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

Melioidosis, due to infection with the environmental organism Burkholderia pseudomallei, continues to be associated with high mortality despite improvements in antibiotic therapy. Using simple clinical findings and baseline laboratory tests available at the time of admission, we attempted to define those patients with acute melioidosis who were at higher risk of death. Using data, collected prospectively from the period October 1989 to June 2002, from patients with acute culture-confirmed melioidosis presenting at the Royal Darwin Hospital, Darwin, Australia, a number of variables were selected that were easily available at the time of admission and reflected organ dysfunction. Mortality was predicted in univariate logistic and multivariate models by the presence of pneumonia, age at diagnosis, serum urea, serum bilirubin, lymphocyte count, and serum bicarbonate. A score was assigned from 0 to 2, based on the degree of abnormality. A melioidosis score was formed from the sum of these scores, with a maximum score of 11. A score of < or = 3 (n = 140) was associated with a mortality of 8.6%, whereas a score of > or = 4 (n = 112) was associated with a mortality of 44.6%. Although this scoring system requires external validation, it may help identify a suitable target group of patients for intensive intervention such as early admission to an intensive care unit, the early use of meropenem, and goal-directed resuscitation therapies.
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PMID:A proposed scoring system for predicting mortality in melioidosis. 1530 31

The use of recombinant severe acute respiratory syndrome-coronavirus (SARS-CoV) nucleocapsid protein (N) enzyme-linked immunosorbent assay (ELISA)-based antibody and antigen tests for diagnosis of SARS-CoV infections have been widely reported. However, no recombinant SARS-CoV spike protein (S)-based ELISA is currently available. In this article, we describe the problems and solutions of setting up the recombinant SARS-CoV S-based ELISA for antibody detection. The SARS-CoV S-based immunoglobulin M (IgM) and IgG ELISAs were evaluated and compared with the corresponding N-based ELISA for serodiagnosis of SARS-CoV pneumonia, using sera from 148 healthy blood donors who donated blood 3 years ago as controls and 95 SARS-CoV pneumonia patients in Hong Kong. Results obtained by the recombinant S (rS)-based IgG ELISA using the regenerated S prepared by dialysis with decreasing concentrations of urea or direct addition of different coating buffers, followed by addition of different regeneration buffer, identified 4 M urea and 1 M sarcosine for plate coating and no regeneration buffer as the most optimal conditions for antibody detection. The specificities of the S-based ELISA for IgG and IgM detection were 98.6% and 93.9%, with corresponding sensitivities of 58.9% and 74.7%, respectively. The sensitivity of the rN IgG ELISA (94.7%) is significantly higher than that of the rS IgG ELISA (P < 0.001), whereas the sensitivity of the rS IgM ELISA is significantly higher than that of the rN IgM ELISA (55.2%) (P < 0.01). An ELISA for detection of IgM against S and N could be more sensitive than one that detects IgM against N alone for serodiagnosis of SARS-CoV pneumonia.
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PMID:Differential sensitivities of severe acute respiratory syndrome (SARS) coronavirus spike polypeptide enzyme-linked immunosorbent assay (ELISA) and SARS coronavirus nucleocapsid protein ELISA for serodiagnosis of SARS coronavirus pneumonia. 1600 Apr 15

A limited field study of covered facilities used for raising dairy calves suggested that respiratory disorders and death rates were highest when calves were continuously housed on bedding composed of wood shavings, where ventilation was poor and where automatic feeders were installed. High concentrations of ammonia were found in the urine-soaked bedding following overnight incubation. A prolific growth of mixed micro-organisms isolated from the shavings rapidly colonised plates of selective urea medium. Death rates of 10% and 13.5% were observed on two properties. Respiratory distress was common and lung disease was intractable to treatment on these farms. A histopathological diagnosis of subacute purulent pneumonia with distal necrotising bronchiolitis was made, similar to lung lesions produced experimentally in cats, guinea pigs and rabbits exposed to ammonia gas.
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PMID:Some preliminary observations on the possible relationship between ammonia production from soiled bedding in calf rearing sheds and calf illness. 1603 1

The Dutch Working Party on Antibiotic Policy (SWAB) has revised the 1998 guideline for community-acquired pneumonia (CAP) in light of changing resistance patterns for common pathogens and new developments in epidemiology, diagnostic testing and treatment strategies. The current guideline is applicable to both primary and inpatient care, and has been developed by delegates of all professional organisations involved in the treatment of CAP, following recommendations for evidence-based guideline development. Assessment of a patient's 'severity of illness' at presentation is considered important when choosing an optimal empirical antibiotic regimen for CAP. Severely-ill patients should be treated with antibiotics covering the most important expected pathogens, including Legionella. Assessment of the severity of illness may be facilitated by the use of validated scoring systems like the pneumonia severity index and the 'confusion, urea, respiratory-rate, blood-pressure, 65-years-of-age' (CURB-65) score. Patients can also be stratified based on their location during treatment: in the community, a normal ward or an intensive-care unit. Legionella urine antigen testing is considered an important tool in the process of deciding on an optimal antibiotic regimen for CAP. Empirical therapy should be replaced with pathogen-directed therapy if the causative agent is identified.
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PMID:[Optimizing the antibiotics policy in The Netherlands. VIII. Revised SWAB guidelines for antimicrobial therapy in adults with community-acquired pneumonia]. 1655 54

The CURB-65 score (Confusion, Urea > 7 mmol x L(-1), Respiratory rate > or = 30 x min(-1), low Blood pressure, and age > or = 65 yrs) has been proposed as a tool for augmenting clinical judgement for stratifying patients with community-acquired pneumonia (CAP) into different management groups. The six-point CURB-65 score was retrospectively applied in a prospective, consecutive cohort of adult patients with a diagnosis of CAP seen in the emergency department of a 400-bed teaching hospital from March 1, 2000 to February 29, 2004. A total of 1,100 inpatients and 676 outpatients were included. The 30-day mortality rate in the entire cohort increased directly with increasing CURB-65 score: 0, 1.1, 7.6, 21, 41.9 and 60% for CURB-65 scores of 0, 1, 2, 3, 4, and 5, respectively. The score was also significantly associated with the need for mechanical ventilation and rate of hospital admission in the entire cohort, and with duration of hospital stay among inpatients. The CURB-65 score (Confusion, Urea > 7 mmol x L(-1), Respiratory rate > or = 30 x min(-1), low Blood pressure, and age > or = 65 yrs), and a simpler CRB-65 score that omits the blood urea measurement, helps classify patients with community-acquired pneumonia into different groups according to the mortality risk and significantly correlates with community-acquired pneumonia management key points. The new score can also be used as a severity adjustment measure.
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PMID:Validation of a predictive rule for the management of community-acquired pneumonia. 1677 96

Streptococcus pneumoniae is an important human pathogen causing life-threatening invasive diseases such as pneumonia, meningitis and bacteraemia. Despite major advances in our understanding of pneumococcal mechanisms of pathogenicity obtained through genomic studies very little has been achieved on the characterisation of the proteome of this pathogen. The highly complex structure of its cell envelope particularly amongst the various capsular forms enables the cell to resist lysis by conventional mechanical methods. It is therefore highly desirable to develop a cellular lysis and protein solubilisation procedure that minimises protein losses and allows for maximum possible coverage of the proteome of S. pneumoniae. Here we have utilised various combinations of mechanical or enzymatic cell lysis with two protein solubilisation mixtures urea/CHAPS-based mixture or SDS/DTT-based mixture in order to achieve best quality protein profiles using two proteomic technologies surface-enhanced laser desorption ionisation (SELDI) TOF MS and 2-DE. While urea/CHAPS-based mixture combined with freeze/thawing provided enough material for good-quality SELDI TOF MS fingerprints, a combination of mechanical, enzymatic and chemical lysis was needed to be used to successfully extract the desired protein content for 2-DE analysis. The methods chosen were also assessed for reproducibility and tested on various capsular types of S. pneumoniae. As a result, good-quality and reproducible profiles were created using various ProteinChip arrays and more than 800 protein spots were separated on a single 2-D gel of S. pneumoniae. Twenty-five of the most abundant protein spots were identified using LC/MS/MS to create a reference map of S. pneumoniae. The proteins identified included glycolytic enzymes such as glyceraldehyde 3-phosphate dehydrogenase, phosphoglycerate kinase, enolase etc. Several fermentation enzymes were also present including two of the components of the arginine deiminase system. Proteins involved in protein synthesis, such as translation factors and ribosomal proteins, as well as several chaperone proteins were also identified.
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PMID:Comparison of extraction procedures for proteome analysis of Streptococcus pneumoniae and a basic reference map. 1667 39

The aim of this study was to evaluate the accuracy of three score systems: the pneumonia severity index (PSI); CURB-65 (confusion; urea >7 mM; respiratory rate > or =30 breaths x min(-1); blood pressure <90 mmHg systolic or < or =60 mmHg diastolic; aged > or =65 yrs old); and modified American Thoracic Society rule for predicting intensive care unit (ICU) need and mortality due to bacteraemic pneumococcal pneumonia. All adult patients (n = 114) with invasive pneumococcal pneumonia at the Karolinska University Hospital, Sweden, 1999-2000, were included in the study. Severity scores were calculated and the independent prognostic importance of different variables was analysed by multiple regression analyses. PSI > or = IV, CURB-65 > or = 2, and the presence of one major or more than one minor risk factor in mATS all had a high sensitivity, but somewhat lower specificity for predicting death and ICU need. The death rate was 12% (13 out of 114). Severity score and treatment in departments other than the Dept of Infectious Diseases were the only factors independently correlated to death. Patients treated in other departments more often had severe underlying illnesses and were more severely ill on admission. However, a significant difference in death rates remained after adjustment for severity between the two groups. In conclusion, all score systems were useful for predicting the need for intensive care unit treatment and death due to bacteremic pneumococcal pneumonia. The pneumonia severity index was the most sensitive, but CURB-65 was easier to use.
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PMID:Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia. 1673 83

A man in his late twenties collapsed shortly after intravenously injecting himself with methamphetamine (MA). He slipped into a deep coma and remained in this condition for 9 days, until his death. Autopsy revealed severe brain edema and localized subarachnoid hemorrhages in the cerebrum and cerebellum. Histopathological examination revealed myocardial necrosis in the left ventricle, rhabdomyolysis and bronchopneumonia. Blood derived from the cadaver was found to have high levels of blood urea nitrogen and creatinine, suggesting he experienced acute renal failure probably due to rhabdomyolysis. Most of the postmortem findings were consistent with MA poisoning. The patient's bronchopneumonia may have represented a hypostatic pneumonia that developed as a result of his deep coma. While the patient's brain edema, myocardial necrosis and rhabdomyolysis were diagnosed soon after admission, his bronchopneumonia and acute renal failure only occurred 6 and 8 days later, respectively. Although MA was not detected in the cadaver's blood, urine or liver, analysis of the decedent's hair using gas chromatography-mass spectrometry confirmed its presence at a concentration of 1.1 ng/mg. Based on these findings, we concluded that the patient's cause of death was multiorganopathy resulting from MA poisoning. This case suggests that the postmortem diagnosis of MA poisoning in patients who survive for relatively longer periods after drug injection should include toxicological hair analysis in combination with histopathological and postmortem physiochemical examination.
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PMID:Toxicological and histopathological analysis of a patient who died nine days after a single intravenous dose of methamphetamine: a case report. 1679 14

The aim of this prospective study was to determine the efficacy and safety of levofloxacin in the treatment of community-aquired pneumonia (CAP) in outpatient with ineffective antibiotic management, requiring hospitalization. The examined group included 25 patients (11 M, 14 F) of mean age 70+/-17,5 years with abnormalities in X-ray on admission to hospital. Risk factors for pneumonia and previous antibacterial therapy were analyzed. In the hospital they were treated for 7 days with levofloxacin 500 mg twice a day administred intravenously. Body temperature, blood cell count, ESR, CRP, AST, ALT, LDH, CPK, creatine, urea, potassium, sodium, ABG, and ECG were measured on admission and in the 3-rd and 7- th day of therapy. The chest X-rays were performed and analyzed on hospital discharge. 18 patients were aged > 65 yrs, cardiovascular diseases co-existed in 14, COPD in 9, smoking habit in 12, renal failure in 3, diabetes in 3 and alkohol addiction in 1 cases. On admission 4 patients had respiratory failure, 10 hypoxaemia. During therapy a decrease of body temperature (p<0,001), concentration of CRP (p<0,004) and LDH (p<0,03), CPK (p<0,04) and increase of PaO2 (p<0,012) were observed. The changes of other parameters were not statistically significant. We did not observe any changes in ECG. On discharge from the hospital in 16 patients complete regression and in 6 patients partial regression of lesions in chest X-ray examination were observed. In 3 patients levofloxacin therapy was noneffective: in 2 because of persistent high body temperature after 3 days of treatment and in 1 patients because of recurrent of fever. Adverse events were mild. Transient exacerbation of renal failure was observed in 3 patients. Our study demonstrates that levofloxacine ni dose 2x500 mg given intravenously for 7 days is effective and safe in treatment of CAP in patients with previously ineffective antibacterial therapy.
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PMID:[Efficacy and safety of levofloxacin treatment of community--acquired pneumonia in hospitalized patients]. 1717 82

We investigated whether hyponatremia is a risk factor of death in patients hospitalized with community-acquired pneumonia (CAP) and estimated the relative risk of death by CAP of other risk factors. The design was prospective multicentre cohort study. In 5 centers in Buenos Aires, Argentina, we studied adults hospitalized with CAP between March 21, 2000 and December 21, 2000. Using stepwise logistic regression, we analyzed risk factors that showed a univariate association with mortality; alpha significance level was 0.05. During a 9-month period, 238 patients were admitted with CAP: 150 (63%) male and 88 (36%) female, mean age 52.99 (+/-20.35) and 55.06 (+/-20.94), respectively. Mortality was 10.5% (25/238). By multivariate analysis, the following variables were statistically associated with evolution: cerebrovascular disease (CD) (B: 2.614, p < 0.001, RRE: 13.6, IC 95%: 3.7-49.6); hyponatremia at admission or during hospitalization (B: 1.994, p<0.001, RRE: 7.3, IC 95%: 2.5-20.8); and elevated blood urea (B: 0.016, p= 0.003, RRE: 1.016, IC 95%: 1.005-1.02). We developed a formula to predict mortality by CAP: P (death) = 1/1 + exp - (-4.03 + 2.61 x l + 1.99 x 2 + 0.016x3), where: x1=CD (yes = 1/ no=0); x2= hyponatremia (yes = 1/ no=0); x3 = blood urea (mg/dl). The predictability was 91.1%. The mortality risk by CAP was statistically higher in patients with CD, hyponatremia and elevated blood urea.
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PMID:[Hyponatremia as a risk factor of death in patients with community-acquired pneumonia requiring hospitalization]. 1724 Jun 20


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