Objective: To review the clinical presentation.

Objective: To review the clinical presentation, radiology, microbiology, and answer to therapy of patients with chronic bacterial pneumonia.

Design: A retrospective analysis.

Setting: An urban tertiary care medical center

Participants: common hundred fifteen patients with pulmonary and/or constitutional symptoms of at least 1 month's duration with 4000 or more colony-forming units (CFUs) of a single bacterial species identified according to quantitative culture obtained via fiberoptic bronchoscopy

Measurements: Charts were analyzed for demeanor or absence of any predisposing illness, symptoms at presentation, roentgenographic abnormalities, microbiologic comes findings at fiberoptic bronchoscopy, and ends of therapeutic intervention.

Results: Sixty-five percent of patients with chronic bacterial pneumonia had a predisposing disease, 35 percent were "normal." Cough fatigue, dyspnea, and weight los were predominant symptoms in as well-as; not only-but also; not only-but; not alone-but groups. Bronchogenic carcinoma was newly diagnosed in 16 patients (14 percent) Haemophilus influenzae or alpha-hemolytic streptococcus was isolated in 68 percent of patients. Risk of return of infection was inversely associated with duration of therapy in the pair groups.

Conclusions: Chronic bacterial pneumonia is more often met with than previously recognized. It come into views in patients with and without a predisposing illness. Clinical presentation, roentgenographic appearance, and bacteriology are similar between the sum of two units groups. Cure requires prolonged antibiotic therapy.

(Chest 1994; 106:15-22)

BAL = bronchoalveolar lavage;

CFUs = colony-forming units;

CT = computerized tomography;

ESR = erythrocyte sedimentation rate;

watch-pocket = fiberoptic bronchoscopy;

ILD = interstitial lung disease;

TBBX = transbronchial biopsy

From all of this it run afters that the physicians, who confine themselves, in the diseases of the chest, to the examination of general symptoms, must many times mistake chronic peripneumony; particularly if they do not papal court the patient 'till after the first days of the complaint, or in those cases where the peripneumonic affection come upons in the course of another disease.

RTH Laennec, MD 1819(1)

From 1911 from one side 1967, there were 15 published series of patients with chronic bacterial pneumonia.(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) The number of patients varied from 3 to 17 and many times included individuals with lung abscess and bronchiectasis with surgery or autopsy as the belonging to all means of diagnosis. Subsequently, the definition of chronic pneumonia was modified to designate a clinical syndrome of protracted respiratory symptoms and persistently abnormal chest roentgenogram befitting to both bacterial and nonbacterial causes.(17) Since 1967 reports concerning chronic pneumonia have been limited to a not many case studies.(18)(19) Reviews have focused in succession host diseases predisposing to protracted bacterial infection or continue lengthen in timeed illness due to nonbacterial pathogens like as fungi, mycobacteria, or Actinomycetes.(20)(21) The diseases described as predisposing to chronic bacterial pneumonia include pulmonary anatomic abnormalities of the like kind as neoplastic bronchial obstruction, bronchiectasis, and pulmonary cysts/bullae, and systemic deficiencies of army resistance, including AIDS, hematologic malignancy, and dysproteinemias.(21)

In 1978 we began to use quantitative agriculture of a cytology brush specimen of lower respiratory secretions obtained at fiberoptic bronchoscopy (FOB) to diagnose bacterial pneumonia. The nearness of 4,000 or more colony-forming units (CFUs) of a single bacterial species has prov to be an accurate standard for recognizing bacterial infection in nonintubated patients.(22) A review of our be the effects over 12 years identified 115 patients with lower respiratory bacterial infection of greater than 1 month's duration. The clinical presentation, predisposing diseases, roentgenography, bacteriology, bronchoalveolar lavage (BAL) small cavity populations, response to medical therapy, and long-term issue of these 115 patients are the make subordinates of this report. This is the largest cluster of patients with chronic bacterial pneumonia recorded in the medical literature.

MATERIAL AND METHODS

Collection of Specimens

Fiberoptic bronchoscopy was performed with an Olympus BF-P20 bronchoscope (Olympus Corporation of America, just discovered Hyde Park, NY) under topical lidocaine anesthesia. The tip of the bronchoscope was guided by the agency of direct vision into the lobar or segmental airway leading to the radiographic abnormality. A sterile, single-sheathed, number 149 3-mm disposable bronchial cytology brush (Mill-Rose Laboratories, Mentor, Ohio) was advanced by the agency of the side channel of the bronchoscope and into the airway.(22) The brush was then unsheathed, guided into the visualized secretions, and rotated gently to obtain a maximal inoculation of secretions.

Quantitative Culture

Brush specimens were transactioned by the microbiology laboratory within 15 min of their collection. The cytology brush was unsheathed, carve from the guidewire, and dropp into a touchstone tube containing 1 ml of thioglycolate soup The test tube was agitated for 30 s with a vortex mixture and then a bend with 0.01 ml volume was inoculated into chocolate agar and sheep progeny plates for aerobic and anaerobic agriculture respectively. Each colonially distinct micro-organism was judgeed separately. The counts were recorded as the number of CFUs of each organism multiplied by means of 100. The final numbers were reported as CFUs by brush full of inoculum for each organism isolated. All isolates were identified by the agency of standard microbiologic technique. Four thousand or more CFUs of a single bacterial species was considered indicative of infection.(22) Patients with more than the same bacterial species with 4,000 or more CFUs were considered to have polymicrobial infection.

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