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The Lancet. Microbe Oct 2023
Topics: Humans; Mycoplasma pneumoniae; Pneumonia, Mycoplasma
PubMed: 37393927
DOI: 10.1016/S2666-5247(23)00182-9 -
Clinics in Chest Medicine Jun 2013The incidence, mortality, and epidemiology of human immunodeficiency virus (HIV)-associated pulmonary infections have changed as a result of effective antiretroviral and... (Review)
Review
The incidence, mortality, and epidemiology of human immunodeficiency virus (HIV)-associated pulmonary infections have changed as a result of effective antiretroviral and prophylaxis antimicrobial therapy. The clinical presentation, radiographic abnormalities, and treatment of pneumonia from various uncommon pathogens in patients with AIDS can be different from those in immunocompetent patients. Advances in invasive and noninvasive testing and molecular biological techniques have improved the diagnosis and prognosis of pulmonary infections in patients infected with HIV. This review focuses on pulmonary infections from nontuberculosis mycobacteria, cytomegalovirus, fungi (aspergillosis, cryptococcosis, endemic fungi), and parasites (toxoplasmosis), and uncommon bacterial pneumonia (nocardiosis, rhodococcosis) in these patients.
Topics: AIDS-Related Opportunistic Infections; Anti-Infective Agents; Diagnosis, Differential; HIV Infections; Humans; Incidence; Lung; Nocardia Infections; Pneumonia; Radiography
PubMed: 23702174
DOI: 10.1016/j.ccm.2013.01.007 -
Respirology (Carlton, Vic.) Jan 2018Pneumonia in the tropics poses a heavy disease burden. The complex interplay of climate change, human migration influences and socio-economic factors lead to changing... (Review)
Review
Pneumonia in the tropics poses a heavy disease burden. The complex interplay of climate change, human migration influences and socio-economic factors lead to changing patterns of respiratory infections in tropical climate but also increasingly in temperate countries. Tropical and poorer countries, especially South East Asia, also bear the brunt of the global tuberculosis (TB) pandemic, accounting for almost one-third of the burden. But, as human migration patterns evolve, we expect to see more TB cases in higher income as well as temperate countries, and rise in infections like scrub typhus from ecotourism activities. Fuelled by the ease of air travel, novel zoonotic infections originating from the tropics have led to global respiratory pandemics. As such, clinicians worldwide should be aware of these new conditions as well as classical tropical bacterial pneumonias such as melioidosis. Rarer entities such as co-infections of leptospirosis and chikungunya or dengue will need careful consideration as well. In this review, we highlight aetiologies of pneumonia seen more commonly in the tropics compared with temperate regions, their disease burden, variable clinical presentations as well as impact on healthcare delivery.
Topics: Climate Change; Humans; Lung Diseases, Parasitic; Pneumonia, Bacterial; Pneumonia, Viral; Tropical Climate
PubMed: 28763150
DOI: 10.1111/resp.13137 -
Pediatric Clinics of North America Feb 2016Pneumonia and diarrhea are the 2 leading infectious causes of death in children younger than 5 years worldwide, most of which occur in low- and middle-income countries... (Review)
Review
Pneumonia and diarrhea are the 2 leading infectious causes of death in children younger than 5 years worldwide, most of which occur in low- and middle-income countries (LMICs) in sub-Saharan Africa and Southern Asia. The past decade has seen large reductions in global childhood mortality, partly due to expansion of nonspecific public health interventions and vaccines against Streptococcus pneumoniae, Haemophilus influenzae, and rotavirus in LMICs. Further progress in this field depends on the international community's commitment to fund and implement programs using currently available vaccines and development of new vaccines against pathogens common to children in LMICs.
Topics: Bacterial Vaccines; Child, Preschool; Diarrhea; Health Promotion; Humans; Infant; Pneumonia; Public Health; Viral Vaccines; World Health Organization
PubMed: 26613689
DOI: 10.1016/j.pcl.2015.08.003 -
Infection Feb 2022Pneumonia remains one of the most frequent death causes worldwide. Among the etiological factors S. pneumoniae-causing lobar pneumonia plays a leading role. According to...
BACKGROUND AND AIM
Pneumonia remains one of the most frequent death causes worldwide. Among the etiological factors S. pneumoniae-causing lobar pneumonia plays a leading role. According to current textbook knowledge at least three sequential stages of lobar pneumonia are distinguished: congestion, red hepatization and gray hepatization. However, there are no detailed data supporting this stage concept. There are also controversial views on its etiology. In this study, the lung changes in lobar pneumonia were related to the cause and duration of the disease. In addition, the complications of the disease were evaluated. PCR studies verified the etiology of pneumonia.
MATERIAL AND METHODS
Lobar pneumonia was analyzed in 252 post mortem cases examined in a large hospital in Irkutsk. The pathology, etiology of pneumonia, course of disease and cause of death were recorded and correlated to its clinical course and duration. In the second part of the study, the results in 95 patients were analyzed in detail and related to PCR findings.
RESULTS
Most patients were adult men of low social status who showed signs of severe alcoholism. Lobar pneumonia was observed in 85% of the patients, while the remaining patients showed sublobar ("lobular", focal) lung involvement. Histologically, three patterns of inflammation were observed, which in most patients occurred concurrently in different parts of the involved lobe: "congestion", characterized by serous exudation with multiple cocci (41% of cases), "red hepatization" (41% of cases) and "gray hepatization" (100% of cases). The latter pattern was subdivided into three subgroups according to the ratio of fibrin-neutrophils and the presence of macrophages. The mean number of different histological patterns observed per patient was 3.8. There was no correlation between the inflammatory patterns and the duration of the disease. In 23% of the patients, the cause of death was of pulmonary origin, while the remaining patients died of extrapulmonary complications (i.e. acute heart failure 26%, acute vascular insufficiency 15% purulent meningitis 11-24.3%. In 29/95 patients (20 with lobar and 9 with focal pneumonia) pneumococcal etiology of pneumonia was established by PCR.
CONCLUSION
Lobar pneumonia is a distinct clinico-pathological entity caused by S. pneumoniae, demonstrated by PCR testing and/or cytological examinations. Bacteriologic studies frequently give falsenegative results. Lobar pneumonia is characterized by three main histopathological patterns (congestion or microbeous edema, and red and gray hepatization) which usually occur side by side and not in chronological order. Early death is often related to heart failure and septic shock, while meningitis is a frequent complication later in the course.
Topics: Humans; Leukocyte Count; Lung; Male; Pneumonia; Pneumonia, Pneumococcal; Streptococcus pneumoniae; Thorax
PubMed: 34472009
DOI: 10.1007/s15010-021-01689-4 -
Clinics in Chest Medicine Mar 2017Secondary bacterial pneumonia after viral respiratory infection remains a significant source of morbidity and mortality. Susceptibility is mediated by a variety of viral... (Review)
Review
Secondary bacterial pneumonia after viral respiratory infection remains a significant source of morbidity and mortality. Susceptibility is mediated by a variety of viral and bacterial factors, and complex interactions with the host immune system. Prevention and treatment strategies are limited to influenza vaccination and antibiotics/antivirals respectively. Novel approaches to identifying the individuals with influenza who are at increased risk for secondary bacterial pneumonias are urgently needed. Given the threat of further pandemics and the heightened prevalence of these viruses, more research into the immunologic mechanisms of this disease is warranted with the hope of discovering new potential therapies.
Topics: Humans; Immunity, Innate; Influenza, Human; Pneumonia, Bacterial
PubMed: 28159155
DOI: 10.1016/j.ccm.2016.11.006 -
Stroke Jan 2022The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its...
BACKGROUND AND PURPOSE
The occurrence of pneumonia after stroke is associated with a higher risk of poor outcome or death. We assessed the temporal profile of pneumonia after stroke and its association with poor outcome at several time points to identify the most optimal period for testing pneumonia prevention strategies.
METHODS
We analyzed individual patient data stored in the VISTA (Virtual International Stroke Trials Archive) from randomized acute stroke trials with an inclusion window up to 24 hours after stroke onset and assessed the occurrence of pneumonia in the first 90 days after stroke. Adjusted odds ratios and hazard ratios were calculated for the association between pneumonia and poor outcome and death by means of logistic and Cox proportional hazard regression, respectively, at different times of follow-up.
RESULTS
Of 10 821 patients, 1017 (9.4%) had a total of 1076 pneumonias. Six hundred eighty-nine (64.0%) pneumonias occurred in the first week after stroke. The peak incidence was on the third day and the median time of onset was 4.0 days after stroke (interquartile range, 2-12). The presence of a pneumonia was associated with an increased risk of poor outcome (adjusted odds ratio, 4.8 [95% CI, 3.8-6.1]) or death (adjusted hazard ratio, 4.1 [95% CI, 3.7-4.6]). These associations were present throughout the 90 days of follow-up.
CONCLUSIONS
Two out of 3 pneumonias in the first 3 months after stroke occur in the first week, with a peak incidence on the third day. The most optimal period to assess pneumonia prevention strategies is the first 4 days after stroke. However, pneumonia occurring later was also associated with poor functional outcome or death.
Topics: Aged; Aged, 80 and over; Brain Ischemia; Databases, Factual; Female; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Retrospective Studies; Stroke; Time Factors
PubMed: 34517764
DOI: 10.1161/STROKEAHA.120.032787 -
BMJ Case Reports Apr 2021A 9-year-old boy presented to the emergency department of a paediatric hospital with non-painful lesions on his lips and inside his mouth, associated with lip swelling....
A 9-year-old boy presented to the emergency department of a paediatric hospital with non-painful lesions on his lips and inside his mouth, associated with lip swelling. On examination, his oral mucosa and lips showed numerous blisters with yellowish serofibrinous content and lip oedema. An eye examination revealed bilateral conjunctival injection. Genitalia was unaffected and no other skin lesions were found. He was on day 4 of clarithromycin prescribed for atypical pneumonia caused by The patient was diagnosed with -associated mucositis and was started on topical treatment with fusidic acid and betamethasone, with gradual improvement of the oral lesions.
Topics: Child; Clarithromycin; Humans; Male; Mouth Mucosa; Mucositis; Mycoplasma pneumoniae; Pneumonia, Mycoplasma
PubMed: 33858884
DOI: 10.1136/bcr-2020-239086 -
Respirology (Carlton, Vic.) May 2009Among the HIV-associated pulmonary complications, opportunistic pneumonias are major causes of morbidity and mortality. The spectrum of HIV-associated opportunistic... (Review)
Review
Among the HIV-associated pulmonary complications, opportunistic pneumonias are major causes of morbidity and mortality. The spectrum of HIV-associated opportunistic pneumonias is broad and includes bacterial, mycobacterial, fungal, viral and parasitic pneumonias. Bacterial pneumonia is the most frequent opportunistic pneumonia in the United States and Western Europe while tuberculosis is the dominant pathogen in sub-Saharan Africa. With the use of combination antiretroviral therapy and prophylaxis, the incidence of Pneumocystis pneumonia (PCP) has declined. Nevertheless, PCP continues to occur in persons who are unaware of their HIV infection, those who fail to access medical care, and those who fail to adhere to antiretroviral therapy or prophylaxis. Although pneumonias due to Cryptococcus neoformans, Histoplasma capsulatum, Coccidioides immitis, cytomegalovirus and Toxoplasma gondii are less frequent, their presence in the lung is often indicative of disseminated disease and is associated with significant mortality.
Topics: AIDS-Related Opportunistic Infections; Humans; Lung Diseases, Fungal; Pneumonia
PubMed: 19645867
DOI: 10.1111/j.1440-1843.2009.01534.x -
The Pediatric Infectious Disease Journal Dec 2023To identify the difference in clinical characteristics between viral pneumonia and Mycoplasma pneumoniae , providing cues on their differential diagnosis for primary...
Differentiate Clinical Characteristics Between Viral Pneumonia and Mycoplasma pneumoniae and Nomograms for Predicting Mycoplasma pneumoniae : A Retrospective Study in Primary Hospitals.
OBJECTIVE
To identify the difference in clinical characteristics between viral pneumonia and Mycoplasma pneumoniae , providing cues on their differential diagnosis for primary hospitals with the insufficient pathogen detection capacity.
METHODS
We retrospectively reviewed the medical records of hospitalized children with acute respiratory tract infections, and pathogenic microbes test results were analyzed. Clinical characteristics, routine blood parameters and hospitalization duration and fee were compared between M. pneumoniae and viral pneumonia. We used in the multivariable logistic regression to predict the probability of children with M. pneumoniae and graphically represented by a dynamic nomogram. The discrimination and clinical utility of the model were confirmed by receiver operating characteristic and decision curve analysis curves.
RESULT
A total of 375 children with community-acquired pneumonia were included. Mycoplasma infection accounted for the largest proportion (22.13%). The incidence of both hypothermia and vomiting was lower in M. pneumoniae compared to viral pneumonia (hypothermia: 10.50% vs. 0.00%; vomiting: 7.90% vs. 0.00%). The prevalence of hyperthermia was higher in M. pneumoniae (hyperthermia: 89.5% vs. 100%). Procalcitonin, peripheral blood white blood cell count and lymphocyte levels were higher in the viral pneumonia group, and eosinophil levels were conversely lower. As for the duration of illness, the mean length of stay was 5.20 ± 2.12 (viral pneumonia) and 6.27 ± 2.48 days ( M. pneumoniae ). Children with M. pneumoniae had higher overall hospital costs and required more medical treatment. The above were all statistically significant with a P < 0.05. The scoring system was established based on the above results. Receiver operating characteristic curves showed good model-discrimination ability with 0.844 of the area under the curve in the training set and 0.778 in the test set. Decision curve analysis curves demonstrated the discriminative superiority of this model. The web-based dynamic nomogram calculator is accessible at https://zhxylxy0160128.shinyapps.io/Nomogram/ .
CONCLUSION
Nomograms have satisfactory discrimination, and clinical utility may benefit in predicting the probability of developing M. pneumoniae in children. Children with M. pneumoniae have a higher burden than those with viral pneumonia and may require more intensive in-hospital monitoring.
Topics: Child; Humans; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Retrospective Studies; Nomograms; Hypothermia; Pneumonia, Viral; Hospitals; Vomiting; Community-Acquired Infections
PubMed: 37820276
DOI: 10.1097/INF.0000000000004082