Acute respiratory distress syndrome clinical presentation

Complications included acute respiratory distress syndrome, renal failure, and multi-organ failure. Evidence that the clinical spectrum of human H5N1 infections is not restricted to pulmonary symptoms was provided by a reported case of possible central nervous system involvement in a Vietnamese boy who presented with diarrhea, followed by coma and death. Influenza H5N1 virus was isolated from throat, rectal, blood, and cerebrospinal fluid specimens, suggesting widely disseminated viral replication. 

Part II of the book explores the role of chemokines in a variety of chronic and acute inflammatory diseases, including acute respiratory distress syndrome (ARDS), asthma, interstitial lung disease, rheumatoid arthritis, and organ transplant rejection. These topics are discussed through a presentation of the pathogenesis of the disease, using a wide range of clinically relevant animal models of the disease, as well as the examination of chemokine expression in clinical samples. 

Acute exacerbations of IPF are characterized by rapid development of cough, dyspnea, hypoxemia, and worsening pulmonary infiltrates in patients with known IPF (29,148-151). Presentation is similar to acute respiratory distress syndrome (ARDS) (29,148,149,151,152). The cardinal histological feature is DAD superimposed on a background of UIP (149,151). Idiopathic acute interstitial pneumonia (AIP) (28,152) exhibits similar clinical and histological features as acute exacerbations of IPF, but lacks the requisite features of UIP. High-dose intravenous (IV) pulse methylprednisolone has been used to treat acute exacerbations of IPF, but data on treatment are limited to anecdotal cases and small series (29,148,149,151). This entity is reviewed in chapter 15 and will not be further discussed here. 

With the publication of two international consensus statements on the IIP, the American Thoracic Society and the European Respiratory Society formally recognized AIP as a distinct IIP with cardinal features of rapid symptom onset, unknown causation, and the presence of a DAD pattern on surgical lung biopsy (8,9). As these same clinical and pathologic features are present in patients with known causes of lower respiratory tract disease, in particular the acute respiratory distress syndrome (ARDS) and overwhelming lower respiratory tract infection, AIP is by necessity, a diagnosis of exclusion (Table 1). 

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