scholarly journals Ultrasound Clues in Lobar Pneumonia

CHEST Journal ◽  
2022 ◽  
Vol 161 (1) ◽  
pp. e59-e62
Deirdre B. Fitzgerald ◽  
John D. Blakey ◽  
Pragnesh Joshi ◽  
Yi Jin Kuok ◽  
Y. C. Gary Lee ◽  
1928 ◽  
Vol 48 (1) ◽  
pp. 83-104 ◽  
Alvan L. Barach ◽  

1. The antigenic function of a pneumococcus vaccine made from the intact cell was compared with that derived fron a watery extract of the cell free from formed elements. In each instance, the immunity produced was dependent upon type-specific protective substance and not upon the elaboration of the common protein antibody. 2. The vaccine made from the intact cell resulted in both active and passive immunity which began on the 3rd day, increased markedly to the 5th, and remained approximately stationery to the 7th day. In the case of the Berkefeld filtrate of the shaken bacteria and the filtrate of the broth culture, the immunity began on the 4th day, increased to the 5th, and remained approximately stationery to the 7th day. The immunity produced by Pneumococcus Type I vaccine is greater than that produced by Type II. On the 3rd day, mice vaccinated with Type I vaccine resisted 100,000 minimal lethal doses, whereas mice immunized with Type II resisted 10,000 minimal lethal doses. On the 5th day, a larger percentage of mice survived these doses than on the 3rd day. 3. Certain factors related to the preparation and dosage of the vaccine are discussed. 4. As far as the time interval and the degree of immunity produced are concerned, these results suggest the possibility of employing pneumococcus vaccine in suitable doses in the treatment of lobar pneumonia. That an earlier activity of the immunity mechanism could actually be initiated in a patient with lobar pneumonia has still to be demonstrated.

The Lancet ◽  
1931 ◽  
Vol 217 (5604) ◽  
pp. 218
P.C. Brett

1937 ◽  
Vol 59 (3) ◽  
pp. 408

1915 ◽  
Vol 22 (6) ◽  
pp. 747-756 ◽  
Warren R. Sisson ◽  
I. Chandler Walker

The foregoing experiments show that in cats a definite lobar pneumonia may be caused by Bacillus mucosus capsulatus. Judging both from the clinical course and from the pathological findings, this form of pulmonary infection differs from the usual pneumococcus types of pneumonia and closely resembles the so called Friedländer's bacillus or Bacillus pneumoniœ in man. In all instances in which a lobar pneumonia was found after the injection of the bacillus, a similar organism was recovered from the lung, and in no case was this associated with other organisms. The course of the disease in cats is very short, the animals developing early symptoms of profound toxemia. In 87 per cent of the animals showing a lobar pneumonia positive blood cultures were obtained. The pathological findings, judging from the early stages of the disease, are subject to considerable variation. In some instances the process may suggest a pseudolobar or confluent lobular distribution. In these cases the lung has a mottled, marble-like appearance. In the majority of cases, however, the process gave a more homogeneous appearance, suggesting a diffuse and uniform distribution. Foci of hemorrhage were not uncommon in both. Such areas cause the mottled appearance sometimes found. In all instances the consolidated lung presents a greater infiltration of tissue than is usually seen in other types of experimental pneumonia. Although the exudate as seen on the cut surface may be abundant and especially viscid in character, this is not present in most cases. The cut surface of the consolidated lung does not present a granular appearance. The histological findings are also subject to considerable variation. In most instances the infundibular and alveolar spaces are completely filled with an exudate made up chiefly of polymorphonuclear cells. Associated with these are the capsulated bacilli, large vacuolated mononuclear phagocytic cells, and red blood cells, and occasionally small amounts of fibrin. The organisms may vary greatly in numbers. Some sections show spaces almost completely filled with bacilli. The contrast between spaces containing an exudate consisting chiefly of polymorphonuclear forms and an adjoining one filled with organisms is often striking (Fig. 4). The bacilli found are both intra- and extracellular. The large vacuolated cells are numerous in this type of pneumonia. They apparently are the first cells to become phagocytic. Often they are seen to contain as many as 10 to 15 capsulated bacilli, while polymorphonuclear cells in the same exudate contain no organisms. The histogenesis of these cells seems to be somewhat clearer from the study of these early stages of pneumonia. In many instances one sees swollen, partially desquamated epithelial cells along the alveolar wall. These closely resemble the large vacuolated forms. Various types of these vacuolated mononuclear cells were observed. These may well represent stages of development from the desquamating epithelial cell to the large vacuolated form. Although similar cells may arise elsewhere, we have been led to regard them in our studies as epithelial in origin (Fig. 5). The number of red blood cells and the amount of fibrin present in the exudate vary greatly. Small foci consisting of alveolar spaces filled with erythrocytes are not uncommon. The fibrin is very much less abundant than in most types of pneumonia. From the above experiments it is seen that a lobar pneumonia in cats can be produced at least by two methods, either by intrabronchial insufflation of the organism or by direct injection into the veins, provided that in the latter case an irritant is introduced into the lungs. In each case there is little doubt but that a local injury of the lung parenchyma was produced. Without this injury (that is, by intravenous injection of the organism alone), no pulmonary lesion was obtained. Further studies with both these methods must be undertaken to ascertain more exactly the sequence of the pathological process. It seems probable that they are identical in each case. The results obtained from the second method employed to produce a lobar pneumonia offer suggestive evidence in support of a hematogenous causation of this disease in at least certain instances. It is not proposed to discuss the aerogenous versus hernatogenous theories at this time. Kidd5 has recently reviewed the subject and states that the aerogenous theory for the causation of pneumonia is most widely held. This view has gained credence especially since the work of Meltzer and Lamar. In spite of this, Kidd emphasizes the fact that based on our knowledge of pulmonary infections in man and upon theoretical grounds and upon certain experimental facts, the hernatogenous theory seems more plausible. No definite conclusions can be drawn from the last series of experiments. From this limited study it seems probable that lobar pneumonic processes are produced less easily after intravenous injection of various cocci and insufflation of irritating substances than by-similar treatment with Friedländer's bacillus.

1965 ◽  
Vol 4 (2) ◽  
pp. 117-122 ◽  
Edward H. Townsend ◽  
H. George Decancq

1920 ◽  
Vol 31 (5) ◽  
pp. 499-518 ◽  
Francis G. Blake ◽  
Russell L. Cecil

Spontaneous pneumonia occurred to a considerable extent among stock monkeys at the Army Medical School. This pneumonia occurred chiefly in the form of an epidemic outbreak shortly after the arrival of a large shipment of monkeys, and was shown to be due in large part to transmission of infection from monkey to monkey, either directly or indirectly. That spread of the epidemic was facilitated by overcrowding was indicated by the fact that in a subsequent shipment of monkeys, which were kept in pairs in separate cages and were not allowed to come into contact with the monkeys among which the epidemic occurred, no cases of spontaneous pneumonia developed. The close analogy between the epidemic of lobar pneumonia that occurred among the monkeys and similar epidemics of lobar pneumonia that occurred during the war among certain groups of newly drafted troops shortly after their arrival at camp is very striking, and would seem to indicate that pneumococcus pneumonia may become an epidemic disease among groups of susceptible individuals when they are assembled under conditions that facilitate the ready transfer of infection from individual to individual. Bacteriological examination showed the spontaneous pneumonia to be due in the great majority of cases to infection with Pneumococcus Type IV. Immunological classification of the strains of pneurnococci by cross-agglutination tests showed that the majority fell into two biological groups. Two cases were apparently caused by Streptococcus hæmolyticus, two by Streptococcus viridans. The clinical course of spontaneous pneumococcus pneumonia in monkeys was characterized by sudden onset, high sustained temperature, leucocytosis, rapid respiration with expiratory grunt, cough, physical signs of consolidation, invasion of the blood by pneurnococci, and termination in death or recovery by crisis about the 7th to 9th day. In a few instances the disease was complicated by acute fibrinopurulent pericarditis, by empyema, and by purulent meningitis. It was, therefore, clinically identical with lobar pneumonia experimentally produced in monkeys and with lobar pneumonia in man. Study of the pathology of spontaneous pneumococcus pneumonia in monkeys showed that it presented the characteristic picture of lobar pneumonia, both macroscopically and microscopically, and was in all respects comparable with the pathology of lobar pneumonia experimentally produced in monkeys and of lobar pneumonia in man.

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