抄録
To investigate the role of infection in acute exacerbations of emphysema, 33 patients with acute exacerbations of emphysema over a period of 22 years (1959-1980) were examined.
The following results were obtained:
1) Of the 56 exacerbations studied in 33 patients with emphysema, 67.8% were associated with respiratory infection: respiratory tract infection (41%) and pneumonia (26.8%). The respiratory infection was the most important cause, although there were many causes of acute exacerbation of emphysema. Seven (77.8%) out of 9 cases with a fatal outcome of exacerbations died from respiratory infection.
2) Twelve (31.6%) out of all 38 exacerbations were caused by microbial infections, 9 of them were associated with bacteria and 3 with viruses. The microbes were Staphylococcus aureus (2), Haemophilus influenzae (2), Pseudomonas aeruginosa (2). Streptococcus pneumoniae (1), both Streptococcus pneumoniae and Haemophilus influenzae (2). Influenza virus A (2) and Parainfluenza type 3 (1).
3) The monthly incidence of exacerbations was greatest in January, February, July and November.
4) The main symptoms in exacerbations were remarkable dyspnea, cyanosis in about half, and dehydration in association with sweating and tachypnea. It was worth mentioning that about 30% of infectious cases had no fever.
5) It was noted that test results were within normal limits in 42% in WBC, 52% in ESR and 26% in CRP in cases of respiratory infection. Laboratory findings showing WBC over 13, 000/mm3, ESR over 50mm/hr and CRP over (3+) in exacerbations were strongly suggestive of respiratory infection.
6) Blood gas findings showing PaO2 below 40 Torr and PaCO2 over 60 Torr in exacerbation indicated a poor prognosis.
7) FEV1.0 and FEV1.0% in cases of respiratory infection were significantly below those of non-infectious cases (p<0.01).
