Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measlesOpie, Eugene L. (Eugene Lindsay)
History
Epidemic Respiratory Disease: The pneumonias and other infections of the repiratory tract accompanying influenza and measles
In a small group of cases abscesses in the lungs have had characters
which serve to distinguish them from the abscesses previously described.
Small, sharply circumscribed yellow nodules, which in their centers have
undergone suppurative softening, form a cluster upon a red, airless
background (Figs. 15 and 16). One or more of these groups several
centimeters across, occur in the lungs. It is usually evident that the
abscesses are clustered about a medium-sized bronchus, but occasionally
with increase in the size of the small cavities the lung tissue assumes
a honey-combed appearance.
These clustered abscesses occur in association with bronchopneumonia and
have been in all instances associated with purulent bronchitis. The
mucosa of the small bronchi may be destroyed so that the surface is
eroded. These small clustered abscesses are seen as conspicuous yellow
spots immediately below the pleura, but there has been no associated
empyema. In 2 instances these abscesses were accompanied by fibrinous
pleurisy, but in the remaining autopsies the pleura has been normal. The
infrequency of empyema is in contrast with its almost invariable
presence when a streptococcus abscess is found below the pleura.
=Autopsy 280.=—Onset of illness with malaise, headache, cough and
fever was on September 24, eight days before death. At autopsy there
were hemorrhagic peribronchiolar and lobular bronchopneumonia,
clustered foci of suppuration in right lung, purulent bronchitis and
fibrinous pleurisy. Hemolytic streptococci were obtained from the
consolidated lung and from a bronchus. A culture from the right lung
was contaminated. In the bronchus were found B. influenzæ and a few
staphylococci. Microscopic examination of the abscesses shows that
they contain Gram-staining cocci grouped into staphylococcus-like
colonies.
=Autopsy 286.=—Duration of illness, which began September 25 with
symptoms of influenza, was nine days. At autopsy there were lobular
and confluent patches of bronchopneumonia, clustered abscesses in
the right lung below the pleura, purulent bronchitis, and
serofibrinous pleurisy localized in the neighborhood of the
abscesses. Pneumococcus IV was obtained from the blood of the heart,
and Pneumococcus IV, staphylococci and B. influenzæ from the right
main bronchus; growth failed to occur on plates from right and left
lungs. Microscopic examination shows the presence of clumps of cocci
with staphylococcus grouping in the centers of the small abscesses.
Section through one abscess shows its continuity with the wall of a
bronchus; along one side of the abscess is epithelium composed of
flattened epithelial cells in multiple layers continuous with that
of the bronchus; the remainder of the abscess wall is formed by
disintegrated lung tissue.
[Illustration:
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