Читать книгу Epidemic Respiratory Disease. The pneumonias and other infections of the repiratory tract accompanying influenza and measles онлайн

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It has been stated that a considerable number of cases of influenza developed a more or less extensive purulent bronchitis. This term is used as descriptive of a group of cases showing clinically evidence of a diffuse bronchitis as manifested by numerous medium and fine moist râles scattered throughout the chest and evidence of a definitely purulent inflammatory reaction as indicated by the expectoration of fairly copious amounts of mucopurulent or frankly purulent sputum. This condition is regarded as quite distinct, on the one hand, from the common type of mucoid bronchitis frequently associated with “common colds” and a fairly common feature of uncomplicated cases of influenza, in which physical examination of the chest reveals only transient sibilant and musical râles without evidence of extension to finer bronchi, and, on the other hand, from bronchopneumonia.

Bacteriology.

Table XIIIBacteriology of the Sputum in Cases of Purulent Bronchitis Following InfluenzaCASESTAINED FILM OF SPUTUMDIRECT CULTURE ON BLOOD AGAR PLATEMOUSE INOCULATIONGJB. influenzæ + + +B. influenzæ + + + +B. influenzæGram + diplococci +Pneumococcus +Pneumococcus (type undetermined)WALB. influenzæ + +B. influenzæ + + +Gram + diplococci + +Pneumococcus IV + +THB. influenzæ + + +B. influenzæ + + + +Gram + diplococci + + +Pneumococcus IV + +LHB. influenzæ +B. influenzæ + +Gram + diplococci +Pneumococcus IV + +FBDGram + diplococci + + + +Pneumococcus IV + + +Pneumococcus IVB. influenzæ +B. influenzæWaB. influenzæ + +B. influenzæ + +Gram + diplococci + +Pneumococcus IV + +ShB. influenzæ + + +B. influenzæ + +Gram + diplococci + +Pneumococcus IV + + +WalGram + diplostrep + + +S. viridans + +B. influenzæ +B. influenzæ + +CLFB. influenzæ + + + + +B. influenzæGram + diplococci +Pneumococcus IVNCCB. influenzæ + +B. influenzæ + + +B. influenzæGram − micrococcus +M. catarrhalis + +M. catarrhalisGram + diplostrep. +S. viridans + +JCMB. influenzæ + + +B. influenzæ + + + +B. influenzæGram + streptococcus +S. hemolyticus +S. hemolyticusGram − micrococcus +M. catarrhalis +Pneumococcus IVGram + diplococcus +BlB. influenzæ +B. influenzæGram + diplococcus +Pneumococcus IIaBuB. influenzæ + + + +B. influenzæ + + +B. influenzæGram + diplococcus + + + +Pneumococcus IV + + +Pneumococcus IV

From the data presented in Table XIII it is evident that a mixed infection existed in all cases. The results obtained by stained sputum films and by direct culture on blood agar plates are of special significance. B. influenzæ was present in all cases, being the predominant organism in 6 cases, abundantly present in others, and few in number in 2. Of other organisms the pneumococcus was most frequently found, occurring in 11 of the 13 cases, in all but 2 instances being present in considerable numbers. S. viridans was encountered twice, once in association with a Gram-negative micrococcus resembling M. catarrhalis culturally. S. hemolyticus was found once, together with M. catarrhalis and a few pneumococci, Type IV, coming through in the mouse only and of doubtful significance. The stained sputum films and direct cultures always showed these organisms present in sufficient abundance to indicate that they were present in the bronchial sputum and were not merely contaminants from the buccal mucosa.