. O objetivo foi propor uma estratégia terapêutica utilizando lavado alveolar múltiplo (LBA) e avaliar a eficácia do tratamento na recuperação clínica, laboratorial e tomográfica da PL. A casuistica incluiu 10 crianças (7 meninas e 3 meninos) com idades entre 2 meses e 9 anos, portadoras de pneumonia crônica não responsiva a antimicrobianos, no período de janeiro de 2005 a julho de 2007. Anamnese direcionada indicou uso de óleo mineral num período médio de 17,2 dias (variação: 1 a 60 dias) devido à constipação intestinal (n=7) e para tratamento de ascaridíase complicada com suboclusão intestinal (n=3). A broncoscopia diagnóstica foi realizada no Serviço de Endoscopia Respiratória do Hospital Universitário Antonio Pedro, da Faculdade de Medicina da Universidade Federal Fluminense em média 30,5 dias (variação: 5 a 90 dias) após o início dos sintomas de pneumonia crônica (n=6) e suspeita de tuberculose (n=4). Os dados clínicos, tomográficos e dosagens no soro e LBA (celularidade, proteína total, enzimas LDH e alfa-1 antitripsina) foram analisados no início e após o final do tratamento com o clareamento e a normalização da celularidade do LBA. Em todos os casos o LBA mostrava aspecto opalescente com halo de gordura sobrenadante e pleocitose. A celularidade (média= 1.810 células/mm³) com predomínio de macrófagos espumosos corados pelo Sudan confirmou o diagnóstico de PL. Em nenhum caso houve suspeição de PL antes da broncoscopia embora a maioria (80%) apresentasse fator de risco para aspiração. Os principais sintomas foram febre, tosse, taquipnéia, dispnéia, perda de peso e gemidos. Anemia, leucocitose, neutrofilia e aumento de plaquetas e da velocidade de hemossedimentação estavam presentes na maioria dos casos. A radiografia de tórax mostrou principalmente áreas de consolidação predominando no pulmão direito e opacidade perihilar. As principais alterações tomográficas incluíram consolidação bilateral com broncograma aéreo, com áreas de densidade de gordura dentro das consolidações. As crianças tratadas com LBA múltiplos (média = 7,4) tornaram-se assintomáticas. A maioria (80%) apresentou normalização tomográfica e do LBA. O diagnóstico de PL deve ser sempre considerado nos casos de pneumonia crônica refratária e/ou tuberculose principalmente quando há história de ingestão de óleo mineral. O tratamento com LBA múltiplos permitiu a retirada do óleo mineral e dos macrófagos alveolares ativados dos pulmões proporcionando resolução clínica e tomográfica, além de reduzir o processo inflamatório alveolar evitando seqüelas como bronquiectasia e fibrose pulmonar. Este estudo mostra que a broncoscopia com LBA múltiplos é um tratamento eficaz e curativo nos casos de PL exógena causada por aspiração de óleo mineral. / Lipoid pneumonia (LP) is of difficult diagnosis because it presents clinic, laboratory and radiologic characteristics similar to current bacterial pneumonia. The aim was to propose a therapeutic strategy for LP using multiple bronchoalveolar lavage (BAL) and to evaluate the efficacy of such treatment in the recovery of clinic, laboratorial and tomography parameters. The study included 10 children (7 girls and 3 boys) with ages between 2 months and 9 yearsold, with chronic pneumonia refractory to current antibiotic therapy during January 2005 and July 2007. Directed anamneses indicated the mineral-oil use during 17.2 days (range 1 to 60 days) due to intestinal constipation (n=7) and for complicated ascariasis with intestinal subcclusion (n=3). The diagnostic bronchoscopy was carried out in the Respiratory Endoscopy Service of the Antonio Pedro University Hospital, by the College of Medicine from the Universidade Federal Fluminense, 30.5 days (range 5 to 90 days) after the beginning of the symptoms related to chronic pneumonia (n=6) and suspicion of tuberculosis (n=4). Clinical parameters, tomography scans (CT) and sera and BAL (cellularity, total protein, enzymes LDH and alpha1 anti-trypsin) data were analyzed at the beginning and after the treatment, until the transparency and normalization of BAL cellularity. The BAL had opalescent aspect with fat supernatant layer and pleocytosis in all cases. The cellularity (mean 1810 cells/mm³) with predominance of Sudan positive foam macrophages confirmed LP diagnosis. None had suspicion of LP before the bronchoscopy, although the majority (80%) presented risk-factor for aspiration. The main reported symptoms were: fever, cough, tachypnea, dyspnea, loss of weight and groaning. The majority presented anemia, leukocytose, neutrophilia, hyperplaquetemia and high erythrosedimentation rate. The thorax X-Ray showed predominance of consolidation areas in the right lung and perihilar opacity. The main tomographic alterations were bilateral air-space consolidation with air bronchogram and areas of fat density within consolidations. All children were treated with multiple BAL (mean 7.4) becoming asymptomatic and, the majority (80%) showed complete recover of CT and BAL. The LP diagnosis should always be considered in those cases of refractory chronic pneumonia and/or tuberculosis with previous history of mineral-oil ingestion. Treatment with multiple BAL, allowed the withdrawal of the mineral oil and of activated alveolar macrophages from the lungs. Such procedure provided clinical and tomographic resolution and further reduced the inflammatory alveolar process thus avoiding the risk of sequels as bronchiectasis and pulmonary fibrosis. The present study demonstrates that bronchoscopy with multiple BAL is an efficient and curative strategy that can be used in patients with exogenous LP induced by mineral-oil aspiration.

Abstract A study is made of the volume of hospital treatment provided for cases of pneumonia in Finland from 1972 to 1993, employing as a source the National Hospital Discharge Register. The results are used to predict changes in the utilization of hospital resources in this respect up to the year 2020. A total of 452 474 treatment periods and 5 935 615 hospitalization days attributable to pneumonia were recorded for the total population over the given period, of which just under 20% applied to children aged under 15 years, over 30% to persons of working age, 15-64 years, and over 50% to elderly persons aged 65 years and over. The mean duration of hospitalization was reduced from 18.4 days to 14.3 days for males and from 19.6 days to 17.5 days for females over the period in question. The number of treatment periods for pneumonia in children per year relative to population decreased by 28.3%, the greatest reduction being in the group under one year of age, 5.7% for boys and 5.5% for girls. The mean duration of treatment decreased from 9.6 days to 4.1 days for boys and 9.7 days to 4.3 days for girls. The numbers of treatment periods and hospitalization days were consistently greater for men than for women in the working-age population, the difference between the sexes being most pronounced in the age group 15 - 24 years, where the number of treatment periods for men was 7.2 times that for women. Likewise, the number of treatment periods for men began to increase with age from 40 years onwards and that for women from 50 years onwards. The mean treatment time for patients of working-age decreased over the period studied, from 10.5 days to 8.2 days for men and from 9.9 days to 8.2 days for women. The duration of treatment similarly increased with advancing age. The absolute numbers of treatment periods increased by 139% among the elderly population, even when standardized for age, whereas the number of hospitalization days diminished. The clearest increase in treatment periods of all was recorded for men aged over 84 years, 3.16%. The mean duration of treatment increased with age in both sexes, being significantly longer for women than for men in each age group. The forecast for changes in the utilization of hospital services for the treatment of pneumonia up to the year 2020 was examined by methods based on both an age structure model and a time series model. Both predicted an increase of over 50% in the total number of treatment periods for the population as a whole, being of the order of 70% for men and 30% for women. The predicted increase in the age group over 64 years was in excess of 90% with both models. The use of hospital services for the treatment of childhood pneumonia decreased significantly over the period examined here, while the majority of the treatment periods recorded for the working-age population concerned young men or persons aged over 40 years. The most significant increase was seen in treatment periods for persons aged over 64 years, and this figure is also predicted to increase in the future, on account of the frequent use made of hospital services by the elderly in general. Preparations should be made for dealing with this increase in demand by improving treatment methods, developing the treatment system and undertaking preventive measures.

Pneumonia is a common disease spread throughout the whole world. It appears within all age groups, however, the most endengered groups are the infants and seniors whose lives are more likely at risk. This final thesis compares direct costs of the preventative actions utilizing the Prevenar 13 vaccine and costs related to the ambulatory treatment and consequent care of the hospitalized patients. Calculations are based on anonymised data from an ambulant care and hospitalized patient treatments in hospital of Melnik town.

Abstract available in the Journal of Investigative Medicine.

Background: HIV infection is a major risk factor for death in childhood pneumonia in HIV-endemic regions. Improved case management and preventive strategies require better understanding of the impact of HIV on causes, clinical presentation, and outcome. Methods: A prospective, clinical descriptive study of Malawian infants and children with severe pneumonia included blood culture and nasopharyngeal aspiration for diagnosis of pneumocystis pneumonia (PcP). A select group with consolidation on chest radiograph, and without severe hypoxia or hyperinflation, also had lung aspirate taken for culture and identification of bacterial deoxyribonucleic acid by real-time polymerase chain reaction (PCR). Results: There were 327 study patients with a median age of 11 months (range, 2 months-14 years). HIV prevalence was 51%. There were 58 cases of confirmed bacterial pneumonia, of which the most common bacterial isolates were Streptococcus pneumoniae and Salmonella typhimurium. Of the 54 lung aspirates, only 2 were positive on culture but 27 were positive for bacterial deoxyribonucleic acid by PCR. PcP was confirmed in 16 patients, and was associated with young age, severe hypoxia, HIV infection, and a very poor outcome. The overall case-fatality rate was 10% despite presumptive therapy for PcP and routine broad-spectrum antibiotic treatment appropriate for local antimicrobial susceptibility data. Most of the deaths occurred in infants of 2 to 6 months of age and PcP was associated with 57% of these deaths. Conclusions: PcP is a major barrier in reducing the case-fatality rate of severe pneumonia in infants of HIV-endemic communities. The use of PCR on lung aspirate specimens greatly increased the diagnostic yield.

Streptococcus pneumoniae (Spn) is the most common etiology of bacterial pneumonia, which is one of the leading causes of death in children and the elderly worldwide. During non-lethal infections with Spn, immune cells accumulate in the lungs and protect against reinfection with more lethal strains, this protection is termed heterotypic immunity. Lymphocyte populations such as resident memory T cells and resident memory B cells are known to be crucial for heterotypic immunity, but their diversity remains understudied. Here, we aimed to elucidate resident lymphocyte heterogeneity in the lungs after recovery from pneumococcal pneumonia, and their contributions to heterotypic immune protection. We developed a comprehensive immunophenotyping panel for full-spectrum flow cytometry (FSFC) to identify novel subsets of lymphocytes and combined it with an unbiased analysis approach. With this tool we discovered that murine lungs were enriched for unexpected subsets of resident lymphocytes, and we defined CD73 as a potential lymphocyte residence marker. We discovered a novel subset of CD4+ T cells defined by the phenotype CD11a+CD69+GL7+, which corresponded to a significant proportion of lung CD4+ TRM cells. Initial analyses demonstrated GL7+ T cells resembled CD4+ TRM cells. Functional studies revealed that unlike GL7- TRM subsets that were mostly RORT+, GL7+ TRM cells were also Gata-3+ and/or T-bet+ could secrete type 2 or type 1 cytokines, suggesting they were poised to be TH2 or TH1-like in function. This study emphasizes the use of a multiparameter panel for FSFC as tool to identify novel lymphocyte subsets. We conclude that the environment of pneumonia-recovered lungs contains heterogeneous subsets of resident lymphocytes, including GL7+ TRM cells. We propose these subsets may contribute to lung immunity in unique ways and may be important players in serotype-independent protection to pneumococcal pneumonia. / 2024-01-23T00:00:00Z

Hospital acquired pneumonia (HAP) causes significant mortality and morbidity and is now no longer reimbursed by Centers for Medicare and Medicaid (CMS). For all of these reasons, hospitals want to minimize their HAP rates. Aggressive oral care (tooth brushing 3 times a day) has been shown to reduce the incidence of HAP in the intensive care unit setting, but this has not been tested in the acute care setting, in which patients are more stable, less sick, and more ambulatory. In an attempt to address HAP rates in acute care settings, this clinical trial entailed providing all patients in four wards with a 3 times per day tooth-brushing oral care protocol, which was implemented or supervised by the nurses on each ward. Six matched wards on a separate campus that received normal standard of care served as controls. The goal of this clinical trial was to cut the pneumonia rate in half, from 2% to 1%. This clinical trial was conducted to determine whether an oral care regimen would reduce the incidence of aspiration pneumonia over the three months of intervention in the experimental group (HAC) versus the control group (ENC) from Nov 5, 2012 to Feb 15, 2013.

No abstract available. / Thesis (M.D.)-University of KwaZulu-Natal, 2004.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2004. / Härtill 4 uppsatser.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-10-23T17:32:31Z No. of bitstreams: 1 Juliana Rebouças de Oliveira Etiologia da pneumonia adquirida....pdf: 2505145 bytes, checksum: d0d9c1cc48dc6e014855686844968a82 (MD5) / Made available in DSpace on 2012-10-23T17:32:31Z (GMT). No. of bitstreams: 1 Juliana Rebouças de Oliveira Etiologia da pneumonia adquirida....pdf: 2505145 bytes, checksum: d0d9c1cc48dc6e014855686844968a82 (MD5) Previous issue date: 2012 / Universidade Federal da Bahia. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / Pneumonia adquirida na comunidade (PAC) é uma das principais causas de hospitalização e óbito em crianças menores de cinco anos, na maioria dos países em desenvolvimento. O controle da PAC depende do entendimento adequado da importância dos agentes etiológicos, o quê tem sido dificultado pela ausência de métodos sensíveis, específicos e disponíveis, para estabelecer a etiologia dos casos. Derrame pleural (DP) é a complicação mais frequente da PAC. A atual compreensão é de que DP ocorre em infecções bacterianas piogênicas, informação essa decorrente do uso restrito de métodos tradicionais e pouco sensíveis que investigam apenas etiologia bacteriana em crianças com PAC e DP. Objetivo principal deste estudo foi determinar a etiologia da PAC em crianças hospitalizadas com DP utilizando métodos abrangentes para investigação etiológica. Desenho do estudo: realizado estudo observacional prospectivo do tipo corte transversal realizado em um hospital público, Centro Pediátrico Professor Hosannah de Oliveira (Salvador-Bahia). Material e métodos: a coleta de dados ocorreu entre setembro de 2003 a maio de 2005. Crianças previamente saudáveis com idade inferior a cinco anos, hospitalizadas com PAC, foram incluídas neste estudo. Resultados: das 277 crianças selecionadas, 206 (74%) tiveram o diagnóstico de pneumonia confirmado pela radiografia de tórax avaliada por um especialista em radiologia pediátrica. A etiologia foi estabelecida em 165 (80%) crianças; nas quais foram encontrados, infecção bacteriana em 20%, viral 48,5% e co-infecção vírus-bactéria em 31,5%. Derrame pleural (DP) foi descrito em 25 casos (12%). Entre as crianças com DP, a etiologia foi estabelecida em 18 casos (72%) sendo infecção bacteriana 28%, viral 50% e viral-bacteriana 22%. Entre todos os 25 casos com DP, a frequência por grupos etiológicos foram: bacteriana 20%, viral 36%, viral-bacteriana 16% e não identificado 28%. Conclusão: infecção exclusivamente viral foi identificada em um terço das crianças internadas com PAC e DP, portanto, quando se faz ampla investigação etiológica para vírus e bactérias, DP não está associado a apenas infecções bacterianas. Estes resultados levantam a necessidade de investigar a etiologia do DP de forma abrangente, procurando agentes virais e bactérianos, pelo uso de métodos moleculares / Community-acquired pneumonia (CAP) is a major cause of hospitalization and death among children under five years old in most developing countries. The control of CAP depends on the appropriate understanding of the matter of etiologic agents, what has been impaired by the lack of sensitive, specific and available diagnostic methods to establish the etiology. Pleural effusion (PE) is the most frequent complication of CAP. The current understanding is that SD occurs mainly in pyogenic bacterial infections. Such idea is probably due to limited use of diagnostic methods that are traditional and less sensitive, and merely investigate bacterial etiology in children with CAP and PE. The main objective of this study was to determine the etiology of CAP in hospitalized children with PE using comprehensive methods for investigating the etiology. We conducted a prospective cross-sectional observational study, performed at a public hospital, the Professor Hosannah de Oliveira Pediatric Center (Salvador-Bahia-Brazil). Data collection occurred between September 2003 and May 2005.Previously healthy children younger than five years, hospitalized with CAP were included in this study. Results: among 277 children selected, 206 (74%) had diagnosis of pneumonia confirmed by chest radiographs evaluated by a specialist in pediatric radiology. The etiology was confirmed in 80% children, in which we found: bacterial infection in 20%, viral infection in 48.5% and co-infection viral-bacterial in 31.5%. Pleural effusion (PE) was reported in 25 cases (12%). Among children with PE, the etiology was established in 18 cases (72%), being bacterial infection in 28%, viral infection in 50% and viral-bacterial infection in 22%. Among all 25 cases with PE, the frequencies by etiological groups were: 20% bacterial, 36% viral, 16% bacterial-viral and 28% unidentified. Conclusion: Viral infection was identified in only one third of children hospitalized with CAP and PE; so when extensive etiologic investigation for viruses and bacteria is performed, PE is not associated exclusively with bacterial infections. These results raise the need to investigate the etiology of PE in a comprehensive way, looking for viral and bacterial agents, including the use of molecular methods.