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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Most patients with community-acquired pneumonia are treated as out-patients with empirical therapy, since initially the etiologic agent is unknown. We prospectively assessed the etiologies and treatment outcomes of pneumonia from February 2003 to 2004 at ambulatory clinics. Forty-four patients were included with a mean age of 49.2 (SD 18.2) years. The male to female ratio was 1:1.4. The incubation period was 6.9 (SD 4.4) days. Half of the patients were healthy. Asthma and COPD were common in patients with underlying diseases. The etiologic diagnosis was determined by a sputum culture and a serology test of paired serum samples. Hemo-culture produced no growth in any patients. Atypical pathogens and H. influenzae were the most common finding, each occurring in 31.8% of the patients followed by S. pneumoniae and H. parainfluenzae (27.3% each). Twenty-two patients were infected with multiple pathogens. C. pneumoniae was the most common co-infecting pathogen. Two of 12 S. pneumoniae isolates were penicillin resistant. Nine of 14 H. influenzae isolates were cotrimoxazole resistant and 8 of 14 were not sensitive to erythromycin. For H. parainfluenzae, 11 of 12 isolates were not sensitive to erythromycin, and 7 of 12 were not sensitive to cotrimoxazole. Oral antibiotics were prescribed as out-patient treatment. Forty patients (90.9%) improved, with symptoms-score improvement averaging 6.4 days. Four patients got worse and needed a change of antibiotics, the symptoms usually worsen within 3-5 days. We conclude that, antibiotics for CAP out-patients should cover atypical pathogens, H. influenzae, S. pneumoniae and H. parainfluenzae. If the clinical symptoms do not respond after 3-5 days of out-patient treatment, resistance or an unusual organism (eg B. pseudomallei) should be considered.
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PMID:Etiologies and treatment outcomes for out-patients with community-acquired pneumonia (CAP) at Srinagarind Hospital, Khon Kaen, Thailand. 1643 55

To determine the impact of initial antimicrobial choice on 30-day mortality rate in patients with community-acquired pneumonia due to Streptococcus pneumoniae (CAP-SP), a prospective, observational study was conducted in 35 Spanish hospitals. A total of 638 patients with CAP-SP were identified. Antimicrobials were chosen by the attending physician. Patients were grouped into the following categories: beta-lactam monotherapy (n = 251), macrolide monotherapy (n = 37), beta-lactam plus macrolide (n = 198), levofloxacin alone/combination (n = 48), and other combinations (n = 104). The reference category was beta-lactam+macrolide. The 30-day survival probability was 84.9%. Using multivariate survival analysis, factors related to mortality in the entire population were: bilateral disease, suspected aspiration, shock, HIV infection, renal failure and pneumonia severity index (PSI) score Class IV versus I-III and categories V versus I-III. The association of beta-lactams+macrolides was not better than the use of beta-lactams alone. The current authors analysed the different groups of patients with significant mortality/morbidity: intensive care unit, PSI Class >III, renal failure, chronic lung disease and bacteraemia. Only in patients with PSI Class >III, who had undergone initial antimicrobial choice classified as other combinations, were associated with higher mortality. In conclusion, the current authors have not demonstrated an independent association between initial antimicrobial regimen and 30-day mortality in community-acquired pneumococcal pneumonia patients, except for those with a higher pneumonia severity index score.
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PMID:Impact of initial antibiotic choice on mortality from pneumococcal pneumonia. 1645 24

An outbreak of Pasteurella anatipestifer infection in young wild waterfowl at the Niska Waterfowl Research Center resulted in losses of approximately 100 Blue and Snow Geese, one White-fronted Goose, five Mandarin Ducks, one Black Duck and one Wood Duck. Clinical signs included diarrhea, paralysis and tremors. Gross lesions were fibrin deposits on serosal surfaces, hemorrhages on the epicardium, consolidation of the lungs, cloudy or flaky deposits on the air sacs, and dark, swollen spleens. Microscopic lesions included fibrinous meningitis, pneumonitis, air saculitis and serositis. Swollen leg and foot joints were seen in some cases. Chloramphenicol treatment seemed to be of benefit in controlling the outbreak.
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PMID:Pasteurella anatipestifer as a cause of mortality in captive wild waterfowl. 1651 47

20 children, diagnosed with scrub typhus who attended Chiang Rai Regional Hospital during a period of 6 months from June 2003 to December 2003, were studied prospectively. All cases were serologically proved to be scrub typhus by using Dipstick or indirect immunofluorescent antibody (IFA) technique. The most common clinical feature was eschar (75%). Others included hepatomegaly (65%), cough (60%), lymphadenopathy (40%), tachypnea (35%), constipation (25%), abdominal pain (20%), edema (20%), splenomegaly (15%), vomiting (15%), rash (15%) and petichia (5%) respectively. Chest radiography showed abnormalities in 85% with mostly bilateral interstitial infiltrations. Elevated of SGOT: SGPT were detected in 18 (90%) and 15 (75%) cases. Hypoalbuminemia was detected in 12 (60%) cases. Complete blood count showed PMN leukocytosis (> 60%) in 12 (60%) cases, lymphocytosis (> 40%) and atypical lymphocytosis (> 5%) in 1 (5%) case each and thrombocytopenia in 16 (80%) cases. The Weil-Felix test was positive in 1 (5%) case. Complications were pneumonia with or without pulmonary edema, meningitis and shock. Chloramphenicol and doxycycline were successfully treated and roxithromycin was not effective.
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PMID:Clinical study of 20 children with scrub typhus at Chiang Rai Regional Hospital. 1651 87

This study aimed to evaluate the relations between the levels of CRP, leukocyte count and ESR on admission and the severity of pneumonia according to the criteria of Turkish Thoracic Society (TTS) and British Thoracic Society (BTS) CAP guidelines. This study included the adult patients with CAP admitted to our clinic between the years 2003-2005. The history, physical findings, hemogram, ESR, the levels of CRP and the results of other laboratory investigations were obtained from the medical records. The patients were grouped according to BTS and TTS guidelines. The mean age was 47.2 years; 70 patients (75.3%) were male and 23 patients (24.7%) were female. The severity of pneumonia according to BTS criteria was correlated with the levels of CRP and leukocyte count (p= 0.037, p= 0.01, respectively). The severity of pneumonia according to TTS criteria was correlated with the levels of CRP, leukocyte count and ESR (p= 0.000, p= 0.014, p= 0.015, respectively). Among TTS pneumonia groups, there were statistically significant differences between groups 1 and 3; groups 1 and 4; groups 2 and 3 (p= 0.006, p= 0.041, p= 0.05, respectively) for mean CRP levels. The mean levels of CRP (103.2 +/- 76.4 mg/L), leukocyte count (19.8 +/- 9.5 x 10(3)/microL) and ESR (57.2 +/- 26.8 mm/hour) were statistically significantly higher in inpatients than the mean levels of CRP (53.2 +/- 52.8 mg/dL), leukocyte count (14.6 +/- 5.4 x 10(3)/microL) and ESR (43.1 +/- 25.9 mm/hour) in outpatients (p= 0.000, p= 0.001, p= 0.012, respectively) according to TTS. It is considered that CRP, a powerful marker of inflammation, is related with severity of pneumonia and a high level of CRP may be useful to make a decision about hospitalisation.
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PMID:[C-reactive protein, leukocyte count and ESR in the assessment of severity of community-acquired pneumonia]. 1661 14

A 43-year-old male patient was diagnosed with acute sinistral pleuropneumonia and a pronounced thoracic pain syndrome. Despite of his painful ailments the patient refused antibiotic treatment. A complementary therapy comprising physiotherapy, hydrotherapy, herbal therapy and vitamin C, cupping and QiGong was initiated. A cantharidin blister was applied topically to the left thorax in order to treat the pain syndrome. The multimodal CAM treatment resulted in a rapid clinical and x-ray resolution of pneumonia, and cantharidin treatment effectively relieved pain. The case and the potential of topical cantharidin in pain syndromes are discussed.
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PMID:[Complementary treatment of pneumonia with pleural effusion]. 1664 92

The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three nonzoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella. These atypical agents, unlike the typical pathogens, often cause extrapulmonary manifestations. Atypical CAPs are systemic infectious diseases with a pulmonary component and may be differentiated clinically from typical CAPs by the pattern of extrapulmonary organ involvement which is characteristic for each atypical CAP. Zoonotic pneumonias may be eliminated from diagnostic consideration with a negative contact history. The commonest clinical problem is to differentiate legionnaire's disease from typical CAP as well as from C. pneumoniae or M. pneumonia infection. Legionella is the most important atypical pathogen in terms of severity. It may be clinically differentiated from typical CAP and other atypical pathogens by the use of a weighted point system of syndromic diagnosis based on the characteristic pattern of extrapulmonary features. Because legionnaire's disease often presents as severe CAP, a presumptive diagnosis of Legionella should prompt specific testing and empirical anti-Legionella therapy such as the Winthrop-University Hospital Infectious Disease Division's weighted point score system. Most atypical pathogens are difficult or dangerous to isolate and a definitive laboratory diagnosis is usually based on indirect, i.e., direct flourescent antibody (DFA), indirect flourescent antibody (IFA). Atypical CAP is virtually always monomicrobial; increased IFA IgG tests indicate past exposure and not concurrent infection. Anti-Legionella antibiotics include macrolides, doxycycline, rifampin, quinolones, and telithromycin. The drugs with the highest level of anti-Legionella activity are quinolones and telithromycin. Therapy is usually continued for 2 weeks if potent anti-Legionella drugs are used. In adults, M. pneumoniae and C. pneumoniae may exacerbate or cause asthma. The importance of the atypical pneumonias is not related to their frequency (approximately 15% of CAPs), but to difficulties in their diagnosis, and their nonresponsiveness to beta-lactam therapy. Because of the potential role of C. pneumoniae in coronary artery disease and multiple sclerosis (MS), and the role of M. pneumoniae and C. pneumoniae in causing or exacerbating asthma, atypical CAPs also have public health importance.
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PMID:The atypical pneumonias: clinical diagnosis and importance. 1666 25

Calf-related drug use was studied on 104 randomly selected Holstein dairy farms in southwestern Ontario between October 1980 and July 1983. About 20% of dairy farmers were observed to administer antimicrobials preventively to healthy newborn calves (primarily as commercial "cocktails" of various antimicrobials, vitamins and minerals given in an oral bolus form) at some time during the year. About 30% of the farmers were observed to use vitamins (primarily vitamins A,D and E) preventively. The pattern of types of antimicrobials used preventively appeared to be different from the pattern seen for therapeutic use. Chloramphenicol was the single most commonly used therapeutic antimicrobial in this population of calves, accounting for some 30% of overall therapeutic antimicrobial use. In this study population, the prophylactic use of antimicrobials was associated with a decreased risk of being treated for pneumonia, and of dying, but an increased risk of being treated for scours. Case fatality rates for calves treated therapeutically varied, depending on the antimicrobial used and the routine of treatment. Calves treated with penicillin consistently suffered the highest case fatality rates. Case fatality rates for calves treated with chloramphenicol were considerably higher for calves treated once per day than for calves treated twice per day. For instance, calves first treated for scours with chloramphenicol, if treated once per day, suffered a case fatality rate of 22%. For scouring calves treated twice per day the case fatality rate was just under five percent. Clinical field trials of specific antimicrobials used preventively and therapeutically are required to delineate the conditions under which they might be useful.
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PMID:Calf-related Drug Use on Holstein Dairy Farms in Southwestern Ontario. 1742 8

Simkania negevensis, a recently found Chlamydia-like organism, has been associated with bronchiolitis and pneumonia in children. S. negevensis findings have been common also in healthy, non-symptomatic subjects. Antibodies to S. negevensis were measured by microimmunofluorescence in 174 frozen paired sera obtained from children with community acquired pneumonia in a population-based study. There was evidence of S. negevensis infection in 18 (10%) cases. All diagnoses were based on the presence of specific IgM antibodies. The numbers of S. negevensis cases increased from 2 (4%) at <24 months to 7 (15%) at > or = 10 y of age. 12 (67%) were mixed infections with viruses or other bacteria. 16 children (9%) had measurable IgG antibodies to S. negevensis, but significant rises were not found in any cases. Thus, S. negevensis may be a real, though rare, cause of CAP in children, occurring often in mixed infections with viruses and other bacteria.
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PMID:Simkania negevensis may be a true cause of community acquired pneumonia in children. 1785 31

Tracheal aspirates were collected from 176 hospitalized antibiotic-pretreated children with community-acquired pneumonia. Haemophilus influenzae and Streptococcus pneumoniae were detected by both culture and target-enriched multiplex (TEM)-PCR whereas Mycoplasma pneumoniae and Chlamydia pneumoniae were detected by TEM-PCR only. TEM-PCR detected more S. pneumoniae (32 vs. 7) and H. influenzae (29 vs. 23) than did culture. TEM-PCR detected an additional 26 M. pneumoniae and 1 C. pneumoniae. TEM-PCR significantly enhances the pathogen-specific diagnosis of CAP in children.
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PMID:Culture versus polymerase chain reaction for the etiologic diagnosis of community-acquired pneumonia in antibiotic-pretreated pediatric patients. 1903 66


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