Treatment of Community-Acquired Pneumonia

Pneumonija je akutna infekcija plućnog parenhima i važan uzrok pobola i smrtnosti diljem svijeta. Pojam izvanbolnička pneumonija, CAP (engl. Community-acquired pneumonia) odnosi se na upalu pluća stečenu izvan bolnice. Kamen temeljac liječenja CAP-a jest empirijska antibiotska terapija koju treba primijeniti što je prije moguće, optimalno u prva četiri do šest sati od postavljanja dijagnoze. Različita su mišljenja i preporuke za empirijsku terapiju CAP-a, a izbor ovisi o težini kliničke slike, komorbiditetima bolesnika, lokalnoj prevalenciji patogena i njihovoj očekivanoj rezistenciji na antibiotike. Sva se veća respiratorna društva slažu da empirijska antibiotska terapija treba biti primarno usmjerena na Streptococcus pneumoniae koji je vodeći uzročnik CAP-a. Ciljano antibiotsko liječenje treba primijeniti nakon mikrobiološke izolacije uzročnika bolesti. Za uspješan ishod CAP-a empirijska antibiotska terapija treba biti popraćena potpornim medicinskim mjerama. U novije se vrijeme istražuju i imunomodulatorni lijekovi čija će se učinkovitost, kao moguće dodatne terapije antibioticima, tek pokazati.Pneumonia is an acute infection of the pulmonary parenchyma and a significant cause of morbidity and mortality worldwide. Community-acquired pneumonia (CAP) refers to pneumonia acquired outside of hospital. The cornerstone of treating CAP is empirical antibiotic therapy to be applied as soon as possible, immediately after the assessment of disease severity and the possible expected causes (within four to six hours of establishing the diagnosis). Recommendations for the introduction of empirical antibiotic therapy for CAP vary, and the choice depends on the severity of clinical presentation, comorbidities of patients, the prevalence of pathogens and their expected resistance to antibiotics. All major respiratory societies agree that empirical antibiotic therapy should be primarily focused on Streptococcus pneumoniae, the leading cause of CAP. The targeted antibiotic therapy should be prescribed after isolating microbial pathogens. For the successful outcome of CAP, empirical antibiotic therapy should be accompanied by supportive medical treatment. The immunomodulatory drugs have recently been investigated, and their efficiency, as well as possible additional antibiotic therapies, are yet to be confirmed in treating community-acquired pneumonia

Tuberculosis of the Oral Cavity Misdiagnosed as Precancerous Lesion

Svrha ovog prikaza slučaja bila je opisati vrlo rijetku oralnu leziju kao posljedicu primarne plućne tuberkuloze. Prikaz slučaja: Opisan je bolesnik s refraktornom bezbolnom ulceracijom ventralne površine jezika. Pacijentu je uzeta detaljna medicinska anamneza te obavljen klinički pregled sluznice usne šupljine i palpacija regionalnih limfnih čvorova. Kliničkim pregledom ustanovljena je ulceracija na ventrolateralnoj površini jezika promjera oko dva centimetra. Palpacijom regionalnih limfnih čvorova nije otkriveno njihovo povećanje. Toluidinski test sumnjive lezije učinjen je tijekom svakoga kontrolnog pregleda. Biopsijski uzorci za histopatološku analizu uzeti su tri puta. Histopatološka analiza prvoga biopsijskog uzorka pokazala je nespecifičnu upalu, druga kazeoznu nekrozu bez pozitivnog bojenja prema Ziehl-Neelsenu, a treća granulomatoznu upalu visoko sumnjivu na sarkoidozu. Pacijent je tijekom hospitalizacije obavio cjelovit fizikalni pregled, te laboratorijsku i radiološku dijagnostiku. Fizikalni pregled prsnog koša pokazao je bilateralno prisutne grube krepitacije, a laboratorijski nalazi krvne slike normocitnu anemiju kronične bolesti. Na rendgenskoj snimci pluća uočeni su mali multipli čvorovi bilateralno, a nalaz direktnog sputuma bio je pozitivan. Zaključak: Iako je oralna tuberkuloza rijetko stanje, mora se uzeti u obzir u diferencijalnoj dijagnozi refraktornih bezbolnih oralnih ulkusa.Introduction: The aim of this case report was to discuss an extremely rare oral lesion as a result of primary pulmonary tuberculosis. Case report: In this case report, the patient with refractory painless ulceration at ventral surface of the tongue was described. Detailed medical history was taken followed by clinical examination of the oral mucosa and palpation of regional lymph nodes. Clinical examination revealed ulceration on the patient’s ventro-lateral surface of the tongue, approximately two centimeters in diameter. Palpation of regional lymph nodes has not revealed enlargement. The toluidine blue test of the suspected lesion was performed at each control examination. Biopsy samples for histopathologic diagnosis were taken three times. The analysis of the first biopsy sample for histopathology revealed a non-specific inflammation, the second biopsy revealed a caseous necrosis without positive Ziehl-Neelsen staining and the third biopsy revealed a granulomatous inflammation which was highly suspicious of sarcoidosis. During hospitalization, the patient underwent a complete physical examination, and laboratory and radiological diagnostics. Physical chest examination revealed bilaterally coarse crepitations and laboratory findings of his complete blood count revealed normocytic anemia of chronic disease. Radiographic examination of lungs showed multiple small nodules bilaterally and positive direct sputum smear. Conclusion: Although oral tuberculosis is a rare condition, it must be taken into account in differential diagnosis of refractory painless oral ulcers

Tuberculosis of the Oral Cavity Misdiagnosed as Precancerous Lesion

Introduction: The aim of this case report was to discuss an extremely rare oral lesion as a result of primary pulmonary tuberculosis. Case report: In this case report, the patient with refractory painless ulceration at ventral surface of the tongue was described. Detailed medical history was taken followed by clinical examination of the oral mucosa and palpation of regional lymph nodes. Clinical examination revealed ulceration on the patient’s ventro-lateral surface of the tongue, approximately two centimeters in diameter. Palpation of regional lymph nodes has not revealed enlargement. The toluidine blue test of the suspected lesion was performed at each control examination. Biopsy samples for histopathologic diagnosis were taken three times. The analysis of the first biopsy sample for histopathology revealed a non-specific inflammation, the second biopsy revealed a caseous necrosis without positive Ziehl-Neelsen staining and the third biopsy revealed a granulomatous inflammation which was highly suspicious of sarcoidosis. During hospitalization, the patient underwent a complete physical examination, and laboratory and radiological diagnostics. Physical chest examination revealed bilaterally coarse crepitations and laboratory findings of his complete blood count revealed normocytic anemia of chronic disease. Radiographic examination of lungs showed multiple small nodules bilaterally and positive direct sputum smear. Conclusion: Although oral tuberculosis is a rare condition, it must be taken into account in differential diagnosis of refractory painless oral ulcers