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The Indian Journal of Medical Research Apr 2020Community-acquired pneumonia (CAP) is the prominent cause of mortality and morbidity with important clinical impact across the globe. India accounts for 23 per cent of... (Review)
Review
Community-acquired pneumonia (CAP) is the prominent cause of mortality and morbidity with important clinical impact across the globe. India accounts for 23 per cent of global pneumonia burden with case fatality rates between 14 and 30 per cent, and Streptococcus pneumoniae is considered a major bacterial aetiology. Emerging pathogens like Burkholderia pseudomallei is increasingly recognized as an important cause of CAP in Southeast Asian countries. Initial management in the primary care depends on clinical assessment while the hospitalized patients require combinations of clinical scores, chest radiography and various microbiological and biomarker assays. This comprehensive diagnostic approach together with additional sampling and molecular tests in selected high-risk patients should be practiced. Inappropriate therapy in CAP in hospitalized patients lengthens hospital stay and increases cost and mortality. In addition, emergence of multidrug-resistant organisms poses tough challenges in deciding empirical as well as definitive therapy. Developing local evidence on the cause and management should be a priority to improve health outcomes in CAP.
Topics: Adult; Anti-Bacterial Agents; Bacteria; Community-Acquired Infections; Humans; India; Pneumonia; Pneumonia, Bacterial; Streptococcus pneumoniae
PubMed: 32461392
DOI: 10.4103/ijmr.IJMR_1678_19 -
Clinical Microbiology and Infection :... Nov 2001Pneumonia is one of the commonest infections in elderly patients. The pathogens responsible for pneumonias in the elderly are the same as in younger adults. Because of... (Review)
Review
Pneumonia is one of the commonest infections in elderly patients. The pathogens responsible for pneumonias in the elderly are the same as in younger adults. Because of associated cardiopulmonary disease and/or impaired host defenses, pneumonia in elderly patients is associated with increased mortality and morbidity compared to younger patients. The clinical importance of pneumonias in the elderly relates to age-dependent and pathologic changes in the immune system as well as the lungs. Pneumonias in the elderly may be classified, for clinical purposes, according to their location of acquisition, i.e. community-acquired pneumonias, nursing home-acquired pneumonias, or hospital-acquired pneumonias. The clinical presentation of pneumonias in the elderly may be difficult, due to pre-existing cardiopulmonary disease that mimics pneumonia. This review discusses the diagnostic and therapeutic approaches to elderly patients with pneumonia.
Topics: Aged; Community-Acquired Infections; Cross Infection; Humans; Nursing Homes; Pneumonia
PubMed: 11737082
DOI: 10.1046/j.1198-743x.2001.00328.x -
The British Journal of Radiology Dec 2010Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at... (Review)
Review
Pneumonia is an acute inflammation of the lower respiratory tract. Lower respiratory tract infection is a major cause of mortality worldwide. Pneumonia is most common at the extremes of life. Predisposing factors in children include an under-developed immune system together with other factors, such as malnutrition and over-crowding. In adults, tobacco smoking is the single most important preventable risk factor. The commonest infecting organisms in children are respiratory viruses and Streptoccocus pneumoniae. In adults, pneumonia can be broadly classified, on the basis of chest radiographic appearance, into lobar pneumonia, bronchopneumonia and pneumonia producing an interstitial pattern. Lobar pneumonia is most commonly associated with community acquired pneumonia, bronchopneumonia with hospital acquired infection and an interstitial pattern with the so called atypical pneumonias, which can be caused by viruses or organisms such as Mycoplasma pneumoniae. Most cases of pneumonia can be managed with chest radiographs as the only form of imaging, but CT can detect pneumonia not visible on the chest radiograph and may be of value, particularly in the hospital setting. Complications of pneumonia include pleural effusion, empyema and lung abscess. The chest radiograph may initially indicate an effusion but ultrasound is more sensitive, allows characterisation in some cases and can guide catheter placement for drainage. CT can also be used to characterise and estimate the extent of pleural disease. Most lung abscesses respond to medical therapy, with surgery and image guided catheter drainage serving as options for those cases who do not respond.
Topics: Female; Humans; Immunocompromised Host; Lung; Male; Pneumonia; Radiography; Reproducibility of Results; Risk Factors; Streptococcus pneumoniae
PubMed: 21088086
DOI: 10.1259/bjr/31200593 -
Postgraduate Medicine Aug 2015Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated. Although it can be caused by... (Review)
Review
Community-acquired pneumonia is still a significant cause of morbidity and mortality and is often misdiagnosed and inappropriately treated. Although it can be caused by a wide variety of micro-organisms, the pneumococcus, atypicals, such as Mycoplasma pneumoniae and Chlamydophila pneumoniae, Staphylococcus aureus and certain Gram-negative rods are the usual pathogens encountered. The site-of-care decision is critical in determining the site and type of care as well as the extent of diagnostic workup. Antimicrobial therapy should be started as soon as possible particularly in those requiring admission to hospital, but typically the physician does not know with any degree of certainty the identity of the etiologic pathogen. A number of national guidelines have been published to help the physician with this choice. The initial drug(s) can be modified if necessary if the pathogen and its antimicrobial susceptibility pattern becomes known. Adjunctive therapy such as pressors and fluid replacement are of value and macrolides appear to help as well, likely secondary to their immunomodulatory effects. Recent data also suggest a role for steroids.
Topics: Anti-Bacterial Agents; Antiviral Agents; Community-Acquired Infections; Humans; Pneumonia
PubMed: 26224210
DOI: 10.1080/00325481.2015.1074030 -
Pharmacology & Therapeutics Jan 2021While the world is grappling with the consequences of a global pandemic related to SARS-CoV-2 causing severe pneumonia, available evidence points to bacterial infection... (Review)
Review
While the world is grappling with the consequences of a global pandemic related to SARS-CoV-2 causing severe pneumonia, available evidence points to bacterial infection with Streptococcus pneumoniae as the most common cause of severe community acquired pneumonia (SCAP). Rapid diagnostics and molecular testing have improved the identification of co-existent pathogens. However, mortality in patients admitted to ICU remains staggeringly high. The American Thoracic Society and Infectious Diseases Society of America have updated CAP guidelines to help streamline disease management. The common theme is use of timely, appropriate and adequate antibiotic coverage to decrease mortality and avoid drug resistance. Novel antibiotics have been studied for CAP and extend the choice of therapy, particularly for those who are intolerant of, or not responding to standard treatment, including those who harbor drug resistant pathogens. In this review, we focus on the risk factors, microbiology, site of care decisions and treatment of patients with SCAP.
Topics: Community-Acquired Infections; Disease Management; Drug Resistance, Multiple, Bacterial; Guidelines as Topic; Humans; Intensive Care Units; Pneumonia
PubMed: 32805298
DOI: 10.1016/j.pharmthera.2020.107663 -
American Family Physician Dec 2021In the United States, pneumonia is the most common cause of hospitalization in children. Even in hospitalized children, community-acquired pneumonia is most likely of... (Review)
Review
In the United States, pneumonia is the most common cause of hospitalization in children. Even in hospitalized children, community-acquired pneumonia is most likely of viral etiology, with respiratory syncytial virus being the most common pathogen, especially in children younger than two years. Typical presenting signs and symptoms include tachypnea, cough, fever, and anorexia. Findings most strongly associated with an infiltrate on chest radiography in children with clinically suspected pneumonia are grunting, history of fever, retractions, crackles, tachypnea, and the overall clinical impression. Chest radiography should be ordered if the diagnosis is uncertain, if patients have hypoxemia or significant respiratory distress, or if patients fail to show clinical improvement within 48 to 72 hours after initiation of antibiotic therapy. Outpatient management of community-acquired pneumonia is appropriate in patients without respiratory distress who can tolerate oral antibiotics. Amoxicillin is the first-line antibiotic with coverage for Streptococcus pneumoniae for school-aged children, and treatment should not exceed seven days. Patients requiring hospitalization and empiric parenteral therapy should be transitioned to oral antibiotics once they are clinically improving and able to tolerate oral intake. Childhood and maternal immunizations against S. pneumoniae, Haemophilus influenzae type b, Bordetella pertussis, and influenza virus are the key to prevention.
Topics: Community-Acquired Infections; Humans; Pediatrics; Pneumonia; United States
PubMed: 34913645
DOI: No ID Found -
Pediatric Radiology Oct 2017Pneumonia remains the leading cause of death in children outside the neonatal period, despite advances in prevention and management. Over the last 20 years, there has... (Review)
Review
Pneumonia remains the leading cause of death in children outside the neonatal period, despite advances in prevention and management. Over the last 20 years, there has been a substantial decrease in the incidence of childhood pneumonia and pneumonia-associated mortality. New conjugate vaccines against Haemophilus influenzae type b and Streptococcus pneumoniae have contributed to decreases in radiologic, clinical and complicated pneumonia cases and have reduced hospitalization and mortality. The importance of co-infections with multiple pathogens and the predominance of viral-associated disease are emerging. Better access to effective preventative and management strategies is needed in low- and middle-income countries, while new strategies are needed to address the residual burden of disease once these have been implemented.
Topics: Child; Community-Acquired Infections; Hospitalization; Humans; Incidence; Pneumococcal Vaccines; Pneumonia; Risk Factors
PubMed: 29043417
DOI: 10.1007/s00247-017-3827-8 -
Radiologic Clinics of North America Sep 2011Pneumonia is an infection of the lung parenchyma caused by a wide variety of organisms in pediatric patients. The role of imaging is to detect the presence of pneumonia,... (Review)
Review
Pneumonia is an infection of the lung parenchyma caused by a wide variety of organisms in pediatric patients. The role of imaging is to detect the presence of pneumonia, and determine its location and extent, exclude other thoracic causes of respiratory symptoms, and show complications such as effusion/empyema and suppurative lung changes. The overarching goal of this article is to review cause, role of imaging, imaging techniques, and the spectrum of acute and chronic pneumonias in children. Pneumonia in the neonate and immunocompromised host is also discussed.
Topics: Adolescent; Child; Child, Preschool; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Infant; Infant, Newborn; Lung; Male; Pneumonia; Tomography, X-Ray Computed; Ultrasonography
PubMed: 21889014
DOI: 10.1016/j.rcl.2011.06.007 -
Advances in Therapy Apr 2020Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for... (Review)
Review
Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for healthcare systems worldwide. Despite important advances in prevention through vaccines, new rapid diagnostic tests and antibiotics, CAP management still has significant drawbacks. Mortality remains very high in severely ill patients presenting with respiratory failure or shock but is also high in the elderly. Even after a CAP episode, higher risk of death remains during a long period, a risk mainly driven by inflammation and patient-related co-morbidities. CAP microbiology has been altered by new molecular diagnostic tests that have turned viruses into the most identified pathogens, notwithstanding uncertainties about the specific role of each virus in CAP pathogenesis. Pneumococcal vaccines also impacted CAP etiology and thus had changed Streptococcus pneumoniae circulating serotypes. Pathogens from specific regions should also be kept in mind when treating CAP. New antibiotics for CAP treatment were not tested in severely ill patients and focused on multidrug-resistant pathogens that are unrelated to CAP, limiting their general use and indications for intensive care unit (ICU) patients. Similarly, CAP management could be personalized through the use of adjunctive therapies that showed outcome improvements in particular patient groups. Although pneumococcal vaccination was only convincingly shown to reduce invasive pneumococcal disease, with a less significant effect in pneumococcal CAP, it remains the best therapeutic intervention to prevent bacterial CAP. Further research in CAP is needed to reduce its population impact and improve individual outcomes.
Topics: Age Factors; Aged; Anti-Bacterial Agents; Community-Acquired Infections; Female; Humans; Pneumococcal Infections; Pneumococcal Vaccines; Pneumonia; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Viral; Respiratory Insufficiency; Severity of Illness Index
PubMed: 32072494
DOI: 10.1007/s12325-020-01248-7 -
Lancet (London, England) Apr 2013Diarrhoea and pneumonia are the leading infectious causes of childhood morbidity and mortality. We comprehensively reviewed the epidemiology of childhood diarrhoea and... (Review)
Review
Diarrhoea and pneumonia are the leading infectious causes of childhood morbidity and mortality. We comprehensively reviewed the epidemiology of childhood diarrhoea and pneumonia in 2010-11 to inform the planning of integrated control programmes for both illnesses. We estimated that, in 2010, there were 1·731 billion episodes of diarrhoea (36 million of which progressed to severe episodes) and 120 million episodes of pneumonia (14 million of which progressed to severe episodes) in children younger than 5 years. We estimated that, in 2011, 700,000 episodes of diarrhoea and 1·3 million of pneumonia led to death. A high proportion of deaths occurs in the first 2 years of life in both diseases--72% for diarrhoea and 81% for pneumonia. The epidemiology of childhood diarrhoea and that of pneumonia overlap, which might be partly because of shared risk factors, such as undernutrition, suboptimum breastfeeding, and zinc deficiency. Rotavirus is the most common cause of vaccine-preventable severe diarrhoea (associated with 28% of cases), and Streptococcus pneumoniae (18·3%) of vaccine-preventable severe pneumonia. Morbidity and mortality from childhood pneumonia and diarrhoea are falling, but action is needed globally and at country level to accelerate the reduction.
Topics: Child; Diarrhea; Female; Global Health; Humans; Incidence; Malnutrition; Pneumonia; Risk Factors; Rotavirus Infections
PubMed: 23582727
DOI: 10.1016/S0140-6736(13)60222-6