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
B. influenzæ was found in the sputum coughed from the deeper air
passages in the majority of cases, being present in 80, or 76.2 per
cent, of the 105 cases. In the 58 cases of lobar pneumonia it was found
41 times, or 70.7 per cent, in the 47 cases of bronchopneumonia 39
times, or 82.9 per cent. The abundance of B. influenzæ in the sputum
varied greatly in different cases. Microscopic examination of stained
sputum films and direct culture of the sputum on blood agar plates
showed that in general it was more abundant in the mucopurulent sputum
from cases of bronchopneumonia than in the mucoid rusty sputum from
cases of lobar pneumonia. This was by no means an invariable rule,
however, since in the former the bacilli were sometimes very few in
number, in the latter quite abundant. Whether B. influenzæ shared in the
production of the actual pneumonia in these cases is difficult to decide
and cannot be stated on the basis of the bacteriologic and clinical
observations which have been made.
=Clinical Features.=—One of the most striking aspects of pneumococcus
pneumonia following influenza was the diversity of clinical pictures
presented. These varied all the way from the classical picture of lobar
pneumonia to that of bronchopneumonia of all grades of severity from the
rapidly fatal coalescing type to that of very mild character with very
slight signs of consolidation. For this reason it is questioned whether
there is any real justification for speaking of a typical influenzal
pneumonia, an opinion that seems well supported by the diversified
picture found at the necropsy table.
For purposes of presentation, pneumococcus pneumonia following influenza
may be divided into three clinical groups: (1) Lobar pneumonia; (2)
lobar pneumonia with purulent bronchitis; (3) bronchopneumonia. No
accurate data are available as to the relative frequency with which
these three types occurred at Camp Pike. In the group of 105 cases
studied there were 58 cases of lobar pneumonia, 11 of which had purulent
bronchitis, and 47 cases of bronchopneumonia. The majority of these
cases, however, occurred during the early days of the epidemic of
influenza and probably show a considerably higher proportion of lobar
pneumonias than actually occurred in the total number of pneumonias
throughout the epidemic. This is indicated by the fact that of 100
consecutive cases of influenza selected for observation at the height of
the epidemic, 3 developed clinical evidence of lobar pneumonia and 12 of
bronchopneumonia.
(1) Lobar pneumonia presenting the typical clinical picture with sudden
onset, tenacious rusty sputum, sustained temperature, and physical signs
of complete consolidation of one or more lobes occurred in 47 cases; 36
cases in this group definitely followed influenza. In 11 cases no
certain clinical evidence of a preceding influenza was obtained, and it
is probable that some of these represent cases of pneumonia occurring
independently of the epidemic of influenza.
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