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American Journal of Respiratory and... Oct 2019This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. A multidisciplinary panel...
Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America.
This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions. The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.
Topics: Adult; Ambulatory Care; Anti-Bacterial Agents; Antigens, Bacterial; Blood Culture; Chlamydophila Infections; Community-Acquired Infections; Culture Techniques; Drug Therapy, Combination; Haemophilus Infections; Hospitalization; Humans; Legionellosis; Macrolides; Moraxellaceae Infections; Pneumonia, Bacterial; Pneumonia, Mycoplasma; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Radiography, Thoracic; Severity of Illness Index; Sputum; United States; beta-Lactams
PubMed: 31573350
DOI: 10.1164/rccm.201908-1581ST -
Paediatric Respiratory Reviews Nov 2019To review epidemiology, aetiology and management of childhood pneumonia in low-and-middle-income countries. (Review)
Review
OBJECTIVES
To review epidemiology, aetiology and management of childhood pneumonia in low-and-middle-income countries.
DESIGN
Review of published English literature between 2013 and 2019.
RESULTS
Pneumonia remains a major cause of morbidity and mortality. Risk factors include young age, malnutrition, immunosuppression, tobacco smoke or air pollution exposure. Better methods for specimen collection and molecular diagnostics have improved microbiological diagnosis, indicating that pneumonia results from several organisms interacting. Induced sputum increases microbiologic yield for Bordetella pertussis or Mycobacterium tuberculosis, which has been associated with pneumonia in high TB prevalence areas. The proportion of cases due to Streptococcus pneumoniae and Haemophilus influenzae b has declined with new conjugate vaccines; Staphylococcus aureus and H. influenzae non-type b are the commonest bacterial pathogens; viruses are the most common pathogens. Effective interventions comprise antibiotics, oxygen and non-invasive ventilation. New vaccines have reduced severity and incidence of disease, but disparities exist in uptake.
CONCLUSION
Morbidity and mortality from childhood pneumonia has decreased but a considerable preventable burden remains. Widespread implementation of available, effective interventions and development of novel strategies are needed.
Topics: Age Factors; Air Pollution; Anti-Bacterial Agents; Child Nutrition Disorders; Child, Preschool; Developing Countries; Haemophilus Infections; Humans; Infant; Infant, Newborn; Noninvasive Ventilation; Oxygen Inhalation Therapy; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Risk Factors; Tobacco Smoke Pollution; Tuberculosis, Pulmonary; Vaccines; Whooping Cough
PubMed: 31422032
DOI: 10.1016/j.prrv.2019.06.001 -
Clinical Microbiology Reviews Jun 2021Haemophilus influenzae serotype b (Hib) was previously the most common cause of bacterial meningitis and an important etiologic agent of pneumonia in children aged... (Review)
Review
Haemophilus influenzae serotype b (Hib) was previously the most common cause of bacterial meningitis and an important etiologic agent of pneumonia in children aged <5 years. Its major virulence factor is the polyribosyl ribitol phosphate (PRP) polysaccharide capsule. In the 1980s, PRP-protein conjugate Hib vaccines were developed and are now included in almost all national immunization programs, achieving a sustained decline in invasive Hib infections. However, invasive Hib disease has not yet been eliminated in countries with low vaccine coverage, and sporadic outbreaks of Hib infection still occur occasionally in countries with high vaccine coverage. Over the past 2 decades, other capsulated serotypes have been recognized increasingly as causing invasive infections. H. influenzae serotype a (Hia) is now a major cause of invasive infection in Indigenous communities of North America, prompting a possible requirement for an Hia conjugate vaccine. H. influenzae serotypes e and f are now more common than serotype b in Europe. Significant year-to-year increases in nontypeable H. influenzae invasive infections have occurred in many regions of the world. Invasive H. influenzae infections are now seen predominantly in patients at the extremes of life and those with underlying comorbidities. This review provides a comprehensive and critical overview of the current global epidemiology of invasive H. influenzae infections in different geographic regions of the world. It discusses those now at risk of invasive Hib disease, describes the emergence of other severe invasive H. influenzae infections, and emphasizes the importance of long-term, comprehensive, clinical and microbiologic surveillance to monitor a vaccine's impact.
Topics: Child; Haemophilus Infections; Haemophilus Vaccines; Haemophilus influenzae type b; Humans; Infant; Serogroup; Vaccines, Conjugate
PubMed: 34076491
DOI: 10.1128/CMR.00028-21 -
The Lancet. Global Health Jul 2018Pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (Hib) vaccine are now used in most countries. To monitor global and regional progress towards...
Burden of Streptococcus pneumoniae and Haemophilus influenzae type b disease in children in the era of conjugate vaccines: global, regional, and national estimates for 2000-15.
BACKGROUND
Pneumococcal conjugate vaccine (PCV) and Haemophilus influenzae type b (Hib) vaccine are now used in most countries. To monitor global and regional progress towards improving child health and to inform national policies for disease prevention and treatment, we prepared global, regional, and national disease burden estimates for these pathogens in children from 2000 to 2015.
METHODS
Using WHO and Maternal and Child Epidemiology Estimation collaboration country-specific estimates of pneumonia and meningitis mortality and pneumonia morbidity from 2000 to 2015, we applied pneumococcal and Hib cause-specific proportions to estimate pathogen-specific deaths and cases. Summary estimates of the proportion of pneumonia deaths and cases attributable to these pathogens were derived from four Hib vaccine and six PCV efficacy and effectiveness study values. The proportion of meningitis deaths due to each pathogen was derived from bacterial meningitis aetiology and adjusted pathogen-specific meningitis case-fatality data. Pneumococcal and Hib meningitis cases were inferred from modelled pathogen-specific meningitis deaths and literature-derived case-fatality estimates. Cases of pneumococcal and Hib syndromes other than pneumonia and meningitis were estimated using the ratio of pathogen-specific non-pneumonia, non-meningitis cases to pathogen-specific meningitis cases from the literature. We accounted for annual HIV infection prevalence, access to care, and vaccine use.
FINDINGS
We estimated that there were 294 000 pneumococcal deaths (uncertainty range [UR] 192 000-366 000) and 29 500 Hib deaths (18 400-40 700) in HIV-uninfected children aged 1-59 months in 2015. An additional 23 300 deaths (15 300-28 700) associated with pneumococcus and fewer than 1000 deaths associated Hib were estimated to have occurred in children infected with HIV. We estimate that pneumococcal deaths declined by 51% (7-74) and Hib deaths by 90% (78-96) from 2000 to 2015. Most children who died of pneumococcus (81%) and Hib (76%) presented with pneumonia. Less conservative assumptions result in pneumococcccal death estimates that could be as high as 515 000 deaths (302 000-609 000) in 2015. Approximately 50% of all pneumococcal deaths in 2015 occurred in four countries in Africa and Asia: India (68 700 deaths, UR 44 600-86 100), Nigeria (49 000 deaths, 32 400-59 000), the Democratic Republic of the Congo (14 500 deaths, 9300-18 700), and Pakistan (14 400 deaths, 9700-17 000]). India (15 600 deaths, 9800-21 500), Nigeria (3600 deaths, 2200-5100), China (3400 deaths, 2300-4600), and South Sudan (1000 deaths, 600-1400) had the greatest number of Hib deaths in 2015. We estimated 3·7 million episodes (UR 2·7 million-4·3 million) of severe pneumococcus and 340 000 episodes (196 000-669 000) of severe Hib globally in children in 2015.
INTERPRETATION
The widespread use of Hib vaccine and the recent introduction of PCV in countries with high child mortality is associated with reductions in Hib and pneumococcal cases and deaths. Uncertainties in the burden of pneumococcal disease are largely driven by the fraction of pneumonia deaths attributable to pneumococcus. Progress towards further reducing the global burden of Hib and pneumococcal disease burden will depend on the efforts of a few large countries in Africa and Asia.
FUNDING
Bill & Melinda Gates Foundation.
Topics: Child, Preschool; Global Health; Haemophilus Infections; Haemophilus influenzae type b; Humans; Infant; Pneumococcal Infections; Streptococcus pneumoniae; Vaccines, Conjugate
PubMed: 29903376
DOI: 10.1016/S2214-109X(18)30247-X -
The Cochrane Database of Systematic... Jan 2015Diffuse panbronchiolitis (DPB) is a chronic airways disease predominantly affecting East Asians. Macrolides, a class of antibiotics, have been used as the main treatment... (Review)
Review
BACKGROUND
Diffuse panbronchiolitis (DPB) is a chronic airways disease predominantly affecting East Asians. Macrolides, a class of antibiotics, have been used as the main treatment for DPB, based on evidence from retrospective and non-randomised studies.
OBJECTIVES
To assess the efficacy and safety of macrolides for DPB.
SEARCH METHODS
We searched CENTRAL (2014, Issue 6), MEDLINE (1966 to July week 1, 2014), EMBASE (1974 to July 2014), Chinese Biomedical Literature Database (CBM) (1978 to July 2014), China National Knowledge Infrastructure (CNKI) (1974 to July 2014), KoreaMed (1997 to July 2014) and Database of Japana Centra Revuo Medicina (1983 to July 2014).
SELECTION CRITERIA
Randomised controlled trials (RCTs) or quasi-RCTs assessing the effect of macrolides for DPB.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed study quality and subsequent risk of bias according to The Cochrane Collaboration's tool for assessing risk of bias. The primary outcomes were five-year survival rate, lung function and clinical response. We used risk ratios (RR) for individual trial results in the data analysis and measured all outcomes with 95% confidence intervals (CI).
MAIN RESULTS
Only one RCT (19 participants) with significant methodological limitations was included in this review. It found that the computerised tomography images of all participants treated with a long-term, low-dose macrolide (erythromycin) improved from baseline, while the images of 71.4% of participants in the control group (with no treatment) worsened and 28.6% remained unchanged. Adverse effects were not reported. This review was previously published in 2010 and 2013. For this 2014 update, we identified no new trials for inclusion or exclusion.
AUTHORS' CONCLUSIONS
There is little evidence for macrolides in the treatment of DPB. We are therefore unable to make any new recommendations. It may be reasonable to use low-dose macrolides soon after diagnosis is made and to continue this treatment for at least six months, according to current guidelines.
Topics: Anti-Bacterial Agents; Bronchiolitis; Erythromycin; Haemophilus Infections; Humans; Macrolides; Randomized Controlled Trials as Topic; Tomography, X-Ray Computed
PubMed: 25618845
DOI: 10.1002/14651858.CD007716.pub4 -
Schweizer Archiv Fur Tierheilkunde Oct 2017
Topics: Animals; Haemophilus Infections; Haemophilus parasuis; Real-Time Polymerase Chain Reaction; Swine; Swine Diseases; Switzerland
PubMed: 28952962
DOI: 10.17236/sat00131 -
BMJ Case Reports Jul 2020typically causes illness and infection in the paediatric population. We report a case of a 53-year-old man who developed invasive non-typeable infection associated... (Review)
Review
typically causes illness and infection in the paediatric population. We report a case of a 53-year-old man who developed invasive non-typeable infection associated with purpura fulminans and multiorgan failure. On review of the literature, this is the first reported case of non-typeable causing purpura fulminans. The patient was treated with intravenous ceftriaxone 2 g/day and was eventually discharged from the hospital almost 2 months after admission. We discuss the role that infection/sepsis plays in disturbances to the coagulation cascade leading to purpura fulminans and the virulence factors that make non-typeable unique. Finally, we review other cases of associated with purpura fulminans and discuss the similarities with our case.
Topics: Haemophilus Infections; Haemophilus influenzae; Humans; Male; Middle Aged; Multiple Organ Failure; Purpura Fulminans
PubMed: 32641317
DOI: 10.1136/bcr-2020-234880 -
Clinical and Vaccine Immunology : CVI May 2015Infections due to nontypeable Haemophilus influenzae result in enormous global morbidity in two clinical settings: otitis media in children and respiratory tract... (Review)
Review
Infections due to nontypeable Haemophilus influenzae result in enormous global morbidity in two clinical settings: otitis media in children and respiratory tract infections in adults with chronic obstructive pulmonary disease (COPD). Recurrent otitis media affects up to 20% of children and results in hearing loss, delays in speech and language development and, in developing countries, chronic suppurative otitis media. Infections in people with COPD result in clinic and emergency room visits, hospital admissions, and respiratory failure. An effective vaccine would prevent morbidity, help control health care costs, and reduce antibiotic use, a major contributor to the global crisis in bacterial antibiotic resistance. The widespread use of the pneumococcal conjugate vaccines is causing a relative increase in H. influenzae otitis media. The partial protection against H. influenzae otitis media induced by the pneumococcal H. influenzae protein D conjugate vaccine represents a proof of principle of the feasibility of a vaccine for nontypeable H. influenzae. An ideal vaccine antigen should be conserved among strains, have abundant epitopes on the bacterial surface, be immunogenic, and induce protective immune responses. Several surface proteins of H. influenzae have been identified as potential vaccine candidates and are in various stages of development. With continued research, progress toward a broadly effective vaccine to prevent infections caused by nontypeable H. influenzae is expected over the next several years.
Topics: Adult; Child; Haemophilus Infections; Haemophilus Vaccines; Haemophilus influenzae; Humans; Otitis Media; Pneumococcal Vaccines; Pulmonary Disease, Chronic Obstructive; Respiratory Tract Infections; Vaccines, Conjugate
PubMed: 25787137
DOI: 10.1128/CVI.00089-15 -
Paediatric Respiratory Reviews Jan 2017Worldwide, pneumonia is the leading cause of death in infants and young children (aged <5 years). We provide an overview of the global pneumonia disease burden, as well... (Review)
Review
Worldwide, pneumonia is the leading cause of death in infants and young children (aged <5 years). We provide an overview of the global pneumonia disease burden, as well as the aetiology and management practices in different parts of the world, with a specific focus on the WHO Western Pacific Region. In 2011, the Western Pacific region had an estimated 0.11 pneumonia episodes per child-year with 61,900 pneumonia-related deaths in children less than 5 years of age. The majority (>75%) of pneumonia deaths occurred in six countries; Cambodia, China, Laos, Papua New Guinea, the Philippines and Viet Nam. Historically Streptococcus pneumoniae and Haemophilus influenzae were the commonest causes of severe pneumonia and pneumonia-related deaths in young children, but this is changing with the introduction of highly effective conjugate vaccines and socio-economic development. The relative contribution of viruses and atypical bacteria appear to be increasing and traditional case management approaches may require revision to accommodate increased uptake of conjugated vaccines in the Western Pacific region. Careful consideration should be given to risk reduction strategies, enhanced vaccination coverage, improved management of hypoxaemia and antibiotic stewardship.
Topics: Anti-Bacterial Agents; Asia, Southeastern; Child; Child, Preschool; Asia, Eastern; Global Health; Haemophilus Infections; Haemophilus Vaccines; Haemophilus influenzae; Humans; Hypoxia; Infant; Influenza Vaccines; Influenza, Human; Pneumococcal Vaccines; Pneumonia; Pneumonia, Mycoplasma; Pneumonia, Pneumococcal; Respiratory Syncytial Virus Infections; Streptococcus pneumoniae; Tuberculosis, Pulmonary; World Health Organization
PubMed: 27569107
DOI: 10.1016/j.prrv.2016.07.004 -
Viral Immunology Mar 2018Influenza virus infections remain a significant health burden worldwide, despite available vaccines. Factors that contribute to this include a lack of broad coverage by... (Review)
Review
Influenza virus infections remain a significant health burden worldwide, despite available vaccines. Factors that contribute to this include a lack of broad coverage by current vaccines and continual emergence of novel virus strains. Further complicating matters, when influenza viruses infect a host, severe infections can develop when bacterial pathogens invade. Secondary bacterial infections (SBIs) contribute to a significant proportion of influenza-related mortality, with Streptococcus pneumoniae, Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus influenzae as major coinfecting pathogens. Vaccines against bacterial pathogens can reduce coinfection incidence and severity, but few vaccines are available and those that are, may have decreased efficacy in influenza virus-infected hosts. While some studies indicate a benefit of vaccine-induced immunity in providing protection against SBIs, a comprehensive understanding is lacking. In this review, we discuss the current knowledge of viral and bacterial vaccine availability, the generation of protective immunity from these vaccines, and the effectiveness in limiting influenza-associated bacterial infections.
Topics: Bacterial Vaccines; Haemophilus Infections; Humans; Influenza, Human; Pneumonia, Bacterial; Staphylococcal Infections; Streptococcal Infections
PubMed: 29148920
DOI: 10.1089/vim.2017.0138