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To identify discrepancies between Pneumonia Severity Index (PSI) risk class and the conventional criteria for deciding the site of care we performed a prospective observational study on 229 patients hospitalized for community-acquired pneumonia. PSI classes and corresponding mortality rates were as following: class I, 41 patients (0%); class II, 20 (0%); class III, 58 (1.7%); class IV, 86 (8.1%); class V, 24 (33.3%). Overall, 119 patients (52%) who were hospitalized according to conventional criteria were assigned to low-risk classes (I-III). Among these low risk patients, 58 (49%) had complications as respiratory failure, pleural effusion, hypotension or shock; among remaining patients, no reasons for admission were found. This latter group deserves prospective evaluation in randomized studies comparing in-hospital versus outpatient management.

We report a case of a HIV+ patient treated with prophylactic aerosolized pentamidine. The patient showed evidence of tensive right pneumothorax and slight pleural effusion. The pleural fluid was aspired from the drainage and processed in our laboratory. The cytologic examination of aspired fluid revealed abundant Pneumocystis carinii organisms. The cytologic presentation is peculiar in pleural fluid because of the presence of a large amount of trophozoites and a small number of cysts. Direct examination and Giemsa stain are suitable methods to detect trophozoites. The diagnosis can be confirmed by Gomori and Toloidine Blu stains that demonstrate the presence of isolated and scarce cysts. Pneumocystis carinii can also be recognized in Papanicolaou-stained smears as eosinophilic aggregates.

Anaerobic infections are quite rare in pediatric age, being that, they affect only neonates and immunodepressed patients. We think to be somewhat interesting to describe the case of our patient, a 9 year old boy, unaffected by any predisposing factor, came under our observation because of a severe respiratory distress. He showed evident clinical and radiological signs of pleural effusion in the right lung, together with a gas coil in the upper field and a left mediastinal shifting. A thoracentesis was then performed, giving rise to 600 ml of foul smelling purulent material; this procedure promptly improved his respiratory function. A permanent drainage trough the chest wall was set and an antibiotic therapy, based on the clinical picture and the character of the exudate, begun. In effect, the typical smell of the purulent material led us to suspect an anaerobic infection, and for this reason we employed the teicoplanin iv, a rarely used in the pediatric age drug. While blood cultures were negative for any organism, exudate cultures yielded Peptostreptococcus anaerobius; the last one resulted highly sensible following antibiogram to the previously chosen drug. The x-ray pattern and the rapid disappearing of the gas coil induced us to exclude further either congenital or acquired lung diseases. We conclude that, in absence of other proved sources of entry, the air presence in the pleural space was secondary to gas formation by the anaerobic micro-organism. The clinical course was very satisfactory allowing the patient to be dismissed on the 28th hospital day, with no need of further surgical therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

A rare case of luetic pleurisy diagnosed in a patient with tertiary syphilis, when the aetiological agent was discovered in the pleuritic exudate is described. The spirochaetes, first revealed by dark field microscopy, were studied further under the electron microscope, using negative colouring and fine sections.

Results are presented on the frequency of Klebsiellae recovery from biologic materials (urines, pleura or peritoneal exudates, cerebrospinal fluids, blood specimens) examined during one year. Tobramycin was the antibiotic with the highest in vitro activity against the isolates.