Biliary pneumonia

Streptococcus pneumoniae Infection with Streptococcus pneumoniae may cause both toxic liver damage and pneumococcal hepatitis with focal necroses, leading to the corresponding laboratory findings. In lobar pneumonia, jaundice (= biliary pneumonia) frequently occurs in the so-called grey hepatization stage. In addition to predominantly bacterial haemolytic jaundice, increased transaminases (20%) and cholestasis (10%) are found. The condition always regresses completely. A liver abscess induced by pneumococci is a rare event. (3-5, 9)... 

Signs and Symptoms Depend on the site of infection. Infection may produce osteomyelitis or arthritis pneumonia [with chills, productive cough, low blood pressure (hypotension), difficulty breathing (dyspnea), or chest pain] meningitis or cerebral abscesses (with headache, fever, vomiting, stupor, coma) or intra-abdominal infections (with biliary drainage, hepatic abscess, pancreatic abscess, peritoneal exudate). 

Cephalosporins are important bactericidal broad spectrum (3-lactam antibiotics used for the treatment of septicaemia, pneumonia, meningitis, urinary tract infections, peritonitis and biliary tract infections. They are obtained from fungus Cephalosporium acremonium and are chemically related to penicillin. It consists of beta lactam ring fused to a dihydrothiazine ring. 

For the relief of pain arising from spasm of smooth muscle, as in renal or biliary colic, morphine is frequently employed. Other measures including antispasmodics such as atropine, atropine substitutes, theophylline, nitrites, and heat may be employed first however, if they are ineffective, meperidine, methadone, or opiates must be used. Morphine relieves pain only by a central action and may aggravate the condition producing the pain by exaggerating the smooth muscle spasm. Morphine may also be indispensable for the relief of pain due to acute vascular occlusion, whether this be peripheral, pulmonary, or coronary in origin. In painful acute pericarditis, pleurisy, and spontaneous pneumothorax, morphine is likewise indicated. Carefully chosen and properly spaced doses of codeine or morphine may occasionally be necessary in pneumonia to control pain, dyspnea, and restlessness. Traumatic pain arising from fractures, bums, etc., frequently requires morphine. In shock, whether due to trauma, poisons, or other causes, morphine may be required to relieve severe pain. 

Oral bioavailability is 57%, and tissue and intracallular penetration is generally good. Telithromycin is metabolized in the liver and eliminated by a combination of biliary and urinary routes of excretion. It is administered as a once-daily dose of 800 mg, which results in peak serum concentrations of approximately 2 g/mL. Telithromycin is indicated for treatment of respiratory tract infections, including community-acquired bacterial pneumonia, acute exacerbations of chronic bronchitis, sinusitis, and streptococcal pharyngitis. Telithromycin is a reversible inhibitor of the CYP3A4 enzyme system. 

The following complications have been reported pneumonia, asthmatic attacks (= asthma verminosum), parasitization of the biliary tract (= cholangitis) (49, 59, 62), liver (= hepatic lesions), pancreatic duct (= pancreatitis) and appendix (= appendicitis), or entanglement of worms (= ileus). 

Abdulkarim, A.S., Petrovic, L.M., Kim, W.R., Angulo, P., Lloyd, R.V., Lindor, K.D. Primary biliary cirrhosis an infectious disease caused by Chlamydia pneumoniae J. Hepatol. 

Jones and Peric-Golia (108) have described a biliary precipitate composed of cholesterol and some pigment in guinea pigs 1-2 days after the intravenous injection of capsular polysaccharide from Klebsiella pneumoniae. No further work has been done with this experimental model. 

In a randomized, single-blind, case-controlled study of ceftriaxone-associated biliary pseudolithiasis, 108 Chinese were randomized to ceftriaxone or ceftazidime for hepatobiliary infections or pneumonia [18 ]. Gallstones were detected in 43% of those who received ceftriaxone and 2% of those who received ceftazidime. Biliary precipitation appeared after 2-7 days. After withdrawal the symptoms resolved within 1-2 days. 

Chronic eosinophilic pneumonia Acute eosinophilic pneumonia Lymphangioleiomyomatosis Langerhans cell histiocytosis Idiopathic pneumonia syndrome Inflammatory bowel disease Cryoglobulinemia Primary biliary cirrhosis... 

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