Diagnosis of ventilator-associated pneumonia

The diagnosis of ventilator pneumonia remains a controversial area. Use of standard clinical criteria has been found to be inadequate. Use of a clinical pulmonary infection score (CPIS) has improved the diagnostic utility of clinical criteria. For the intubated patient, there is ready access to the lower respiratory tract. Samples include endotracheal aspirates, bronchoalveolar lavage and protected brush specimen. The latter two can be obtained blindly or via a bronchoscope. The culture results are more meaningful if reported in a semi-quantitative model. There is increasing evidence that culture results predict mortality and can be used to direct duration and type of therapy.     

Diagnosis of Pneumocystis carinii pneumonia

Pneumocystis carinii is the prime opportunistic pathogen of our time, the leading cause of fatal pneumonia in the increasing number of immunosuppressed subjects encountered on oncology and transplant programmes' and in subjects with the acquired immuno-deficiency syndrome (AIDS).     

Diagnosis and antibiotic treatment of community-acquired pneumonia.

Only a few pathogens cause most community-acquired pneumonias. In outpatients, treatment is empiric, based on the results of chest films, leukocyte counts, and Gram''s stains (if available). Antibiotics must always cover pneumococci and should cover Mycoplasma pneumoniae in young adults and during epidemic periods. A follow-up chest film in smokers and those older than 40 years is strongly recommended. In inpatients, the evaluation and treatment are tailored to individual cases. A search for a wider range of causes, using invasive tests if necessary, is undertaken, and all likely pathogens should be covered with the initial antibiotic therapy.     

Diagnosis of Legionella micdadei pneumonia from cytologic specimens

Legionella micdadei is a recently described opportunistic pulmonary pathogen that produces an acute, suppurative pneumonia in patients receiving steroid therapy. Most prospective diagnoses have been made by open lung biopsy. We present a case in which the diagnosis was made from cytologic material. The clinicopathologic features of L. micdadei pneumonia are discussed, and criteria for diagnosis from cytologic specimens are presented.     

Prevalence of ornithosis in the Lithuanian SSR

As a result of immunological examination of 658 domestic ducks of 6 poultry farms and 269 doves caught in Vilnius, antiornithosis antibodies were revealed in 3.1 +/- 0.7% of ducks and in 36.4 +/- 2.9% of doves. They were also found in 20 of 34 wild waterfowl. The causative agent of ornithosis was isolated in virological examination of the organs of a coot. Ornithosis nature of an epizootic outbreak among ducks of a poultry farm was proved by virological examination. The population was examined immunologically (2285 persons) and by intradermal test with the ornithosis antigen (80 persons). Positive specific reactions were revealed in 32.6% of persons engaged in poultry tending, and in 7.6% of other rural population. A case of ornithosis in man engaged in fowling (of doves) for their examination is described.     

Natural foci of ornithosis in Kazakhstan]

An investigation (clinical, immunological and epidemiological) of the workers of various fowl-farms was carried out in various regions of Kazakhstan for a number for years; the sera of domestic fowl and birds was studied as well. On the basis of examination of 6264 persons the greatest percentage of ornithosis was revealed among the workers of the slaughter house and the shop for the processing of the fowl. Examination of 4749 sera of bird blood showed that the highest incidence of ornithosis was among doves and ducks (43.2 and 11.6%), and the least--in chickens (5.3%); there proved to be a direct relationship between the infection of man and birds. Thus, it was shown that domestic fowl and also doves served as the source of ornithosis infection; foci of ornithosis were revealed in a number of Kazakhstan regions as a result of these investigations.     

An outbreak of ornithosis at a textile factory

For the first time an outbreak of ornithosis at a textile factory is described. The data on the specific epidemiological features of the outbreak, the specific clinical features of the disease, the results of catamnestic observations and the study of the titers of specific antibodies in the complement fixation test are presented.     

Alveolar macrophage response to experimentally induced ornithosis.

Effects of two strains of the agent of ornithosis upon alveolar macrophages of mice were compared. Macrophages were obtained by lavages of the lower respiratory tract. Experimental mice were intranasally infected with 100 LD50 of strain P 89 and strain Stanglová, respectively. Up to the culmination of the disease (from 6th to 8th day in P 89 and from 5th to 8th day in Stanglová), the number of harvested macrophages increased. The phagocytic index soon reached values around 40% (P 89) and 25% (Stanglová). Basophilic and eosinophilic macrophages increased in volume and their nuclear as well as plasma membranes became disrupted. A tendency of alveolar macrophages to fuse and form syncytial elements and sporadically, rosets, was observed. All cells in the lavage went through the same changes. Histological examination has shown initial changes in epithelial cells of bronchi and development of pneumonia after fusion of peribronchial leucocytic infiltrates. By employing the above described technique, no great changes in the quality of the effects of either strain P 89 or Stanglová were found. A slight difference was observed only in the degree of alveolar macrophage stimulation and in the onset of symptoms.