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[Practical recommendations for examining the pulmonary pleura of fetuses and newborn infants using contact
Insights
The fetal and neonatal visceral pleura can indicate early signs of Gram-negative pneumonia, aiding pathologists in timely diagnosis. Examining pleural tissue during autopsy can reveal subtle infections not yet apparent in the lungs.
Area of Science:
- Pathology
- Neonatal Medicine
- Infectious Diseases
Context:
- Neonatal pneumonias caused by Gram-negative bacteria (Citrobacter sp., Escherichia coli, Klebsiella sp., Serratia marcescens) often involve the visceral pleura.
- The pleura may exhibit inflammatory signs of infection before pneumonia is clinically or radiographically evident.
Purpose:
- To highlight the role of the visceral pleura in early neonatal Gram-negative pneumonia detection.
- To provide guidance on utilizing pleural tissue for early infectious disorder diagnosis in neonates.
Summary:
- The visceral pleura of fetuses and neonates is consistently affected by Gram-negative bacterial pneumonias.
- Pleural inflammation can be an early indicator of infection, even before pneumonia is apparent.
- Specific morphologic features distinguish infections caused by different Gram-negative organisms (e.g., Citrobacter, Klebsiella, Serratia).
Impact:
- Suggests examining pulmonary pleura and staining preparations for contact microscopy during or shortly after autopsy for early diagnosis.
- Offers diagnostic value for pathologists in identifying neonatal infectious disorders.
- Characterizes distinct morphological findings associated with Citrobacter, Klebsiella, and Serratia marcescens infections in the pleura and lung tissue.
Abstract:
It has been found that the pleura visceralis of fetuses and neonates is consistently involved in inflammatory processes occurring in pneumonias caused by Gram-negative organisms (Citrobacter sp., Escherichia coli, Klebsiella sp., Serratia marcescens) and may display signs of infection when the pneumonia is not yet apparent. This property of the pleura as a filtration membrane may help the pathologist in the early diagnosis of infectious disorders in neonates. Recommendations are given on the excision of pulmonary pleura and the staining of its preparations for contact microscopy whereby these can be examined during or shortly after the autopsy. Morphologic features of the infections caused by the indicated organisms are detailed. Citrobacter infections, for example, show a preponderance of macrophage responses, Klebsiella-caused lesions are characterized by involvement of the lymphatic bed, while those due to S. marcescens have hemolysis in the lung tissue and pleura as their main feature.