Anaerobic pleuropulmonary infections

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Anaerobic infections are undoubtedly the most commonly overlooked of all bacterial infections. This is the case in pleuropulmonary infections, particularly when specimens for anaerobic culture usually are not obtained and standard micro-biologic techniques often are inadequate. The purpose of this paper is to discuss a few of the clinical problems associated with anaerobic pleuropulmonary infections, to mention techniques for collection of materials for proper culture of anaerobic pulmonary pathogens, and to consider briefly the spectrum of pulmonary diseases produced by anaerobes based on our recent experiences.

Figure 1 is the posteroanterior chest roentgenogram of a 67-year-old man who had just been admitted to the hospital with an extensive necrotizing pneumonia involving much of the left lung. There was apparently an empyema at the right base as well, but numerous attempts at recovering fluid from this area by thoracentesis were unsuccessful. Coughed sputum culture yielded Pseudomonas aeruginosa in heavy growth. The house officer questioned this laboratory report, since this patient had not been hospitalized previously, and it would be most unusual for someone to come into the hospital with an extensive necrotizing pneumonia due to P. aeruginosa in the absence of any severe underlying disease. Furthermore, the patient had been chronically ill for 6 months and had lost 27.3 kg before becoming acutely ill and seeking hospitalization. Again, this is not the clinical picture of Pseudomonas pneumonia. In addition, this patient was an alcoholic and thus might well have aspirated and was bringing up foul-smelling sputum, a sure indication that anaerobes. . .



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