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Bacterial haemophilus pneumonia complicated by chicken pox
92
Tubercle and Lung Disease: Supplement
total dosage - 10.0 g. Patients were between 15 and 65 years of age. At 4-5 days after the surnamed administration the reduction of phlegm discharge, cough and shortness of breath, disappearance of intoxication signs as well as pain syndrom were recorded. Recovering period when taking erythromicinum passed longer, the improving after the treatment was recorded at 8-10 days. On the background of treatment course every 5 days in 30% of patients taking surnamed the total resolving of inflammatory infiltration was reached roentgenologically, in 60% the partial resolving was fixed and only in 10 % of patients - roentgenological dynamics was not recorded. Positive dynamics in group of patients taking an erythromicinum was recorded not earlier than every 8-10 days, Immunocorrective action of surnamed was established, namely: the normalization of number and functional properties of T-cells, their subpopulation composition, as well as the functional activity of phagocytic cells. We did not noted the reliable normalization of immunological reactivity in group of patients taking erythromicinum. This study provides evidence of a beneficial effect of 5-days surnamed course compared with lo-days course of erythromicinum in treatment of patients with acute pneumonia.
338 LACTOFERRIN IN BRONCHIECTASIS CHILDREN Orlova, O., Nemizova, E.; Institute of Pediatrics, Russian AMS, Lomonosovsky pr. 2162, 117296 Moscow, Russia
Humoral factors of nonspecific host defence are considered to play an important role in resistance to infection especially in children. In attempt to clarify clinical significance of host nonspecific defence factors lactoferrin (LF) level was measured by ELISA in plasma and by radial immunodifusion both in bronchoalveolar lavage fluid (BAL) and saliva in 86 bronchiectasis children aged 2-15 including conjenital malformations (27) as well as primary humoral immunodeficiency (9). The control group consisted of 15 healthy children of the same age. We’ve found significant increase of LF production in bronchial secretions at the time of exacerbation especially in purulent bronchitis. No difference was seen in LF concentration in saliva in bronchiectasis children and in controls. The data show nonspecific local immunity activation in the inflamation focus during exacerbation. No significant correlation was found between LF level in plasma and BAL. In children with moderate lung exacerbation LF level in plasma was increased, while in severe course of desease it was even decreased in comparison with controls. These findings approve of activation of non-specific host defence factors in children with chronic lung suppurations in response to exacerbation.
339 BACTERIAL HAEMOPHILUS PNEUMONIA COMPLICATED CHICKEN POX
BY
Haeffner, A., Dockter, G., Sitzmann, F. C.; Universitiitsklinik fiir Kinder- und Jugendmedizin, D-66421 Homburg
Since effective antimicrobial agents are available for erradication of most microorganism and infants are vaccibacterial infections, nated against haemophilus pneumonia became rare in children. We report a 2 years 10 months old boy, known in our hospital for valproate treated seizures, admitted with
segmental pneumonia caused by Haemophilus influenzae B. First of all he recovered rapidly under i. v. cefotaxim. At day 5 deterioration with sepsis like symptoms as fever, CRP > 100, consumptive coagulopathy, haemorrhagic pleuritis, pericarditis and ascites. For conservatice treatment including polychemotherapy (imipenem, netilmicin, erythromcycin), heparinisation and pleural punctures were ineffective, explorative thoracotomy (diffuse haemorrhagic pleuritis!, no iatrogenic lesions) was performed and thoracic drainages were placed for 4 days, then removed. At day 10 the boy developed varicella. Additional i. v. aciclovir. In the following days developement of a great abcess in the apical segment of the right lower lobe. Only by chemotherapy for one more month the abcess became smaller, the boy recovered well and left hospital with normal pulmonary function. The course is recorded by X-ray and CT-series. The boy got an incomplete HIB-vaccination (2~) at 19 months. We discussed an impaired immune response. A primary immune deficiency was excluded, a secondary due to the chicken pox and imcomplete vaccination might be possible.
340 DIAGNOSTIC
VALUE OF ENDOTOXIN LEVELS IN TRACHEAL ASPIRATES OF MECHANICALLY-VENTILATED PATIENTS IN A PROSPECTIVE STUDY
Rickerts, V., Linde, H.-J., Shah, P. M.; Zentrum der lnneren Medizin, Infektiologie, Universitiitsklinikum, Theodor-Stern-Kai 7, D-60590 Frankfurt
Ventilator-associated pneumonia is still a diagnosis very difficult to make requiring combined diagnostic efforts. Assessment of endotoxin levels in bronchoalveolar lavage (BAL) has been of use in early diagnosis of Gramnegative bacterial pneumonia but requires bronchoscopy. We prospectively monitor endotoxin levels in blind tracheal aspirates of mechanically-ventilated patients in an ICU (Internal Medicine) for the time of ventilation using a limulus assay. The results are compared to the clinical status of the patient and to the results of chest-X-ray, bronchoscopy, or post-mortem, if available. Preliminary results derived from 12 patients (data of more patients will be presented) are: endotoxin values ranged from 30 Units/ ml to 928,000 Units/ml and correlated well with the number of Gram-negative bacilli recovered by routine bacteriological methods. 7 patients had no signs of Gramnegative bacterial pneumonia (1 x pneumococci isolated, IX candida [BALI, IX virus [open lung biopsy], IX shocklung [post-mortem], 3 x no signs of pneumonia [ 1 x post-mortem, lx BAL sterile]). All endotoxin levels recorded in these patients never exceded 30,000 Units/ml. In 3 cases pneumonia was suspected with levels of endotoxin moderately elevated to 70,000 Units/ml. In 2 cases pneumonia was proven (1 x BAL, 1 x post-mortem) and values of 604,000 Units/ml and 928,000 Units/ml were found, declining after therapy. We also noted modest elevation of endotoxin preceding detection of Gramnegative bacilli in culture by 1 day in 2 cases. These preliminary data suggest that a cut-off value for endotoxin levels in tracheal aspirates indicative for Gram-negative pneumonia can be defined. This would offer a rapid (< 3 h) non-invasive tool in diagnosis of Gram-negative bacterial pneumonia.
Tubercle and Lung Disease: Supplement
total dosage - 10.0 g. Patients were between 15 and 65 years of age. At 4-5 days after the surnamed administration the reduction of phlegm discharge, cough and shortness of breath, disappearance of intoxication signs as well as pain syndrom were recorded. Recovering period when taking erythromicinum passed longer, the improving after the treatment was recorded at 8-10 days. On the background of treatment course every 5 days in 30% of patients taking surnamed the total resolving of inflammatory infiltration was reached roentgenologically, in 60% the partial resolving was fixed and only in 10 % of patients - roentgenological dynamics was not recorded. Positive dynamics in group of patients taking an erythromicinum was recorded not earlier than every 8-10 days, Immunocorrective action of surnamed was established, namely: the normalization of number and functional properties of T-cells, their subpopulation composition, as well as the functional activity of phagocytic cells. We did not noted the reliable normalization of immunological reactivity in group of patients taking erythromicinum. This study provides evidence of a beneficial effect of 5-days surnamed course compared with lo-days course of erythromicinum in treatment of patients with acute pneumonia.
338 LACTOFERRIN IN BRONCHIECTASIS CHILDREN Orlova, O., Nemizova, E.; Institute of Pediatrics, Russian AMS, Lomonosovsky pr. 2162, 117296 Moscow, Russia
Humoral factors of nonspecific host defence are considered to play an important role in resistance to infection especially in children. In attempt to clarify clinical significance of host nonspecific defence factors lactoferrin (LF) level was measured by ELISA in plasma and by radial immunodifusion both in bronchoalveolar lavage fluid (BAL) and saliva in 86 bronchiectasis children aged 2-15 including conjenital malformations (27) as well as primary humoral immunodeficiency (9). The control group consisted of 15 healthy children of the same age. We’ve found significant increase of LF production in bronchial secretions at the time of exacerbation especially in purulent bronchitis. No difference was seen in LF concentration in saliva in bronchiectasis children and in controls. The data show nonspecific local immunity activation in the inflamation focus during exacerbation. No significant correlation was found between LF level in plasma and BAL. In children with moderate lung exacerbation LF level in plasma was increased, while in severe course of desease it was even decreased in comparison with controls. These findings approve of activation of non-specific host defence factors in children with chronic lung suppurations in response to exacerbation.
339 BACTERIAL HAEMOPHILUS PNEUMONIA COMPLICATED CHICKEN POX
BY
Haeffner, A., Dockter, G., Sitzmann, F. C.; Universitiitsklinik fiir Kinder- und Jugendmedizin, D-66421 Homburg
Since effective antimicrobial agents are available for erradication of most microorganism and infants are vaccibacterial infections, nated against haemophilus pneumonia became rare in children. We report a 2 years 10 months old boy, known in our hospital for valproate treated seizures, admitted with
segmental pneumonia caused by Haemophilus influenzae B. First of all he recovered rapidly under i. v. cefotaxim. At day 5 deterioration with sepsis like symptoms as fever, CRP > 100, consumptive coagulopathy, haemorrhagic pleuritis, pericarditis and ascites. For conservatice treatment including polychemotherapy (imipenem, netilmicin, erythromcycin), heparinisation and pleural punctures were ineffective, explorative thoracotomy (diffuse haemorrhagic pleuritis!, no iatrogenic lesions) was performed and thoracic drainages were placed for 4 days, then removed. At day 10 the boy developed varicella. Additional i. v. aciclovir. In the following days developement of a great abcess in the apical segment of the right lower lobe. Only by chemotherapy for one more month the abcess became smaller, the boy recovered well and left hospital with normal pulmonary function. The course is recorded by X-ray and CT-series. The boy got an incomplete HIB-vaccination (2~) at 19 months. We discussed an impaired immune response. A primary immune deficiency was excluded, a secondary due to the chicken pox and imcomplete vaccination might be possible.
340 DIAGNOSTIC
VALUE OF ENDOTOXIN LEVELS IN TRACHEAL ASPIRATES OF MECHANICALLY-VENTILATED PATIENTS IN A PROSPECTIVE STUDY
Rickerts, V., Linde, H.-J., Shah, P. M.; Zentrum der lnneren Medizin, Infektiologie, Universitiitsklinikum, Theodor-Stern-Kai 7, D-60590 Frankfurt
Ventilator-associated pneumonia is still a diagnosis very difficult to make requiring combined diagnostic efforts. Assessment of endotoxin levels in bronchoalveolar lavage (BAL) has been of use in early diagnosis of Gramnegative bacterial pneumonia but requires bronchoscopy. We prospectively monitor endotoxin levels in blind tracheal aspirates of mechanically-ventilated patients in an ICU (Internal Medicine) for the time of ventilation using a limulus assay. The results are compared to the clinical status of the patient and to the results of chest-X-ray, bronchoscopy, or post-mortem, if available. Preliminary results derived from 12 patients (data of more patients will be presented) are: endotoxin values ranged from 30 Units/ ml to 928,000 Units/ml and correlated well with the number of Gram-negative bacilli recovered by routine bacteriological methods. 7 patients had no signs of Gramnegative bacterial pneumonia (1 x pneumococci isolated, IX candida [BALI, IX virus [open lung biopsy], IX shocklung [post-mortem], 3 x no signs of pneumonia [ 1 x post-mortem, lx BAL sterile]). All endotoxin levels recorded in these patients never exceded 30,000 Units/ml. In 3 cases pneumonia was suspected with levels of endotoxin moderately elevated to 70,000 Units/ml. In 2 cases pneumonia was proven (1 x BAL, 1 x post-mortem) and values of 604,000 Units/ml and 928,000 Units/ml were found, declining after therapy. We also noted modest elevation of endotoxin preceding detection of Gramnegative bacilli in culture by 1 day in 2 cases. These preliminary data suggest that a cut-off value for endotoxin levels in tracheal aspirates indicative for Gram-negative pneumonia can be defined. This would offer a rapid (< 3 h) non-invasive tool in diagnosis of Gram-negative bacterial pneumonia.