Tag Archives: Lungs

Bacteria: The Risks Of Pseudomonas Aeruginosa

Bacteria have long been classified according to how they are stained by the chemical dye called the Gram stain. Pseudomonas aeruginosa is Gram-negative, compared to the Staph aureus which is gram-positive.

Being Gram negative, Pseudomonas has an extra membrane, the outer membrane, and a shell of a nasty material called Lipo polysaccharide. These extra structures act as a barrier to entrance of antibiotics. In addition, the Pseudomonas has many more genes than the average bacterium and uses these genes for adaptation. For instance, it is good at forming a raft of mutually supporting cells called a biofilm, which enables it to become particularly entrenched. In a condition of the lung called cystic fibrosis, this biofilm contains specialized cells, one of which is called the Persister cell. When Pseudomonas senses that a critical number of bacteria is present, called quorum sensing, the persister cell multiplies to become around 10% of the bacterial population, and slows down their metabolism massively, becoming a sort of “zombie cell”. These cells are very hard to kill and persist through an antibiotic treatment that kills other Pseudomonas cells, only to rev up their metabolism and become active again once treatment is withdrawn.

In addition, Pseudomonas has all of the other resistant talents mentioned in the previous article on Staphylococcus aureus, such  as plasmid acceptance, ability to destroy penicillin, efflux pumps, and rerouting of metabolism.

In trying to control Pseudomonas, techniques other than antibiotics are being tried out of desperation, including interference with a quorum sensing, use of bacteriophages and chemical  elements such as Gallium which masquerades as the iron this bacterium requires.

Pseudomonas is not as actively pathogenic as Staphylococcus aureus, but it has made a great niche for itself in the respiratory tract, especially in people with a compromised immune system, or pulmonary abnormality such as cystic fibrosis. Ventilation tubes and other hospital equipment can become contaminated and spread the infection, unless thoroughly cleansed of Pseudomonas; it is very sensitive to acidic solutions, and those who need nasal CPAP for sleep apnea may recall that they have to rinse their equipment in vinegar, or acetic acid. Swimmers can get an external ear infection with this organism, and the drops for swimmers ear often contains acetic acid.

The next rogue to consider is a frightful yeast called Candida auris.

—Dr. C.

Infographic: Diagnosis & Treatment Of Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Technology: Lung Cancer Robotic Surgery (Video)

Inside the OR: Lung Cancer Robotic Surgery

Northwestern Medicine Thoracic Surgeon Samuel S. Kim, MD, explains a breakthrough in lung cancer surgery.

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CANCERS: DIAGNOSING CARCINOID TUMORS

Cancer is a huge problem, since it is actually a collection of a lot of different diseases in different places, resulting from mutation of the genes and invasiveness as the common characteristic. All cancers are different.

Carcinoid tumor is a good illustration. These are so called neutoendocrine tumors. They are slow growing, and are usually not detected until they are quite advanced. They can be located in different organs such as the gastrointestinal tract and the lung.

In their vicinity they produce symptoms characteristic of the area; trouble swallowing, nausea, vomiting, constipation and abdominal pain for gastrointestinal carcinoid, and cough, wheezing, shortness of breath and chest pain for those located in the lung.

Many advanced cancers can produce weight loss, muscle pain and fatigue In addition to symptoms characteristic of their location. The special characteristic of carcinoid tumors is that they may secrete substances that produce diverse symptoms such as  flushing of the skin, sudden diarrhea and vomiting and, strangest of all, heart valve leakages.

Diagnosis of carcinoid tumors is often made by checking for serotonin or chromogranin-A in the blood, and 5-Hydroxy indolacetic acid ( 5-HIAA) in the urine, and locating the tumor with Imaging such as CT and MRI.

It is usually treated best for surgery, but cell surface somatostatin can be targeted for hormone therapy, and targeted radiotherapy with PRRT. It is very much to the advantage of the patient if she has a tumor with specific hormone or other marker that can be targeted for treatment, such as a breast cancer with estrogen receptors that can be targeted by tamoxifen.

Please check the accompanying mayo clinic article for more information.

—Dr. C.

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Bronchitis Or Pneumonia: What Is The Difference?

Infections: Cryptococcus Neoformans (Fungi)

Cryptococcus neoformans and gattii are fungi that most commonly infect people with immunodeficiency, especially AIDS, which is highly prevalent in Africa. Cryptococcus is the final cause of death in perhaps 25% of AIDS patients and preventative treatment is sometimes used if the lymphocyte count is too low.

It is an opportunistic fungus, with similarities to pneumocystis carina, which is discussed in a previous entry.

The areas in the body most commonly affected are the lungs, the skin, and the brain. The lung and skin, being exposed to the environment, are the most common entry points for the fungus, and the brain is a frequently involved area. Chronic meningitis, where the symptoms include headache, blurred vision, and confusion, is frequently caused by cryptococcus.

Sometimes, in healthy people, the skin can be infected with “pigeon breeders disease”. Pigeon droppings are a very common source of cryptococcus organisms.

Infection In the lung is usually restricted to immunocompromised individuals, who develop cough, shortness of breath, and fever. Pulmonary cryptococcosis is a slowly developing disease, can be mistaken for tuberculosis, and frequently gets into the bloodstream and then into the brain.

Treatment is usually with amphotericin B and flucytosine.

—Dr. C.

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DR. C’S JOURNAL: WHAT IS PNEUMOCYSTIS PNEUMONIA?

Pneumocystis is found in the respiratory tract of most mammals and Man. Pneumonia from this organism was extremely rare or unknown before the advent of AIDS.

When the lymphocyte count of a person with AIDS drops below 500, or especially 200, pneumocystis pneumonia is a frequent complication. Symptoms include cough, fever, rapid breathing, and shortness of breath.. The chest x-ray typically shows a “ground glass” appearance, caused by fluid inside the air sacs and throughout the lung. Treatment is usually with trimethoprim sulfa.

Immunosuppressive therapy is often given for organ transplants and auto immune diseases these days. Patients and doctors should be on the lookout for pneumocystis symptoms in this situation. Even long-term corticosteroids can produce enough immunosuppression to allow pneumocystis to invade the body.

Pneumocystis Jeroveci is the causative organism, and used to be called pneumocystis Carini. Doctors suspect this disease when an immuno-suppressed patient, especially AIDS , has a dry cough, with pneumonia and  a very low oxygen concentration, more severe than expected.  Fluid taken from the lung shows several  organisms in little sacks or cysts.

Treatment is with sulfonamids, if they are tolerated. Cortisone must be given not the same time to prevent a severe reaction from absorption of the dead organisms. Pneumocystis is a yeast-like fungus and is also discussed under opportunistic fungal infections.

The following article will give you more information.

—Dr. C.

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DR. C’S JOURNAL: EFFECTS & SYMPTOMS OF LONG COVID

COVID-19 is admittedly a pandemic and has caused much economic and social disruption in the world. Now we learn that it may not be over after a few of weeks of illness. LONG COVID is now an accepted syndrome.

You can tell because of the many clinics for handling it being set up by the NHS in England, and millions in research money being directed towards a solution.

The most disturbing thing to me is that infected but asymptomatic or mildly ill people may get this condition, and have one or more symptoms for a long time .Certainly, those more seriously ill develop long Covid symptoms more commonly.

Long Covid is taking its place with chronic fatigue syndrome, posttraumatic stress disorder and post ICU syndrome as poorly understood conditions. They may in fact be taking place simultaneously, even if they are not identical.

The cause  can  be due to continuing viral infection in older or immune compromised individuals. Vascular damage is another reason that could account for the widespread involvement of practically any organ system that doesn’t go away after a few weeks.

Structural damage to the alveoli of the lungs and other organs can also play a role, which would account for shortness of breath as a prominent persistent symptom. Although it has not been highlighted in the articles that I have read, auto immunity can also be playing a role in long Covid.

This would go along with The myocarditis rarely caused by the mRNA vaccines; perhaps some of the protein sequences of the spike proteins have similar shapes to some human tissues. Name a symptom, and you’ll probably find it listed among the 50 odd symptoms mentioned in the Wikipedia article on long Covid, which is appended to the end of this article.

The most prominent symptoms include extreme fatigue, mental fog, and shortness of breath. Treatment is mainly supportive and general. After ruminating on this condition, it’s going to be quite a while before Yours truly wants to breathe in other peoples air spaces; I plan to continue masking in public, distancing and avoiding large groups.

That being said, I am planning to go out to eat dinner tonight, and can hopefully be placed at the edge of the room. I will inquire as to the vaccination status of our waiter. The people at my table will all be doubly vaccinated, which is not complete assurance of safety, but will help make me feel relatively comfortable.

I also plan on getting a booster shot as soon as it is available. Hopefully, the vaccine incorporating the special mutations of the delta virus will be soon available. You don’t want to be infected by this nasty, promethian shape-shifter. Take care.

–Dr. C

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DR. C’S JOURNAL: COPD -CHRONIC OBSTRUCTIVE PULMONARY DISEASE

COPD is the brother of asthma. Both can cause shortness of breath and wheezing. Asthma is the more Treatable of the two, and is due to muscle spasm around the airways which narrow those airways making it more difficult to breathe in and especially out.

COPD comes in 2 general forms,  Chronic bronchitis and emphysema.
Chronic bronchitis is an inflammation of the airways, which differs from the usual allergic asthmatic TH2 type of inflammation. The inflammation of chronic bronchitis is the more common TH1 inflammation that comes from the likes of bacteria and viruses.

The second type of COPD is usually caused by cigarette smoke or other fumes which lead to the destruction of the air sacs and associated elastic tissue, allowing a check valve type of obstruction to occur on breathing out.

COPD is rarely a pure type of chronic bronchitis or emphysema, and is usually an admixture of the two. In fact there can be an “asthmatic element” mixed into COPD, which allows for a better response to the myriads of medication that we now have for asthma.

The symptoms of COPD include shortness of breath, wheezing, chest tightness and chronic cough with production of sputum. Coughing up a significant volume of phlegm from your chest suggests chronic bronchitis rather than emphysema.

The symptoms of COPD come on rather slowly and are usually not noticed until the problem is severe. After all, the cigarette smoker is EXPECTED to cough isn’t he?

As COPD becomes very advanced, fatigue, lack of energy, and unintended weight loss may occur. Swelling of the legs may be a problem and could indicate involvement of a heart; with COPD the right side of the heart has a hard time moving blood through the diseased lungs.

We’ve all seen people pushing around a cart with an oxygen tank. These people most often are smokers who developed COPD. One particularly disgusting advertisement against cigarette smoking showed a person with a hole in the windpipe (tracheostomy) through which he was smoking his cigarette.

Pulmonary function testing it’s often helpful in diagnosing asthma and COPD. In pulmonary function testing, the amount of air in the lungs  and the rapidity with which it can be expelled from the Lungs is measured and graphed. it is the rate of flow on exhalation that is diminished in COPD and asthma, the slower the rate the worse the blockage.

In the case of asthma the test is repeated after a bronchodilating adrenaline type medication has been given. The REVERSIBILITY of the airway obstruction is shown by comparing the airway function before and after treatment  With no improvement, usually COPD is usually the culprit.

In both asthma and COPD, respiratory infection is a big problem. The compromised lung is usually very vulnerable to these inflammatory reactions. There are a score of medications  that are commonly used in asthma which also benefit COPD to a certain degree. Doctors have a large armamentarium for respiratory disease these days.
As mentioned, asthma is more treatable. However if it is poorly treated or neglected, a condition known as REMODELING can occur which will render treatment less effectual.

Please check with the Mayo clinic article on COPD for more information.

—Dr. C.

Mayo Clinic article