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[Autopsy cases of terminal pulmonary infections]
Abstract:
In order to clarify the present state of terminal pulmonary infections, all autopsy cases from 1976 to 1985 reported in the annual records of autopsy cases in Kyushu University Hospital were reviewed. Of the total of 2,238 autopsy cases, pulmonary infections were present in 1,042 (46.6%) and in 595 (26.6%) pulmonary infections were fatal. Among the primary diseases associated with pulmonary infections, hematologic diseases such as leukemia and malignant lymphoma, lung cancer, esophageal cancer and cerebrovascular disease were most frequent. The pathogens of fatal pulmonary infections occurring in autopsy cases were bacteria (26.6%), Aspergillus (3.2%), Candida (1.8%), cytomegalovirus (1.7%), Pneumocystis carinii (1.1%), Mycobacterium (0.9%), Cryptococcus (0.6%) and phycomycetes (0.1%). The incidence of non-bacterial, especially fungal, pulmonary infections has increased during the recent five-year period. Among the pulmonary infections associated with lung cancer in autopsy cases, mycobacteriosis occurred more frequently than fungal infection. The incidence of fatal mycobacteriosis was more frequent in cases receiving steroids than in those not receiving steroids. Antemortem diagnosis of pulmonary infections was made in only 4.6% and 26.3% of cases of non-bacterial infection and mycobacteriosis, respectively. There was no autopsy case diagnosed before death as aspergillosis, which most frequently occurred among the fungal pulmonary infections in autopsy cases.
Insights
Fatal pulmonary infections are common, with bacteria being the most frequent cause. However, non-bacterial infections, particularly fungal ones, are increasing, often missed before death.
Area of Science:
- Pulmonary Medicine
- Infectious Diseases
- Pathology
Context:
- Terminal pulmonary infections are a significant cause of mortality.
- Autopsy data from Kyushu University Hospital (1976-1985) provides insight into infection prevalence.
- Understanding primary diseases linked to pulmonary infections is crucial.
Purpose:
- To analyze the trends and causes of terminal pulmonary infections.
- To identify the spectrum of pathogens responsible for fatal pulmonary infections.
- To assess the accuracy of antemortem diagnoses for these infections.
Summary:
- A review of 2,238 autopsy cases revealed pulmonary infections in 46.6%, with 26.6% being fatal.
- Bacteria were the most common pathogens, but fungal infections (e.g., Aspergillus) showed an increasing trend.
- Non-bacterial infections, including mycobacteriosis and fungal infections, were frequently undiagnosed antemortem.
Impact:
- Highlights the rising incidence of non-bacterial pulmonary infections, especially fungal and mycobacterial.
- Underscores the diagnostic challenges and low antemortem detection rates for these infections.
- Informs clinical practice regarding the diagnosis and management of pulmonary infections in high-risk patients.