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
There were 18 fatal cases in the group. Nine of these are summarized in
Table XVI as illustrative of the frequently complex character of
bronchopneumonia following influenza and because of the interest
attaching to the bacteriologic examinations made during life and at
necropsy. Case 70 is a typical instance of the rapidly progressive type
of confluent lobular pneumonia with extensive purulent bronchitis,
intense cyanosis, and appearance of suffocation, with which pneumococci,
in this case Pneumococcus IV, and B. influenzæ are commonly associated.
Case 59 is illustrative of the small group of bronchopneumonias
following influenza which die, often unexpectedly, after a long drawn
out course, in this instance three weeks after onset. Examination of the
sputum at the time the pneumonia began, showed Pneumococcus Type IV and
B. influenzæ. At necropsy there was a lobular pneumonia with clustered
small abscesses, probably due to a superimposed infection with S.
aureus. There was a well-developed bronchiectasis in the left lower
lobe. Cultures taken at autopsy showed a sterile heart’s blood, which is
not infrequently the case in cases of pneumococcus lobular pneumonia
after influenza. Cultures from the consolidated portions of the lung
showed no growth, the pneumococcus having disappeared as might be
expected from the duration of the case. B. influenzæ together with
staphylococci were found in the bronchi. In Cases 50 and 56 a second
attack of pneumonia caused by a different type of pneumococcus from that
responsible for the first attack occurred, the second attack in both
instances being due to contact infection with Pneumococcus Type II from
a patient in a neighboring bed suffering with Pneumococcus Type II
pneumonia. Both cases showed at necropsy the type of confluent lobular
pneumonia so commonly found in pneumococcus pneumonias following
influenza. Case 107 illustrates well the extent to which mixed
infections may occur, especially when cases are treated in crowded
hospital wards. The sputum at time of onset showed Pneumococcus IV in
abundance and a few staphylococci. At necropsy there was a confluent
lobular pneumonia with clustered abscesses, purulent bronchitis, and
bronchiectasis in the left lower lobe. The heart’s blood was sterile,
the lungs showed Pneumococcus Type III and staphylococci. B. influenzæ
was not found, but through oversight, no cultures were taken from the
bronchi. Cases 92, 99, 102, and 104 are all examples of superimposed
hemolytic streptococcus infection occurring in the presence of a
Pneumococcus Type IV pneumonia, with the picture of interstitial
suppuration, abscess formation, and empyema due to S. hemolyticus on the
background of a pneumococcus lobular pneumonia found at necropsy. All
showed abundant pneumococci and B. influenzæ in the sputum and were free
from hemolytic streptococci at time of onset of pneumonia, except Case
92 which showed 2 colonies of S. hemolyticus in the first sputum culture
made.
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