Neumopatía por aspiración (sindrome aspirativo / Aspiration pneumonia (aspiration syndrome)

Aspiration pulmonary disease is the condition in which there is a passage of gastric or oral content to the airways; the extent of aspiration is conditioned by the amount and frequency with which it occurs. The diagnostic approach of this pathology begins with an adequate clinical history with special emphasis on pathologies that generate poor swallowing mechanics such as neurological diseases, esophageal atresia and patients with a history of gastroesophageal reflux. The studies used for the diagnosis of this syndrome are chest X-ray, swallowing mechanics evaluation with barium, Ph-metry, scintigraphy with Tc99 for gastroesophageal reflux, delayed pulmonary scanning, endoscopic study of the digestive tract and bronchoscopy in search of lesions in the respiratory mucosa and bronchial lavage to detect lipid-laden alveolar macrophages which have been linked to the presence of aspiration syndromes in several publications

La neumopatía por aspiración es la condición en la que existe un paso de contenido gástrico a la vía aérea. La magnitud de la aspiración depende de la cantidad y la frecuencia con la que se presenta. El abordaje diagnóstico de esta patología se inicia con una historia clínica adecuada con especial énfasis en patologías que generen una mala mecánica de deglución como pueden ser enfermedades neurológicas, atresia esofágica y pacientes con antecedentes de reflujo gastroesofágico. Los estudios que se requieren para el diagnóstico de esta enfermedad constan de radiografía de tórax, estudio de deglución, Ph-metria, gamagrama para reflujo, estudio endoscópico de vía digestiva y broncoscopia en búsqueda de lesiones en la mucosa respiratoria y realización de lavado bronquial para macrófagos alveolares cargados de lípidos

Study on the Correlation between Barium Radiography and Pulmonary Infection rate in the Evaluation of Swallowing Function

OBJECTIVES: To compare the results respectively obtained from the utilization of 60% barium sulfate suspension and Iohexol as contrast agents for videofluoroscopic swallowing studies and the relationship between the clinical application of the two kinds of contrast agents and the incidence of pneumonia. METHODS: Sixty cases of stroke patients with dysphagia were selected in rehabilitation department of our hospital, and the gender, age, position of the disease, and stroke nature between groups had no significant difference. Among which, 30 patients who were administered 350 mgI/ml Iohexol, and the other 30 patients with 60% barium sulfate suspension as contrast agent. We performed videofluoroscopic swallowing studies with barium 60% versus Iohexol within 1 week after admission and 2 weeks after admission. RESULTS: After 2 weeks in hospital, the aspiration pneumonia incidence of two groups was statistically significant (p<0.05), the pneumonia incidence of Iohexol group was lower than barium sulfate group which might have a impossble relevance with barium aspiration. CONCLUSIONS: During the videofluoroscopic swallowing study of dysphagia after stroke, barium sulfate can enhance the pneumonia incidence, and Iohexol can be widely applied in videofluoroscopic swallowing study.

Aspiration Pneumonia in Children with Cerebral Palsy after Videofluoroscopic Swallowing Study

Abstract Introduction Dysphagia is a common symptom in children with cerebral palsy, either in oral or pharyngeal phases. Children who face such difficulties tend to show health problems such as food aspiration, malnutrition and respiratory infections. Videofluoroscopic swallowing study is the most recommended for these cases, as it reveals the real situation during swallowing. Objective The study aimed to verify the occurrence of aspiration pneumonia in children with cerebral palsy after videofluoroscopy. Methods The population for this prospective cross-sectional study involved 103 children with cerebral palsy, referred for videofluoroscopic who had returned for medical examination after a week to search for signs and symptoms of pneumonia. Results The study involved 46 girls (44.66%) and 57 boys (55.34%), aged between 0 and 14 years of age. Of the total, 84 (81.5%) had dysphagia, of which 24 (23.3%) were severe, 8 (7.7%) were moderate and 52 (50.4%) were mild dysphagia. None of the children presented aspiration pneumonia or infectious complications during the course of videofluoroscopy or after the procedure. Conclusion In the population studied, the authors found no cases of aspiration pneumonia, even with tracheal aspiration present in 32 (31.07%) cases.

Program to Diagnose Probability of Aspiration Pneumonia in Patients with Ischemic Stroke

Introduction: Stroke is a major cause of death and disability worldwide, with a strong economic and social impact. Approximately 40% of patients show motor, language, and swallowing disorders after stroke. Objective: To evaluate the use of software to infer the probability of pneumonia in patients with ischemic stroke. Methods: Prospective and cross-sectional study conducted in a university hospital from March 2010 to August 2012. After confirmation of ischemic stroke by computed axial tomography, a clinical and flexible endoscopic evaluation of swallowing was performed within 72 hours of onset of symptoms. All patients received speech therapy poststroke, and the data were subsequently analyzed by the software. The patients were given medical treatment and speech therapy for 3 months. Results: The study examined 52 patients with a mean age of 62.05 ± 13.88 years, with 23 (44.2%) women. Of the 52 patients, only 3 (5.7%) had a probability of pneumonia between 80 and 100% as identified by the software. Of all patients, 32 (61.7%) had pneumonia probability between 0 and 19%, 5 (9.5%) between 20 and 49%, 3 (5.8%) between 50 and 79%, and 12 (23.0%) between 80 and 100%. Conclusion The computer program indicates the probability of patient having aspiration pneumonia after ischemic stroke...

Neumonía aspirativa en pacientes adultos mayores / Aspiration pneumonia in the elderly patients

En la neumonía aspirativa hay evidencia radiológica de infiltrado parenquimal pulmonar en diferentes segmentos, como consecuencia del paso de secreciones contaminadas por agentes patógenos que proceden de la región orofaríngea o gastroesofágica hacia el árbol traqueobronquial. Se presenta principalmente en adultos mayores y en pacientes con alteraciones neurodegenerativas. Los mecanismos implicados en la aspiración son: la disfagia orofaríngea funcional y las alteraciones gastroesofágicas. Los gérmenes implicados son Streptococcus pneumoniae, Haemophilus influenza y S. aureus cuando la neumonía aspirativa ocurre en la comunidad y bacilos gramnegativos si es de ocurrencia intrahospitalaria. Los anaerobios pocas veces son agentes responsables. La historia clínica, radiografía pulmonar y otros procedimientos como la videofluroscopia orofaríngea, resultan útiles para el diagnóstico. El tratamiento está basado en el uso de antibióticos principalmente contra gérmenes aeróbicos grampositivos y gramnegativos y, excepcionalmente, contra anaerobios en situaciones especiales; y, medidas para disminuir las condiciones que favorecen la broncoaspiración.

In aspiration pneumonia there is radiological evidence of an infiltrate in the pulmonary parenchyma, in different segments, as a result of the passage of secretions contaminated by pathogens that come from the region of oropharyngeal or gastroesophageal tube to the tracheobronchial tree. It occurs mainly in the elderly and in patients with neurodegenerative disorders. The involved mechanisms in the aspiration are: functional oropharyngeal dysphagia and gastroesophageal alterations. The involved germs are Streptococcus pneumoniae, Haemophilus influenza and Staphylococcus aureus when the aspiration pneumonia occurs in the community and gram-negative bacilli in hospital occurrence. Anaerobic bacteria are rarely responsible agents. The clinical history, pulmonary x-ray and other procedures such as oropharyngeal videofluoroscopy are useful for diagnosis. Treatment is mainly based on the use of antibiotics against gram-positive and gram-negative aerobic germs and, exceptionally, against anaerobes in special situations; and, measures to reduce the conditions that favor the aspiration into lungs.

First Korean Case of Robinsoniella peoriensis Bacteremia in a Patient with Aspiration Pneumonia

Robinsoniella peoriensis has recently been identified as a Gram-positive, spore-forming, anaerobic rod originally recovered from swine manure storage pits. To date, 6 cases of R. peoriensis infection have been reported, including 2 cases of bacteremia, 1 of abdominal fluid collection, and 3 of wound infection. In the present study, we report a 76-yr-old man with R. peoriensis bacteremia who developed aspiration pneumonia. Gram staining of a purified colony revealed Gram-positive, rod-shaped bacteria. Biochemical identification using API 20 A (bioMerieux, France) indicated presence of Clostridium spp. We performed both 500-bp and full-gene sequencing of 16S rRNA of the isolate. The sequence was analyzed with MicroSeq ID 16S rRNA Library v2.0 (Applied Biosystems, USA), GenBank Basic Local Alignment Search Tool (BLAST) (http://www.ncbi.nlm.nih.gov/genbank), and EzTaxon database v2.1 (http://www.eztaxon.org). The 500-bp 16S rRNA sequence of the blood culture isolate showed 99.16-99.79% similarity with R. peoriensis and the full-gene 16S rRNA sequence showed 98.87-99.50% similarity with R. peoriensis. The organism was confirmed as R. peoriensis by using all of the mentioned databases except for MicroSeq, which did not include the RNA sequence of this bacterium. This case suggests that identification of R. peoriensis might be challenging in clinical laboratories with no access to molecular methods, as certain commercial identification systems may not identify, or may misidentify, this organism. To the best of our knowledge, this is the first report of the isolation of R. peoriensis in Korea.

Pneumonia lipoídica em adulto / Lipoid pneumonia in adult

A pneumonia lipoídica é uma condição pulmonar incomum que,freqüentemente, se apresenta com início insidioso.Essa doença tem duas formas clínicas: endógena e exógena.A causa mais comum de pneumonia lipoídica exógena é a aspiraçãocrônica de óleo mineral,usado como substância laxativa. O óleo mineral, relativamente inerte, é inicialmente emulsificado e ingerido por macrófagos.Com repetidas aspirações, o óleo mineral pode provocar uma reação de corpo estranho,que pode resultar em fibrose.Relatamos um caso de um homem, com história prévia de acidente vascular encefálico, que apresentava como seqüela alteração da deglutição, com engasgos frequentes, além de sequela motora à esquerda.O paciente tinha históriade ingestão crônica de laxantes contendo óleo mineral.A broncofibroscopia com biópsia transbrônquica confirmou odiagnóstico de pneumonia lipoídica pela histopatologia.

Pneumonia lipoídica em adultos: aspectos na tomografia computadorizada de alta resolução / Lipoid pneumonia in adults: findings on high-resolution computed tomography

OBJETIVO: Apresentar os aspectos na tomografia computadorizada de alta resolução do tórax da pneumonia lipoídica exógena por aspiração de óleo mineral, em pacientes adultos MATERIAIS E MÉTODOS: Foram estudados oito pacientes adultos - quatro mulheres e quatro homens - com média de idade de 69,4 anos, todos usuários de óleo mineral para tratamento de constipação intestinal. Os exames foram avaliados por dois radiologistas, de forma independente RESULTADOS: Os achados tomográficos mais comuns foram as consolidações com áreas de densidade de gordura de permeio, e o padrão de pavimentação em mosaico. As lesões foram bilaterais em seis pacientes, e unilaterais em dois CONCLUSÃO: O encontro de consolidações pulmonares com áreas de densidade de gordura de permeio, associado à história clínica do uso de óleo mineral, é diagnóstico de pneumonia lipoídica exógena.

OBJECTIVE: The present study was aimed at describing the findings on high-resolution computed tomography in patients with exogenous lipoid pneumonia secondary to mineral oil aspiration MATERIALS AND METHODS: Eight adult patients - four men and four women - with mean age of 69.4 years were studied. All of the patients were users of mineral oil for treating intestinal constipation. High-resolution computed tomography studies of these patients were blindly evaluated by two radiologists. RESULTS: Air-space consolidation with areas of fat density and crazy paving pattern were the most frequent findings. The lesions were bilateral in six cases and unilateral in two CONCLUSION: Air-space consolidation with areas of fat density, associated with a clinical history of mineral oil ingestion virtually indicates a diagnosis of exogenous lipoid pneumonia.

Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004 / Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004

OBJETIVO: Apresentar a experiência de um serviço especializado em doenças respiratórias no manejo de casos de abscesso pulmonar de aspiração. MÉTODOS: Descrevem-se aspectos diagnósticos e resultados terapêuticos de 252 casos consecutivos de pacientes com abscesso de pulmão, hospitalizados de 1968 a 2004. RESULTADOS: Dos 252 casos, 209 ocorreram em homens e 43 em mulheres, com média de idade de 41,4 anos. Eram alcoolistas 70,2 por cento dos pacientes. Tosse, expectoração, febre e comprometimento do estado geral ocorreram em mais de 97 por cento dos casos, 64 por cento tinham dor torácica, 30,2 por cento hipocratismo digital, 82,5 por cento apresentavam dentes em mau estado de conservação, 78,6 por cento tiveram episódio de perda de consciência e 67,5 por cento apresentavam odor fétido de secreções broncopulmonares. Em 85,3 por cento dos casos as lesões localizavam-se nos segmentos posterior de lobo superior ou superior de lobo inferior, 96,8 por cento delas unilateralmente. Em 24 pacientes houve associação de empiema pleural (9,5 por cento). Flora mista foi identificada em secreções broncopulmonares ou pleurais em 182 pacientes (72,2 por cento). Todos os doentes foram inicialmente tratados com antibióticos (principalmente penicilina ou clindamicina) e 98,4 por cento deles foram submetidos à drenagem postural. Procedimentos cirúrgicos foram efetuados em 52 (20,6 por cento) pacientes (24 drenagens de empiema, 22 ressecções pulmonares e 6 pneumostomias). Cura foi obtida em 242 pacientes (96,0 por cento) e 10 faleceram (4,0 por cento). CONCLUSÃO: O abscesso pulmonar de aspiração ocorreu predominantemente em indivíduos adultos masculinos com doença dentária e episódio antecedente de perda de consciência (especialmente por alcoolismo). A maioria dos pacientes foi tratada clinicamente (antibióticos e drenagem postural). Um quinto deles submeteu-se a algum procedimento cirúrgico.

Neumonía lipoidea exógena aguda, a propósito de un come fuego / Acute exogenous lipoid pneumonia

Se presenta el caso de un adulto de 19 años de edad, malabarista y manipulador de fuego quien ingresa al servicio de emergencias médicas del Hospital Dr. Rafael A. Calderón Guardia, por un cuadro súbito de dolor tóracico derecho y disnea. Se documenta derrame pleural en base pulmonar derecha y masa redondeada en base pulmonar izquierda. Inicia clínica sugestiva de bronconeumonía horas despúes, abordándosele inicialmente como neumonía adquiridad en la comunidad. Considerando sus antecedentes laborales y características clínicas, se reorienta caso y se concluye que se trata de lo que en la bibliografía médica en habla inglesa se denomina "fire-eater pneumonia", infrecuente neumonía por aspiración de la que se hace una revisión. Descriptores: neumonía lipoidea, neumonía por aspiración, neumonía en come fuego.

Síndrome de Mendelson: relato de caso / Mendelson syndrome: a case report

Paciente admitida com quadro de engasgo seguido de dispnéia, cianose e perda de consciência, recuperada após aspiração de vias aéreas. Evoluiu com agravamento do quadro clínico até início de tratamento de suporte, quando apresentou rápido restabelecimento. Radiografia de tórax do dia da internação demonstrou infiltrado difuso bilateral e à tomografia observou-se imagem em vidro fosco difuso. Objetiva-se demonstrar alterações tomográficas nesta síndrome.

Predicción clínica de aspiración en pacientes con patología neurológica aguda / Clinical prediction of aspiration in acute neurological patients

Glottic dysfunction is a frequent condition in patients with acute neurological diseases: the incidence in stroke patients is between 45 - 51 percent increasing mortality three times. The principal complication is aspiration, which demands the involvement of pulmonary physicians and neurologists. The purpose of this study is to evaluate wet voice, water swallow test and cervical auscultation as clinical predictors of aspiration using endoscopical observation as a gold standard. During a period of one year we have prospectively evaluated these tests in acute neurological patients hospitalized in an intensive care unit. Wet voice, 3 oz water swallow test and cervical auscultation demonstrated sensibilities of 66.7, 88.9 and 77.8 percent, with a respective specificity of 85.2, 59.3 and 77.8 percent. Positive predictive values were 60, 42.1 and 53.8 percent, with negative predictive values of 88.5, 94.1 and 91.3 percent respectively. These results support the utility of clinical aspiration screening as a simple and valuable technique that can be done at the bedside.

La disfunción glótica es una entidad prevalente en enfermos con patología neurológica aguda: compromete aproximadamente entre el 45 al 51 por ciento de los pacientes que padecen un ataque cerebrovascular, incrementando su mortalidad en una relación de 3/1. Su complicación principal es el síndrome aspirativo, que involucra diversas especialidades, entre ellas enfermedades respiratorias y neurología. El propósito de este estudio ha sido evaluar la fonación húmeda, el test del vaso de agua y la auscultación cervical como indicadores clínicos de aspiración frente a la certificación nasolaringoscópica, considerada patrón estándar de evaluación al lado de la cama del enfermo. Evaluamos prospectivamente durante un año a pacientes neurológicos agudos hospitalizados en una unidad de tratamiento intensivo. La fonación húmeda, el test del vaso de agua y la auscultación cervical demostraron sensibilidades de 66,7, 88,9 y 77,8 por ciento, con una especificidad respectiva de 85,2, 59,3 y 77,8 por ciento. Los valores predictivos positivo fueron de 60, 42,1 y 53,8 por ciento, con valores predictivos negativo de 88,5, 94,1 y 91,3 por ciento respectivamente. Nuestros resultados permiten afirmar que el monitoreo clínico de aspiración es un instrumento sencillo y valioso, que puede ser realizado al lado de la cama del enfermo.

Clinical Implications of the Glucose Test Strip Method for Early Detection of Pulmonary Aspiration in Nasogastric Tube- Fed Patients / 간호학회지

PURPOSE: This study was performed to test the clinical usefulness of the glucose test strip method for early detection of pulmonary aspiration in tube fed patients. METHOD: The subjects for the study were 36 patients who were receiving enteral feedings and 39 patients who were not given enteral feedings. For the analysis, the tube fed patients were divided into two groups (clinically significant aspiration and no aspiration) according to criteria. RESULT: The mean glucose concentration of tracheal secretions from non enteral fed patients was 26.35mg/dl and were lower than those concentrations found in tube fed patients (32.75mg/dl). The mean glucose concentration of the aspiration group was 45.60mg/dl and the glucose concentration of the non aspiration group was 19.93mg/dl. The difference was statistically significant (t=2.163, p=. 038). More subjects in the no aspiration group (73%) than the aspiration group (56%) had glucose concentrations below 20mg/dl. After deleting the cases that had samples containing blood, glucose concentrations of tracheal aspirates were lower in both groups. CONCLUSION: The glucose level of the aspiration group was significantly lower than the no aspiration group and more subjects in the aspiration group had a glucose level higher than 101mg/dl. Therefore, the glucose test of tracheal secretions in tube fed patients could be a desirable test for screening for tracheal aspiration. Especially the patient who is showing repeatedly high glucose levels should not be given feedings until reassessment is completed.

Revision Bibliografica Sindrome de Distres Respiratorio Agudo / Acute bibliographic revision syndrome of distres respiratory

El sindrome de Distres Respiratorio agudo es una patologia frecuente en los Servicios de Terapia Intensiva,los criterios, diagnosticos estan establecidos (Consenso Europeo-Americano de 1994)que indican que una relacion de p02/Fi02< de 200 infiltrados alveorales bilaterales , y presion capilar pulmonar < de18mmHg. constituyen los criterios mas importantes para su diagnostico. Sin embargo los criterios de ventilacion mecanica son los que se han ido modificado de acuerdo a la evidencia medica encontrada. Los problemas de la ventilacion mecanica giraban alrededor de definir cuanto de Volumen corriente (Vt) se deberia utilizar en el SDRA, como utilizar la Presion AL FINAL DE LA EXPRIRACION (PEEP), como obtener la mejor PEEP y que metodo utilizar para llegar a la mejor PEEP, cuando la presion en meseta (Pmes) se deberia utilizar como maximo, antes de inducir barotrauma. Estas preguntas se han resuelto, pero no completamente, con la publicacion de trabajo de ARDS Network (N Engl J. Med 2000;342:1301-1308), estudio multicentrico realizado en 10 centros universitarios de EEUU, se incluyo 861 pacientes, promovido por NIH (Instituto Nacional de Salud). Fue un estudio aleatorizado, con asignacion oculta, controlado y no ciego, con seguimiento total de 180 dias. Los enfermos que cumplian los criterios de ingreso se sometieron a dos estrategias de ventilacion: convencional con 12 ml/kg y ventilacion "protectora" de 6 ml/kg. La mortalidad con ventilacion protectora 31 porciento lo que supone una reduccion relativa del 22 porciento. Los pacientes que recibieron ventilacion protectora estuvieron menos tiempo con ventilacion con ventilacion mecanica y estuvieron mas dias sin disfucion de organos no pulmonares. Este trabajo establecio que la ventilacion con bajo volumen es actualmente la mejor opsion en el manejo del SDRA. El PEEP es util en el manejo de SDRA, sus benefios estan demostrados. (tiene efectos indeseables) pero no esta claro si niveles por encima de 12 cm. de H2O o menores son los mejores en cuanto a la suprevivencia y mortalidad de los pacientes con SDRA. La presion en meseta (Pmes) es un indice sencible de mortalidad y valores por encima de 30 cm. H2O aumenta progresivamente la mortalidad en el SDRA.

Evaluation of ventilator-associated lower respiratory tract infection and tracheobronchial aspiration of gastrointestinal contents.

STUDY OBJECTIVE: Ventilator-associated lower respiratory tract infection (LRTI) in a set up of respiratory intensive care unit was evaluated. Also the incidence of tracheobronchial aspiration of gastrointestinal contents was explored among these patients. DESIGN: Twenty eight patients admitted in the respiratory intensive care unit of referral teaching hospital were studied. All patients were evaluated for tracheobronchial aspiration of gastrointestinal contents in the initial 48 hours of initiating mechanical ventilation using methylene blue as marker and glucostix reagent strip. Protected endotracheal aspirate was secured after 48 hours of beginning of mechanical ventilation and was submitted for microbiological assay. RESULTS: Of the 28 mechanically ventilated patients, 82% were found to have developed LRTI. Aerobic gram-negative bacilli accounted for 79% of the infections, Klesiella responsible for 39% while Pseudomonas and Escherichia accounted for 18% each. The remaining 4% were caused by Acinetobacter. Gram-positive cocci were responsible for 21% of infection with Staphylococcus and enterococci 14% and 7% respectively. Tracheobronchial aspiration of GI contents was found to be present in 72% of the patients which was significantly correlated with the incidence of LRTI (p=0.014). Significant association was also found between the incidence of LRTI and mortality (p=0.05). CONCLUSION: The incidence of gastrointestinal aspiration was found to be high and correlation with LRTI was significant. Both glucostix reagent strip and methylene blue were observed to have same positivity rate.

Patología de la deglución y enfermedades respiratorias / Swallowing disorders and respiratory diseases

La patología de la deglución es una patología prevalente y relacionada con las enfermedades respiratorias, estimándose en series internacionales que la padece el 7 al 10 por ciento de los individuos mayores de 50 años, y entre el 30-40 por ciento de los ancianos que viven en casas de reposoû². A nuestro saber, en nuestro medio no se dispone de catastros estadísticos de esta patología. El diagnóstico acucioso del paciente con alteraciones de la deglución, incluyendo la disfagia, requiere de la comprensión de la anatomía y la fisiopatología de la deglución, de las patologías que puedan comprometerla, de las técnicas de laboratorio disponibles para su diagnóstico y del tratamiento de cada una de ellas. Como se podrá apreciar en esta revisión, se trata de un problema que compromete transversalmente a varias sub especialidades, entre ellas neurología, otorrinolaringología, enfermedades respiratorias y gastroenterología, entre otras, por lo que su aproximación multidisciplinaria parece más razonbleü

Neumonia por anaerobios: a propósito de un caso: Hospital Central de San Cristóbal 1996 / Anaerobes by pneumoniae: a purpose of a case: Hospital Central of San Cristobal 1996

The main cause of pulmonary infection due to anaerobes is aspiration. There are many risk factors including: depressed consciousness level, seizures, CNS illnesses, etc. Weight loss, sickness and stinking sputum productive cough are the clinical findings. The radiographics, clinical findings and pulmonary aspirate Gram's stained are diagnosis supportive and confirmated by microorganism culture. The treatment includes proper drainage, necrotic tissues debridement, and antibiotc therapy against aeroes and anaerobes. A school age male, seven years old, with a curse of four month with lengthy pneumony history treated 10 days as a a outpatient and 35 dyas inside the hospital is the case shown. He was admited again due to foul smelling vomit and bad conditions. He was treated with therapy against anaerobes. Culture and biopsy were carried out with a sample of vomit resulted: Peptococus, Peptostreptococcus and Acynetobacter calcoaceticus in the first and necrotic pulmonary tissue in the second. His curse at hospital was slow but satisfactory

Aspiración pulmonar en niños: cuantificación de macrófagos alveolar cargados de lípidos / Pulmonary aspiration in children: quantification of lipid laden alveolar macrophages

The search for lipid laden macrophages in sputum could be a simple diagnosis method for pulmonary aspiration. To assess the usefulness of sputum lipid laden macrophages in the diagnosis of pulmonary aspiration, 16 children aged 0 to 4 years old, admitted with aspiration pneumonia were studied. The diagnosis was based on clinical grounds (vomiting or radiologically diagnosed swallowing abnormalities plus persistent pulmonary condensations) or radionucleide milk scanning. As controls, 6 children of 1 to 5 years old, admitted for elective tonsillectomy, were studied. Sputum was stained with Sudan III-Hematoxylin, 100 macrophages were read and each cell received a score from 0 to 4 according to the degree of ataining. Lipid laden macrophages of children with aspiration pneumonia had a mean score of 150ñ107 (8-323) compared with those of controls that had a score of 1.3ñ1.5 (0-4). The study of sputum lipid laden macrophages may be a useful diagnostic method for aspiration pneumonia