Infectious Diseases in Critical Care Medicine

Table 8

Radiographic Findings (

Continued

)

Pathogen

Chest radiographic findings

Comments and other radiologic findings

Epsilon toxin of

C. perfringens

In calves severe acute pulmonary edema that was

particularly marked in the interlobular septa. Thehistological lesions consisted of intra-alveolar andinterstitial edema of the lung and variable degrees ofperivascular proteinaceous edema in the internal capsule,thalamus, and cerebellar white matter.

In sheep experiments histological changes consisted of severe

edema of pleura and interlobular septa and around bloodvessels and airways and acidophilic, homogeneous,proteinaceous, perivascular edema in the brain.

Food safety threats (e.g.,

Salmonella

sp

.,

E. coli

O157:H7,

Shigella,

Vibrio spp.

,

L. monocytogenes,

C. jejuni, Y. enterocolitica

)

Salmonella

sp.: Pneumonia, empyema, and lung abscess.

E. coli

: Severe confluent bronchopneumonia, empyema,

abscess.

L. monocytogenes

: Pneumonia is rare.

C. jejuni

: Food aspiration has caused lung abscess, lobar

pneumonia in splenectomized patients.

Y. enterocolitica

: Pneumonia, interstitial pneumonia,

empyema (child), cavitary disease, lung abscess, nodularinfiltrates, and necrotizing pneumonia especially but notexclusively in compromised patients

Glanders (

Bk. mallei

)

Acute pneumonia, abscess formation frequent, empyema,

and hilar adenopathy. Chronic granulomatous diseaseimitates tuberculosis.

Majority of infected patients are asymptomatic.

Melioidosis (

Bk. pseudomallei

)

Acute disease: irregular nodular opacities 3–15 mm,

disseminated bilaterally or segmental or lobarconsolidation (one or more segments may be involved),Nodules enlarge, coalesce, and cavitate (40–60% ofpatients). 15% have pleural effusion at or nearpresentation.

Acute disease: CT frequently demonstrates liver and spleen

abscesses.

Chronic disease: nodular, irregular, linear opacities,

consolidation and cavitation predominantly or exclusivelyinvolving the upper lobe but not the apex-liketuberculosis.

Chronic disease seldom associated with retraction of the hila and

rarely calcifies.

Psittacosis (

C. psittaci

)

The chest X ray often abnormal (72%): homogeneous

ground-glass opacity sometimes with small radiolucentareas, patchy reticular pattern radiating from the hilum, ornonsegmental consolidation with or without atelectasis.Enlarged hilar node not uncommon. Rare miliary patternseen.

Takes many weeks (average 6 wk, range 1–20 wk) for X ray to

clear after treatment.

462 Cleri et al.