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
Comparison of Table LIV with the analogous figures for acute
bronchopneumonia shows little noteworthy difference. Pneumococci are
less frequently found in the lung (12.5 per cent) and in the blood (16.6
per cent) with chronic bronchopneumonia than with acute bronchopneumonia
(lung 43.9 per cent; blood, 40.3 per cent). Hemolytic streptococci and
staphylococci are not more frequently found with unresolved than with
acute bronchopneumonia and failure to resolve cannot be referred to
either or to both microorganisms, for bronchopneumonia not infrequently
remains unresolved in their absence. B. influenzæ is present in the
bronchi in at least 80 per cent of instances and perhaps in all; it is
usually combined both in the lungs and in the bronchi with one of the
pyogenic cocci.
The severity of the injury to the walls of bronchi resulting in
continued infection with a variety of bacteria, appears to be the factor
determining failure of resolution and the persistence of
bronchopneumonia.
=The Relation of Unresolved Bronchopneumonia to Interstitial Suppurative
Pneumonia Caused by Hemolytic Streptococci.=—Hemolytic streptococci have
been present in a considerable proportion of those who have had
unresolved bronchopneumonia and its occurrence in the bronchi, lung and
blood of the heart indicates that it has had an important part in
causing death. Unresolved bronchopneumonia, following measles,
designated by MacCallum “interstitial bronchopneumonia” in a series of
autopsies at Fort Sam Houston in the spring of 1918, was constantly
associated with hemolytic streptococci. Among the lesions described as
interstitial bronchopneumonia was at least one which was evidently what
we have designated interstitial suppurative pneumonia. Lymphangitis was
not infrequently found with “interstitial bronchopneumonia” following
measles. At Camp Lee and Camp Dix, following the epidemic of influenza,
MacCallum found “interstitial bronchopneumonia” with no hemolytic
streptococci and noted that lymphatics in the interstitial septa were
inconspicuous and that none was found distended with exudate; empyema
was not present.
We have shown that interstitial suppurative pneumonia is an acute lesion
caused by hemolytic streptococci. Unresolved bronchopneumonia is
accompanied by chronic pneumonia and has no necessary relation to this
microorganism.
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