RT Book, Section
A1 Mandal, Kaushik
A2 Yuh, David D.
A2 Vricella, Luca A.
A2 Yang, Stephen C.
A2 Doty, John R.
SR Print(0)
ID 1104584575
T1 Thoracic Infections
T2 Johns Hopkins Textbook of Cardiothoracic Surgery
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-166350-2
LK accesssurgery.mhmedical.com/content.aspx?aid=1104584575
RD 2024/04/23
AB The  etiology  and  clinical  manifestations  of  pneumonia  depend  on  the  environment  where  the  disease  is  acquired  and  the  host  characteristics.Treatment  of  pneumonia  is  based  on  an  assessment  of  place  of  therapy  (outpatient,  hospital  ward,  or  ICU),  the  presence  of  coexisting  cardiopulmonary  diseases,  and  the  presence  of  modifying  factors.Although  prompt  initiation  of  antibiotics  is  critical  in  patients  with  nosocomial  pneumonia,  all  patients  with  suspected  pneumonia  should  have  a  sampling  done  of  lower  respiratory  tract  secretions  to  better  guide  the  therapy.Lung  abscess  should  be  managed  initially  with  appropriate  medical  therapy  and/or  percutaneous  drainage.Owing  to  the  presence  of  branching  hyphae,  infections  due  to  actinomycosis  and  nocardiosis  may  be  mistaken  for  fungal  infections.  It  is  important  to  make  the  distinction  because  actinomycotic  infections  do  not  respond  to  antifungal  therapy  but  rather  to  antibiotics.Surgical  consultation  is  regularly  requested  for  the  diagnosis  and  treatment  of  pulmonary  complications  of  the  endemic  mycoses:  Histoplasma  capsulatum,  Blastomyces  dermatitidis  and  Coccidioidomycosis  immitis,  and  the  yeast  Cryptococcus  neoformans.  All  resemble  pulmonary  malignancies.Histoplasmosis  causes  pericarditis,  mediastinal  fibrosis,  and  mediastinal  granuloma,  which  can  cause  entrapment  of  vascular  structures,  the  esophagus,  and  the  trachea.Coccidioidomycosis  can  cause  both  spontaneous  pneumothorax  associated  with  effusion  and  thin-walled  cavities  that  can  become  superinfected  with  tuberculosis  and  aspergillosis.Cryptococcosis  can  result  in  organ  damage  from  tissue  distortion  secondary  to  an  expanding  fungal  burden.Most  patients  with  pulmonary  aspergillosis  have  either  impaired  immunity  or  underlying  preexisting  chronic  lung  disease.  Aspergillomas  may  develop  in  preexisting  cavities.  Surgery  is  indicated  for  complications  of  the  disease,  such  as  massive  hemoptysis.Surgery  has  largely  been  supplanted  by  multiple-regimen  medical  therapy  for  tuberculous  and  nontuberculous  mycobacterial  infections.  There  is  still  a  role  for  pulmonary  resection  in  multidrug-resistant  infection,  cavitary  lesions,  and  lung  destruction.