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
Three clinical types of pneumococcus pneumonia following influenza
occurred: lobar pneumonia, lobar pneumonia with purulent bronchitis, and
bronchopneumonia. Lobar pneumonia was usually sudden in onset and ran
the characteristic course of the primary disease. Lobar pneumonia with
purulent bronchitis similarly ran the characteristic course of the
primary disease but presented the unusual picture of lobar pneumonia
with mucopurulent rather than rusty, tenacious sputum and numerous moist
râles throughout the unconsolidated portions of the lungs. The cases of
bronchopneumonia ran a very variable course from mild cases of a few
days’ duration and meager signs of consolidation to rapidly progressive
cases with signs of extensive pulmonary involvement. Purulent bronchitis
was very frequently associated with bronchopneumonia.
Hemolytic streptococcus pneumonia following influenza presented the
clinical picture of bronchopneumonia and was not readily distinguished
on clinical grounds from pneumococcus bronchopneumonia except in those
cases which developed a pleural exudate early in the disease. The advent
of tertiary infection of the lower respiratory tract with hemolytic
streptococci in cases of secondary pneumococcus pneumonia presented no
symptoms sufficiently constant or certain to make clinical diagnosis
easy. The development of empyema in pneumococcus bronchopneumonia
usually meant streptococcus infection.
Pure B. influenzæ pneumonia, if such cases existed, presented no
diagnostic features by which it could be distinguished from pneumococcus
bronchopneumonia following influenza. It was impossible to determine on
clinical and bacteriologic grounds alone what part the prevalent
influenza bacilli played in the causation of the actual pneumonia.
Discussion
That wide variations in the conception of influenza have arisen during
the recent pandemic, even a hasty review of the literature makes clear.
In its essence this divergence of opinion seems to depend upon whether
pneumonia is considered an essential part of influenza or a complication
due either to the primary cause of influenza or to secondary infection.
One extreme is expressed by Dunn[30] who says “the so-called
complication is the disease,” the other by Fantus[31] who finds
influenza a relatively mild disease with pneumonia a relatively
infrequent and largely preventable complication.
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