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158. The pleural surface at the lower left demonstrates areas of yellow-tan purulent exudate. Pneumonia may be complicated by a pleuritis. Initially, there may just be an effusion into the pleural space. There may also be a fibrinous pleuritis. However, bacterial infections of lung can spread to the pleura to produce a purulent pleuritis. A collection of pus in the pleural space is known as empyema .
220. Pneumocystis carinii pneumonitis (PCP) is a common opportunistic disease that occurs almost exclusively in persons who have profound immunodeficiency. PCP was and still is the most common life-threatening opportunistic infection occurring in patients with HIV disease.
221.
222. The mode of replication of P carinii has not been established. However, the stages in its life cycle have been characterized. Sporozoites excyst through breaks in the cyst wall and then are termed trophozoites. The means by which the trophozoite form progresses to the cyst phase is not known.
223. The portal of entry for P carinii has not been firmly established; however, because with rare exceptions the organism has been found only in the lung, inhalation is a likely mode of transmission. Airborne transmission has been demonstrated in animals. In most individuals, the organism is dormant and sparsely dispersed in the lung, with no apparent host response (latent infection). In susceptible (immunocompromised) hosts, the organism occurs in massive numbers.
224. With rare exceptions, P carinni causes disease only when natural mechanisms of host defense are compromised.
225. Pneumocystis carinii has been found in the lungs of rats, rabbits, mice, dogs, sheep, goats, ferrets, chimpanzees, guinea pigs, horses, and monkeys. The organism has been reported in lower animals and humans from all continents. Animal to animal transmission by the airborne route has been demonstrated. Because about 70 percent of healthy individuals may have humoral antibody to P carinii , subclinical infection must be highly prevalent.
226. Tachypnea and fever are consistent features of the pneumonitis, and diffuse bilateral alveolar disease can be observed by radiography. Diagnosis requires the identification of P carinii in pulmonary tissue or lower airway fluids. Such specimens may be obtained by lung biopsy, inducement of sputum, bronchoalveolar lavage, or needle aspiration of the lung. The Gomori, Giemsa, fluorescence-labelled antibody, or toluidine blue O stains may be used to identify the organism.
Continuing with the definition : Acquired by a patient in the following settings: 1. In a hospital or long-term-care facility after being admitted for >48 hours or 2. <7 days after a patient is discharged from the hospital with the caveat that the patient’s initial hospirtalization should be 3 days duration.
07/16/96 ## * * The next slide presents the implicated pathogens in nosocomial bacterial pneumonia. -Gram-negative enteric bacilli which are the predominant microorganisms. - Gram-positive cocci, including Staphylococcus aureus, especially methicillin- resistant strains and other Gram-positive cocci such as Streptococcus pneumoniae have emerged as important isolates recently. -Anaerobes account for few cases, and lastly, other microorganisms including, Legionella pneumophila and other species as well as Haemophilus influenzae .
Let me start with the disease definition of Acute Nosocomial bacterial pneumonia which is broadly defined as a pneumonia characterized by a new cough with auscultatory findings of pneumonia in conjunction with a new inflitrate or progressive infiltrate or infiltrates on chest radiograph accompanied by: fever or hypothermia, leukocytosis and sputum production which could be purulent , caused by polymicrobial organisms
Cysts predispose to pneumothorax. Nuclear medicine scan uses gallium and shows widespread lung activity. This is a somewhat outdated form of diagnosis.