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
Purulent bronchitis of varying extent developed in approximately 35 per
cent of the cases and often prolonged the course of the illness to a
considerable extent. Bacteriologic studies showed that it was invariably
associated with a mixed infection of the bronchi with B. influenzæ and
other bacteria, in most instances the pneumococcus, and indicated that
it should be regarded as a complication rather than as an essential part
of influenza. Its clinical features consisted of a mild febrile
reaction, frequent cough with the raising of considerable amounts of
purulent sputum, and the physical signs of a more or less diffuse
bronchitis. It led to a varying degree of bronchiectasis in at least
some instances.
Pneumonia complicating influenza presented a very diversified picture
and appeared to have only one constant character, namely, that influenza
was the predisposing cause. It may be best classified on an etiologic
basis since the clinical features to some extent and the pathology to a
much greater extent depended upon the infecting bacteria in a given
case.
Bacteriologic examination showed that a very large proportion of the
cases was due to infection with the different immunologic types of
pneumococci or to a mixed infection with B. influenzæ and pneumococci.
The types of pneumococci commonly found in normal mouths, namely, II
atypical, III, and IV, comprised approximately 88 per cent of these, the
highly parasitic Pneumococci Types I and II, but 12 per cent. A small
number of cases were due to hemolytic streptococci or to mixed infection
with B. influenzæ and S. hemolyticus. No certain evidence was obtained
that pneumonia was due to B. influenzæ alone. This organism was present
in varying numbers, however, in approximately 80 per cent of the sputums
examined, and it seems fairly certain that it must have played at least
a part in the development of the pneumonia in many of the cases in which
it was found. Superimposed infections with other types of pneumococci
than those primarily responsible for the development of pneumonia, with
hemolytic streptococci and with Staphylococcus aureus occurred
frequently in cases of pneumococcus or mixed pneumococcus and B.
influenzæ pneumonia and undoubtedly contributed to a considerable extent
in increasing the number of deaths.
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