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Sample records for pneumonia

  1. Pneumonia

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Pneumonia KidsHealth > For Teens > Pneumonia Print A A A ... having to go to the hospital. What Is Pneumonia? Pneumonia (pronounced: noo-MOW-nyuh) is an infection ...

  2. Pneumonia

    MedlinePlus

    ... en español Neumonía You're out in the rain, jumping around in puddles, and somebody yells, "Get ... you really catch it from playing in the rain? What Is Pneumonia? Pneumonia (say: noo-MOW-nyuh) ...

  3. Pneumonia

    MedlinePlus

    ... better than treating it. Vaccines are available to prevent pneumococcal pneumonia and the flu. Other preventive measures include washing your hands frequently and not smoking. NIH: National Heart, Lung, and Blood Institute

  4. Aspiration pneumonia

    MedlinePlus

    Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis ... The type of bacteria that caused the pneumonia depends on: Your ... facility, for example) Whether you were recently hospitalized ...

  5. Pneumonia (image)

    MedlinePlus

    Pneumonia is an inflammation of the lungs caused by an infection. Many different organisms can cause it, including bacteria, viruses, and fungi. Pneumonia is a common illness that affects millions of ...

  6. Viral pneumonia

    MedlinePlus

    ... Names Pneumonia - viral; "Walking pneumonia" - viral Images Lungs Respiratory system References Lee FE, Treanor J. Viral infections. In: Mason RJ, VC Broaddus, Martin TR, et al, eds. Murray and Nadel’s Textbook of Respiratory Medicine . 5th ed. Philadelphia, PA: Saunders Elsevier; 2010: ...

  7. Viral pneumonia.

    PubMed

    Greenberg, S B

    1991-09-01

    Viral pneumonias are common in infants and young children but rare in adults. Respiratory syncytial virus (RSV) and para-influenza viruses are the most frequent viral pathogens in infants and children. Influenza virus types A and B account for over one half of viral pneumonias in adults. Immunocompromised hosts are susceptible to pneumonias caused by cytomegalovirus (CMV) and other herpesviruses, as well as rubeola and adenovirus. Diagnosis of viral pneumonia depends on appropriate viral cultures and acute and convalescent sera for specific antibodies. Superinfection with bacteria is common in adults. Anti-viral therapy is available for several respiratory viruses. Ribavirin, amantadine/rimantadine, interferon alpha, and acyclovir are antiviral drugs that may be of benefit in treatment and prophylaxis. Prevention of viral pneumonia will depend upon improved viral immunization practices.

  8. Hydrocarbon pneumonia

    MedlinePlus

    Pneumonia - hydrocarbon ... Coughing Fever Shortness of breath Smell of a hydrocarbon product on the breath Stupor (decreased level of ... Most children who drink or inhale hydrocarbon products and develop ... hydrocarbons may lead to rapid respiratory failure and death.

  9. Eosinophilic Pneumonias

    PubMed Central

    Akuthota, Praveen

    2012-01-01

    Summary: This review starts with discussions of several infectious causes of eosinophilic pneumonia, which are almost exclusively parasitic in nature. Pulmonary infections due specifically to Ascaris, hookworms, Strongyloides, Paragonimus, filariasis, and Toxocara are considered in detail. The discussion then moves to noninfectious causes of eosinophilic pulmonary infiltration, including allergic sensitization to Aspergillus, acute and chronic eosinophilic pneumonias, Churg-Strauss syndrome, hypereosinophilic syndromes, and pulmonary eosinophilia due to exposure to specific medications or toxins. PMID:23034324

  10. How Is Pneumonia Treated?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Pneumonia Treated? Treatment for pneumonia depends on the type ... can go back to their normal routines. Bacterial Pneumonia Bacterial pneumonia is treated with medicines called antibiotics. ...

  11. Calf pneumonia.

    PubMed

    Bryson, D G

    1985-07-01

    Infectious calf pneumonia is a high-mortality pneumonia of housed dairy-type calves. Viruses are important etiologic agents and infection with bovine respiratory syncytial virus (RSV) and parainfluenza type 3 virus (PI-3 virus) may result in extensive, and sometimes fatal, lung damage. Respiratory viral infections are frequently followed by mycoplasmal and secondary bacterial invasion of the lower respiratory tract, which increases the extent and severity of lung damage. Bad housing, particularly bad ventilation, will increase the severity of pneumonia outbreaks. Although the source of respiratory viral infections is not always obvious, it is likely that a proportion of calves acquired infection from their dams early in life. The possibility of cross-infections from other domestic animals and from humans must also be considered. Diagnosis of respiratory virus infections necessitates submission of suitable respiratory tract specimens that are taken at an early stage in the outbreak together with paired sera. Various therapeutic and prophylactic regimens for the control of calf pneumonia are described. PMID:3907774

  12. [Nosocomial pneumonia].

    PubMed

    Díaz, Emili; Martín-Loeches, Ignacio; Vallés, Jordi

    2013-12-01

    The hospital acquired pneumonia (HAP) is one of the most common infections acquired among hospitalised patients. Within the HAP, the ventilator-associated pneumonia (VAP) is the most common nosocomial infection complication among patients with acute respiratory failure. The VAP and HAP are associated with increased mortality and increased hospital costs. The rise in HAP due to antibiotic-resistant bacteria also causes an increase in the incidence of inappropriate empirical antibiotic therapy, with an associated increased risk of hospital mortality. It is very important to know the most common organisms responsible for these infections in each hospital and each Intensive Care Unit, as well as their antimicrobial susceptibility patterns, in order to reduce the incidence of inappropriate antibiotic therapy and improve the prognosis of patients. Additionally, clinical strategies aimed at the prevention of HAP and VAP should be employed in hospital settings caring for patients at risk for these infections.

  13. [Nosocomial pneumonia].

    PubMed

    Díaz, Emili; Martín-Loeches, Ignacio; Vallés, Jordi

    2013-12-01

    The hospital acquired pneumonia (HAP) is one of the most common infections acquired among hospitalised patients. Within the HAP, the ventilator-associated pneumonia (VAP) is the most common nosocomial infection complication among patients with acute respiratory failure. The VAP and HAP are associated with increased mortality and increased hospital costs. The rise in HAP due to antibiotic-resistant bacteria also causes an increase in the incidence of inappropriate empirical antibiotic therapy, with an associated increased risk of hospital mortality. It is very important to know the most common organisms responsible for these infections in each hospital and each Intensive Care Unit, as well as their antimicrobial susceptibility patterns, in order to reduce the incidence of inappropriate antibiotic therapy and improve the prognosis of patients. Additionally, clinical strategies aimed at the prevention of HAP and VAP should be employed in hospital settings caring for patients at risk for these infections. PMID:23827827

  14. How Is Pneumonia Diagnosed?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Is Pneumonia Diagnosed? Pneumonia can be hard to diagnose because it may ... than these other conditions. Your doctor will diagnose pneumonia based on your medical history, a physical exam, ...

  15. What Is Pneumonia?

    MedlinePlus

    ... page from the NHLBI on Twitter. What Is Pneumonia? Pneumonia (nu-MO-ne-ah) is an infection in ... such as bacteria, viruses, and fungi—can cause pneumonia. The infection inflames your lungs' air sacs, which ...

  16. Pneumonia (For Parents)

    MedlinePlus

    ... kids under 6 years old. Take your child's temperature at least once each morning and each evening, ... Respiratory System Croup Fever and Taking Your Child's Temperature Influenza (Flu) Walking Pneumonia Word! Pneumonia Pneumonia Hib ...

  17. Healthcare-associated Pneumonia and Aspiration Pneumonia.

    PubMed

    Komiya, Kosaku; Ishii, Hiroshi; Kadota, Jun-Ichi

    2015-02-01

    Healthcare-associated pneumonia (HCAP) is a new concept of pneumonia proposed by the American Thoracic Society/Infectious Diseases Society of America in 2005. This category is located between community-acquired pneumonia and hospital-acquired pneumonia with respect to the characteristics of the causative pathogens and mortality, and primarily targets elderly patients in healthcare facilities. Aspiration among such patients is recognized to be a primary mechanism for the development of pneumonia, particularly since the HCAP guidelines were published. However, it is difficult to manage patients with aspiration pneumonia because the definition of the condition is unclear, and the treatment is associated with ethical aspects. This review focused on the definition, prevalence and role of aspiration pneumonia as a prognostic factor in published studies of HCAP and attempted to identify problems associated with the concept of aspiration pneumonia.

  18. Pneumonia - weakened immune system

    MedlinePlus

    If you have a weakened immune system, you may receive daily antibiotics to prevent some types of pneumonia. Ask your provider if you should receive the influenza (flu) and pneumococcal (pneumonia) vaccines. Practice ...

  19. Pneumocystis Pneumonia (For Parents)

    MedlinePlus

    ... 5 Things to Know About Zika & Pregnancy Pneumocystis Pneumonia KidsHealth > For Parents > Pneumocystis Pneumonia Print A A A Text Size What's in ... article? About PCP Diagnosing PCP Treating PCP Pneumocystis pneumonia (PCP) is an infection caused by Pneumocystis jiroveci , ...

  20. The History of Mycoplasma pneumoniae Pneumonia.

    PubMed

    Saraya, Takeshi

    2016-01-01

    In the United States in the 1930s, although the pathogen was not known, atypical pneumonia was clinically distinguished from pneumococcal pneumonia by its resistance to sulfonamides. Reimann (1938) reported seven patients with an unusual form of tracheo bronchopneumonia and severe constitutional symptoms. He believed the clinical picture of this disease differed from that of the disease caused by influenza viruses or known bacteria and instead suspected "primary atypical pneumonia." For many years, the responsible infectious agent was tentatively classified as a filterable virus that could pass through a Seitz filter to remove bacteria and was reported to be a psittacosis-like or new virus. After that, Eaton et al. (1942, 1944, 1945) identified an agent that was the principal cause of primary atypical pneumonia using cotton rats, hamsters, and chick embryos. Eaton et al. (1942, 1944, 1945) did not perform an inoculation study in human volunteers. During the 1940s, there were three groups engaged in discovering the etiology of the primary atypical pneumonia. (1) Commission on Acute Respiratory Diseases Diseases directed by John Dingle, (2) Dr. Monroe Eaton's group, the Virus Research Laboratory of the California State Public Health Department, (3) The Hospital of the Rockefeller Institute for Medical Research directed by Horsfall. During 1940s, the members of the Commission on Acute Respiratory Diseases concluded that the bacteria-free filtrates obtained from the patients, presumably containing a virus, could induce primary atypical pneumonia in human volunteers via Pinehurst trials. During 1950s, serological approaches for identification of the Eaton agent developed such as Fluorescent-Stainable Antibody, and at the beginning of the1960s, the Eaton agent successfully grew in media, and finally accepted as a cause of primary atypical pneumonia. Thus, technical difficulties with visualizing the agent and failure to recognize the full significance of the Pinehurst

  1. How Can Pneumonia Be Prevented?

    MedlinePlus

    ... page from the NHLBI on Twitter. How Can Pneumonia Be Prevented? Pneumonia can be very serious and ... t last as long Fewer serious complications Pneumococcal Pneumonia Vaccine A vaccine is available to prevent pneumococcal ...

  2. Cryptogenic organising pneumonia.

    PubMed

    Cordier, J-F

    2006-08-01

    Organising pneumonia is defined histopathologically by intra-alveolar buds of granulation tissue, consisting of intermixed myofibroblasts and connective tissue. Although nonspecific, this histopathological pattern, together with characteristic clinical and imaging features, defines cryptogenic organising pneumonia when no cause or peculiar underlying context is found. Rapid clinical and imaging improvement is obtained with corticosteroid treatment, but relapses are common after stopping treatment.

  3. [Pneumonia in the elderly].

    PubMed

    Catherinot, Emilie

    2012-01-01

    Pneumonia is a serious medical pathology frequent in elderly people. The physiological changes of the respiratory system linked with age reduce postural drainage capacities and increase the risk of acute respiratory failure. Associated with other comorbidities, chronic inhalation is a major risk factor of pneumonia in elderly people. Prevention is based on vaccination, nutrition, dental care and an adapted diet.

  4. Antibody responses of Chlamydophila pneumoniae pneumonia: Why is the diagnosis of C. pneumoniae pneumonia difficult?

    PubMed

    Miyashita, Naoyuki; Kawai, Yasuhiro; Tanaka, Takaaki; Akaike, Hiroto; Teranishi, Hideto; Wakabayashi, Tokio; Nakano, Takashi; Ouchi, Kazunobu; Okimoto, Niro

    2015-07-01

    The ELNAS Plate Chlamydophila pneumoniae commercial test kit for the detection of anti-C. pneumoniae-specific immunoglobulin M (IgM), IgA and IgG antibodies has become available in Japan recently. To determine the optimum serum collection point for the ELNAS plate in the diagnosis of C. pneumoniae pneumonia, we analyzed the kinetics of the antibody response in patients with laboratory-confirmed C. pneumoniae pneumonia. We enrolled five C. pneumoniae pneumonia cases and collected sera from patients for several months. The kinetics of the IgM and IgG antibody responses were similar among the five patients. Significant increases in IgM and IgG antibody titer between paired sera were observed in all patients. IgM antibodies appeared approximately 2-3 weeks after the onset of illness, reached a peak after 4-5 weeks, and were generally undetectable after 3-5 months. IgG antibodies developed slowly for the first 30 days and reached a plateau approximately 3-4 months after the onset of illness. The kinetics of IgA antibody responses were different among the five patients, and significant increases in IgA antibody titer between paired sera were observed in only two patients. Although the sample size was small, the best serum collection time seemed to be approximately 3-6 weeks after onset of illness when using a single serum sample for the detection of IgM antibodies. Paired sera samples should be obtained at least 4 weeks apart. IgA antibody analysis using ELNAS may not be a useful marker for acute C. pneumoniae pneumonia.

  5. Community-acquired pneumonia.

    PubMed

    Falguera, M; Ramírez, M F

    2015-11-01

    This article not only reviews the essential aspects of community-acquired pneumonia for daily clinical practice, but also highlights the controversial issues and provides the newest available information. Community-acquired pneumonia is considered in a broad sense, without excluding certain variants that, in recent years, a number of authors have managed to delineate, such as healthcare-associated pneumonia. The latter form is nothing more than the same disease that affects more frail patients, with a greater number of risk factors, both sharing an overall common approach. PMID:26186969

  6. Community-acquired pneumonia.

    PubMed

    Falguera, M; Ramírez, M F

    2015-11-01

    This article not only reviews the essential aspects of community-acquired pneumonia for daily clinical practice, but also highlights the controversial issues and provides the newest available information. Community-acquired pneumonia is considered in a broad sense, without excluding certain variants that, in recent years, a number of authors have managed to delineate, such as healthcare-associated pneumonia. The latter form is nothing more than the same disease that affects more frail patients, with a greater number of risk factors, both sharing an overall common approach.

  7. [Chronic eosinophilic pneumonia].

    PubMed

    Vivero, F; Ciocchini, C; Gandini, M J; Wehbe, L

    2012-03-01

    Chronic eosinophilic pneumonia. The chronic eosinophilic pneumonia is part of Pulmonary Eosinophilic Syndroms. It is presented a 33-years old man, Asmathic, with dry cough, fever, night sweats and fatigue of several weeks. The chest X-ray showed opacity in the right hemithorax. He was treated with antibiotics without response. A chest TC showed multifocal involvement. The patient refused bronchoalveolar lavage (BAL) so treatment antituberculostatic was started. Despite treatment the symptoms worsened. The Chest X-ray showed migration of the infiltrates and the blood smear marked eosinophilia. Finally, bronchoalveolar lavage was carried out and it showed a high percentage of eosinophils (over 50%). The patient was treated with inmmunosuppresive doses of corticosteroids with excellent response. The blood smear in Nonresolving pneumonia is key to consider eosinophilic pneumonia, an uncommon pathology but amenable to treatment.

  8. Hospital-acquired pneumonia

    MedlinePlus

    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  9. Pneumonia in adults - discharge

    MedlinePlus

    ... In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious ... ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 69. Mandell LA. Streptococcus pneumoniae infections. In: Goldman L, Schafer ...

  10. Acute interstitial pneumonia.

    PubMed

    Bouros, D; Nicholson, A C; Polychronopoulos, V; du Bois, R M

    2000-02-01

    The term "acute interstitial pneumonia" (AIP) describes an idiopathic clinicopathological condition, characterized clinically by an interstitial lung disease causing rapid onset of respiratory failure, which is distinguishable from the other more chronic forms of interstitial pneumonia. It is synonymous with Hamman-Rich syndrome, occurring in patients without pre-existing lung disease. The histopathological findings are those of diffuse alveolar damage. AIP radiologically and physiologically resembles acute respiratory distress syndrome (ARDS) and is considered to represent the small subset of patients with idiopathic ARDS. It is frequently confused with other clinical entities characterized by rapidly progressive interstitial pneumonia, especially secondary acute interstitial pneumonia, acute exacerbations and accelerated forms of cryptogenic fibrosing alveolitis . Furthermore, many authors use the above terms, both erroneously and interchangeably. It has a grave prognosis with >70% mortality in 3 months, despite mechanical ventilation. This review aims to clarify the relative clinical and pathological issues and terminology.

  11. Community-acquired pneumonia.

    PubMed

    Prina, Elena; Ranzani, Otavio T; Torres, Antoni

    2015-09-12

    Community-acquired pneumonia causes great mortality and morbidity and high costs worldwide. Empirical selection of antibiotic treatment is the cornerstone of management of patients with pneumonia. To reduce the misuse of antibiotics, antibiotic resistance, and side-effects, an empirical, effective, and individualised antibiotic treatment is needed. Follow-up after the start of antibiotic treatment is also important, and management should include early shifts to oral antibiotics, stewardship according to the microbiological results, and short-duration antibiotic treatment that accounts for the clinical stability criteria. New approaches for fast clinical (lung ultrasound) and microbiological (molecular biology) diagnoses are promising. Community-acquired pneumonia is associated with early and late mortality and increased rates of cardiovascular events. Studies are needed that focus on the long-term management of pneumonia.

  12. A Compendium for Mycoplasma pneumoniae.

    PubMed

    Parrott, Gretchen L; Kinjo, Takeshi; Fujita, Jiro

    2016-01-01

    Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, "walking" pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder, and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review. PMID:27148202

  13. A Compendium for Mycoplasma pneumoniae

    PubMed Central

    Parrott, Gretchen L.; Kinjo, Takeshi; Fujita, Jiro

    2016-01-01

    Historically, atypical pneumonia was a term used to describe an unusual presentation of pneumonia. Currently, it is used to describe the multitude of symptoms juxtaposing the classic symptoms found in cases of pneumococcal pneumonia. Specifically, atypical pneumonia is a syndrome resulting from a relatively common group of pathogens including Chlamydophila sp., and Mycoplasma pneumoniae. The incidence of M. pneumoniae pneumonia in adults is less than the burden experienced by children. Transmission rates among families indicate children may act as a reservoir and maintain contagiousness over a long period of time ranging from months to years. In adults, M. pneumoniae typically produces a mild, “walking” pneumonia and is considered to be one of the causes of persistent cough in patients. M. pneumoniae has also been shown to trigger the exacerbation of other lung diseases. It has been repeatedly detected in patients with bronchitis, asthma, chronic obstructive pulmonary disorder, and cystic fibrosis. Recent advances in technology allow for the rapid diagnosis of M. pneumoniae through the use of polymerase chain reaction or rapid antigen tests. With this, more effort has been afforded to identify the causative etiologic agent in all cases of pneumonia. However, previous practices, including the overprescribing of macrolide treatment in China and Japan, have created increased incidence of macrolide-resistant M. pneumoniae. Reports from these countries indicate that >85% of M. pneumoniae pneumonia pediatric cases are macrolide-resistant. Despite its extensively studied past, the smallest bacterial species still inspires some of the largest questions. The developments in microbiology, diagnostic features and techniques, epidemiology, treatment and vaccines, and upper respiratory conditions associated with M. pneumoniae in adult populations are included within this review. PMID:27148202

  14. Chlamydia pneumoniae (TWAR).

    PubMed Central

    Kuo, C C; Jackson, L A; Campbell, L A; Grayston, J T

    1995-01-01

    Chlamydia pneumoniae (TWAR) is a recently recognized third species of the genus Chlamydia that causes acute respiratory disease. It is distinct from the other two chlamydial species that infect humans, C. trachomatis and C. psittaci, in elementary body morphology and shares less than 10% of the DNA homology with those species. The organism has a global distribution, with infection most common among children between the ages of 5 and 14 years. In children, TWAR infection is usually mild or asymptomatic, but it may be more severe in adults. Pneumonia and bronchitis are the most common clinical manifestations of infection, and TWAR is responsible for approximately 10% of cases of pneumonia and 5% of cases of bronchitis in the United States. The microimmunofluorescence serologic assay is specific for TWAR and can distinguish between recent and past infections. The organism can be isolated in cell culture; however, PCR techniques have recently facilitated its detection in tissues and clinical specimens. PMID:8665464

  15. Exogenous lipoid pneumonia.

    PubMed

    Cornacchia, D J; Snyder, C H; Dupont, D C; Yaron, N S

    1989-05-01

    Although a rare form of nonresolving pulmonary infiltrate, exogenous lipoid pneumonia is a great mimicker. It often is mistaken for bacterial pneumonia or cancer. Many cases have been diagnosed only by open lung biopsy or other invasive procedures. Depending on the type of lipid ingested and the degree of inflammation that occurs, damage to the lung can be little to none or can fulminate to necrosis and hemorrhage. Symptoms may range from none to respiratory failure. In the case presented, the patient was ingesting Vaseline Intensive Care Lotion and baby oil as laxatives. This information was elicited only after diagnosis was made by open lung biopsy.

  16. Vaccinating welders against pneumonia

    PubMed Central

    Palmer, Keith T; Cosgrove, Martin P

    2013-01-01

    Background In 2011 the Department of Health in England recommended that welders should each receive a single dose of the 23-valent pneumococcal vaccine (PPV23). This review assesses the evidence behind the advice and its practical implications. Method The review was informed by a systematic search in Medline, which related pneumonia to welding and/or exposure to metal fume, and was supplemented using the personal libraries of the authors. Findings There is consistent evidence that welders die more often of pneumonia, especially lobar pneumonia, are hospitalised more often with lobar and pneumococcal pneumonia, and more often develop invasive pneumococcal disease (IPD). It is estimated that one case of IPD may be prevented over a 10-year period by vaccinating 588 welders against pneumococcal infection. Conclusions A good case exists that employers should offer PPV23 vaccination to welders and other employees exposed to metal fume. Additionally, reasonable measures must be taken to minimise exposure to welding fume and welders should be encouraged not to smoke. PMID:22764269

  17. [Pneumonia in wounded].

    PubMed

    Ovchinnikov, Iu V; Kharitonov, M A; Sadykov, R R; Shelukhin, V A; Gaĭduk, S V; Bogomolov, A B; Ivanov, V V; Dobrovol'skaia, L M

    2015-02-01

    Pneumonia is one of the common complications of wounds of any localization. Therapists are involved into the treatment of lung lesions in wounded in the ICU, in the surgical and if the patient arrives "on follow-up care,"--in the medical ward. The article analyzes the main statistical indicators reflecting the prevalence and clinical and pathogenetic characteristics of lung pathology in wounded during the Great Patriotic War, during the fighting Soviet troops in the Republic of Afghanistan, the 1st and 2nd Chechen campaign. Pneumonia as a manifestation of traumatic disease can occur in two ways. Primary pneumonia is in close connection with the pathogenetic traumatic injury. Secondary lung lesions complicate the injury at a later date and are due to the introduction of a nosocomial infection process flora. We describe the clinical picture of pneumonia in the affected, the basic pathogenesis, principles of therapy. Successful treatment of lung pathology in wounded depends on the performance of a complex of activities involving a wide range of doctors of various specialties. PMID:25920173

  18. Chlamydia pneumoniae and cardiovascular disease.

    PubMed Central

    Campbell, L. A.; Kuo, C. C.; Grayston, J. T.

    1998-01-01

    Chlamydia pneumoniae is a ubiquitous pathogen that causes acute respiratory disease. The spectrum of C. pneumoniae infection has been extended to atherosclerosis and its clinical manifestations. Seroepidemiologic studies have associated C. pneumoniae antibody with coronary artery disease, myocardial infarction, carotid artery disease, and cerebrovascular disease. The association of C. pneumoniae with atherosclerosis is corroborated by the presence of the organism in atherosclerotic lesions throughout the arterial tree and the near absence of the organism in healthy arterial tissue. C. pneumoniae has also been isolated from coronary and carotid atheromatous plaques. To determine whether chronic infection plays a role in initiation or progression of disease, intervention studies in humans have been initiated, and animal models of C. pneumoniae infection have been developed. This review summarizes the evidence for the association and potential role of C. pneumoniae in cardiovascular disease. PMID:9866733

  19. Klebsiella pneumoniae Bloodstream Infection

    PubMed Central

    Girometti, Nicolò; Lewis, Russell E.; Giannella, Maddalena; Ambretti, Simone; Bartoletti, Michele; Tedeschi, Sara; Tumietto, Fabio; Cristini, Francesco; Trapani, Filippo; Gaibani, Paolo; Viale, Pierluigi

    2014-01-01

    Abstract Multidrug resistance associated with extended-spectrum beta-lactamase (ESBL) and Klebsiella pneumoniae carbapenemase (KPC) among K. pneumoniae is endemic in southern Europe. We retrospectively analyzed the impact of resistance on the appropriateness of empirical therapy and treatment outcomes of K. pneumoniae bloodstream infections (BSIs) during a 2-year period at a 1420-bed tertiary-care teaching hospital in northern Italy. We identified 217 unique patient BSIs, including 92 (42%) KPC-positive, 49 (23%) ESBL-positive, and 1 (0.5%) metallo-beta-lactamase-positive isolates. Adequate empirical therapy was administered in 74% of infections caused by non-ESBL non-KPC strains, versus 33% of ESBL and 23% of KPC cases (p < 0.0001). To clarify the impact of resistance on BSI treatment outcomes, we compared several different models comprised of non-antibiotic treatment-related factors predictive of patients’ 30-day survival status. Acute Physiology and Chronic Health Evaluation (APACHE) II score determined at the time of positive blood culture was superior to other investigated models, correctly predicting survival status in 83% of the study cohort. In multivariate analysis accounting for APACHE II, receipt of inadequate empirical therapy was associated with nearly a twofold higher rate of death (adjusted hazard ratio 1.9, 95% confidence interval 1.1–3.4; p = 0.02). Multidrug-resistant K. pneumoniae accounted for two-thirds of all K. pneumoniae BSIs, high rates of inappropriate empirical therapy, and twofold higher rates of patient death irrespective of underlying illness. PMID:25398065

  20. Community-acquired pneumonia.

    PubMed

    Polverino, E; Torres Marti, A

    2011-02-01

    Despite the remarkable advances in antibiotic therapies, diagnostic tools, prevention campaigns and intensive care, community-acquired pneumonia (CAP) is still among the primary causes of death worldwide, and there have been no significant changes in mortality in the last decades. The clinical and economic burden of CAP makes it a major public health problem, particularly for children and the elderly. This issue provides a clinical overview of CAP, focusing on epidemiology, economic burden, diagnosis, risk stratification, treatment, clinical management, and prevention. Particular attention is given to some aspects related to the clinical management of CAP, such as the microbial etiology and the available tools to achieve it, the usefulness of new and old biomarkers, and antimicrobial and other non-antibiotic adjunctive therapies. Possible scenarios in which pneumonia does not respond to treatment are also analyzed to improve clinical outcomes of CAP. PMID:21242952

  1. Acinetobacter Pneumonia: A Review

    PubMed Central

    Hartzell, Joshua D.; Kim, Andrew S.; Kortepeter, Mark G.; Moran, Kimberly A.

    2007-01-01

    Acinetobacter species are becoming a major cause of nosocomial infections, including hospital-acquired and ventilator-associated pneumonia. Acinetobacter species have become increasingly resistant to antibiotics over the past several years and currently present a significant challenge in treating these infections. Physicians now rely on older agents, such as polymyxins (colistin), for treatment. This paper reviews the epidemiology, treatment, and prevention of this emerging pathogen. PMID:18092011

  2. Chlamydia pneumoniae and asthma

    PubMed Central

    Cook, P; Davies, P; Tunnicliffe, W; Ayres, J; Honeybourne, D; Wise, R

    1998-01-01

    BACKGROUND—This study was designed to test the association of Chlamydia pneumoniae infection with asthma in a multiracial population, after adjustments for several potential confounding variables.
METHODS—Antibodies to C pneumoniae were measured by microimmunofluorescence in 123 patients with acute asthma, 1518 control subjects admitted to the same hospital with various non-cardiovascular, non-pulmonary disorders, and 46 patients with severe chronic asthma, including some with "brittle" asthma. Acute infection or reinfection was defined by titres of IgG of ⩾512 or IgM ⩾8 or a fourfold rise in IgG, and previous infection by IgG 64-256 or IgA ⩾8. Logistic regression was used to control for likely confounders, including ethnic origin, age, sex, smoking habit, steroid medication, diabetes mellitus and social deprivation, on antibody levels.
RESULTS—Antibody titres consistent with acute C pneumoniae infection were found in 5.7% of patients with acute asthma and 5.7% of control patients, while 14.6% of patients with acute asthma and 12.7% of control patients had titres suggesting previous infection. These two groups did not differ significantly. However, titres suggesting previous infection were found in 34.8% of patients with severe chronic asthma: the difference between this group and the control group was statistically significant with an adjusted odds ratio of 3.99 (95% confidence interval 1.60 to 9.97).
CONCLUSIONS—These data raise important questions about the previously demonstrated association of C pneumoniae infection with asthma, and suggest that future studies of this association should give particular attention to the presence or absence of a history of severe chronic asthma.

 PMID:9741366

  3. Fungal diagnostics in pneumonia.

    PubMed

    Lease, Erika D; Alexander, Barbara D

    2011-12-01

    Fungal pneumonia is increasingly common, particularly in highly immunosuppressed patients, such as solid organ or hematopoietic stem cell transplant recipients, and the diagnosis is evolving. Although standard techniques such as microscopy and culture remain the mainstays of diagnosis, relatively recent advances in serological and molecular testing are important additions to the field. This article reviews the laboratory tools used to diagnose fungal respiratory disease. PMID:22167394

  4. Fungal Diagnostics in Pneumonia

    PubMed Central

    Lease, Erika D.; Alexander, Barbara D.

    2014-01-01

    Fungal pneumonia is increasingly common, particularly in highly immunosuppressed patients, such as solid organ or hematopoietic stem cell transplant recipients, and the diagnosis is evolving. While standard techniques such as microscopy and culture remain the mainstay of diagnosis, relatively recent advances in serologic and molecular testing are important additions to the field. This chapter will review the laboratory tools used to diagnose fungal respiratory disease. PMID:22167394

  5. [Travel-associated pneumonias].

    PubMed

    Geerdes-Fenge, H F

    2014-10-01

    Respiratory infections are responsible for up to 11% of febrile infections in travellers or immigrants from tropical and subtropical regions. The main pathogens are the same as in temperate climate zones: Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydophila pneumoniae, influenza viruses, Legionella pneumophila. However, some pulmonary diseases can be attributed to bacterial, parasitic, viral or fungal pathogens that are endemic in tropical and subtropical regions. The most commonly imported infections are malaria, dengue, and tuberculosis. Pulmonary symptoms and eosinophilia in returning travellers and migrants may be caused by several parasitic infections such as Katayama syndrome, Loeffler syndrome, tropical pulmonary eosinophilia, amebiasis, paragonimiasis, echinococcosis, and toxocariasis. In Asia, Tsutsugamushi fever is transmitted by chiggers, spotted fever rickettsiae are transmitted by ticks. Transmission of zoonotic diseases occurs mainly via contact with infected animals or their excretions, human-to-human transmission is generally rare: MERS-CoA (dromedary camels), pulmonary hantavirus infection (rodents), tularemia (rabbits and hares), leptospirosis (rats), Q-fever (sheep and goats), very rarely anthrax (hides of ruminants) and pest (infected rats and wildlife). Inhalation of contaminated dust can cause infections with dimorphic fungi: histoplasmosis (bat guano) and coccidioidomycosis in America and parts of Africa, blastomycosis in America. Some infections can cause symptoms years after a stay in tropical or subtropical regions (melioidosis, tuberculosis, histoplasmosis, schistosomiasis-associated pulmonary hypertension). Noninfectious respiratory diseases caused by inhalation of high amounts of air pollution or toxic dusts may also be considered. PMID:25290923

  6. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae

    PubMed Central

    Shon, Alyssa S.; Bajwa, Rajinder P.S.; Russo, Thomas A.

    2013-01-01

    A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae has emerged. First described in the Asian Pacific Rim, it now increasingly recognized in Western countries. Defining clinical features are the ability to cause serious, life-threatening community-acquired infection in younger healthy hosts, including liver abscess, pneumonia, meningitis and endophthalmitis and the ability to metastatically spread, an unusual feature for enteric Gram-negative bacilli in the non-immunocompromised. Despite infecting a healthier population, significant morbidity and mortality occurs. Although epidemiologic features are still being defined, colonization, particularly intestinal colonization, appears to be a critical step leading to infection. However the route of entry remains unclear. The majority of cases described to date are in Asians, raising the issue of a genetic predisposition vs. geospecific strain acquisition. The traits that enhance its virulence when compared with “classical” K. pneumoniae are the ability to more efficiently acquire iron and perhaps an increase in capsule production, which confers the hypermucoviscous phenotype. An objective diagnostic test suitable for routine use in the clinical microbiology laboratory is needed. If/when these strains become increasingly resistant to antimicrobials, we will be faced with a frightening clinical scenario. PMID:23302790

  7. Motility of Mycoplasma pneumoniae.

    PubMed Central

    Radestock, U; Bredt, W

    1977-01-01

    Cell of Mycoplasma pneumoniae FH gliding on a glass surface in liquid medium were examined by microscopic observation and quantitatively by microcinematography (30 frames per min). Comparisons were made only within the individual experiments. The cells moved in an irregular pattern with numerous narrow bends and circles. They never changed their leading end. The average speed (without pauses) was relatively constant between o.2 and 0.5 mum/s. The maximum speed was about 1.5 to 2.0 mum/s. The movements were interrupted by resting periods of different lengths and frequency. Temperature, viscosity, pH, and the presence of yeast extract in the medium influenced the motility significantly; changes in glucose, calcium ions, and serum content were less effective. The movements were affected by iodoacetate, p-mercuribenzoate, and mitomycin C at inhibitory or subinhibitory concentrations. Sodium fluoride, sodium cyanide, dinitrophenol, chloramphenicol, puromycin, cholchicin, and cytochalasin B at minimal inhibitory concentrations did not affect motility. The movements were effectively inhibited by anti-M. pneumoniae antiserum. Studies with absorbed antiserum suggested that the surface components involved in motility are heat labile. The gliding of M. pneumoniae cells required an intact energy metabolism and the proteins involved seemed to have a low turnover. Images PMID:14925

  8. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates

    PubMed Central

    Farooqui, Habib; Jit, Mark; Heymann, David L.; Zodpey, Sanjay

    2015-01-01

    The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3–3.9 million) episodes of severe pneumonia and 0.35 million (0.31–0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49–0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92–119 thousand) pneumococcal deaths occurred in India. The top contributors to India’s pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our

  9. Burden of Severe Pneumonia, Pneumococcal Pneumonia and Pneumonia Deaths in Indian States: Modelling Based Estimates.

    PubMed

    Farooqui, Habib; Jit, Mark; Heymann, David L; Zodpey, Sanjay

    2015-01-01

    The burden of severe pneumonia in terms of morbidity and mortality is unknown in India especially at sub-national level. In this context, we aimed to estimate the number of severe pneumonia episodes, pneumococcal pneumonia episodes and pneumonia deaths in children younger than 5 years in 2010. We adapted and parameterized a mathematical model based on the epidemiological concept of potential impact fraction developed CHERG for this analysis. The key parameters that determine the distribution of severe pneumonia episode across Indian states were state-specific under-5 population, state-specific prevalence of selected definite pneumonia risk factors and meta-estimates of relative risks for each of these risk factors. We applied the incidence estimates and attributable fraction of risk factors to population estimates for 2010 of each Indian state. We then estimated the number of pneumococcal pneumonia cases by applying the vaccine probe methodology to an existing trial. We estimated mortality due to severe pneumonia and pneumococcal pneumonia by combining incidence estimates with case fatality ratios from multi-centric hospital-based studies. Our results suggest that in 2010, 3.6 million (3.3-3.9 million) episodes of severe pneumonia and 0.35 million (0.31-0.40 million) all cause pneumonia deaths occurred in children younger than 5 years in India. The states that merit special mention include Uttar Pradesh where 18.1% children reside but contribute 24% of pneumonia cases and 26% pneumonia deaths, Bihar (11.3% children, 16% cases, 22% deaths) Madhya Pradesh (6.6% children, 9% cases, 12% deaths), and Rajasthan (6.6% children, 8% cases, 11% deaths). Further, we estimated that 0.56 million (0.49-0.64 million) severe episodes of pneumococcal pneumonia and 105 thousand (92-119 thousand) pneumococcal deaths occurred in India. The top contributors to India's pneumococcal pneumonia burden were Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan in that order. Our results

  10. Update on cryptogenic organising pneumonia (idiopathic bronchiolitis obliterans organising pneumonia).

    PubMed

    Cordier, Jean-François

    2002-11-23

    Organising pneumonia, defined by intraalveolar buds of connective tissue, may be a disorder secondary to a determined cause (infectious agents, drugs) or occurring in a specific context (as the connective tissue disorders). It may also be a cryptogenic interstitial pneumonia with characteristic clinical and imaging features and especially an excellent response to corticosteroids.

  11. Klebsiella pneumoniae FimK Promotes Virulence in Murine Pneumonia.

    PubMed

    Rosen, David A; Hilliard, Julia K; Tiemann, Kristin M; Todd, Elizabeth M; Morley, S Celeste; Hunstad, David A

    2016-02-15

    Klebsiella pneumoniae, a chief cause of nosocomial pneumonia, is a versatile and commonly multidrug-resistant human pathogen for which further insight into pathogenesis is needed. We show that the pilus regulatory gene fimK promotes the virulence of K. pneumoniae strain TOP52 in murine pneumonia. This contrasts with the attenuating effect of fimK on urinary tract virulence, illustrating that a single factor may exert opposing effects on pathogenesis in distinct host niches. Loss of fimK in TOP52 pneumonia was associated with diminished lung bacterial burden, limited innate responses within the lung, and improved host survival. FimK expression was shown to promote serum resistance, capsule production, and protection from phagocytosis by host immune cells. Finally, while the widely used K. pneumoniae model strain 43816 produces rapid dissemination and death in mice, TOP52 caused largely localized pneumonia with limited lethality, thereby providing an alternative tool for studying K. pneumoniae pathogenesis and control within the lung.

  12. Pneumonia caused by Pittsburgh pneumonia agent: radiologic manifestations

    SciTech Connect

    Muder, R.R.; Reddy, S.C.; Yu, V.L.; Kroboth, F.J.

    1984-03-01

    Using an objective scoring system, chest radiographs were reviewed in 23 cases of pneumonia due to the Pittsburgh pneumonia agent (PPA, Tatlockia micdadei, Legionella micdadei), including six cases of pneumonia with simultaneous isolation of PPA and L pneumophila (Legionnaires' disease). Infiltrates were typically segmental to lobar; nodular infiltrates were noted in three cases. Spread to additional lobes after presentation occurred in four of 17 PPA infections. Pneumonia caused by both PPA and L pneumophila was unusually severe, with involvement of all lobes occurring in four of six cases, compared with one of 17 cases of PPA infection (p>0.02). Radiographic severity did not correlate with underlying disease, immune status, or outcome. The majority of patients receiving erythromycin demonstrated objective radiologic improvement. In a patients, population that included nonimmunosuppressed patient, nodule formation and rapid radiologic progression were not found to be characteristic of PPA pneumonia.

  13. Feedlot Acute Interstitial Pneumonia.

    PubMed

    Woolums, Amelia R

    2015-11-01

    Acute interstitial pneumonia (AIP) of feedlot cattle is a sporadically occurring respiratory condition that is often fatal. Affected cattle have a sudden onset of labored breathing. There is no confirmed effective treatment of feedlot AIP; however, administration of antibiotics effective against common bacterial respiratory pathogens and nonsteroidal anti-inflammatory drugs, especially aspirin, has been recommended. Protective strategies are not well defined, but efforts to limit dust exposure and heat stress; to ensure consistent formulation, mixing, and delivery of feed; and to identify and treat infectious respiratory disease in a timely manner may decrease rates of feedlot AIP.

  14. Lymphocytic Interstitial Pneumonia.

    PubMed

    Panchabhai, Tanmay S; Farver, Carol; Highland, Kristin B

    2016-09-01

    Lymphocytic interstitial pneumonia (LIP) is a rare lung disease on the spectrum of benign pulmonary lymphoproliferative disorders. LIP is frequently associated with connective tissue diseases or infections. Idiopathic LIP is rare; every attempt must be made to diagnose underlying conditions when LIP is diagnosed. Computed tomography of the chest in patients with LIP may reveal ground-glass opacities, centrilobular and subpleural nodules, and randomly distributed thin-walled cysts. Demonstrating polyclonality with immunohistochemistry is the key to differentiating LIP from lymphoma. The 5-year mortality remains between 33% and 50% and is likely to vary based on the underlying disease process. PMID:27514593

  15. Klebsiella pneumoniae splenic abscess.

    PubMed

    Gill, V; Marzocca, F J; Cunha, B A

    1994-01-01

    Splenic abscesses may be solitary or multiple and are unusual infections. Signs and symptoms are variable and do not always include left upper quadrant pain or tenderness, as the Case Report illustrate. Abscesses of the spleen may occur as a result of endocarditis or from hematogenous seeding from a distant focus of infection. Computed tomographic scan of the spleen is the diagnostic method of choice. We report a case of multiple splenic abscesses caused by Klebsiella pneumoniae that resulted from a Klebsiella urinary tract infection and was successfully managed with antibiotic therapy and splenectomy. PMID:8039997

  16. Enteral Tube Feeding and Pneumonia

    ERIC Educational Resources Information Center

    Gray, David Sheridan; Kimmel, David

    2006-01-01

    To determine the effects of enteral tube feeding on the incidence of pneumonia, we performed a retrospective review of all clients at our institution who had gastrostomy or jejunostomy tubes placed over a 10-year period. Ninety-three subjects had a history of pneumonia before feeding tube insertion. Eighty had gastrostomy and 13, jejunostomy…

  17. Animal models of polymicrobial pneumonia

    PubMed Central

    Hraiech, Sami; Papazian, Laurent; Rolain, Jean-Marc; Bregeon, Fabienne

    2015-01-01

    Pneumonia is one of the leading causes of severe and occasionally life-threatening infections. The physiopathology of pneumonia has been extensively studied, providing information for the development of new treatments for this condition. In addition to in vitro research, animal models have been largely used in the field of pneumonia. Several models have been described and have provided a better understanding of pneumonia under different settings and with various pathogens. However, the concept of one pathogen leading to one infection has been challenged, and recent flu epidemics suggest that some pathogens exhibit highly virulent potential. Although “two hits” animal models have been used to study infectious diseases, few of these models have been described in pneumonia. Therefore the aims of this review were to provide an overview of the available literature in this field, to describe well-studied and uncommon pathogen associations, and to summarize the major insights obtained from this information. PMID:26170617

  18. Bronchoscopic diagnosis of pneumonia.

    PubMed Central

    Baselski, V S; Wunderink, R G

    1994-01-01

    Lower respiratory tract infections are characterized by significant morbidity and mortality but also by a relative inability to establish a specific etiologic agent on clinical grounds alone. With the recognized shortcomings of expectorated or aspirated secretions toward establishing an etiologic diagnosis, clinicians have increasingly used bronchoscopy to obtain diagnostic samples. A variety of specimen types may be obtained, including bronchial washes or brushes, protected specimen brushings, bronchoalveolar lavage, and transbronchial biopsies. Bronchoscopy has been applied in three primary clinical settings, including the immunocompromised host, especially human immunodeficiency virus-infected and organ transplant patients; ventilator-associated pneumonia; and severe, nonresolving community- or hospital-acquired pneumonia in nonventilated patients. In each clinical setting, and for each specimen type, specific laboratory protocols are required to provide maximal information. These protocols should provide for the use of a variety of rapid microscopic and quantitative culture techniques and the use of a variety of specific stains and selective culture to detect unusual organism groups. PMID:7834604

  19. Granzyme A impairs host defense during Streptococcus pneumoniae pneumonia.

    PubMed

    van den Boogaard, Florry E; van Gisbergen, Klaas P J M; Vernooy, Juanita H; Medema, Jan P; Roelofs, Joris J T H; van Zoelen, Marieke A D; Endeman, Henrik; Biesma, Douwe H; Boon, Louis; Van't Veer, Cornelis; de Vos, Alex F; van der Poll, Tom

    2016-08-01

    Streptococcus pneumoniae is the most common causative pathogen in community-acquired pneumonia (CAP). Granzyme A (GzmA) is a serine protease produced by a variety of cell types involved in the immune response. We sought to determine the role of GzmA on the host response during pneumococcal pneumonia. GzmA was measured in bronchoalveolar lavage fluid (BALF) harvested from CAP patients from the infected and contralateral uninfected side and in lung tissue slides from CAP patients and controls. In CAP patients, GzmA levels were increased in BALF obtained from the infected lung. Human lungs showed constitutive GzmA expression by both parenchymal and nonparenchymal cells. In an experimental setting, pneumonia was induced in wild-type (WT) and GzmA-deficient (GzmA(-/-)) mice by intranasal inoculation of S. pneumoniae In separate experiments, WT and GzmA(-/-) mice were treated with natural killer (NK) cell depleting antibodies. Upon infection with S. pneumoniae, GzmA(-/-) mice showed a better survival and lower bacterial counts in BALF and distant body sites compared with WT mice. Although NK cells showed strong GzmA expression, NK cell depletion did not influence bacterial loads in either WT or GzmA(-/-) mice. These results implicate that GzmA plays an unfavorable role in host defense during pneumococcal pneumonia by a mechanism that does not depend on NK cells. PMID:27343190

  20. Carbapenemase-producing Klebsiella pneumoniae

    PubMed Central

    Deresinski, Stan

    2014-01-01

    The continuing emergence of infections due to multidrug resistant bacteria is a serious public health problem. Klebsiella pneumoniae, which commonly acquires resistance encoded on mobile genetic elements, including ones that encode carbapenemases, is a prime example. K. pneumoniae carrying such genetic material, including both blaKPC and genes encoding metallo-β-lactamases, have spread globally. Many carbapenemase-producing K. pneumoniae are resistant to multiple antibiotic classes beyond β-lactams, including tetracyclines, aminoglycosides, and fluoroquinolones. The optimal treatment, if any, for infections due to these organisms is unclear but, paradoxically, appears to often require the inclusion of an optimally administered carbapenem. PMID:25343037

  1. Pathology of Idiopathic Interstitial Pneumonias

    PubMed Central

    Hashisako, Mikiko; Fukuoka, Junya

    2015-01-01

    The updated classification of idiopathic interstitial pneumonias (IIPs) in 2013 by American Thoracic Society/European Respiratory Society included several important revisions to the categories described in the 2002 classification. In the updated classification, lymphoid interstitial pneumonia (LIP) was moved from major to rare IIPs, pleuroparenchymal fibroelastosis (PPFE) was newly included in the rare IIPs, acute fibrinous and organizing pneumonia (AFOP) and interstitial pneumonias with a bronchiolocentric distribution are recognized as rare histologic patterns, and unclassifiable IIP (UCIP) was classified as an IIP. However, recent reports indicate the areas of concern that may require further evaluation. Here, we describe the histopathologic features of the updated IIPs and their rare histologic patterns and also point out some of the issues to be considered in this context. PMID:26949346

  2. What Are the Signs and Symptoms of Pneumonia?

    MedlinePlus

    ... Twitter. What Are the Signs and Symptoms of Pneumonia? The signs and symptoms of pneumonia vary from ... have sudden changes in mental awareness. Complications of Pneumonia Often, people who have pneumonia can be successfully ...

  3. Inflammation-inducing Factors of Mycoplasma pneumoniae

    PubMed Central

    Shimizu, Takashi

    2016-01-01

    Mycoplasma pneumoniae, which causes mycoplasmal pneumonia in human, mainly causes pneumonia in children, although it occasionally causes disease in infants and geriatrics. Some pathogenic factors produced by M. pneumoniae, such as hydrogen peroxide and Community-Acquired Respiratory Distress Syndrome (CARDS) toxin have been well studied. However, these factors alone cannot explain this predilection. The low incidence rate of mycoplasmal pneumonia in infants and geriatrics implies that the strong inflammatory responses induced by M. pneumoniae coordinate with the pathogenic factors to induce pneumonia. However, M. pneumoniae lacks a cell wall and does not possess an inflammation-inducing endotoxin, such as lipopolysaccharide (LPS). In M. pneumoniae, lipoproteins were identified as an inflammation-inducing factor. Lipoproteins induce inflammatory responses through Toll-like receptors (TLR) 2. Because Mycoplasma species lack a cell wall and lipoproteins anchored in the membrane are exposed, lipoproteins and TLR2 have been thought to be important for the pathogenesis of M. pneumoniae. However, recent reports suggest that M. pneumoniae also induces inflammatory responses also in a TLR2-independent manner. TLR4 and autophagy are involved in this TLR2-independent inflammation. In addition, the CARDS toxin or M. pneumoniae cytadherence induces inflammatory responses through an intracellular receptor protein complex called the inflammasome. In this review, the inflammation-inducing factors of M. pneumoniae are summarized. PMID:27065977

  4. Macrolide Resistance in Streptococcus pneumoniae

    PubMed Central

    Schroeder, Max R.; Stephens, David S.

    2016-01-01

    Streptococcus pneumoniae is a common commensal and an opportunistic pathogen. Suspected pneumococcal upper respiratory infections and pneumonia are often treated with macrolide antibiotics. Macrolides are bacteriostatic antibiotics and inhibit protein synthesis by binding to the 50S ribosomal subunit. The widespread use of macrolides is associated with increased macrolide resistance in S. pneumoniae, and the treatment of pneumococcal infections with macrolides may be associated with clinical failures. In S. pneumoniae, macrolide resistance is due to ribosomal dimethylation by an enzyme encoded by erm(B), efflux by a two-component efflux pump encoded by mef (E)/mel(msr(D)) and, less commonly, mutations of the ribosomal target site of macrolides. A wide array of genetic elements have emerged that facilitate macrolide resistance in S. pneumoniae; for example erm(B) is found on Tn917, while the mef (E)/mel operon is carried on the 5.4- or 5.5-kb Mega element. The macrolide resistance determinants, erm(B) and mef (E)/mel, are also found on large composite Tn916-like elements most notably Tn6002, Tn2009, and Tn2010. Introductions of 7-valent and 13-valent pneumococcal conjugate vaccines (PCV-7 and PCV-13) have decreased the incidence of macrolide-resistant invasive pneumococcal disease, but serotype replacement and emergence of macrolide resistance remain an important concern. PMID:27709102

  5. [Cough syncope caused by a possible Chlamydia pneumoniae pneumonia].

    PubMed

    Cinotti, R; Moubarak, G; Gervais, R; Mabo, P

    2009-09-01

    We report the case of a 61-year-old man who presented with coughing fits followed by sinus pauses and syncope. Cardiac and neurological diagnostic work-up was negative and the patient was considered to have cough syncope. As this occurred within the context of febrile pneumonia, an infectious disease was suspected but diagnostic work-up only revealed an increase of antibodies against Chlamydia pneumoniae. The responsibility of this agent is discussed. Clinical recovery was obtained with the prescription of antitussive medication.

  6. Acute fibrinous and organising pneumonia.

    PubMed

    Guimarães, Catarina; Sanches, Inês; Ferreira, Catarina

    2012-03-20

    Acute fibrinous and organising pneumonia (AFOP) was recently described as an unusual pattern of diffuse lung disease. Particular characteristics make the differential diagnosis with the well recognised clinical patterns of diffuse alveolar damage, cryptogenic organising pneumonia or eosinophilic pneumonia. The lack of hyaline membranes, the presence of intra-alveolar fibrin, absence of noticeable eosinophils and patchy distribution suggests that AFOP define a distinct histological pattern. The authors describe the case of a woman diagnosed with AFOP after surgical lung biopsy, in association with primary biliary cirrhosis. The patient presented dyspnoea, fatigue, dry cough and thoracic pain. The CT scan showed bilateral patchy infiltrates predominantly in the lower lobes. Flexible bronchoscopy and subsidiary techniques were inconclusive and biopsy through video-assisted thoracoscopic surgery led to anatomopathological diagnosis of AFOP. The patient is having a good clinical response to prednisone.

  7. [Severe haemolysis caused by Mycoplasma pneumoniae].

    PubMed

    Bohr, Anne Lisbeth; Aagaard, Thomas Granum; Birgens, Henrik; Søborg, Christian

    2015-10-01

    Mycoplasma pneumoniae is naturally resistant to betalactamase antibiotics but is sensitive to macrolides. Occasionally, infections with M. pneumoniae can lead to severe anaemia due to its ability to cause haemolysis when cold agglutination occurs. Increasing bacterial resistance to macrolid antibiotics is a growing concern worldwide. We present two cases where infection with M. pneumoniae caused severe haemolysis, one of which was macrolide-resistant.

  8. Bacterial Pneumonia in Older Adults.

    PubMed

    Marrie, Thomas J; File, Thomas M

    2016-08-01

    Community-acquired pneumonia is common in the elderly person; its presentation in this population is often confounded by multiple comorbid illnesses, including those that result in confusion. Although severity-of-illness scoring systems might aid decision-making, clinical judgment following a careful assessment is key in deciding on the site of care and appropriate therapy.

  9. Eosinophilic pneumonia induced by daptomycin.

    PubMed

    Hayes, Don; Anstead, Michael I; Kuhn, Robert J

    2007-04-01

    We present a case of drug-induced eosinophilic pneumonia resulting from intravenous daptomycin being used as therapy for recurrent methicillin-sensitive Staphlococcus aureus endocarditis. The patient developed hypoxic respiratory failure requiring intubation and mechanical ventilation. Daptomycin therapy was discontinued immediately, and the patient improved significantly after the administration of intravenous corticosteroids allowing for extubation 3 days later.

  10. Exogenous lipoid pneumonia caused by herbicide inhalation.

    PubMed

    Hotta, Takamasa; Tsubata, Yukari; Okimoto, Tamio; Hoshino, Teppei; Hamaguchi, Shun-Ichi; Isobe, Takeshi

    2016-09-01

    Exogenous lipoid pneumonia is caused by aspiration or inhalation of oily substances. Generally, lipoid pneumonia has non-specific clinical and radiological presentations and may be misdiagnosed as bacterial pneumonia. Our patient, a 68-year-old man who had been diagnosed with pneumonia on three previous occasions, was admitted to our hospital with a fourth similar episode. Computed tomography of the chest revealed extensive consolidations with air bronchograms in lung fields on the right side. The bronchoalveolar lavage fluid (BALF) increased ghost-like macrophages that stained positive for lipid. Our patient reported that he had sprayed herbicide in large quantities without wearing a mask. We analysed the BALF and herbicide by gas chromatography and diagnosed exogenous lipoid pneumonia caused by inhalation of herbicide. Clinicians should be aware of lipoid pneumonia, which may present as infectious pneumonia. PMID:27516888

  11. Pneumonia in stroke patients: a retrospective study.

    PubMed

    Ding, R; Logemann, J A

    2000-01-01

    This is a retrospective study of 378 consecutive stroke patients who were referred between June 1994 and June 1997 for videofluorographic study of oropharyngeal swallow. Patients who had radiation therapy, brain tumor, brain surgery, head and/or spinal cord trauma, oral-pharyngeal disease or surgery, or other neurologic diseases in addition to the stroke were excluded from the study. Patients were assigned to two groups: one with pneumonia and one without pneumonia. One hundred one patients were included in the pneumonia group, and 277 patients were included in the nonpneumonia group. Within the pneumonia group, patients were assigned to an acute pneumonia group (pneumonia within 6 months poststroke) and a chronic pneumonia group (pneumonia more than 6 months poststroke). Variables examined in the study included patients' medical history and the findings from the videofluorographic studies. Pearson chi-square analysis was used to identify those variables that were significantly different between the pneumonia and nonpneumonia patient groups and between the acute and chronic pneumonia groups. Results showed that stroke patients who developed pneumonia had a significantly higher incidence of multiple-location and unspecified lesion strokes, chronic airway disease in their medical history, and aspiration during the videofluorographic studies when compared with patients who did not develop pneumonia. Within the pneumonia group, the acute pneumonia group was found to have a significantly higher incidence of hypertension and diabetes in their medical history and a significantly higher incidence of aspiration and reduced laryngeal elevation during the videofluorographic studies. Between 48% and 55% of all stroke patients in the study aspirated. Patients who suffered multiple strokes, brainstem stroke, or subcortical stroke had the greatest frequency of aspiration.

  12. Epidemiology of Mycoplasma pneumoniae Infections in Japan and Therapeutic Strategies for Macrolide-Resistant M. pneumoniae.

    PubMed

    Yamazaki, Tsutomu; Kenri, Tsuyoshi

    2016-01-01

    Pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae pneumonia) is a major cause of community-acquired pneumonia worldwide. The surveillance of M. pneumoniae pneumonia is important for etiological and epidemiological studies of acute respiratory infections. In Japan, nation-wide surveillance of M. pneumoniae pneumonia has been conducted as a part of the National Epidemiological Surveillance of Infectious Diseases (NESID) program. This surveillance started in 1981, and significant increases in the numbers of M. pneumoniae pneumonia patients were noted in 1984, 1988, 2006, 2010, 2011, 2012, and 2015. The epidemics in 2011 and 2012 were particularly widespread and motivated researchers to conduct detailed epidemiological studies, including genotyping and drug resistance analyses of M. pneumoniae isolates. The genotyping studies based on the p1 gene sequence suggested that the p1 gene type 1 lineage has been dominant in Japan since 2003, including the epidemic period during 2011-2012. However, more detailed p1 typing analysis is required to determine whether the type 2 lineages become more relevant after the dominance of the type 1 lineage. There has been extensive research interest in implications of the p1 gene types on the epidemiology of M. pneumoniae infections. Serological characterizations of sera from patients have provided a glimpse into these associations, showing the presence of type specific antibody in the patient sera. Another important epidemiological issue of M. pneumoniae pneumonia is the emergence of macrolide-resistant M. pneumoniae (MRMP). MRMPs were noted among clinical isolates in Japan after 2000. At present, the isolation rate of MRMPs from pediatric patients is estimated at 50-90% in Japan, depending on the specific location. In view of the situation, Japanese societies have issued guiding principles for treating M. pneumoniae pneumonia. In these guiding principles, macrolides are still recommended as the first-line drug, however, if the

  13. Epidemiology of Mycoplasma pneumoniae Infections in Japan and Therapeutic Strategies for Macrolide-Resistant M. pneumoniae

    PubMed Central

    Yamazaki, Tsutomu; Kenri, Tsuyoshi

    2016-01-01

    Pneumonia caused by Mycoplasma pneumoniae (M. pneumoniae pneumonia) is a major cause of community-acquired pneumonia worldwide. The surveillance of M. pneumoniae pneumonia is important for etiological and epidemiological studies of acute respiratory infections. In Japan, nation-wide surveillance of M. pneumoniae pneumonia has been conducted as a part of the National Epidemiological Surveillance of Infectious Diseases (NESID) program. This surveillance started in 1981, and significant increases in the numbers of M. pneumoniae pneumonia patients were noted in 1984, 1988, 2006, 2010, 2011, 2012, and 2015. The epidemics in 2011 and 2012 were particularly widespread and motivated researchers to conduct detailed epidemiological studies, including genotyping and drug resistance analyses of M. pneumoniae isolates. The genotyping studies based on the p1 gene sequence suggested that the p1 gene type 1 lineage has been dominant in Japan since 2003, including the epidemic period during 2011–2012. However, more detailed p1 typing analysis is required to determine whether the type 2 lineages become more relevant after the dominance of the type 1 lineage. There has been extensive research interest in implications of the p1 gene types on the epidemiology of M. pneumoniae infections. Serological characterizations of sera from patients have provided a glimpse into these associations, showing the presence of type specific antibody in the patient sera. Another important epidemiological issue of M. pneumoniae pneumonia is the emergence of macrolide-resistant M. pneumoniae (MRMP). MRMPs were noted among clinical isolates in Japan after 2000. At present, the isolation rate of MRMPs from pediatric patients is estimated at 50–90% in Japan, depending on the specific location. In view of the situation, Japanese societies have issued guiding principles for treating M. pneumoniae pneumonia. In these guiding principles, macrolides are still recommended as the first-line drug, however, if

  14. Mycoplasma pneumoniae associated organising pneumonia in a 10 year old boy.

    PubMed

    Wachowski, O; Demirakça, S; Müller, K-M; Scheurlen, W

    2003-03-01

    We describe a 10 year old boy with organising pneumonia associated with acute Mycoplasma pneumoniae infection. The diagnosis of organising pneumonia was made by open lung biopsy and the M pneumoniae infection was proven serologically. Antibiotic and long term corticosteroid treatment resulted in steadily improving pulmonary function monitored by spirometry. The introduction of anti-inflammatory treatment with NSAIDs/immunosuppressive agents in order to spare steroids was well tolerated and resulted in further improvement of the pulmonary function. To our knowledge this is the first documented case of Mycoplasma pneumoniae associated organising pneumonia to be reported in a child.

  15. Community-onset Klebsiella pneumoniae pneumonia in Taiwan: clinical features of the disease and associated microbiological characteristics of isolates from pneumonia and nasopharynx

    PubMed Central

    Lin, Yi-Tsung; Wang, Yu-Ping; Wang, Fu-Der; Fung, Chang-Phone

    2015-01-01

    Klebsiella pneumoniae is an important cause of community-onset pneumonia in Asian countries and South Africa. We investigated the clinical characteristics of K. pneumoniae causing community-onset pneumonia, and the associated microbiological features between K. pneumoniae isolates from pneumonia and those from the nasopharynx in Taiwan. This study was conducted at the Taipei Veterans General Hospital during July, 2012 to February, 2014. The clinical characteristics in patients with community-onset K. pneumoniae pneumonia were analyzed. K. pneumoniae isolates from the nasopharynx of adults attending otorhinolaryngology outpatient clinics were collected to compare their microbiological features with those from pneumonia. Capsular genotypes, antimicrobial susceptibility, and multilocus sequence type (MLST) were determined among these strains. Ninety-one patients with community-onset K. pneumoniae pneumonia were enrolled. We found a high mortality (29.7%) among these patients. Capsular types K1, K2, K5, K20, K54, and K57 accounted for ∼70% of the K. pneumoniae isolates causing pneumonia, and ∼70% of all the K. pneumoniae strains isolated from the nasopharynx of patients in outpatient clinics. The MLST profiles further demonstrated the genetic relatedness between most pneumonia isolates and those from the nasopharynx. In conclusion, our results show that community-onset pneumonia caused by K. pneumoniae was associated with high mortality and could have a reservoir in the nasopharynx. To tackle this high-mortality disease, the distribution of capsular types in the nasopharynx might have implications for future vaccine development. PMID:25741336

  16. Community-onset Klebsiella pneumoniae pneumonia in Taiwan: clinical features of the disease and associated microbiological characteristics of isolates from pneumonia and nasopharynx.

    PubMed

    Lin, Yi-Tsung; Wang, Yu-Ping; Wang, Fu-Der; Fung, Chang-Phone

    2015-01-01

    Klebsiella pneumoniae is an important cause of community-onset pneumonia in Asian countries and South Africa. We investigated the clinical characteristics of K. pneumoniae causing community-onset pneumonia, and the associated microbiological features between K. pneumoniae isolates from pneumonia and those from the nasopharynx in Taiwan. This study was conducted at the Taipei Veterans General Hospital during July, 2012 to February, 2014. The clinical characteristics in patients with community-onset K. pneumoniae pneumonia were analyzed. K. pneumoniae isolates from the nasopharynx of adults attending otorhinolaryngology outpatient clinics were collected to compare their microbiological features with those from pneumonia. Capsular genotypes, antimicrobial susceptibility, and multilocus sequence type (MLST) were determined among these strains. Ninety-one patients with community-onset K. pneumoniae pneumonia were enrolled. We found a high mortality (29.7%) among these patients. Capsular types K1, K2, K5, K20, K54, and K57 accounted for ∼70% of the K. pneumoniae isolates causing pneumonia, and ∼70% of all the K. pneumoniae strains isolated from the nasopharynx of patients in outpatient clinics. The MLST profiles further demonstrated the genetic relatedness between most pneumonia isolates and those from the nasopharynx. In conclusion, our results show that community-onset pneumonia caused by K. pneumoniae was associated with high mortality and could have a reservoir in the nasopharynx. To tackle this high-mortality disease, the distribution of capsular types in the nasopharynx might have implications for future vaccine development.

  17. Persistent Pneumonia in an Infant

    PubMed Central

    Padilla, Kristen; Logan, Latania; Codispoti, Christopher; Jones, Carolyn

    2015-01-01

    A 4-month-old boy with past medical history of eczema presented with fever and cough; a chest radiograph showed lung consolidation, and he was initially treated with amoxicillin for presumed community-acquired pneumonia. After several days, his fever persisted. He was also profoundly anemic. Antibiotic coverage was broadened because of the concern for resistant organisms; he began to improve and was discharged from the hospital. However, at 5 months of age, his fever returned, and he continued to demonstrate lung consolidation on chest radiograph. Additionally, he had lost weight and continued to be anemic. Splenic cysts were noted on abdominal ultrasound. He was diagnosed with an unusual etiology for his pneumonia and improved with the appropriate therapy. An underlying immunodeficiency was suspected, but initial testing was nondiagnostic. At 12 months of age, he presented with another infection, and the final diagnosis was made. PMID:26122810

  18. Persistent Pneumonia in an Infant.

    PubMed

    Padilla, Kristen; Logan, Latania; Codispoti, Christopher; Jones, Carolyn; Van Opstal, Elizabeth

    2015-07-01

    A 4-month-old boy with past medical history of eczema presented with fever and cough; a chest radiograph showed lung consolidation, and he was initially treated with amoxicillin for presumed community-acquired pneumonia. After several days, his fever persisted. He was also profoundly anemic. Antibiotic coverage was broadened because of the concern for resistant organisms; he began to improve and was discharged from the hospital. However, at 5 months of age, his fever returned, and he continued to demonstrate lung consolidation on chest radiograph. Additionally, he had lost weight and continued to be anemic. Splenic cysts were noted on abdominal ultrasound. He was diagnosed with an unusual etiology for his pneumonia and improved with the appropriate therapy. An underlying immunodeficiency was suspected, but initial testing was nondiagnostic. At 12 months of age, he presented with another infection, and the final diagnosis was made. PMID:26122810

  19. Receptor for Advanced Glycation End Products (RAGE) Serves a Protective Role during Klebsiella pneumoniae - Induced Pneumonia.

    PubMed

    Achouiti, Ahmed; de Vos, Alex F; van 't Veer, Cornelis; Florquin, Sandrine; Tanck, Michael W; Nawroth, Peter P; Bierhaus, Angelika; van der Poll, Tom; van Zoelen, Marieke A D

    2016-01-01

    Klebsiella species is the second most commonly isolated gram-negative organism in sepsis and a frequent causative pathogen in pneumonia. The receptor for advanced glycation end products (RAGE) is expressed on different cell types and plays a key role in diverse inflammatory responses. We here aimed to investigate the role of RAGE in the host response to Klebsiella (K.) pneumoniae pneumonia and intransally inoculated rage gene deficient (RAGE-/-) and normal wild-type (Wt) mice with K. pneumoniae. Klebsiella pneumonia resulted in an increased pulmonary expression of RAGE. Furthermore, the high-affinity RAGE ligand high mobility group box-1 was upregulated during K. pneumoniae pneumonia. RAGE deficiency impaired host defense as reflected by a worsened survival, increased bacterial outgrowth and dissemination in RAGE-/- mice. RAGE-/- neutrophils showed a diminished phagocytosing capacity of live K. pneumoniae in vitro. Relative to Wt mice, RAGE-/- mice demonstrated similar lung inflammation, and slightly elevated-if any-cytokine and chemokine levels and unchanged hepatocellular injury. In addition, RAGE-/- mice displayed an unaltered response to intranasally instilled Klebsiella lipopolysaccharide (LPS) with respect to pulmonary cell recruitment and local release of cytokines and chemokines. These data suggest that (endogenous) RAGE protects against K. pneumoniae pneumonia. Also, they demonstrate that RAGE contributes to an effective antibacterial defense during K. pneumoniae pneumonia, at least partly via its participation in the phagocytic properties of professional granulocytes. Additionally, our results indicate that RAGE is not essential for the induction of a local and systemic inflammatory response to either intact Klebsiella or Klebsiella LPS.

  20. Complete Genome Sequence of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Siphophage Sushi.

    PubMed

    Nguyen, Dat T; Lessor, Lauren E; Cahill, Jesse L; Rasche, Eric S; Kuty Everett, Gabriel F

    2015-09-03

    Klebsiella pneumoniae is a Gram-negative bacterium in the family Enterobacteriaceae. It is associated with numerous nosocomial infections, including respiratory and urinary tract infections in humans. The following reports the complete genome sequence of K. pneumoniae carbapenemase-producing K. pneumoniae T1-like siphophage Sushi and describes its major features.

  1. Complete Genome Sequence of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Siphophage Sushi.

    PubMed

    Nguyen, Dat T; Lessor, Lauren E; Cahill, Jesse L; Rasche, Eric S; Kuty Everett, Gabriel F

    2015-01-01

    Klebsiella pneumoniae is a Gram-negative bacterium in the family Enterobacteriaceae. It is associated with numerous nosocomial infections, including respiratory and urinary tract infections in humans. The following reports the complete genome sequence of K. pneumoniae carbapenemase-producing K. pneumoniae T1-like siphophage Sushi and describes its major features. PMID:26337889

  2. Pneumonia Outbreak Caused by Chlamydophila pneumoniae among US Air Force Academy Cadets, Colorado, USA.

    PubMed

    Fajardo, Kevin A; Zorich, Shauna C; Voss, Jameson D; Thervil, Jeffrey W

    2015-06-01

    During October 2013-May 2014, there were 102 cases of pneumonia diagnosed in US Air Force Academy cadets. A total of 73% of tested nasal washes contained Chlamydophila pneumoniae. This agent can be considered to be present on campus settings during outbreaks with numerous, seemingly disconnected cases of relatively mild pneumonia.

  3. Klebsiella pneumoniae inoculants for enhancing plant growth

    SciTech Connect

    Triplett, Eric W.; Kaeppler, Shawn M.; Chelius, Marisa K.

    2008-07-01

    A biological inoculant for enhancing the growth of plants is disclosed. The inoculant includes the bacterial strains Herbaspirillum seropedicae 2A, Pantoea agglomerans P101, Pantoea agglomerans P102, Klebsiella pneumoniae 342, Klebsiella pneumoniae zmvsy, Herbaspirillum seropedicae Z152, Gluconacetobacter diazotrophicus PA15, with or without a carrier. The inoculant also includes strains of the bacterium Pantoea agglomerans and K. pneumoniae which are able to enhance the growth of cereal grasses. Also disclosed are the novel bacterial strains Herbaspirillum seropedicae 2A, Pantoea agglomerans P101 and P102, and Klebsiella pneumoniae 342 and zmvsy.

  4. Aspiration syndromes: aspiration pneumonia and pneumonitis.

    PubMed

    Marik, Paul E

    2010-02-01

    Aspiration pneumonia and pneumonitis are common clinical syndromes that occur in hospitalized patients. Aspiration pneumonia occurs in patients with dysphagia and usually presents as a community-acquired pneumonia with a focal infiltrate in a dependent bronchopulmonary segment. Patients with aspiration pneumonia require treatment with broad-spectrum antibiotics and management of the underlying dysphagia. Aspiration pneumonitis follows the aspiration of gastric contents, usually in patients with a marked decreased level of consciousness. Treatment of aspiration pneumonitis is essentially supportive; however, corticosteroids and other immunomodulating agents may have a role in these patients.

  5. [Pneumonia: The urgent problem of 21st century medicine].

    PubMed

    Chuchalin, A G

    2016-01-01

    The paper analyzes the systematic reviews and meta-analyses on the strategic issues of pneumonia, which have been published in the past 3 years. It discusses the prevalence and mortality rates of acquired pneumonia, hospital-acquired (nosocomial) pneumonia, healthcare-associated pneumonia, ventilator-associated pneumonia, and Mycoplasma pneumonia, and the specific features of their etiology, diagnosis, and treatment. A large number of investigations emphasize the relevance of this problem in current clinical practice.

  6. Pericardiectomy for Pleuropericardial Effusion Complicating Bacterial Pneumonia

    PubMed Central

    Quarti, Andrea; de Benedictis, Fernando Maria; Soura, Elli; Pozzi, Marco

    2010-01-01

    Severe pericardial effusion is a rare complication of bacterial pneumonia and it usually disappears under medical treatment. Herein we report a case of a girl with a congenital immunodeficient syndrome and bacterial pneumonia, who developed recurrent and life-threatening pericardial effusion refractory to medical treatment. She was finally treated with pericardiectomy. PMID:20585369

  7. Gallium-67 pulmonary uptake in eosinophilic pneumonia

    SciTech Connect

    Morais, J.; Carrier, L.; Gariepy, G.; Le Bel, L.; Chartrand, R.; Picard, D.

    1988-01-01

    Eosinophilic pneumonia is usually diagnosed based on the findings on chest x-ray, white blood count, and transbronchial biopsy. After reporting a case of Ga-67 lung uptake in eosinophilic pneumonia, its histopathology is discussed and the mechanisms of Ga-67 uptake by inflammatory lesions are reviewed.

  8. Organizing pneumonia: chest HRCT findings*

    PubMed Central

    Faria, Igor Murad; Zanetti, Gláucia; Barreto, Miriam Menna; Rodrigues, Rosana Souza; Araujo-Neto, Cesar Augusto; Silva, Jorge Luiz Pereira e; Escuissato, Dante Luiz; Souza, Arthur Soares; Irion, Klaus Loureiro; Mançano, Alexandre Dias; Nobre, Luiz Felipe; Hochhegger, Bruno; Marchiori, Edson

    2015-01-01

    OBJECTIVE: To determine the frequency of HRCT findings and their distribution in the lung parenchyma of patients with organizing pneumonia. METHODS: This was a retrospective review of the HRCT scans of 36 adult patients (26 females and 10 males) with biopsy-proven organizing pneumonia. The patients were between 19 and 82 years of age (mean age, 56.2 years). The HRCT images were evaluated by two independent observers, discordant interpretations being resolved by consensus. RESULTS: The most common HRCT finding was that of ground-glass opacities, which were seen in 88.9% of the cases. The second most common finding was consolidation (in 83.3% of cases), followed by peribronchovascular opacities (in 52.8%), reticulation (in 38.9%), bronchiectasis (in 33.3%), interstitial nodules (in 27.8%), interlobular septal thickening (in 27.8%), perilobular pattern (in 22.2%), the reversed halo sign (in 16.7%), airspace nodules (in 11.1%), and the halo sign (in 8.3%). The lesions were predominantly bilateral, the middle and lower lung fields being the areas most commonly affected. CONCLUSIONS: Ground-glass opacities and consolidation were the most common findings, with a predominantly random distribution, although they were more common in the middle and lower thirds of the lungs. PMID:26176521

  9. Pneumonia

    MedlinePlus

    ... who are receiving chemotherapy are also at increased risk. You work in construction or agriculture. Working in environments where you breathe in dust, chemicals, air pollution or toxic fumes can damage ...

  10. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    PubMed

    Ishikawa, Teruhiko; Isono, Shiroh

    2016-01-01

    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia. PMID:27004381

  11. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    PubMed

    Ishikawa, Teruhiko; Isono, Shiroh

    2016-01-01

    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia.

  12. Many radiologic facies of pneumococcal pneumonia

    SciTech Connect

    Kantor, H.G.

    1981-12-01

    In 1978, 89 patients were treated for (S. pneumoniae) pneumonia at New York Hospital-Cornell Medical Center. Only 40 cases met rather strict diagnostic criteria. Of these, 12 demonstrated the classical consolidative (air space) pattern usually ascribed to this disease. A bronchopneumonic (patch) pattern was demonstrated in an equal number of patients; interstitial (irregular linear) infiltrates were manifest in nine cases and a mixed interstitial and patchy presentation shown in seven cases. Absence of the consolidative pattern does not exclude pneumococcal pneumonia. Bacteriologic investigation is required to determine the proper diagnosis and course of therapy.

  13. A plasmid in Streptococcus pneumoniae.

    PubMed Central

    Smith, M D; Guild, W R

    1979-01-01

    Plasmid deoxyribonucleic acid has been detected in three related laboratory strains of Streptococcus pneumoniae. Strains D39S, R36, and R36NC each contain a minimum of two copies per cell of a 2.0-megadalton plasmid (pDP1). A plasmid twice as large as this smaller one is also present in much lower quantity in these strains, but neither plasmid is present in four strains related to these or in a drug-resistant clinical isolate from Paris. The plasmid yield was not amplified in the presence of chloramphenicol. No phenotype has been correlated with the presence of pDP1, which has existed in strains carried for many years in laboratory collections. Images PMID:33961

  14. Coccidioidomycosis with diffuse miliary pneumonia.

    PubMed

    Sotello, David; Rivas, Marcella; Fuller, Audra; Mahmood, Tashfeen; Orellana-Barrios, Menfil; Nugent, Kenneth

    2016-01-01

    Coccidioidomycosis is a well-known infection in the southwestern United States, and its occurrence is becoming more frequent in endemic areas. This disease can have a significant economic and medical impact; therefore, accurate diagnosis is crucial. In conjunction with patient symptoms, residence in or travel to an endemic area is essential for diagnosis. Diagnosis is usually made with serology, culture, or biopsy and confirmed with DNA probe technology. Pulmonary disease is the most common presentation and is seen in almost 95% of all cases. One-half to two-thirds of all Coccidioides infections are asymptomatic or subclinical. Most pulmonary infections are self-limited and do not require treatment except in special populations. When treatment is warranted, itraconazole and fluconazole are frequently used. Diffuse miliary pneumonia is uncommon and is especially rare in immunocompetent patients. Herein we describe a rare presentation of miliary coccidioidomycosis in a nonimmunocompromised patient. PMID:26722164

  15. [Unusual pneumonia by Pasteurella multocida].

    PubMed

    Duhautois, J; Chabrol, J; Terce, G; Ampere, A; Bart, F; Wallaert, B

    2013-02-01

    Pasteurellosis is an infection caused by inoculation usually through bites or scratches. Pasteurella multocida is involved in 50 to 60% of cases. Cats are the main vectors of the pathogen. Immunodepression increases the risk of systemic disease. We report a case of Pasteurella multocida pneumonia in an 81-year-old patient who had no cutaneous portal of entry. The patient had a past medical history of rectal neoplasia and prostate neoplasia treated with brachytherapy and hormonal therapy respectively. He had an environmental risk factor (the presence of a cat at home). The diagnosis was confirmed by repeated blood cultures. Antimicrobial therapy resulted in clinical, biological and radiological improvement. This case report raises the question of a possible pathogenesis different from the commonly described "inoculation". PMID:23333046

  16. Antimicrobial and immunologic activities of clarithromycin in a murine model of Mycoplasma pneumoniae-induced pneumonia.

    PubMed

    Hardy, Robert D; Rios, Ana Maria; Chavez-Bueno, Susana; Jafri, Hasan S; Hatfield, Jeanine; Rogers, Beverly B; McCracken, George H; Ramilo, Octavio

    2003-05-01

    Because macrolide antibiotics are hypothesized to possess immunomodulatory activity independent of their antimicrobial activity, we evaluated the immunomodulatory effect of clarithromycin in a murine model of lung inflammation induced by either live or UV-killed Mycoplasma pneumoniae. BALB/c mice were intranasally inoculated once with live or UV-killed M. pneumoniae. Clarithromycin (25 mg/kg of body weight) or placebo was subcutaneously administered once daily in both groups of mice. In mice infected with live M. pneumoniae, clarithromycin treatment significantly reduced quantitative M. pneumoniae bronchoalveolar lavage (BAL) culture, pulmonary histopathologic scores (HPS), and airway resistance-obstruction (as measured by plethysmography) compared with placebo. Concentrations of tumor necrosis factor alpha, gamma interferon, interleukin-6 (IL-6), mouse KC (functional IL-8), JE/MCP-1, and MIP-1alpha in BAL fluid were also significantly decreased in mice infected with live M. pneumoniae given clarithromycin. In contrast, mice inoculated with UV-killed M. pneumoniae had no significant reduction in HPS, airway resistance-obstruction, or BAL cytokine or chemokine concentrations in response to clarithromycin administration. Clarithromycin therapy demonstrated beneficial effects (microbiologic, histologic, respiratory, and immunologic) on pneumonia in the mice infected with live M. pneumoniae; this was not observed in the mice inoculated with UV-killed M. pneumoniae.

  17. Granzymes A and B Regulate the Local Inflammatory Response during Klebsiella pneumoniae Pneumonia.

    PubMed

    García-Laorden, M Isabel; Stroo, Ingrid; Blok, Dana C; Florquin, Sandrine; Medema, Jan Paul; de Vos, Alex F; van der Poll, Tom

    2016-01-01

    Klebsiella pneumoniae is a common cause of hospital-acquired pneumonia. Granzymes (gzms), mainly found in cytotoxic lymphocytes, have been implicated as mediators of infection and inflammation. We here sought to investigate the role of gzmA and gzmB in the host response to K. pneumoniae-induced airway infection and sepsis. For this purpose, pneumonia was induced in wild-type (WT) and gzmA-deficient (gzmA-/-), gzmB-/- and gzmAxB-/- mice by intranasal infection with K. pneumoniae. In WT mice, gzmA and gzmB were mainly expressed by natural killer cells. Pneumonia was associated with reduced intracellular gzmA and increased intracellular gzmB levels. Gzm deficiency had little impact on antibacterial defence: gzmA-/- and gzmAxB-/- mice transiently showed modestly higher bacterial loads in the lungs but not in distant organs. GzmB-/- and, to a larger extent, gzmAxB-/- mice displayed transiently increased lung inflammation, reflected in the semi-quantitative histology scores and levels of pro-inflammatory cytokines and chemokines. Most differences between gzm-deficient and WT mice had disappeared during late-stage pneumonia. Gzm deficiency did not impact on distant organ injury or survival. These results suggest that gzmA and gzmB partly regulate local inflammation during early pneumonia but eventually play an insignificant role during pneumosepsis by the common human pathogen K. pneumoniae.

  18. Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications

    PubMed Central

    Saraya, Takeshi; Kurai, Daisuke; Nakagaki, Kazuhide; Sasaki, Yoshiko; Niwa, Shoichi; Tsukagoshi, Hiroyuki; Nunokawa, Hiroki; Ohkuma, Kosuke; Tsujimoto, Naoki; Hirao, Susumu; Wada, Hiroo; Ishii, Haruyuki; Nakata, Koh; Kimura, Hirokazu; Kozawa, Kunihisa; Takizawa, Hajime; Goto, Hajime

    2014-01-01

    Mycoplasma pneumoniae (Mp) is a leading cause of community acquired pneumonia. Knowledge regarding Mp pneumonia obtained from animal models or human subjects has been discussed in many different reports. Accumulated expertise concerning this critical issue has been hard to apply clinically, and potential problems may remain undiscovered. Therefore, our multidisciplinary team extensively reviewed the literature regarding Mp pneumonia, and compared findings from animal models with those from human subjects. In human beings, the characteristic pathological features of Mp pneumonia have been reported as alveolar infiltration with neutrophils and lymphocytes and lymphocyte/plasma cell infiltrates in the peri-bronchovascular area. Herein, we demonstrated the novel aspects of Mp pneumonia that the severity of the Mp pneumonia seemed to depend on the host innate immunity to the Mp, which might be accelerated by antecedent Mp exposure (re-exposure or latent respiratory infection) through up-regulation of Toll-like receptor 2 expression on bronchial epithelial cells and alveolar macrophages. The macrolides therapy might be beneficial for the patients with macrolide-resistant Mp pneumonia via not bacteriological but immunomodulative effects. This exhaustive review focuses on pathogenesis and extends to some therapeutic implications such as clarithromycin, and discusses the various diverse aspects of Mp pneumonia. It is our hope that this might lead to new insights into this common respiratory disease. PMID:25157244

  19. Lymphatic fluctuation in the parenchymal remodeling stage of acute interstitial pneumonia, organizing pneumonia, nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis.

    PubMed

    Parra, E R; Araujo, C A L; Lombardi, J G; Ab'Saber, A M; Carvalho, C R R; Kairalla, R A; Capelozzi, V L

    2012-05-01

    Because the superficial lymphatics in the lungs are distributed in the subpleural, interlobular and peribroncovascular interstitium, lymphatic impairment may occur in the lungs of patients with idiopathic interstitial pneumonias (IIPs) and increase their severity. We investigated the distribution of lymphatics in different remodeling stages of IIPs by immunohistochemistry using the D2-40 antibody. Pulmonary tissue was obtained from 69 patients with acute interstitial pneumonia/diffuse alveolar damage (AIP/DAD, N = 24), cryptogenic organizing pneumonia/organizing pneumonia (COP/OP, N = 6), nonspecific interstitial pneumonia (NSIP/NSIP, N = 20), and idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP, N = 19). D2-40+ lymphatic in the lesions was quantitatively determined and associated with remodeling stage score. We observed an increase in the D2-40+ percent from DAD (6.66 ± 1.11) to UIP (23.45 ± 5.24, P = 0.008) with the advanced process of remodeling stage of the lesions. Kaplan-Meier survival curves showed a better survival for patients with higher lymphatic D2-40+ expression than 9.3%. Lymphatic impairment occurs in the lungs of IIPs and its severity increases according to remodeling stage. The results suggest that disruption of the superficial lymphatics may impair alveolar clearance, delay organ repair and cause severe disease progress mainly in patients with AIP/DAD. Therefore, lymphatic distribution may serve as a surrogate marker for the identification of patients at greatest risk for death due to IIPs.

  20. Aspiration pneumonia in children: an iconographic essay.

    PubMed

    de Oliveira, Gabriel Antonio; Pessanha, Laís Bastos; Guerra, Luiz Felipe Alves; Martins, Diego Lima Nava; Rondina, Ronaldo Garcia; Silva, Jamine Ronacher Passos

    2015-01-01

    In most cases of aspiration pneumonia in children, the disease is specific to this age group. Clinical and radiological correlation is essential for the diagnosis. The present pictorial essay is aimed at showing typical images of the most common etiologies.

  1. Pneumonia Can Be Prevented -- Vaccines Can Help

    MedlinePlus

    ... Past Emails CDC Features Pneumonia Can Be Prevented—Vaccines Can Help Language: English Español (Spanish) Recommend on ... not recommended. Learn more . Lower Your Risk with Vaccines In the United States, there are vaccines that ...

  2. Lipoid Pneumonia in a Gas Station Attendant

    PubMed Central

    Yampara Guarachi, Gladis Isabel; Barbosa Moreira, Valeria; Santos Ferreira, Angela; Sias, Selma M. De A.; Rodrigues, Cristovão C.; Teixeira, Graça Helena M. do C.

    2014-01-01

    The exogenous lipoid pneumonia, uncommon in adults, is the result of the inhalation and/or aspiration of lipid material into the tracheobronchial tree. This is often confused with bacterial pneumonia and pulmonary tuberculosis due to a nonspecific clinical and radiologic picture. It presents acutely or chronically and may result in pulmonary fibrosis. We describe here a case of lipoid pneumonia in a gas station attendant who siphoned gasoline to fill motorcycles; he was hospitalized due to presenting with a respiratory infection that was hard to resolve. The patient underwent bronchoscopy with bronchoalveolar lavage, which, on cytochemical (oil red O) evaluation, was slightly positive for lipid material in the foamy cytoplasm of alveolar macrophages. Due to his occupational history and radiographic abnormalities suggestive of lipoid pneumonia, a lung biopsy was performed to confirm the diagnosis. The patient was serially treated with segmental lung lavage and showed clinical, functional, and radiological improvement. PMID:25374742

  3. Haemophilus influenzae sepsis resulting from pneumonia.

    PubMed

    Marinella, M A

    1997-01-01

    Haemophilus influenzae is a pleomorphic gram-negative bacterium that causes a myriad of infections in both adults and children. The organism frequently causes respiratory infections in patients with obstructive lung disease but may on occasion cause invasive infections including pneumonia with bacteremia. We report the case of a patient with underlying lung disease and metastatic malignancy in whom sepsis related to pneumonia caused by H. influenzae developed.

  4. Relationships between periodontal disease and bacterial pneumonia.

    PubMed

    Scannapieco, F A; Mylotte, J M

    1996-10-01

    Bacterial pneumonia is a prevalent and costly infection that is a significant cause of morbidity and mortality in patients of all ages. The continuing emergence of antibiotic-resistant bacteria (e.g., penicillin-resistant pneumococci) suggests that bacterial pneumonia will assume increasing importance in the coming years. Thus, knowledge of the pathogenesis of, and risk factors for, bacterial pneumonia is critical to the development of strategies for prevention and treatment of these infections. Bacterial pneumonia in adults is the result of aspiration of oropharyngeal flora into the lower respiratory tract and failure of host defense mechanisms to eliminate the contaminating bacteria, which multiply in the lung and cause infection. It is recognized that community-acquired pneumonia and lung abscesses can be the result of infection by anaerobic bacteria; dental plaque would seem to be a logical source of these bacteria, especially in patients with periodontal disease. It is also possible that patients with high risk for pneumonia, such as hospitalized patients and nursing home residents, are likely to pay less attention to personal hygiene than healthy patients. One important dimension of this personal neglect may be diminished attention to oral hygiene. Poor oral hygiene and periodontal disease may promote oropharyngeal colonization by potential respiratory pathogens (PRPs) including Enterobacteriaceae (Klebsiella pneumoniae, Escherichia coli, Enterobacter species, etc.), Pseudomonas aeruginosa, and Staphylococcus aureus. This paper provides the rationale for the development of this hypothesis especially as it pertains to mechanically ventilated intensive care unit patients and nursing home residents, two patient groups with a high risk for bacterial pneumonia. PMID:8910830

  5. Klebsiella pneumoniae in orange juice concentrate.

    PubMed Central

    Fuentes, F A; Hazen, T C; López-Torres, A J; Rechani, P

    1985-01-01

    Fecal coliform-positive, capsule-forming Klebsiella pneumoniae cells were observed in high densities (10(4) to 10(8) CFU/100 ml) in two commercial batches of frozen orange juice concentrate at a cannery in Puerto Rico. Contamination of both lots was gross and included off colors and odors. Isolates of K. pneumoniae from these concentrates revealed growth at 4, 25, and 34 degrees C with generation times from 0.39 to 1.84 h. PMID:3893321

  6. Subselective magnification angiography of experimental pneumonia

    SciTech Connect

    Bookstein, J.J.; Alazraki, N.P.; Jassy, L.N.

    1983-04-01

    An experiment was designed to determine whether or not acute pneumococcal pneumonia in dogs is associated with intravascular thrombosis, or with angiographic features distinguishable from pulmonary embolism. In dogs with normal baseline chest radiographs and perfusion scans, pneumonia was produced by transbronchial instillation of type III pneumococcus. After 2 days, perfusion scans demonstrated discrete appropriate defects. In vivo magnification pulmonary arteriography, postmortem pulmonary arteriography, and histologic examination disclosed no evidence of thrombi.

  7. Acute and subacute idiopathic interstitial pneumonias.

    PubMed

    Taniguchi, Hiroyuki; Kondoh, Yasuhiro

    2016-07-01

    Idiopathic interstitial pneumonias (IIPs) may have an acute or subacute presentation, or acute exacerbation may occur in a previously subclinical or unrecognized chronic IIP. Acute or subacute IIPs include acute interstitial pneumonia (AIP), cryptogenic organizing pneumonia (COP), nonspecific interstitial pneumonia (NSIP), acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) and AE-NSIP. Interstitial lung diseases (ILDs) including connective tissue disease (CTD) associated ILD, hypersensitivity pneumonitis, acute eosinophilic pneumonia, drug-induced lung disease and diffuse alveolar haemorrhage need to be differentiated from acute and subacute IIPs. Despite the severe lack of randomized controlled trials for the treatment of acute and subacute IIPs, the mainstream treatment remains corticosteroid therapy. Other potential therapies reported in the literature include corticosteroids and immunosuppression, antibiotics, anticoagulants, neutrophil elastase inhibitor, autoantibody-targeted treatment, antifibrotics and hemoperfusion therapy. With regard to mechanical ventilation, patients in recent studies with acute and subacute IIPs have shown better survival than those in previous studies. Therefore, a careful value-laden decision about the indications for endotracheal intubation should be made for each patient. Noninvasive ventilation may be beneficial to reduce ventilator associated pneumonia. PMID:27123874

  8. Acute and subacute idiopathic interstitial pneumonias.

    PubMed

    Taniguchi, Hiroyuki; Kondoh, Yasuhiro

    2016-07-01

    Idiopathic interstitial pneumonias (IIPs) may have an acute or subacute presentation, or acute exacerbation may occur in a previously subclinical or unrecognized chronic IIP. Acute or subacute IIPs include acute interstitial pneumonia (AIP), cryptogenic organizing pneumonia (COP), nonspecific interstitial pneumonia (NSIP), acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) and AE-NSIP. Interstitial lung diseases (ILDs) including connective tissue disease (CTD) associated ILD, hypersensitivity pneumonitis, acute eosinophilic pneumonia, drug-induced lung disease and diffuse alveolar haemorrhage need to be differentiated from acute and subacute IIPs. Despite the severe lack of randomized controlled trials for the treatment of acute and subacute IIPs, the mainstream treatment remains corticosteroid therapy. Other potential therapies reported in the literature include corticosteroids and immunosuppression, antibiotics, anticoagulants, neutrophil elastase inhibitor, autoantibody-targeted treatment, antifibrotics and hemoperfusion therapy. With regard to mechanical ventilation, patients in recent studies with acute and subacute IIPs have shown better survival than those in previous studies. Therefore, a careful value-laden decision about the indications for endotracheal intubation should be made for each patient. Noninvasive ventilation may be beneficial to reduce ventilator associated pneumonia.

  9. A review of interstitial pneumonia in cattle.

    PubMed

    Kerr, L A; Linnabary, R D

    1989-06-01

    Interstitial pneumonias comprise a significant proportion of cattle respiratory diseases. Known by different names, such as acute bovine pulmonary emphysema and edema (ABPE), fog fever, atypical interstitial pneumonia (AIP) and cow asthma, the condition seems to occur predominantly in late summer or fall. However, depending on the etiology, cases have occurred throughout the year. Interstitial pneumonia often begins with acute respiratory distress in animals that were clinically normal 12 hr earlier. Animals are observed breathing very rapid and shallow with their mouths open. If disturbed, death may occur rapidly from hypoxia. Causes of interstitial pneumonia are quite varied ranging from parasitic, viral and bacterial to toxic. Toxic agents constitute the most economically important cause of this condition in cattle. The primary toxin is the amino acid L-tryptophan in lush pasture grasses, a compound which is converted to 3-methylindole by rumen microorganisms. Other leading toxic causes of interstitial pneumonia are perilla mint and moldy sweet potatoes. Although treatments are mainly symptomatic and ineffective, preventive measures will reduce the occurrence of interstitial pneumonia. Prevention consists of denying animals exposure to know pneumotoxic agents, eliminating certain rumen microflora that break down the toxic compounds to reactive metabolites, and supplying ample good forage so that cattle will not as likely consume toxic plants.

  10. Prevention of ventilator-associated pneumonia.

    PubMed

    Lau, Arthur C W; So, H M; Tang, S L; Yeung, Alwin; Lam, S M; Yan, W W

    2015-02-01

    Ventilator-associated pneumonia is the commonest, yet mostly preventable, infection in mechanically ventilated patients. Successful control of ventilator-associated pneumonia can save hospitalisation cost, and is possible by using a multidisciplinary clinical and administrative approach. The ventilator-associated pneumonia rate should be expressed as the number of ventilator-associated pneumonia days per 1000 ventilator days to take into account the device-utilisation duration for meaningful comparison. Various strategies address the issue, including general infection control measures, body positioning, intubation and mechanical ventilation, oral and gastro-intestinal tract, endotracheal tube, airway pressure, cuff pressure, selective digestive and/or oropharyngeal decontamination, and probiotic or early antibiotic treatment, as well as overall administration at a policy level. The rationale and controversy of these approaches are discussed in this article. The authors suggest that all units treating mechanically ventilated patients should have a ventilator-associated pneumonia prevention protocol in place, and ventilator-associated pneumonia should be seriously considered as a key performance indicator in local intensive care units.

  11. Early recognition of Streptococcus pneumoniae in patients with community-acquired pneumonia.

    PubMed

    Bohte, R; Hermans, J; van den Broek, P J

    1996-03-01

    The objective of this study was to assess the predictive value of signs, symptoms, and rapidly available laboratory parameters for pneumococci in community-acquired pneumonia (CAP). A prospective study on patients with CAP who were admitted to hospital was conducted. Clinical and laboratory data were collected according to a protocol. Two hundred sixty-eight patients aged 18 years or older, not living in a nursing home or not admitted to hospital within one week of this admission, with a new infiltrate on the chest radiograph consistent with pneumonia were included. According to microbiological and serological tests, patients were allocated to one of two aetiological groups, Streptococcus pneumoniae or "other pathogens". Seventy-three variables were examined for a correlation with one of the aetiological categories by means of univariate and multivariate analysis. The resulting discriminant function was considered a clinical test for which posttest probabilities for pneumococcal pneumonia were calculated. Streptococcus pneumoniae was demonstrated in 79 patients and other pathogens in 83; no pathogens were detectable in 106 patients. The variables "cardiovascular disease", "acute onset", "pleuritic pain", "gram-positive bacteria in the sputum Gram stain", and "leucocyte count" correctly predicted the cause of CAP in 80% of all cases in both groups. Depending on the prevalence of Streptococcus pneumoniae, posttest probabilities for pneumococcal pneumonia were up to 90%. It is concluded that data on history, together with the result of the Gram stain of sputum and the leucocyte count, can help to distinguish Streptococcus pneumoniae from other pathogens causing CAP.

  12. Molecular characterization of Chlamydia pneumoniae in animals and humans from Argentina: Genetic characterization of Chlamydia pneumoniae.

    PubMed

    Frutos, María C; Monetti, Marina S; Mosmann, Jessica; Kiguen, Ana X; Venezuela, Fernando R; Ré, Viviana E; Cuffini, Cecilia G

    2016-10-01

    In this study, genetic diversity of Chlamydia pneumoniae was investigated and the relationships between sequences amplified of different sources, clinical conditions and geographical regions of central Argentina were established. Samples amplified were similar to human C. pneumoniae patterns and show the high clonality of the population.

  13. Adenovirus Type 7 Pneumonia in Children Who Died from Measles-Associated Pneumonia, Hanoi, Vietnam, 2014.

    PubMed

    Hai, Le Thanh; Thach, Hoang Ngoc; Tuan, Ta Anh; Nam, Dao Huu; Dien, Tran Minh; Sato, Yuko; Kumasaka, Toshio; Suzuki, Tadaki; Hanaoka, Nozomu; Fujimoto, Tsuguto; Katano, Harutaka; Hasegawa, Hideki; Kawachi, Shoji; Nakajima, Noriko

    2016-04-01

    During a 2014 measles outbreak in Vietnam, postmortem pathologic examination of hospitalized children who died showed that adenovirus type 7 pneumonia was a contributory cause of death in children with measles-associated immune suppression. Adenovirus type 7 pneumonia should be recognized as a major cause of secondary infection after measles. PMID:26926035

  14. Preliminary investigation of a mice model of Klebsiella pneumoniae subsp. ozaenae induced pneumonia.

    PubMed

    Renois, Fanny; Jacques, Jérôme; Guillard, Thomas; Moret, Hélène; Pluot, Michel; Andreoletti, Laurent; de Champs, Christophe

    2011-11-01

    In the present study, we comparatively assessed the pathophysiological mechanisms developed during lung infection of BALB/C female mice infected by an original wild type Klebsiella pneumoniae subsp. ozaenae strain (CH137) or by a referent subspecies K. pneumoniae. subsp. pneumoniae strain (ATCC10031). The mice infected with 2.10⁶ CFU K. p. subsp. pneumoniae (n = 10) showed transient signs of infection and all of them recovered. All of those infected with 1.10⁶ CFU K. p. subsp. ozaenae (n = 10) developed pneumonia within 24 h and died between 48 and 72 h. Few macrophages, numerous polymorphonuclear cells and lymphocytes were observed in their lungs in opposite to K. p. subsp. pneumoniae. In bronchoalveolar lavage, a significant increase in MIP-2, IL-6, KC and MCP-1 levels was only observed in K. p. subsp. ozaenae infected mice whereas high levels of TNF-α were evidenced with the two subspecies. Our findings indicated a lethal effect of a wild type K. p. subsp. ozaenae strain by acute pneumonia reflecting an insufficient alveolar macrophage response. This model might be of a major interest to comparatively explore the pathogenicity of K. p. subsp ozaenae strains and to further explore the physiopathological mechanisms of gram-negative bacteria induced human pneumonia.

  15. Molecular characterization of Chlamydia pneumoniae in animals and humans from Argentina: Genetic characterization of Chlamydia pneumoniae.

    PubMed

    Frutos, María C; Monetti, Marina S; Mosmann, Jessica; Kiguen, Ana X; Venezuela, Fernando R; Ré, Viviana E; Cuffini, Cecilia G

    2016-10-01

    In this study, genetic diversity of Chlamydia pneumoniae was investigated and the relationships between sequences amplified of different sources, clinical conditions and geographical regions of central Argentina were established. Samples amplified were similar to human C. pneumoniae patterns and show the high clonality of the population. PMID:27328126

  16. [Histopathological classification of idiopathic interstitial pneumonias].

    PubMed

    Povýsil, Ctibor

    2010-01-01

    The classification scheme of interstitial lung diseases has undergone numerous revisions. The criteria for distinguishing seven distinct subtypes of idiopathic interstitial pneumonias are now well defined by consensus in the recently published ATS/ERS classification of these lung diseases. In our present review the histological patterns of the different types are described and the differential diagnosis of idiopathic interstitial pneumonias is discussed. Surgical lung biopsy remains the gold standard for the diagnosis of interstitial pneumonias, and sampling from at least 2 sites is recommended. Video-assisted thoracoscopic surgical biopsy is the preferred method for obtaining lung tissue as this procedure offers a similar yield as an open thoracotomy The most common histological subtype of chronic interstitial lung disease is the usual interstitial pneumonia [UIP] which makes up 47-71% of cases. The key histologic features include patchy subpleural and paraseptal distribution of remodeling lung architecture with dense fibrosis, frequent honeycombing, and large fibroblastic foci. Temporal and spatial heterogeneity are the hallmarks. Nonspecific interstitial pneumonia [NSIP] occurs primarily in middle-aged women who have never smoked, with more than 5-years survival rate in 80% of patients. The major feature of NSIP is a uniform interstitial thickening of alveolar septa by a fibrosing or cellular process. The cardinal histological feature in respiratory bronchiolitis and desquamative pneumonia is an excess of intraalveolar histiocytes. In both patterns, there is variable interstitial fibrosis and chronic inflammation, and a strong association with a history of smoking. Organizing pneumonia (idiopathic bronchiolitis obliterans-organizing pneumonia [BOOP]) is not strictly an interstitial process, because the alveoli and bronchioles are filled by intraluminal polyps of fibroblastic tissue and the expansion of the interstitium is mild. Lymphocytic interstitial pneumonia

  17. Macrolide-resistant Mycoplasma pneumoniae in adolescents with community-acquired pneumonia

    PubMed Central

    2012-01-01

    Background Although the prevalence of macrolide-resistant Mycoplasma pneumoniae isolates in Japanese pediatric patients has increased rapidly, there have been no reports concerning macrolide-resistant M. pneumoniae infection in adolescents aged 16 to 19 years old. The purpose of this study was to clarify the prevalence and clinical characteristics of macrolide-resistant M. pneumoniae in adolescent patients with community-acquired pneumonia. Methods A total of 99 cases with M. pneumoniae pneumonia confirmed by polymerase chain reaction (PCR) and culture were analyzed. Forty-five cases were pediatric patients less than 16 years old, 26 cases were 16 to 19-year-old adolescent patients and 28 cases were adult patients. Primers for domain V of 23S rRNA were used and DNA sequences of the PCR products were compared with the sequence of an M. pneumoniae reference strain. Results Thirty of 45 pediatric patients (66%), 12 of 26 adolescent patients (46%) and seven of 28 adult patients (25%) with M. pneumoniae pneumonia were found to be infected with macrolide-resistant M. pneumoniae (MR patients). Although the prevalence of resistant strains was similar in pediatric patients between 2008 and 2011, an increase in the prevalence of resistant strains was observed in adolescent patients. Among 30 pediatric MR patients, 26 had an A-to-G transition at position 2063 (A2063G) and four had an A-to-G transition at position 2064 (A2064G). In 12 adolescent MR patients, 10 showed an A2063G transition and two showed an A2064G transition, and in seven adult MR patients, six showed an A2063G transition and one showed an A2064G transition. Conclusions The prevalence of macrolide-resistant M. pneumoniae is high among adolescent patients as well as pediatric patients less than 16-years old. To prevent outbreaks of M. pneumoniae infection, especially macrolide-resistant M. pneumoniae, in closed populations including among families, in schools and in university students, physicians should pay

  18. [THREE CASES OF DRUG-INDUCED PNEUMONIA CAUSED BY MESALAZINE].

    PubMed

    Akiyama, Norimichi; Yokomura, Koshi; Nozue, Tsuyoshi; Abe, Takefumi; Matsui, Takashi; Suda, Takafumi

    2015-12-01

    We report three cases of drug-induced pneumonia caused by mesalazine. They were all diagnosed as ulcerative colitis and treated with mesalazine orally. Our three cases and literature review revealed that mesalazine-induced pneumonia resemble like eosinophilic pneumonia or organizing pneumonia and that have good prognosis with drug cessation or administration of corticosteroid. The patient of ulcerative colitis is increasing every year and it is anticipated that the patient with mesalazine-induced pneumonia may also increase. In the treatment of ulcerative colitis with mesalazine, we should pay attention with patient's cough or fever for early detection of drug-induced pneumonia.

  19. Klebsiella pneumoniae Siderophores Induce Inflammation, Bacterial Dissemination, and HIF-1α Stabilization during Pneumonia

    PubMed Central

    Holden, Victoria I.; Breen, Paul; Houle, Sébastien; Dozois, Charles M.

    2016-01-01

    ABSTRACT Klebsiella pneumoniae is a Gram-negative pathogen responsible for a wide range of infections, including pneumonia and bacteremia, and is rapidly acquiring antibiotic resistance. K. pneumoniae requires secretion of siderophores, low-molecular-weight, high-affinity iron chelators, for bacterial replication and full virulence. The specific combination of siderophores secreted by K. pneumoniae during infection can impact tissue localization, systemic dissemination, and host survival. However, the effect of these potent iron chelators on the host during infection is unknown. In vitro, siderophores deplete epithelial cell iron, induce cytokine secretion, and activate the master transcription factor hypoxia inducible factor-1α (HIF-1α) protein that controls vascular permeability and inflammatory gene expression. Therefore, we hypothesized that siderophore secretion by K. pneumoniae directly contributes to inflammation and bacterial dissemination during pneumonia. To examine the effects of siderophore secretion independently of bacterial growth, we performed infections with tonB mutants that persist in vivo but are deficient in siderophore import. Using a murine model of pneumonia, we found that siderophore secretion by K. pneumoniae induces the secretion of interleukin-6 (IL-6), CXCL1, and CXCL2, as well as bacterial dissemination to the spleen, compared to siderophore-negative mutants at an equivalent bacterial number. Furthermore, we determined that siderophore-secreting K. pneumoniae stabilized HIF-1α in vivo and that bacterial dissemination to the spleen required alveolar epithelial HIF-1α. Our results indicate that siderophores act directly on the host to induce inflammatory cytokines and bacterial dissemination and that HIF-1α is a susceptibility factor for bacterial invasion during pneumonia. PMID:27624128

  20. The management of pneumonia in internal medicine.

    PubMed

    Bouza, E; Giannella, M; Pinilla, B; Pujol, R; Capdevila, J A; Muñoz, P

    2013-01-01

    Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP. PMID:23664752

  1. The management of pneumonia in internal medicine.

    PubMed

    Bouza, E; Giannella, M; Pinilla, B; Pujol, R; Capdevila, J A; Muñoz, P

    2013-01-01

    Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP. PMID:26530942

  2. Association of Alzheimer's disease and Chlamydophila pneumoniae.

    PubMed

    Stallings, Tiffany L

    2008-06-01

    This paper critically reviews the association of infection by Chlamydophila pneumoniae (C. pneumoniae) and Alzheimer's disease (AD). The aging population has increased interest in finding the cause of AD, but studies have yielded contradictory results that are likely due to varying diagnostic tools and different uses of diagnostic tests. Knowledge of AD's characteristics, risk factors, and hypothesized etiologies has expanded since Alois Alzheimer's initial description of AD. Epidemiologic and projection studies provide incidence estimates of AD through a two-stage method: (1) primary diagnosis of dementia by cognitive testing such as Mini-Mental State Examination (MMSE), and (2) clinical diagnosis of AD through criteria such as National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA). Cross-sectional studies yield prevalence estimates of infection by C. pneumoniae by detecting immunoglobulins through laboratory tests such as microimmunofluorescence (MIF). Studies examining the association of C. pneumoniae and AD are limited, but brain autopsy provides information about presence, proximity to areas associated with AD, and bacterial load. Standardization of diagnostic techniques would allow for better comparability of studies, but uncertainty about the best method of diagnosis of infection by C. pneumoniae and AD may call for revised or novel diagnostic tools.

  3. [Severe community-acquired pneumonia in adults].

    PubMed

    Arancibia H, Francisco; Díaz P, Orlando

    2005-01-01

    Patients with severe community acquired pneumonia (CAP) need continuous surveillance and monitoring at intensive care units (ICU), where they can receive specialized support as mechanical ventilation and/or hemodynamic support. Patients that require ICU admittance represent 10 to 30% of all patients interned because a pneumonia. In this category, high complication rate, prolonged hospital stay and high mortality rate are the rule. The American Thoracic Society (ATS) criteria for severe pneumonia establishes the following main criteria: necessity of mechanical ventilation and presence of septic shock; minor criteria: systolic blood pressure < 90 mmHg, radiological multilobar involvement and PaO2/FiO2 < 250 mmHg. British Thoracic Society (BTS) criteria for severe CAP are: respiratory rate over 30 breaths/min, diastolic blood pressure under 60 mmHg, BUN > 20 mg/dl and mental confusion. In all patients with CAP it is recommended the evaluation of its severity at admission. This evaluation should be done in conjunction with an experienced physician, and if criteria for poor prognosis are met, an early admission to ICU is recommended. ATS and BTS modified criteria (CURB) are useful in this procedure. In severely ill patients with CAP it is recommended to perform the following microbiological analysis: sputum Gram stain and culture, blood culture, pleural fluid Gram stain and culture, if present and tapped, Legionella pneumophila urine antigen test, influenza A and B antigen detection tests (epidemic period: autumn and winter), and serology for atypical bacteria (Mycoplasma pneumoniae and Chlamydia pneumoniae).

  4. Ventilator associated pneumonia in major paediatric burns.

    PubMed

    Rogers, Alan David; Deal, Cailin; Argent, Andrew Charles; Hudson, Donald Anthony; Rode, Heinz

    2014-09-01

    More than three-quarters of deaths related to major burns are a consequence of infection, which is frequently ventilator associated pneumonia (VAP). A retrospective study was performed, over a five-year period, of ventilated children with major burns. 92 patients were included in the study; their mean age was 3.5 years and their mean total body surface area burn was 30%. 62% of the patients sustained flame burns, and 31% scalds. The mean ICU stay was 10.6 days (range 2-61 days) and the mean ventilation time was 8.4 days (range 2-45 days). There were 59 documented episodes of pneumonia in 52 patients with a rate of 30 infections per 1000 ventilator days. Length of ventilation and the presence of inhalational injury correlate with the incidence of VAP. 17.4% of the patients died (n=16); half of these deaths may be attributed directly to pneumonia. Streptococcus pneumonia, Pseudomonas aeruginosa, Acinetobacter baumanii and Staphylococcus aureus were the most prominent aetiological organisms. Broncho-alveolar lavage was found to be more specific and sensitive at identifying the organism than other methods. This study highlights the importance of implementing strictly enforced strategies for the prevention, detection and management of pneumonia in the presence of major burns.

  5. The management of pneumonia in internal medicine.

    PubMed

    Bouza, E; Giannella, M; Pinilla, B; Pujol, R; Capdevila, J A; Muñoz, P

    2013-01-01

    Pneumonia generates a high workload for internal medicine departments. Management of this disease is challenging, because patients are usually elderly and have multiple comorbid conditions. Furthermore, the interpretation and adherence to guidelines are far from clear in this setting. We report the opinion of 43 internists especially interested in infectious diseases that were questioned at the 2011 XXXII National Conference of Spanish Society of Internal Medicine about the main issues involved in the management of pneumonia in the internal medicine departments, namely, classification, admission criteria, microbiological workup, therapeutic management, discharge policy, and prevention of future episodes. Participants were asked to choose between 2 options for each statement by 4 investigators. Consensus could not be reached in many cases. The most controversial issues concerned recognition and management of healthcare-associated pneumonia (HCAP). Most participants were aware of the differences in terms of underlying diseases, etiological distribution, and outcome of HCAP compared with community-acquired pneumonia, but only a minority agreed to manage HCAP as hospital-acquired pneumonia, as suggested by some guidelines. A clinical patient-to-patient approach proved to be the option preferred by internists in the management of HCAP.

  6. Streptococcus pneumoniae NanC

    PubMed Central

    Owen, C. David; Lukacik, Petra; Potter, Jane A.; Sleator, Olivia; Taylor, Garry L.; Walsh, Martin A.

    2015-01-01

    Streptococcus pneumoniae is an important human pathogen that causes a range of disease states. Sialidases are important bacterial virulence factors. There are three pneumococcal sialidases: NanA, NanB, and NanC. NanC is an unusual sialidase in that its primary reaction product is 2-deoxy-2,3-didehydro-N-acetylneuraminic acid (Neu5Ac2en, also known as DANA), a nonspecific hydrolytic sialidase inhibitor. The production of Neu5Ac2en from α2–3-linked sialosides by the catalytic domain is confirmed within a crystal structure. A covalent complex with 3-fluoro-β-N-acetylneuraminic acid is also presented, suggesting a common mechanism with other sialidases up to the final step of product formation. A conformation change in an active site hydrophobic loop on ligand binding constricts the entrance to the active site. In addition, the distance between the catalytic acid/base (Asp-315) and the ligand anomeric carbon is unusually short. These features facilitate a novel sialidase reaction in which the final step of product formation is direct abstraction of the C3 proton by the active site aspartic acid, forming Neu5Ac2en. NanC also possesses a carbohydrate-binding module, which is shown to bind α2–3- and α2–6-linked sialosides, as well as N-acetylneuraminic acid, which is captured in the crystal structure following hydration of Neu5Ac2en by NanC. Overall, the pneumococcal sialidases show remarkable mechanistic diversity while maintaining a common structural scaffold. PMID:26370075

  7. Mycoplasma pneumoniae and Streptococcus pneumoniae caused different microbial structure and correlation network in lung microbiota

    PubMed Central

    Wang, Heping; Dai, Wenkui; Qiu, Chuangzhao; Li, Shuaicheng; Wang, Wenjian; Xu, Jianqiang; Li, Zhichuan; Wang, Hongmei; Li, Yuzheng; Yang, Zhenyu; Feng, Xin; Zhou, Qian; Han, Lijuan; Li, Yinhu

    2016-01-01

    Pneumonia is one of the most serious diseases for children, with which lung microbiota are proved to be associated. We performed 16S rDNA analysis on broncho-alveolar lavage fluid (BALF) for 32 children with tracheomalacia (C group), pneumonia infected with Streptococcus pneumoniae (S. pneumoniae) (D1 group) or Mycoplasma pneumoniae (M. pneumoniae) (D2 group). Children with tracheomalacia held lower microbial diversity and accumulated Lactococcus (mean ± SD, 45.21%±5.07%, P value <0.05), Porphyromonas (0.12%±0.31%, P value <0.05). D1 and D2 group were enriched by Streptococcus (7.57%±11.61%, P value <0.01 when compared with D2 group) and Mycoplasma (0.67%±1.25%, P value <0.01) respectively. Bacterial correlation in C group was mainly intermediated by Pseudomonas and Arthrobacter. Whilst, D1 group harbored simplest microbial correlation in three groups, and D2 group held the most complicated network, involving enriched Staphylococcus (0.26%±0.71%), Massilia (0.81%±2.42%). This will be of significance for understanding pneumonia incidence and progression more comprehensively, and discerning between bacterial infection and carriage. PMID:27293852

  8. Mycoplasma pneumoniae and Chlamydia spp. infection in community-acquired pneumonia, Germany, 2011-2012.

    PubMed

    Dumke, Roger; Schnee, Christiane; Pletz, Mathias W; Rupp, Jan; Jacobs, Enno; Sachse, Konrad; Rohde, Gernot

    2015-03-01

    Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011-2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1.4%). M. pneumoniae P1 type 1 predominated, and levels of macrolide resistance were low (3.1%). Quarterly rates of M. pneumoniae-positive samples ranged from 1.5% to 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year. M. pneumoniae-positive patients were younger and more frequently female, had fewer co-occurring conditions, and experienced milder disease than did patients who tested negative. Clinicians should be aware of the epidemiology of these pathogens in CAP.

  9. Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia.

    PubMed

    Giannella, M; Pinilla, B; Capdevila, J A; Martínez Alarcón, J; Muñoz, P; López Álvarez, J; Bouza, E

    2012-08-01

    Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2 weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5 years; p < 0.001), had poorer functional status (Barthel 100, 30 and 65; p < 0.001) and had more risk factors for aspiration pneumonia (18, 50 and 34%; p < 0.001). The frequency of testing to establish an aetiological diagnosis was lower among HCAP patients (87, 72 and 79; p < 0.001), as was adherence to the therapeutic recommendations of guidelines (70, 23 and 56%; p < 0.001). In-hospital mortality increased progressively between CAP, HCAP and HAP (8, 19 and 27%; p < 0.001). Streptococcus pneumoniae was the main pathogen in CAP and HCAP. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) caused 17 and 12.3% of HCAP. In patients with a confirmed aetiological diagnosis, the independent risk factors for pneumonia due do difficult-to-treat microorganisms (Enterobacteriaceae, P. aeruginosa or MRSA) were HCAP, chronic obstructive pulmonary diseases and higher Port Severity Index. Our data confirm the importance of maintaining high awareness of HCAP among patients treated in IMDs, because of the different aetiologies, therapy requirements and prognosis of this population.

  10. Pneumonia treated in the internal medicine department: focus on healthcare-associated pneumonia.

    PubMed

    Giannella, M; Pinilla, B; Capdevila, J A; Martínez Alarcón, J; Muñoz, P; López Álvarez, J; Bouza, E

    2012-08-01

    Patients with pneumonia treated in the internal medicine department (IMD) are often at risk of healthcare-associated pneumonia (HCAP). The importance of HCAP is controversial. We invited physicians from 72 IMDs to report on all patients with pneumonia hospitalized in their department during 2 weeks (one each in January and June 2010) to compare HCAP with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP). We analysed 1002 episodes of pneumonia: 58.9% were CAP, 30.6% were HCAP and 10.4% were HAP. A comparison between CAP, HCAP and HAP showed that HCAP patients were older (77, 83 and 80.5 years; p < 0.001), had poorer functional status (Barthel 100, 30 and 65; p < 0.001) and had more risk factors for aspiration pneumonia (18, 50 and 34%; p < 0.001). The frequency of testing to establish an aetiological diagnosis was lower among HCAP patients (87, 72 and 79; p < 0.001), as was adherence to the therapeutic recommendations of guidelines (70, 23 and 56%; p < 0.001). In-hospital mortality increased progressively between CAP, HCAP and HAP (8, 19 and 27%; p < 0.001). Streptococcus pneumoniae was the main pathogen in CAP and HCAP. Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) caused 17 and 12.3% of HCAP. In patients with a confirmed aetiological diagnosis, the independent risk factors for pneumonia due do difficult-to-treat microorganisms (Enterobacteriaceae, P. aeruginosa or MRSA) were HCAP, chronic obstructive pulmonary diseases and higher Port Severity Index. Our data confirm the importance of maintaining high awareness of HCAP among patients treated in IMDs, because of the different aetiologies, therapy requirements and prognosis of this population. PMID:22284436

  11. Lobar pneumonia treated by Musgrave Park physicians

    PubMed Central

    Hedley-Whyte, John; Milamed, Debra R

    2009-01-01

    In the decade 1935-45 the treatment of lobar pneumonia in the developed and warring world underwent a series of evolutions—anti-sera, specific anti-sera, refinement of sulpha drugs, sulpha and anti-sera, the introduction of penicillin for bacteriology, then ophthalmology, and then for penicillin-sensitive bacterial infections such as lobar pneumonia with its many Cooper types of Streptococcus pneumoniae. Penicillin for civilian use was essentially banned in World War II, a ban that early in 1941 two Musgrave Park physicians tried to circumvent. Strict secrecy on the details of penicillin production was enforced. The treatment option chosen by the Musgrave Park physicians in 1941, and the non-availability of penicillin led to sequelae affecting the post-Belfast careers of both patient and physicians. PMID:19568449

  12. Childhood pneumonia - the Drakenstein Child Health Study.

    PubMed

    Zar, Heather Jessica; Barnett, Whitney; Myer, Landon; Nicol, Mark P

    2016-07-01

    Advances in immunisation, improvements in socioeconomic status and effective HIV prevention and treatment strategies have reduced the population burden of childhood pneumonia and severe disease. However, pneumonia remains the major single cause of death in children outside the neonatal period, causing approximately 1 million deaths annually, or 15% of an estimated 6.3 million deaths in children aged under 5 years. This burden is disproportionately high in low- and middle-income countries and in Africa, where almost 50% of deaths in children aged  under 5 years occur, despite African children comprising only 25% of live births globally. Pneumonia incidence and severity are highest in the first year of life, especially in the first 6 months. PMID:27384352

  13. Therapeutic strategies in pneumonia: going beyond antibiotics.

    PubMed

    Müller-Redetzky, Holger; Lienau, Jasmin; Suttorp, Norbert; Witzenrath, Martin

    2015-09-01

    Dysregulation of the innate immune system drives lung injury and its systemic sequelae due to breakdown of vascular barrier function, harmful hyperinflammation and microcirculatory failure, which contribute to the unfavourable outcome of patients with severe pneumonia. A variety of promising therapeutic targets have been identified and numerous innovative therapeutic approaches demonstrated to improve lung injury in experimental preclinical studies. However, at present specific preventive or curative strategies for the treatment of lung failure in pneumonia in addition to antibiotics are still missing. The aim of this mini-review is to give a short overview of some, but not all, adjuvant therapeutic strategies for pneumonia and its most important complications, sepsis and acute respiratory distress syndrome, and briefly discuss future perspectives.

  14. Air pollution and infant mortality from pneumonia

    SciTech Connect

    Penna, M.L.; Duchiade, M.P. )

    1991-03-01

    This study examines the relationship between air pollution, measured as concentration of suspended particulates in the atmosphere, and infant mortality due to pneumonia in the metropolitan area of Rio de Janeiro. Multiple linear regression (progressive or stepwise method) was used to analyze infant mortality due to pneumonia, diarrhea, and all causes in 1980, by geographic area, income level, and degree of contamination. While the variable proportion of families with income equivalent to more than two minimum wages was included in the regressions corresponding to the three types of infant mortality, the average contamination index had a statistically significant coefficient (b = 0.2208; t = 2.670; P = 0.0137) only in the case of mortality due to pneumonia. This would suggest a biological association, but, as in any ecological study, such conclusions should be viewed with caution. The authors believe that air quality indicators are essential to consider in studies of acute respiratory infections in developing countries.

  15. Aggressive Cunninghamella pneumonia in an adolescent.

    PubMed

    Malkan, Alpin D; Wahid, Fazal N; Rao, Bhaskar N; Sandoval, John A

    2014-10-01

    Children with hematologic malignancies may be challenged with life-threatening, invasive fungal infections by organisms that would otherwise have a low potential for virulence in healthy hosts. Presented is a case of a 15-year-old adolescent with B-cell acute lymphoblastic leukemia who was receiving steroids and chemotherapy. He developed cough associated with left chest pain with suspicion for fungal pneumonia. He began systemic antifungal therapy, underwent computed tomography of the chest demonstrating a large cavitary lesion (reversed halo sign) in the left lung. Over a 48-hour period the patient clinically deteriorated with worsening pneumonia and required left thoracotomy with nonanatomic pulmonary resection. This case illustrates the aggressive nature of Cunninghamella pneumonia in patients with hematologic malignancies, and the multidisciplinary approach required to have the greatest possible outcome. PMID:25089609

  16. [Chlamydia pneumoniae infections--diagnostic methods].

    PubMed

    Stepień, Ewa; Pieniazek, Piotr; Branicka, Agnieszka; Bozek, Maria

    2002-01-01

    Gram-negative bacteria Chlamydia pneumonia was found in 1989 to cause acute and chronic respiratory tract infections. This agent has been as well associated with other disease: atherogenesis and coronary heart disease. This study is aimed both at making an introduction to the issues related to C. pneumoniae diagnosis and presenting contemporary laboratory methods. Given the limitations of traditional diagnostics methods, serodiagnosis (EIA) and nucleic acids amplification (PCR, hybridisation) provide the most convincing evidence of C. pneumoniae infections. Culture and direct fluorescence antibody (DFA) may be useful in confirming these results. A variety of methods applied can provide an opportunity to detect bacteria in different clinical samples--incl. sputum, nasopharyngeal and throat swabs, bronchoalveolar lavage (BAL) and tissues from biopsy and autopsy. PMID:12184026

  17. Pneumonia identification using statistical feature selection

    PubMed Central

    Xia, Fei; Vanderwende, Lucy; Wurfel, Mark M; Yetisgen-Yildiz, Meliha

    2012-01-01

    Objective This paper describes a natural language processing system for the task of pneumonia identification. Based on the information extracted from the narrative reports associated with a patient, the task is to identify whether or not the patient is positive for pneumonia. Design A binary classifier was employed to identify pneumonia from a dataset of multiple types of clinical notes created for 426 patients during their stay in the intensive care unit. For this purpose, three types of features were considered: (1) word n-grams, (2) Unified Medical Language System (UMLS) concepts, and (3) assertion values associated with pneumonia expressions. System performance was greatly increased by a feature selection approach which uses statistical significance testing to rank features based on their association with the two categories of pneumonia identification. Results Besides testing our system on the entire cohort of 426 patients (unrestricted dataset), we also used a smaller subset of 236 patients (restricted dataset). The performance of the system was compared with the results of a baseline previously proposed for these two datasets. The best results achieved by the system (85.71 and 81.67 F1-measure) are significantly better than the baseline results (50.70 and 49.10 F1-measure) on the restricted and unrestricted datasets, respectively. Conclusion Using a statistical feature selection approach that allows the feature extractor to consider only the most informative features from the feature space significantly improves the performance over a baseline that uses all the features from the same feature space. Extracting the assertion value for pneumonia expressions further improves the system performance. PMID:22539080

  18. Antigen detection for the diagnosis of pneumonia.

    PubMed

    Nunes, Altacílio A; Camargos, Paulo A M; Costa, Petrônio R; Campos, Maria Tereza K

    2004-08-01

    Streptococcus pneumoniae and Haemophilus influenzae type b are the main agents of bacterial community-acquired pneumonia in developing countries, although a definite etiologic diagnosis cannot be established in most cases. This study was carried out to assess the performance of a latex particle agglutination test (LPAT) from a commercial kit (Slidex Méningite Kit trade mark, BioMérieux, France) in diagnosing pneumococcal and H. influenzae type b pneumonia. One hundred and seven children (45 ill subjects and 62 healthy controls) were enrolled. All 45 cases had a presumptive diagnosis of bacterial pneumonia based on clinical (WHO criteria), laboratory (white blood cell count > or = 15.000/mm3, polymorphonuclear leukocytes > or = 70%, bands > or = 500/mm3, and C-reactive protein > or = 40 mg/l), and radiological findings, i.e., two or more positive points in the scoring system described by Khamapirad and Glezen (Semin Respir Infect 1987;2:130-144). Clinical, laboratory, and radiological assessments were performed in a blinded manner. LPAT was performed in urine samples after concentration through an ethanol-acetone solution. Sensitivity, specificity, and positive and negative predictive values were 77.3% (95% CI, 61.8-88.0%), 90.3% (95% CI, 79.5-96.0%), 85.0% (95% CI, 69.5-93.8%), and 84.8% (95% CI, 73.4-92.1%), respectively. Results suggest that LPAT is a useful diagnostic tool for the etiologic diagnosis of S. pneumoniae and H. influenzae type b pneumonia, especially in the developing world. PMID:15211697

  19. Epidemiology and Virulence of Klebsiella pneumoniae.

    PubMed

    Clegg, Steven; Murphy, Caitlin N

    2016-02-01

    Strains of Klebsiella pneumoniae are frequently opportunistic pathogens implicated in urinary tract and catheter-associated urinary-tract infections of hospitalized patients and compromised individuals. Infections are particularly difficult to treat since most clinical isolates exhibit resistance to several antibiotics leading to treatment failure and the possibility of systemic dissemination. Infections of medical devices such as urinary catheters is a major site of K. pneumoniae infections and has been suggested to involve the formation of biofilms on these surfaces. Over the last decade there has been an increase in research activity designed to investigate the pathogenesis of K. pneumoniae in the urinary tract. These investigations have begun to define the bacterial factors that contribute to growth and biofilm formation. Several virulence factors have been demonstrated to mediate K. pneumoniae infectivity and include, but are most likely not limited to, adherence factors, capsule production, lipopolysaccharide presence, and siderophore activity. The development of both in vitro and in vivo models of infection will lead to further elucidation of the molecular pathogenesis of K. pneumoniae. As for most opportunistic infections, the role of host factors as well as bacterial traits are crucial in determining the outcome of infections. In addition, multidrug-resistant strains of these bacteria have become a serious problem in the treatment of Klebsiella infections and novel strategies to prevent and inhibit bacterial growth need to be developed. Overall, the frequency, significance, and morbidity associated with K. pneumoniae urinary tract infections have increased over many years. The emergence of these bacteria as sources of antibiotic resistance and pathogens of the urinary tract present a challenging problem for the clinician in terms of management and treatment of individuals.

  20. Cytomegalovirus pneumonia in a patient with interstitial pneumonia and Nocardia asiatica presenting as cavitary lung lesions.

    PubMed

    Saraya, Takeshi; Ohkuma, Kosuke; Kikuchi, Ken; Tamura, Masaki; Honda, Kojiro; Yamada, Atsuko; Araki, Koji; Ishii, Haruyuki; Makino, Hiroshi; Takei, Hidefumi; Karita, Shin; Fujiwara, Masachika; Takizawa, Hajime; Goto, Hajime

    2013-01-01

    A 66-year-old man who suffered from an acute exacerbation of interstitial pneumonia developed a cavitary lesion after taking immunosuppressive drugs. He was diagnosed with cytomegalovirus (CMV) pneumonia. CMV was not thought to be the underlying cause of the cavitary lung lesions, as only six cases have been described thus far. However, this case clearly demonstrates that the development of cavitary lung lesions can be caused by CMV. Following CMV pneumonia, cavitary lesions again occurred in the patient's lungs that were thought to be the first case of cavitary lesions caused by Nocardia asiatica infection. PMID:23448771

  1. Facts and controversies in the classification of idiopathic interstitial pneumonias.

    PubMed

    Poletti, V; Kitaichi, M

    2000-10-01

    Idiopathic interstitial pneumonias are defined from the pathological point of view as non granulomatous intralobular inflammatory and fibrotic processes involving the alveolar walls. More than thirty years ago Liebow and Carrington pioneered the notion that morphological characteristics could be used with benefit in separating the different entities found in this group, which present with typical, but not pathognomonic clinical features. In the mid-1980s some entities, including giant cell interstitial pneumonia (GIP) and lymphocytic interstitial pneumonia (LIP), were removed from this group and considered as peculiar forms. In the early 90s the concept of cellular or nonspecific interstitial pneumonia was reconsidered, leading to an in depth revision of various types of interstitial pneumonia of unknown etiology. The histological pattern observed in patients with idiopathic pulmonary fibrosis is now referred to as usual interstitial pneumonia (UIP). Other entities that have been revised during the last ten years are desquamative interstitial pneumonia/alveolar macrophage pneumonia (DIP/AMP), respiratory bronchiolitis-interstitial lung disease (RB-ILD), acute interstitial pneumonia (AIP), cryptogenic organizing pneumonia (COP) and nonspecific interstitial pneumonia (NSIP). This paper provides a detailed description of pulmonary disorders which have been included in the new classification systems of idiopathic interstitial pneumonias. In the second part of the paper we will discuss several doubts and controversies that this new classification schemes leave unresolved.

  2. Aspiration pneumonia in dogs: treatment, monitoring, and prognosis.

    PubMed

    Schulze, Heidi M; Rahilly, Louisa J

    2012-12-01

    Aspiration pneumonia and aspiration pneumonitis are associated with significant morbidity in both veterinary and human medicine. A variety of medical conditions and medications can predispose patients to aspiration. Ideally, aspiration should be prevented, but in dogs that develop aspiration pneumonia, close monitoring and supportive care are imperative. This article describes antimicrobial treatment, fluid therapy, ancillary medical therapy, oxygen therapy, and prognosis for aspiration pneumonia.

  3. Cloning of the complete Mycoplasma pneumoniae genome.

    PubMed Central

    Wenzel, R; Herrmann, R

    1989-01-01

    The complete genome of Mycoplasma pneumoniae was cloned in an ordered library consisting of 34 overlapping or adjacent cosmids, one plasmid and two lambda phages. The genome size was determined by adding up the sizes of either the individual unique EcoRI restriction fragments of the gene bank or of the XhoI fragments of genomic M. pneumoniae DNA. The values from these calculations, 835 and 849 kbp, are in good agreement. An XhoI restriction map was constructed by identifying adjacent DNA fragments by probing with selected cosmid clones. Images PMID:2506532

  4. A rare cause of cavitatory pneumonia.

    PubMed

    Harsha, N S; Sandeepa, H S; Hemantha Kumar, S; Prakash, B; Jayalakshmi, K

    2016-01-01

    Radiographic findings of thick walled cavities in the lungs are typically seen in mycobacterial infections, malignant lesions, fungal infections, pulmonary vasculitis or other inflammatory lesions of the lungs. Necrotizing infections of the lungs caused by gram negative bacteria (Klebsiella, Psudomonas, Legionella) and Staphylococcus aureus may also form cavities of varying thickness, with consolidation. Escherichia coli pneumonia causing pulmonary cavities is very rare and the few cases reported are of pneumatocele formation. Here we present an unusual case of Escherichia coli infection as a rare cause of bilateral cavitating necrotizing pneumoniae, in a 67 year old male with uncontrolled type 2 diabetes mellitus. PMID:27672553

  5. Carcinoma of the lung complicating lipoid pneumonia

    SciTech Connect

    Felson, B.; Ralaisomay, G.

    1983-11-01

    The authors have encountered four cases of oil aspiration pneumonia complicated by carcinoma. Each had a clear-cut history of chronic intake of an oily substance, radiographic changes, and histologically documented oil aspiration pneumonia. Lung cancer later appeared in the involved area. A small number of similar cases also have been reported. The implication is that oil aspiration pneumonitis may induce bronchogenic carcinoma, particularly either the alveolar cell or the squamous cell variety. The radiographic diagnosis of the malignant transformation is difficult, and consequently the prognosis is poor.

  6. [Radiation and endoscopic diagnosis of pneumonia].

    PubMed

    Fedchenko, G G; Chernekhovskaia, N E; Rannev, I B

    2002-01-01

    The authors analyze the results of different types of radiation and endoscopic studies of 151 patients with pneumonia with an established etiological agent. There is a correlation of X-ray semiotics and endoscopic changes with the clinical manifestation and causative agent of the disease. When the studies are combined, emphasis is laid on the role of endoscopy in verifying the diagnosis, in specifying an etiological agent, and in implementing therapeutical measures to prevent complications. An algorithm of radiation imaging techniques is proposed to examine patients with pneumonia and of their purpose-oriented use according to the task set.

  7. Effects of Microgravity on Streptoccoccus Pneumonia

    NASA Technical Reports Server (NTRS)

    2003-01-01

    These gels were obtained by two-dimensional (2D) electrophoresis, in which proteins move different substances through a polyacrylamide gel matrix based on their molecular weight and total charge in an electric field. The gels illustrate principal investigator David Niesel's findings that exposure to modeled microgravity results in some Streptoccoccus Pneumonia's proteins being upregulated and others being downregulated. In 2D protein profiles of whole cell lysates of Streptoccoccus Pneumonia, 6,304 cultured under normal gravity (left), appear to be expressed at higher levels indicated with black circles. Red circles (right) indicate proteins that were grown under modeled microgravity in a high aspect ratio vessel HARV).

  8. Revisitingmolecular serotyping of Streptococcus pneumoniae

    PubMed Central

    2015-01-01

    Background Ninety-two Streptococcus pneumoniae serotypes have been described so far, but the pneumococcal conjugate vaccine introduced in the Brazilian basic vaccination schedule in 2010 covers only the ten most prevalent in the country. Pneumococcal serotype-shifting after massive immunization is a major concern and monitoring this phenomenon requires efficient and accessible serotyping methods. Pneumococcal serotyping based on antisera produced in animals is laborious and restricted to a few reference laboratories. Alternatively, molecular serotyping methods assess polymorphisms in the cps gene cluster, which encodes key enzymes for capsular polysaccharides synthesis in pneumococci. In one such approach, cps-RFLP, the PCR amplified cps loci are digested with an endonuclease, generating serotype-specific fingerprints on agarose gel electrophoresis. Methods In this work, in silico and in vitro approaches were combined to demonstrate that XhoII is the most discriminating endonuclease for cps-RFLP, and to build a database of serotype-specific fingerprints that accommodates the genetic diversity within the cps locus of 92 known pneumococci serotypes. Results The expected specificity of cps-RFLP using XhoII was 76% for serotyping and 100% for serogrouping. The database of cps-RFLP fingerprints was integrated to Molecular Serotyping Tool (MST), a previously published web-based software for molecular serotyping. In addition, 43 isolates representing 29 serotypes prevalent in the state of Minas Gerais, Brazil, from 2007 to 2013, were examined in vitro; 11 serotypes (nine serogroups) matched the respective in silico patterns calculated for reference strains. The remaining experimental patterns, despite their resemblance to their expected in silico patterns, did not reach the threshold of similarity score to be considered a match and were then added to the database. Conclusion The cps-RFLP method with XhoII outperformed the antisera-based and other molecular serotyping

  9. Complete occlusion of the right middle cerebral artery associated with Mycoplasma pneumoniae pneumonia

    PubMed Central

    Kang, Ben; Kim, Dong Hyun; Hong, Young Jin; Son, Byong Kwan; Lim, Myung Kwan; Choe, Yon Ho

    2016-01-01

    We report a case of a 5-year-old girl who developed left hemiparesis and left facial palsy, 6 days after the initiation of fever and respiratory symptoms due to pneumonia. Chest radiography, conducted upon admission, showed pneumonic infiltration and pleural effusion in the left lung field. Brain magnetic resonance imaging showed acute ischemic infarction in the right middle cerebral artery territory. Brain magnetic resonance angiography and transfemoral cerebral angiography revealed complete occlusion of the right middle cerebral artery. Mycoplasma pneumoniae infection was identified by a 4-fold increase in IgG antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. Fibrinogen and D-dimer levels were elevated, while laboratory exams in order to identify other predisposing factors of pediatric stroke were all negative. This is the first reported pediatric case in English literature of a M. pneumoniae-associated cerebral infarction involving complete occlusion of the right middle cerebral artery. PMID:27186223

  10. H1N1 influenza pneumonia and bacterial coinfection.

    PubMed

    Calbo, Esther; Robles, Alejandro; Sangil, Anna; Benet, Susana; Viladot, Maria Eugenia; Pascual, Vanesa; Barreiro, Bienvenido

    2011-12-01

    The model described by Bewick et al seems to be able to distinguish between H1N1 influenza-related pneumonia and non-H1N1 community acquired pneumonia (CAP) based on five criteria. However, bacterial infection in the influenza group has not been accurately excluded. Therefore, this model could misidentify these patients and lead to an inappropriate treatment. We conducted a prospective observational study to compare mixed pneumonia vs viral pneumonia. In the mixed pneumonia group patients were older, had higher levels of procalcitonine and higher scores of severity. In our cohort the model proposed by Bewick et al would not identify patients with coinfection. PMID:21994246

  11. Genetic Analysis of Sporadic and Familial Interstitial Pneumonia

    PubMed Central

    Schwartz, David A.

    2008-01-01

    Although much progress has been made in understanding the biology and clinical course of interstitial pneumonia, the etiology of this disease remains elusive. Epidemiologic studies have consistently identified cigarette smoke as an important exposure; however, most smokers do not develop interstitial pneumonia and many individuals with interstitial pneumonia do not smoke cigarettes. Moreover, interstitial pneumonias have been reported to cluster in families. Thus, a more thorough understanding of the genetic etiology of interstitial pneumonia may prove critically important in defining the biology and clinical course of this complex human disease. PMID:18403331

  12. New aspirations: the debate on aspiration pneumonia treatment guidelines.

    PubMed

    Kwong, Jason C; Howden, Benjamin P; Charles, Patrick G P

    2011-10-01

    Aspiration pneumonia occurs most commonly in patients with a predisposition to aspiration (eg, those with neurological bulbar dysfunction). There is limited evidence regarding the involvement of anaerobes in most cases of aspiration pneumonia. Most patients respond to treatment for aspiration pneumonia without specific anti-anaerobic therapy such as metronidazole. Metronidazole has adverse side effects, and widespread use where not indicated can promote carriage of multiresistant intestinal flora such as vancomycin-resistant enterococci. Use of metronidazole may be appropriate in patients with aspiration pneumonia and evidence of a lung abscess, necrotising pneumonia, putrid sputum or severe periodontal disease.

  13. [Community acquired pneumonia in children: an update for outpatients management].

    PubMed

    Wagner, Noémie; Gehri, Mario; Gervaix, Alain; Guinan, Stéphane; Barazzone-Argiroffo, Constance

    2016-02-17

    Pneumonia should be considered in febrile children with tachypnea and/or chest recession. Virus are the most common cause of pneumonia in children under 5 years old. Streptococcus pneumonia can be found at any age. Mycoplasma pneumonia is more frequent in older children. Systematic chest radiograph is not necessary but must be obtained in patients with hypoventilation and in those with failed initial antibiotic therapy. Mycoplasma pneumonia should be tested according to patient age and response to initial antibiotic. First line antibiotherapy is amoxicilline. Antibiotic treatment is frequently not necessary in children under 5 but should be considered depending on clinical presentation and C reactive protein value.

  14. Mechanisms of Interferon-γ Production by Neutrophils and Its Function during Streptococcus pneumoniae Pneumonia

    PubMed Central

    Gomez, John C.; Yamada, Mitsuhiro; Martin, Jessica R.; Dang, Hong; Brickey, W. June; Bergmeier, Wolfgang; Dinauer, Mary C.

    2015-01-01

    Bacterial pneumonia is a common public health problem associated with significant mortality, morbidity, and cost. Neutrophils are usually the earliest leukocytes to respond to bacteria in the lungs. Neutrophils rapidly sequester in the pulmonary microvasculature and migrate into the lung parenchyma and alveolar spaces, where they perform numerous effector functions for host defense. Previous studies showed that migrated neutrophils produce IFN-γ early during pneumonia induced by Streptococcus pneumoniae and that early production of IFN-γ regulates bacterial clearance. IFN-γ production by neutrophils requires Rac2, Hck/Lyn/Fgr Src family tyrosine kinases, and NADPH oxidase. Our current studies examined the mechanisms that regulate IFN-γ production by lung neutrophils during acute S. pneumoniae pneumonia in mice and its function. We demonstrate that IFN-γ production by neutrophils is a tightly regulated process that does not require IL-12. The adaptor molecule MyD88 is critical for IFN-γ production by neutrophils. The guanine nucleotide exchange factor CalDAG-GEFI modulates IFN-γ production. The CD11/CD18 complex, CD44, Toll-like receptors 2 and 4, TRIF, and Nrf2 are not required for IFN-γ production by neutrophils. The recently described neutrophil–dendritic cell hybrid cell, identified by its expression of Ly6G and CD11c, is present at low numbers in pneumonic lungs and is not a source of IFN-γ. IFN-γ produced by neutrophils early during acute S. pneumoniae pneumonia induces transcription of target genes in the lungs, which are critical for host defense. These studies underline the complexity of the neutrophil responses during pneumonia in the acute inflammatory response and in subsequent resolution or initiation of immune responses. PMID:25100610

  15. Molecular epidemiological characteristics of Klebsiella pneumoniae associated with bacteremia among patients with pneumonia.

    PubMed

    Ito, Ryota; Shindo, Yuichiro; Kobayashi, Daisuke; Ando, Masahiko; Jin, Wanchun; Wachino, Jun-ichi; Yamada, Keiko; Kimura, Kouji; Yagi, Tetsuya; Hasegawa, Yoshinori; Arakawa, Yoshichika

    2015-03-01

    Some important virulence factors have been elucidated in Klebsiella pneumoniae infections. We investigated the relationship between virulence factors and multilocus sequence types (STs) and assessed the risk factors for bacteremia in patients with pneumonia due to K. pneumoniae. From April 2004 through April 2012, a total of 120 K. pneumoniae isolates from patients with pneumonia (23 with bacteremia and 97 without bacteremia) were collected from 10 medical institutions in Japan. Additionally, 10 strains of K. pneumoniae serotype K2 that were isolated >30 years ago were included in this study. These isolates were characterized using multilocus sequence typing (MLST), and the characteristics of their virulence factors, such as hypermucoviscosity phenotype and RmpA and aerobactin production between patients with and without bacteremia, were examined. MLST analysis was performed on the 120 isolates from patients with pneumonia, and some sequence type groups were defined as genetic lineages (GLs). GL65 was more prevalent among patients with bacteremia (21.7%) than in those without bacteremia (7.2%). The majority of the strains with serotype K2 were classified into GL14 or GL65, and rmpA and the gene for aerobactin were present in all GL65-K2 strains but absent in all GL14-K2 strains. In a multivariate analysis, the independent risk factors for bacteremia included GL65 (adjusted odds ratio [AOR], 9.46; 95% confidence interval [CI], 1.81 to 49.31), as well as neoplastic disease (AOR, 9.94; 95% CI, 2.61 to 37.92), immunosuppression (AOR, 17.85; 95% CI, 1.49 to 214.17), and hypoalbuminemia (AOR, 4.76; 95% CI, 1.29 to 17.61). GL65 was more prevalent among patients with bacteremia and was associated with the virulence factors of K. pneumoniae.

  16. Pneumonia outbreaks in calves and finishers.

    PubMed

    2016-03-19

    Pneumonia in calves and finishers. Ovarian tumour in a calf . Abortion associated with bovine herpesvirus 1 in a suckler herd. Parasitic gastroenteritis causing illthrift and death in sheep. Outbreaks of acute fasciolosis in sheep. These are among matters discussed in the disease surveillance report for December 2015 from SAC Consulting: Veterinary Services (SAC C VS). PMID:26993450

  17. Community-acquired pneumonia among smokers.

    PubMed

    Almirall, Jordi; Blanquer, José; Bello, Salvador

    2014-06-01

    Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers. Streptococcus pneumoniae is the causative microorganism responsible for community-acquired pneumonia (CAP) most frequently associated with smoking, particularly in invasive pneumococcal disease and septic shock. It is not clear how it acts on the progress of pneumonia, but there is evidence to suggest that the prognosis for pneumococcal pneumonia is worse. In CAP caused by Legionella pneumophila, it has also been observed that smoking is the most important risk factor, with the risk rising 121% for each pack of cigarettes smoked a day. Tobacco use may also favor diseases that are also known risk factors for CAP, such as periodontal disease and upper respiratory viral infections. By way of prevention, while giving up smoking should always be proposed, the use of the pneumococcal vaccine is also recommended, regardless of the presence of other comorbidities.

  18. Community-acquired pneumonia among smokers.

    PubMed

    Almirall, Jordi; Blanquer, José; Bello, Salvador

    2014-06-01

    Recent studies have left absolutely no doubt that tobacco increases susceptibility to bacterial lung infection, even in passive smokers. This relationship also shows a dose-response effect, since the risk reduces spectacularly 10 years after giving up smoking, returning to the level of non-smokers. Streptococcus pneumoniae is the causative microorganism responsible for community-acquired pneumonia (CAP) most frequently associated with smoking, particularly in invasive pneumococcal disease and septic shock. It is not clear how it acts on the progress of pneumonia, but there is evidence to suggest that the prognosis for pneumococcal pneumonia is worse. In CAP caused by Legionella pneumophila, it has also been observed that smoking is the most important risk factor, with the risk rising 121% for each pack of cigarettes smoked a day. Tobacco use may also favor diseases that are also known risk factors for CAP, such as periodontal disease and upper respiratory viral infections. By way of prevention, while giving up smoking should always be proposed, the use of the pneumococcal vaccine is also recommended, regardless of the presence of other comorbidities. PMID:24387877

  19. Nontypeable Streptococcus pneumoniae as an Otopathogen

    PubMed Central

    Xu, Qingfu; Kaur, Ravinder; Casey, Janet R.; Sabharwal, Vishakha; Pelton, Stephen; Pichichero, Michael E.

    2014-01-01

    Among 34 Spn sequential isolates from middle ear fluid we found a case of a nontypeable Streptococcus pneumoniae (NT-Spn) in a child with AOM. The strain was pneumolysin PCR positive and capsule gene PCR negative. Virulence of the NT-Spn was confirmed in a chinchilla model of AOM. PMID:21251566

  20. [Community-acquired pneumonia in the elderly].

    PubMed

    Füri, Julia; Oestmann, Andreas; Repond, Fernand

    2016-04-13

    We report the case of a 88 years old patient with cough and new onset confusion. Delirium was caused by a necrotizing Methicillin-sensible staphylococcus aureus pneumonia with bacteremia. Despite antibiotic therapy for several weeks and fall of inflammatory markers the patient died from consequences of delirium. PMID:27078731

  1. [Mycoplasma pneumoniae meningoencephalitis in a young adult].

    PubMed

    Del Castillo, Marcelo; D'Giano, Carlos; Goicoechea, María Teresa; Morello, Fernando; Salsamendi, Paz; Mora, Andrea

    2005-01-01

    Mycoplasma pneumoniae infections have extrapulmonary complications that involve the nervous system. The neurologic manifestations are diverse. Although the prognosis is usually favorable, the patients can undergo severe permanent sequelae. We present a young female adult with acute meningoencephalitis as a complication of a lower respiratory infection, which followed a benign course without neurologic sequelae.

  2. Aspiration pneumonia in children: an iconographic essay*

    PubMed Central

    de Oliveira, Gabriel Antonio; Pessanha, Laís Bastos; Guerra, Luiz Felipe Alves; Martins, Diego Lima Nava; Rondina, Ronaldo Garcia; Silva, Jamine Ronacher Passos

    2015-01-01

    In most cases of aspiration pneumonia in children, the disease is specific to this age group. Clinical and radiological correlation is essential for the diagnosis. The present pictorial essay is aimed at showing typical images of the most common etiologies. PMID:26811557

  3. Pneumatoceles and pneumothorax after Pneumocystis carinii pneumonia.

    PubMed

    Sauleda, J; Aran, X; Gea, J; Aguar, M C; Sanz, M; Broquetas, J M

    1993-01-01

    Pneumocystis carinii pneumonia (PCP) is common in patients with AIDS. The usual chest X-ray pattern is a diffuse interstitial pulmonary infiltrate. Nevertheless, unusual roentgenographic forms can appear. A patient with PCP that resulted in pneumatoceles and a further pneumothorax is described. PMID:8284529

  4. Pneumonia outbreaks in calves and finishers.

    PubMed

    2016-03-19

    Pneumonia in calves and finishers. Ovarian tumour in a calf . Abortion associated with bovine herpesvirus 1 in a suckler herd. Parasitic gastroenteritis causing illthrift and death in sheep. Outbreaks of acute fasciolosis in sheep. These are among matters discussed in the disease surveillance report for December 2015 from SAC Consulting: Veterinary Services (SAC C VS).

  5. Balantidium coli pneumonia in an immunocompromised patient.

    PubMed

    Vasilakopoulou, Alexandra; Dimarongona, Kyriaki; Samakovli, Anastasia; Papadimitris, Konstantinos; Avlami, Athina

    2003-01-01

    A fatal case is reported of Balantidium coli pneumonia in a 71-y-old woman suffering from anal cancer. The diagnosis was made by the discovery of motile trophozoites in a wet mount from bronchial secretions. The usual habitat of the parasite is the colon; lung balantidiasis is very rare. PMID:12693570

  6. Correlation between Radiological and Pathological Findings in Patients with Mycoplasma pneumoniae Pneumonia

    PubMed Central

    Tanaka, Hiroshi

    2016-01-01

    Studies focused on the pathological–radiological correlation of human Mycoplasma (M) pneumoniae pneumonia have rarely been reported. Therefore, we extensively reviewed the literature regarding pathological and radiological studies of Mycoplasma pneumonia, and compared findings between open lung biopsy specimen and computed tomography (CT). Major three correlations were summarized. (1) Peribronchial and perivascular cuffing characterized by mononuclear cells infiltration was correlated with bronchovascular bundles thickening on CT, which was the most common finding of this pneumonia. (2) Cellular bronchitis in the small airways accompanied with exudates or granulation tissue in the lumen revealed as centrilobular nodules on CT. (3) Neutrophils and exudates in the alveolar lumen radiologically demonstrated as air-space consolidation or ground-glass opacities. In M. pulmonis-infected mice model, pathologic patterns are strikingly different according to host cell-mediated immunity (CMI) levels; treatment with interleukin-2 lead to marked cellular bronchitis in the small airways and treatment with prednisolone or cyclosporin-A lead to neutrophils and exudates in the alveolar lumen. Patients with centrilobular nodules predominant radiologic pattern have a high level of CMI, measuring by tuberculin skin test. From these findings, up-regulation of host CMI could change radiological pattern to centrilobular nodules predominant, on the other hand down-regulation of host CMI would change radiological pattern to ground-glass opacity and consolidation. It was suggested the pathological features of M. pneumoniae pneumonia may be altered by the level of host CMI. PMID:27242720

  7. [A case of eosinophilic pneumonia due to Nicolase (serrapeptase) after recovery from acute eosinophilic pneumonia].

    PubMed

    Kai, Naoko; Shirai, Ryo; Hirata, Norio; Iwata, Atsuko; Umeki, Kenji; Ishii, Hiroshi; Kishi, Kenji; Tokimatsu, Issei; Hiramatsu, Kazufumi; Kadota, Jun-ichi

    2009-03-01

    A case of eosinophilic pneumonia due to Nicolase (serrapeptase) after recovery from acute eosinophilic pneumonia is described. A 32-year-old woman was previously admitted to another hospital because of acute onset of dyspnea accompanied by cough and fever. Chest X-ray films revealed diffuse infiltration in both lungs two days after her symptoms occurred. Her bronchoalveolar lavage fluid showed 13% eosinophils and transbronchial lung biopsy specimen also showed many eosinophils infiltrating in the lesions of the bronchial submucosa and alveolar septa. No infectious causes or related drugs were found. Acute eosinophilic pneumonia was diagnosed, and her condition improved gradually without steroid treatment. Because she recovered clinically and radiologically, she was discharged from hospital. Half a month later she was treated with Nicolase because of pharyngitis. She was admitted to the hospital again because of dyspnea, cough and fever three days after commencing to take Nicolase. Chest X-ray films also revealed diffuse infiltration in both lungs with pleural effusion, and her bronchoalveolar lavage fluid showed 37% eosinophils. When the drug lymphocyte stimulation test was performed, it was positive for Nicolase. Therefore drug-induced eosinophilic pneumonia was diagnosed. This is a very rare case of Nicolase (serrapeptase)-induced eosinophilic pneumonia after recovering from acute eosinophilic pneumonia.

  8. A cohort study of bacteremic pneumonia

    PubMed Central

    Guillamet, Cristina Vazquez; Vazquez, Rodrigo; Noe, Jonas; Micek, Scott T.; Kollef, Marin H.

    2016-01-01

    Abstract Bacteremic pneumonia is usually associated with greater mortality. However, risk factors associated with hospital mortality in bacteremic pneumonia are inadequately described. The study was a retrospective cohort study, conducted in Barnes-Jewish Hospital (2008–2015). For purposes of this investigation, antibiotic susceptibility was determined according to ceftriaxone susceptibility, as ceftriaxone represents the antimicrobial agent most frequently recommended for hospitalized patients with community-acquired pneumonia as opposed to nosocomial pneumonia. Two multivariable analyses were planned: the first model included resistance to ceftriaxone as a variable, whereas the second model included the various antibiotic-resistant species (methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae). In all, 1031 consecutive patients with bacteremic pneumonia (mortality 37.1%) were included. The most common pathogens associated with infection were S aureus (34.1%; methicillin resistance 54.0%), Enterobacteriaceae (28.0%), P aeruginosa (10.6%), anaerobic bacteria (7.3%), and Streptococcus pneumoniae (5.6%). Compared with ceftriaxone-susceptible pathogens (46.8%), ceftriaxone-resistant pathogens (53.2%) were significantly more likely to receive inappropriate initial antibiotic treatment (IIAT) (27.9% vs 7.1%; P < 0.001) and to die during hospitalization (41.5% vs 32.0%; P = 0.001). The first logistic regression analysis identified IIAT with the greatest odds ratio (OR) for mortality (OR 2.2, 95% confidence interval [CI] 1.5–3.2, P < 0.001). Other independent predictors of mortality included age, mechanical ventilation, immune suppression, prior hospitalization, prior antibiotic administration, septic shock, comorbid conditions, and severity of illness. In the second multivariable analysis that included the antibiotic-resistant species, IIAT was still associated with excess mortality, and P aeruginosa infection was

  9. Health care-associated Staphylococcus aureus pneumonia

    PubMed Central

    Webster, Duncan; Chui, Linda; Tyrrell, Gregory J; Marrie, Thomas J

    2007-01-01

    INTRODUCTION While Staphylococcus aureus is an uncommon but serious cause of traditional community-acquired pneumonia (CAP), it is a predominant cause of nosocomial pneumonia in addition to the unique clinical entity of health care-associated pneumonia (HCAP). A cohort of bacteremic S aureus pneumonia cases was reviewed to determine the role of HCAP among the cohort, and to assess for differences between CAP and HCAP. PATIENTS AND METHODS Bacteremic S aureus pneumonia cases were identified from a prospective study of all patients diagnosed with CAP who presented to hospitals in Edmonton, Alberta, between November 2000 and November 2002. These cases were subsequently reviewed retrospectively. Demographic, clinical and microbiological data were obtained, and patients were classified as having CAP or HCAP. Relatedness of isolates was determined by pulsed-field gel electrophoresis analysis in conjunction with epidemiological information. RESULTS There were 28 cases of bacteremic S aureus pneumonia identified. Fifty-seven per cent were reclassified as having HCAP, and 43% remained classified as having CAP. The CAP cohort was significantly younger than the HCAP cohort (mean age 49.0±23.7 years versus 67.8±18.6 years; P=0.035) with higher rates of intravenous drug use (50% versus 0%; P=0.002). Long-term care facility residence (44%) was common in the HCAP cohort. The HCAP cohort presented with more severe illness, having a higher mean pneumonia severity index score (143.1±41.1 versus 98.2±54.6; P=0.028), and despite fewer embolic complications, there was a trend toward a significantly higher mortality rate (31% versus 0%; P=0.052). Two community-acquired isolates cultured in the setting of intravenous drug use were methicillin-resistant, and no isolates were positive for Panton-Valentine leukocidin. There was evidence of relatedness involving 44% of the HCAP isolates by pulsed-field gel electrophoresis analysis. CONCLUSION HCAP accounts for a significant number of

  10. Molecular evidence of Chlamydophila pneumoniae infection in reptiles in Argentina.

    PubMed

    Frutos, María C; Monetti, Marina S; Ré, Viviana E; Cuffini, Cecilia G

    2014-01-01

    In the central area of Argentina, the epidemiological and molecular characteristics of Chlamydophila pneumoniae infections in reptiles are still unknown. A nested polymerase chain reaction of the rpoB gene was used to detect C. pneumoniae in cloacal swab samples from 19 reptiles at a recreational area. Eleven (57.89%) reptiles were positive; the sequencing and phylogenetic analysis confirmed the presence of this bacterium. Neither C. pneumoniae DNA in the caregivers pharynges nor IgM antibodies anti-C. pneumoniae in their serum samples were detected; however, caregivers presented very high titers of IgG anti-C. pneumoniae. The detection of C. pneumoniae DNA in reptiles demonstrated the circulation of this agent in the recreational area and could be responsible for the exacerbated immune response of the personnel handling the reptiles, which suggests a potential zoonotic cycle. This is the first report of the detection of C. pneumoniae in reptiles in Argentina.

  11. A case of acute interstitial pneumonia indistinguishable from bronchiolitis obliterans organizing pneumonia/cryptogenic organizing pneumonia: high-resolution CT findings and pathologic correlation.

    PubMed

    Ichikado, K; Johkoh, T; Ikezoe, J; Yoshida, S; Honda, O; Mihara, N; Nakamura, H; Tsujimura, T; Suga, M; Ando, M

    1998-01-01

    We report a case of histologically proved acute interstitial pneumonia (AIP) with subacute onset whose high-resolution CT (HRCT) findings were indistinguishable from those of bronchiolitis obliterans organizing pneumonia (BOOP)/cryptogenic organizing pneumonia (COP). The HRCT findings were air-space consolidation with air-bronchiologram associated with little ground-glass attenuation, and nodules. Some cases of AIP present HRCT findings indistinguishable from those of BOOP/COP.

  12. Effect of Porins and Plasmid-Mediated AmpC β-Lactamases on the Efficacy of β-Lactams in Rat Pneumonia Caused by Klebsiella pneumoniae

    PubMed Central

    Padilla, Emma; Alonso, Diana; Doménech-Sánchez, Antonio; Gomez, Cristina; Pérez, José Luis; Albertí, Sebastián; Borrell, Nuria

    2006-01-01

    The in vivo activities of imipenem, meropenem, and cefepime were studied in a model of rat pneumonia caused by a plasmid-mediated AmpC β-lactamase ACT-1-producing Klebsiella pneumoniae strain (K. pneumoniae strain 12) and a derivative porin-deficient mutant (K. pneumoniae strain 12dp). No differences between these activities were seen with K. pneumoniae 12. Only meropenem showed an activity slightly better than that of imipenem with K. pneumoniae 12dp. PMID:16723600

  13. Risk of pneumonia recurrence in patients previously hospitalized for pneumonia--a retrospective study (1998-2000).

    PubMed

    Polić-Vizintin, Marina; Leppée, Marcel; Stimac, Danijela; Vodopija, Ivan; Cindrić, Jasna

    2005-06-01

    Although elderly hospitalized patients, irrespective of the cause of hospitalization, are known to be at a high risk of subsequent development of pneumonia, some studies suggest the risk to be even higher in those hospitalized for pneumonia than in those hospitalized for other diseases. The aim of this retrospective study was to determine the association of hospitalization for pneumonia and some other diseases with subsequent pneumonia morbidity and mortality. The risk of recurrent pneumonia in patients hospitalized for pneumonia was investigated. Rehospitalization of pneumonia patients previously hospitalized for the same disease was followed-up and compared with rehospitalization of patients hospitalized for other diseases during the same study period. The study included patients aged overl8, initially hospitalized in 1998 for pneumonia (J12-J18), or for some particular gastrointestinal (K20-K31) and urogenital diseases (N10-N12, N30-N39). All rehospitalizations for pneumonia in nine Zagreb hospitals were followed-up during a 3-year study period (1998-2000). Out of 975 patients followed-up for rehospitalization, 227 (23.3%) had initially been hospitalized for pneumonia, and 748 (76.7%) for other diagnoses. During the 3-year period, 30 patients were rehospitalized for pneumonia, out of which number 22 had initially been hospitalized for pneumonia, yielding a statistically significant difference between the two study groups (chi2 = 34.780, p < 0.001). The mortality directly caused by pneumonia was also significantly higher in the group of patients with the initial diagnosis of pneumonia than in the group of patients with other diagnoses (chi2 = 15.82, p < 0.001).

  14. Dysphagia, dystussia, and aspiration pneumonia in elderly people.

    PubMed

    Ebihara, Satoru; Sekiya, Hideki; Miyagi, Midori; Ebihara, Takae; Okazaki, Tatsuma

    2016-03-01

    Despite the development and wide distribution of guidelines for pneumonia, death from pneumonia is increasing due to population aging. Conventionally, aspiration pneumonia was mainly thought to be one of the infectious diseases. However, we have proven that chronic repeated aspiration of a small amount of sterile material can cause the usual type of aspiration pneumonia in mouse lung. Moreover, chronic repeated aspiration of small amounts induced chronic inflammation in both frail elderly people and mouse lung. These observations suggest the need for a paradigm shift of the treatment for pneumonia in the elderly. Since aspiration pneumonia is fundamentally based on dysphagia, we should shift the therapy for aspiration pneumonia from pathogen-oriented therapy to function-oriented therapy. Function-oriented therapy in aspiration pneumonia means therapy focusing on slowing or reversing the functional decline that occurs as part of the aging process, such as "dementia → dysphagia → dystussia → atussia → silent aspiration". Atussia is ultimate dysfunction of cough physiology, and aspiration with atussia is called silent aspiration, which leads to the development of life-threatening aspiration pneumonia. Research pursuing effective strategies to restore function in the elderly is warranted in order to decrease pneumonia deaths in elderly people.

  15. Polyamine transporter in Streptococcus pneumoniae is essential for evading early innate immune responses in pneumococcal pneumonia

    PubMed Central

    Rai, Aswathy N.; Thornton, Justin A.; Stokes, John; Sunesara, Imran; Swiatlo, Edwin; Nanduri, Bindu

    2016-01-01

    Streptococcus pneumoniae is the most common bacterial etiology of pneumococcal pneumonia in adults worldwide. Genomic plasticity, antibiotic resistance and extreme capsular antigenic variation complicates the design of effective therapeutic strategies. Polyamines are ubiquitous small cationic molecules necessary for full expression of pneumococcal virulence. Polyamine transport system is an attractive therapeutic target as it is highly conserved across pneumococcal serotypes. In this study, we compared an isogenic deletion strain of S. pneumoniae TIGR4 in polyamine transport operon (ΔpotABCD) with the wild type in a mouse model of pneumococcal pneumonia. Our results show that the wild type persists in mouse lung 24 h post infection while the mutant strain is cleared by host defense mechanisms. We show that intact potABCD is required for survival in the host by providing resistance to neutrophil killing. Comparative proteomics analysis of murine lungs infected with wild type and ΔpotABCD pneumococci identified expression of proteins that could confer protection to wild type strain and help establish infection. We identified ERM complex, PGLYRP1, PTPRC/CD45 and POSTN as new players in the pathogenesis of pneumococcal pneumonia. Additionally, we found that deficiency of polyamine transport leads to up regulation of the polyamine synthesis genes speE and cad in vitro. PMID:27247105

  16. Mycoplasma pneumoniae and Chlamydia spp. Infection in Community-Acquired Pneumonia, Germany, 2011–2012

    PubMed Central

    Dumke, Roger; Schnee, Christiane; Pletz, Mathias W.; Rupp, Jan; Jacobs, Enno; Sachse, Konrad; Group, CAPNETZ Study

    2015-01-01

    Mycoplasma pneumoniae and Chlamydia spp., which are associated with community-acquired pneumonia (CAP), are difficult to propagate, and can cause clinically indistinguishable disease patterns. During 2011–2012, we used molecular methods to test adult patients in Germany with confirmed CAP for infection with these 2 pathogens. Overall, 12.3% (96/783) of samples were positive for M. pneumoniae and 3.9% (31/794) were positive for Chlamydia spp.; C. psittaci (2.1%) was detected more frequently than C. pneumoniae (1.4%). M. pneumoniae P1 type 1 predominated, and levels of macrolide resistance were low (3.1%). Quarterly rates of M. pneumoniae–positive samples ranged from 1.5% to 27.3%, showing a strong epidemic peak for these infections, but of Chlamydia spp. detection was consistent throughout the year. M. pneumoniae–positive patients were younger and more frequently female, had fewer co-occurring conditions, and experienced milder disease than did patients who tested negative. Clinicians should be aware of the epidemiology of these pathogens in CAP. PMID:25693633

  17. Polyamine transporter in Streptococcus pneumoniae is essential for evading early innate immune responses in pneumococcal pneumonia.

    PubMed

    Rai, Aswathy N; Thornton, Justin A; Stokes, John; Sunesara, Imran; Swiatlo, Edwin; Nanduri, Bindu

    2016-01-01

    Streptococcus pneumoniae is the most common bacterial etiology of pneumococcal pneumonia in adults worldwide. Genomic plasticity, antibiotic resistance and extreme capsular antigenic variation complicates the design of effective therapeutic strategies. Polyamines are ubiquitous small cationic molecules necessary for full expression of pneumococcal virulence. Polyamine transport system is an attractive therapeutic target as it is highly conserved across pneumococcal serotypes. In this study, we compared an isogenic deletion strain of S. pneumoniae TIGR4 in polyamine transport operon (ΔpotABCD) with the wild type in a mouse model of pneumococcal pneumonia. Our results show that the wild type persists in mouse lung 24 h post infection while the mutant strain is cleared by host defense mechanisms. We show that intact potABCD is required for survival in the host by providing resistance to neutrophil killing. Comparative proteomics analysis of murine lungs infected with wild type and ΔpotABCD pneumococci identified expression of proteins that could confer protection to wild type strain and help establish infection. We identified ERM complex, PGLYRP1, PTPRC/CD45 and POSTN as new players in the pathogenesis of pneumococcal pneumonia. Additionally, we found that deficiency of polyamine transport leads to up regulation of the polyamine synthesis genes speE and cad in vitro. PMID:27247105

  18. Cytoskeletal elements in the bacterium Mycoplasma pneumoniae

    NASA Astrophysics Data System (ADS)

    Hegermann, Jan; Herrmann, Richard; Mayer, Frank

    2002-09-01

    Mycoplasma pneumoniae is a pathogenic eubacterium lacking a cell wall. Three decades ago, a "rod", an intracellular cytoskeletal structure, was discovered that was assumed to define and stabilize the elongated cell shape. Later, by treatment with detergent, a "Triton shell" (i.e. a fraction of detergent-insoluble cell material) could be obtained, believed to contain additional cytoskeletal elements. Now, by application of a modified Triton X-100 treatment, we are able to demonstrate that M. pneumoniae possesses a cytoskeleton consisting of a blade-like rod and a peripheral lining located close to the inner face of the cytoplasmic membrane, exhibiting features of a highly regular network. Attached "stalks" may support the cytoplasmic membrane. The rod was connected to the cell periphery by "spokes" and showed a defined ultrastructure. Its proximal end was found to be attached to a wheel-like complex. Fibrils extended from the proximal end of the rod into the cytoplasm.

  19. Pneumonia and empyema: causal, casual or unknown

    PubMed Central

    Dean, Nathan

    2015-01-01

    Parapneumonic effusions complicating pneumonia are associated with increased morbidity and mortality. Along with increased mortality, complicated parapneumonic effusion and empyema often necessitate prolonged treatment, longer hospital stay and interventions. Parapneumonic effusions arise from inflammation in the lungs and pleural space from direct invasion of bacteria, cascade of inflammatory events and bacteriologic virulence features. Patient factors and comorbidities also contribute to the pathophysiology of parapneumonic effusion development. The evolution of parapneumonic effusion can be divided into three progressive stages: (I) exudative stage; (II) fibrinopurulent stage; and (III) organizing stage with pleural peel formation. These stages can help categorize effusions into groups in order to evaluate the risk of a complicated course requiring intervention. We recommend that clinical data be evaluated and a stepwise approach be taken in management of these patients. This review article discusses current understanding of the development and relationship of parapneumonic effusions with pneumonia. PMID:26150912

  20. Rothia mucilaginosa pneumonia in an immunocompetent patient.

    PubMed

    Baeza Martínez, Carlos; Zamora Molina, Lucia; García Sevila, Raquel; Gil Carbonell, Joan; Ramos Rincon, José Manuel; Martín Serrano, Concepción

    2014-11-01

    Rothia mucilaginosa is a gram-postive coccus that occurs as part of the normal flora of the oropharynx and upper respiratory tract. Lower respiratory tract infections caused by this organism are rare and usually occur in immunocompromised patients. This is the case of an immunocompetent 47-year-old woman with right upper lobe pneumonia in which R.mucilaginosa was isolated in sputum and bronchial aspirate. Infections caused by this agent in the last four years in our hospital were reviewed. The most common predisposing factor was COPD with bronchiectasis. R.mucilaginosa was identified as the causative agent for pneumonia in only two cases, of which one was our case and the other was a patient with lung cancer.

  1. Streptococcus pneumoniae: virulence factors, pathogenesis, and vaccines.

    PubMed Central

    AlonsoDeVelasco, E; Verheul, A F; Verhoef, J; Snippe, H

    1995-01-01

    Although pneumococcal conjugate vaccines are close to being licensed, a more profound knowledge of the virulence factors responsible for the morbidity and mortality caused by Streptococcus pneumoniae is necessary. This review deals with the major structures of pneumococci involved in the pathogenesis of pneumococcal disease and their interference with the defense mechanisms of the host. It is well known that protection against S. pneumoniae is the result of phagocytosis of invading pathogens. For this process, complement and anticapsular polysaccharide antibodies are required. Besides, relatively recent experimental data suggest that protection is also mediated by the removal of disintegrating pneumococci and their degradation products (cell wall, pneumolysin). These structures seem to be major contributors to illness and death caused by pneumococci. An effective conjugate vaccine should therefore preferably include the capsular polysaccharide and at least one of these inflammatory factors. PMID:8531887

  2. Experimental studies of chronic pneumonia of sheep.

    PubMed

    Gilmour, J S; Jones, G E; Rae, A G

    1979-01-01

    Strains of Mycoplasma ovipneumoniae and Pasteurella haemolytica isolated from sheep affected with chronic pneumonia were inoculated by endobronchial route to conventionally-reared and SPF (Specific Pathogen-Free) lambs. Changes resembling those of the naturally-occurring disease were produced in most lambs given the organisms in combination and in some given M. ovipneumoniae alone. Similar but less extensive changes were seen in SPF lambs and fewer animals were affected. Different strains of M. ovipneumoniae did not affect the extent of changes produced in SPF lambs. M. ovipneumoniae became established in the lungs of both types of sheep; P. haemolytica did so less readily. It was concluded that chronic pneumonia may be reproduced in conventional animals by combined inoculation of M. ovipneumoniae and P. haemolytica. Age and status of immunity to mycoplasmas may account for the different responses of conventional and SPF lambs.

  3. Rothia mucilaginosa pneumonia in an immunocompetent patient.

    PubMed

    Baeza Martínez, Carlos; Zamora Molina, Lucia; García Sevila, Raquel; Gil Carbonell, Joan; Ramos Rincon, José Manuel; Martín Serrano, Concepción

    2014-11-01

    Rothia mucilaginosa is a gram-postive coccus that occurs as part of the normal flora of the oropharynx and upper respiratory tract. Lower respiratory tract infections caused by this organism are rare and usually occur in immunocompromised patients. This is the case of an immunocompetent 47-year-old woman with right upper lobe pneumonia in which R.mucilaginosa was isolated in sputum and bronchial aspirate. Infections caused by this agent in the last four years in our hospital were reviewed. The most common predisposing factor was COPD with bronchiectasis. R.mucilaginosa was identified as the causative agent for pneumonia in only two cases, of which one was our case and the other was a patient with lung cancer. PMID:24568756

  4. Understanding, preventing and eradicating Klebsiella pneumoniae biofilms.

    PubMed

    Ribeiro, Suzana Meira; Cardoso, Marlon Henrique; Cândido, Elizabete de Souza; Franco, Octávio Luiz

    2016-01-01

    The ability of pathogenic bacteria to aggregate and form biofilm represents a great problem for public health, since they present extracellular components that encase these micro-organisms, making them more resistant to antibiotics and host immune attack. This may become worse when antibiotic-resistant bacterial strains form biofilms. However, antibiofilm screens with different compounds may reveal potential therapies to prevent/treat biofilm infections. Here, we focused on Klebsiella pneumoniae, an opportunistic bacterium that causes different types of infections, including in the bloodstream, meninges, lungs, urinary system and at surgical sites. We also highlight aspects involved in the formation and maintenance of K. pneumoniae biofilms, as well as resistance and the emergence of new trends to combat this health challenge. PMID:27064296

  5. Pseudomonas aeruginosa ventilator-associated pneumonia management

    PubMed Central

    Ramírez-Estrada, Sergio; Borgatta, Bárbara; Rello, Jordi

    2016-01-01

    Ventilator-associated pneumonia is the most common infection in intensive care unit patients associated with high morbidity rates and elevated economic costs; Pseudomonas aeruginosa is one of the most frequent bacteria linked with this entity, with a high attributable mortality despite adequate treatment that is increased in the presence of multiresistant strains, a situation that is becoming more common in intensive care units. In this manuscript, we review the current management of ventilator-associated pneumonia due to P. aeruginosa, the most recent antipseudomonal agents, and new adjunctive therapies that are shifting the way we treat these infections. We support early initiation of broad-spectrum antipseudomonal antibiotics in present, followed by culture-guided monotherapy de-escalation when susceptibilities are available. Future management should be directed at blocking virulence; the role of alternative strategies such as new antibiotics, nebulized treatments, and vaccines is promising. PMID:26855594

  6. Community-Acquired Pneumonia Caused by Mycoplasma pneumoniae: How Physical and Radiological Examination Contribute to Successful Diagnosis.

    PubMed

    Kishaba, Tomoo

    2016-01-01

    Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia (CAP), particularly in young adults. Vital signs are usually normal except for temperature. On physical examination, general appearance is normal compared with that of typical pneumonia such as pneumococcal pneumonia patients. Mycoplasma sometimes causes ear infections such as otitis media. It is important to distinguish between typical pneumonia and atypical pneumonia such as mycoplasma pneumonia because having the right diagnosis allows for the use of the correct antibiotic to treat CAP while preventing development of drug-resistant bacteria and also decreasing medical cost. The symptoms and diagnosis of mycoplasma pneumonia is multi-fold. Auscultation of patients can demonstrate trace late inspiratory crackles or normal alveolar sounds; however, bilateral polyphonic wheezes can sometimes be heard because of bronchiolitis. With regard to radiological findings, a chest radiogragh often shows bilateral reticulonodular or patchy consolidation in both lower lobes. Pleural effusion is rarely observed in adult cases. Immunocompetent patients tend to reveal more extensive shadowing compared with immunocompromised patients. As serological diagnostic methods are not able to offer 100% reliable diagnosis, integration of physical and radiological examination is crucial to accurately diagnose mycoplasma pneumonia. Herein, I review the typical findings from physical examination and imaging patterns of patients with mycoplasma pneumonia.

  7. Community-Acquired Pneumonia Caused by Mycoplasma pneumoniae: How Physical and Radiological Examination Contribute to Successful Diagnosis

    PubMed Central

    Kishaba, Tomoo

    2016-01-01

    Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia (CAP), particularly in young adults. Vital signs are usually normal except for temperature. On physical examination, general appearance is normal compared with that of typical pneumonia such as pneumococcal pneumonia patients. Mycoplasma sometimes causes ear infections such as otitis media. It is important to distinguish between typical pneumonia and atypical pneumonia such as mycoplasma pneumonia because having the right diagnosis allows for the use of the correct antibiotic to treat CAP while preventing development of drug-resistant bacteria and also decreasing medical cost. The symptoms and diagnosis of mycoplasma pneumonia is multi-fold. Auscultation of patients can demonstrate trace late inspiratory crackles or normal alveolar sounds; however, bilateral polyphonic wheezes can sometimes be heard because of bronchiolitis. With regard to radiological findings, a chest radiogragh often shows bilateral reticulonodular or patchy consolidation in both lower lobes. Pleural effusion is rarely observed in adult cases. Immunocompetent patients tend to reveal more extensive shadowing compared with immunocompromised patients. As serological diagnostic methods are not able to offer 100% reliable diagnosis, integration of physical and radiological examination is crucial to accurately diagnose mycoplasma pneumonia. Herein, I review the typical findings from physical examination and imaging patterns of patients with mycoplasma pneumonia. PMID:27379238

  8. Setting a standard for the initiation of steroid therapy in refractory or severe Mycoplasma pneumoniae pneumonia in adolescents and adults.

    PubMed

    Miyashita, Naoyuki; Kawai, Yasuhiro; Inamura, Norikazu; Tanaka, Takaaki; Akaike, Hiroto; Teranishi, Hideto; Wakabayashi, Tokio; Nakano, Takashi; Ouchi, Kazunobu; Okimoto, Niro

    2015-03-01

    Serum interleukin (IL)-18 level was thought to be a useful as a predictor of refractory or severe Mycoplasma pneumoniae pneumonia, and steroid administration is reported to be effective in this situation. The serum levels of IL-18 correlated significantly with those of lactate dehydrogenase (LDH). The purpose of this study was to set a standard for the initiation of steroid therapy in M. pneumoniae pneumonia using a simple serum marker. We analyzed 41 adolescent and adult patients with refractory or severe M. pneumoniae pneumonia who received steroid therapy, and compared them with 108 patients with M. pneumoniae pneumonia who responded to treatment promptly (control group). Serum LDH levels were significantly higher in the refractory and severe group than in the control group at the initiation of steroid therapy (723 vs 210 IU/L, respectively; p < 0.0001). From receiver operating characteristic curve analysis, we calculated serum LDH cut-off levels of 364 IU/L at initiation of steroid therapy and 302 IU/L at 1-3 days before the initiation of steroid therapy. The administration of steroids to patients in the refractory and severe group resulted in the rapid improvement of symptoms and a decrease in serum LDH levels in all patients. Serum LDH level can be used as a useful parameter to determine the initiation of steroid therapy in refractory or severe M. pneumoniae pneumonia. A serum LDH level of 302-364 IU/L seems to be an appropriate criterion for the initiation of steroid therapy.

  9. Pneumonia - Multiple Languages: MedlinePlus

    MedlinePlus

    ... 繁體中文) Farsi (فارسی) French (français) Hindi (हिन्दी) Japanese (日本語) Korean (한국어) Russian (Русский) Somali (af Soomaali) ... हिन्दी (Hindi) Bilingual PDF Health Information Translations Japanese (日本語) Pneumonia 肺炎 - 日本語 (Japanese) Bilingual PDF Health ...

  10. Acute eosinophilic pneumonia following recent cigarette smoking.

    PubMed

    Thakur, Lokendra K; Jha, Kunal Kishor

    2016-01-01

    In this report we describe the case of an 18 year old female who presented with fever, shortness of breath, and chest pain. Chest X-ray revealed diffuse bilateral infiltrates and eosinophilia was reported from her broncholaveolar lavage (BAL) fluid. She started smoking 3 weeks prior to the onset of symptoms and based on her clinical presentation, BAL findings and dramatic improvement, acute eosinophilic pneumonia (AEP) was diagnosed. PMID:27642564

  11. Ventilator-associated Acinetobacter baumannii pneumonia.

    PubMed

    Ebenezer, Kala; James, Ebor Jacob G; Michael, Joy Sarojini; Kang, Gagandeep; Verghese, Valsan Philip

    2011-12-01

    We report an outbreak of ventilator-associated pneumonia caused by carbapenem-resistant Acinetobacter baumannii in 6 infants with acute lower respiratory tract infection. Non-bronchoscopic bronchoalveolar lavage isolated A. baumannii in all these infants. Environmental microbiological survey of the Pediatric intensive care unit and pediatric wards identified oxygen humidifying chambers as the source of Acinetobacter. Practices of cleaning and changing of the humidifiers were reviewed and the outbreak was controlled with new recommendations.

  12. Aspiration pneumonia associated with a double fracture of the mandible.

    PubMed

    Ohba, Seigo; Yoshimura, Hitoshi; Matsuda, Shinpei; Sano, Kazuo

    2014-11-01

    Aspiration pneumonia is one of the most life-threatening diseases in the elderly. A 73-year-old woman was diagnosed with aspiration pneumonia after a mandibular fracture. Because her persistent aspiration pneumonia was accompanied by a diminished swallowing function that was believed to be due to a double fracture of the mandible, the patient underwent an open reduction while having pneumonia. Her symptoms of aspiration pneumonia improved immediately after the surgery. The hyoid bone was repositioned to its original position, and the movements of the hyoid bone and mandible were recovered after the surgery. In cases in which the medial bone segment of the mandible moves inside because of a double fracture and the movement of the hyoid bone declines, we strongly suggest that an open reduction should be performed as soon as possible to prevent aspiration pneumonia caused by a swallowing dysfunction.

  13. [Infectious aortitis caused by Streptococcus pneumoniae].

    PubMed

    Zizi, O; Jiber, H; Bouarhroum, A

    2016-02-01

    Infectious aortitis is a rare clinical entity that most often manifests itself by an aortic aneurysm. The syphilitic or tubercular forms can be subacute. When it is caused by Salmonella sp., Staphylococcus sp. or Streptococcus pneumoniae, the aortitis is acute with alarming symptoms. Germs found in most cases are Salmonella and Staphylococcus aureus. S. pneumoniae rarely causes infectious aortitis. We report the case of a 75-year-old patient seen in an emergency setting for sudden-onset abdominal pain with fever. An abdominal angio-computed tomography (CT) scan showed a sacciform infrarenal abdominal aortic aneurysm, with an inflammatory aspect and periaortic hematoma. Surgical cure was undertaken because of the impending rupture. An interposition aortic replacement graft was implanted. Blood cultures and bacteriological study of the aortic wall isolated a S. pneumoniae. The anatomical pathology study reported fibrin clot leukocyte remodeling of the aortic wall. An intravenous antibiotic regimen was started. Several organisms, including Streptococcus, can cause infectious aortitis. We found 36 cases described in the literature in addition to our patient. PMID:26775836

  14. Community-acquired pneumonia: An overview.

    PubMed

    Mandell, Lionel A

    2015-08-01

    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.

  15. Parallel Evolution in Streptococcus pneumoniae Biofilms

    PubMed Central

    Churton, Nicholas W. V.; Misra, Raju V.; Howlin, Robert P.; Allan, Raymond N.; Jefferies, Johanna; Faust, Saul N.; Gharbia, Saheer E.; Edwards, Richard J.; Clarke, Stuart C.; Webb, Jeremy S.

    2016-01-01

    Streptococcus pneumoniae is a commensal human pathogen and the causative agent of various invasive and noninvasive diseases. Carriage of the pneumococcus in the nasopharynx is thought to be mediated by biofilm formation, an environment where isogenic populations frequently give rise to morphological colony variants, including small colony variant (SCV) phenotypes. We employed metabolic characterization and whole-genome sequencing of biofilm-derived S. pneumoniae serotype 22F pneumococcal SCVs to investigate diversification during biofilm formation. Phenotypic profiling revealed that SCVs exhibit reduced growth rates, reduced capsule expression, altered metabolic profiles, and increased biofilm formation compared to the ancestral strain. Whole-genome sequencing of 12 SCVs from independent biofilm experiments revealed that all SCVs studied had mutations within the DNA-directed RNA polymerase delta subunit (RpoE). Mutations included four large-scale deletions ranging from 51 to 264 bp, one insertion resulting in a coding frameshift, and seven nonsense single-nucleotide substitutions that result in a truncated gene product. This work links mutations in the rpoE gene to SCV formation and enhanced biofilm development in S. pneumoniae and therefore may have important implications for colonization, carriage, and persistence of the organism. Furthermore, recurrent mutation of the pneumococcal rpoE gene presents an unprecedented level of parallel evolution in pneumococcal biofilm development. PMID:27190203

  16. Serological study of Mycoplasma pneumoniae infections.

    PubMed

    Srifuengfung, Somporn; Techachaiwiwat, Wanida; Dhiraputra, Chertsak

    2004-08-01

    Mycoplasma pneumoniae antibody was determined in 811 sera of different patients admitted to Siriraj Hospital with respiratory tract infection from July 1, 2000 to August 31, 2003 by agglutination with gelatin particle agglutination test kit (SERODIA-MYCO II, Fujirebio Inc. Japan) in microtiter plates. Three hundred and three sera were positive (37.36%). The five most positive titer were found in patients 5-9 yr (40.26%), followed by patients 1-4 yr (24.75%), 10-14 yr (19.80%), 30-39 yr (5.28%) and 20-29 yr (3.96%). The positive titers ranged from 40 to > 20,480. Female:male ratio in positive patients was approximately the same (1.19:1). High titers (> or = 320) were found in 146 out of 303 patients (48.18%). The infection was mostly found in children aged 5-9 yr. Detection of antibody to M. pneumoniae infection showed that 37.36% of patients who were suspected of having atypical bacterial pneumonia were positive.

  17. Infection with and Carriage of Mycoplasma pneumoniae in Children

    PubMed Central

    Meyer Sauteur, Patrick M.; Unger, Wendy W. J.; Nadal, David; Berger, Christoph; Vink, Cornelis; van Rossum, Annemarie M. C.

    2016-01-01

    “Atypical” pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 years of age, with a decline after adolescence and tapering off in adulthood. Detection rates by polymerase chain reaction (PCR) or serology in children with CAP admitted to the hospital amount 4–39%. Although the infection is generally mild and self-limiting, patients of every age can develop severe or extrapulmonary disease. Recent studies indicate that high rates of healthy children carry M. pneumoniae in the upper respiratory tract and that current diagnostic PCR or serology cannot discriminate between M. pneumoniae infection and carriage. Further, symptoms and radiologic features are not specific for M. pneumoniae infection. Thus, patients may be unnecessarily treated with antimicrobials against M. pneumoniae. Macrolides are the first-line antibiotics for this entity in children younger than 8 years of age. Overall macrolides are extensively used worldwide, and this has led to the emergence of macrolide-resistant M. pneumoniae, which may be associated with severe clinical features and more extrapulmonary complications. This review focuses on the characteristics of M. pneumoniae infections in children, and exemplifies that simple clinical decision rules may help identifying children at high risk for CAP due to M. pneumoniae. This may aid physicians in prescribing appropriate first-line antibiotics, since current diagnostic tests for M. pneumoniae infection are not reliably predictive. PMID:27047456

  18. Aspiration pneumonia in dogs: pathophysiology, prevention, and diagnosis.

    PubMed

    Schulze, Heidi M; Rahilly, Louisa J

    2012-12-01

    Aspiration pneumonia and aspiration pneumonitis are associated with significant morbidity in veterinary and human medicine. A variety of medical conditions and medications can predispose patients to aspiration, and every precaution should be taken to prevent aspiration from occurring. For dogs that aspirate oral or gastric contents and subsequently develop pneumonia, monitoring and supportive care are imperative. This article discusses the pathophysiology, prevention, and diagnosis of aspiration pneumonia.

  19. Conventional NK cells can produce IL-22 and promote host defense in Klebsiella pneumoniae pneumonia.

    PubMed

    Xu, Xin; Weiss, Ido D; Zhang, Hongwei H; Singh, Satya P; Wynn, Thomas A; Wilson, Mark S; Farber, Joshua M

    2014-02-15

    It was reported that host defense against pulmonary Klebsiella pneumoniae infection requires IL-22, which was proposed to be of T cell origin. Supporting a role for IL-22, we found that Il22(-/-) mice had decreased survival compared with wild-type mice after intratracheal infection with K. pneumoniae. Surprisingly, however, Rag2(-/-) mice did not differ from wild-type mice in survival or levels of IL-22 in the lungs postinfection with K. pneumoniae. In contrast, K. pneumoniae-infected Rag2(-/-)Il2rg(-/-) mice failed to produce IL-22. These data suggested a possible role for NK cells or other innate lymphoid cells in host defense and production of IL-22. Unlike NK cell-like innate lymphoid cells that produce IL-22 and display a surface phenotype of NK1.1(-)NKp46(+)CCR6(+), lung NK cells showed the conventional phenotype, NK1.1(+)NKp46(+)CCR6(-). Mice depleted of NK cells using anti-asialo GM1 showed decreased survival and higher lung bacterial counts, as well as increased dissemination of K. pneumoniae to blood and liver, compared with control-treated mice. NK cell depletion also led to decreased production of IL-22 in the lung. Within 1 d postinfection, although there was no increase in the number of lung NK cells, a subset of lung NK cells became competent to produce IL-22, and such cells were found in both wild-type and Rag2(-/-) mice. Our data suggest that, during pulmonary infection of mice with K. pneumoniae, conventional NK cells are required for optimal host defense, which includes the production of IL-22.

  20. Source and extent of Klebsiella pneumoniae in the paper industry.

    PubMed Central

    Caplenas, N R; Kanarek, M S; Dufour, A P

    1981-01-01

    Three pulp and paper mill processing plants were evaluated for fecal coliform and Klebsiella pneumoniae bacterial concentrations. Freshwater consumed by paper industries contained minimum detectable levels of K. pneumoniae, less than 10 organisms per 100 ml. Elevated concentrations of K. pneumoniae could be traced from early pulping stages to water processing reuse systems. Concentrations of K. pneumoniae (thermotolerant and thermointolerant) ranged from 40,000 organisms per 100 ml to an estimated 3 x 10(6) organisms per 100 ml. K. pneumoniae biotyping provided evidence for the selective growth and persistence of K. pneumoniae from the initial wood washing stages through to the final effluent discharge. Wastewater treatment had limited effects in reducing K. pneumoniae concentrations. K. pneumoniae levels ranged from 40 organisms per 100 ml to an estimated 10(6) organisms per 100 ml. The presence of K. pneumoniae in water indicates degraded water quality, and its significance with regard to human health effects has yet to be examined. PMID:7032419

  1. Adult human metapneumonovirus (hMPV) pneumonia mimicking Legionnaire's disease.

    PubMed

    Cunha, Burke A; Irshad, Nadia; Connolly, James J

    2016-01-01

    In adults hospitalized with viral pneumonias the main differential diagnostic consideration is influenza pneumonia. The respiratory viruses causing viral influenza like illnesses (ILIs), e.g., RSV may closely resemble influenza. Rarely, extrapulmonary findings of some ILIs may resemble Legionnaire's disease (LD), e.g., adenovirus, human parainfluenza virus (HPIV-3). We present a most unusual case of human metapneumonovirus pneumonia (hMPV) with some characteristic extrapulmonary findings characteristic of LD, e.g., relative bradycardia, as well as mildly elevated serum transaminases and hyphosphatemia. We believe this is the first reported case of hMPV pneumonia in a hospitalized adult that had some features of LD.

  2. Antibiotic Resistance Related to Biofilm Formation in Klebsiella pneumoniae.

    PubMed

    Vuotto, Claudia; Longo, Francesca; Balice, Maria Pia; Donelli, Gianfranco; Varaldo, Pietro E

    2014-01-01

    The Gram-negative opportunistic pathogen, Klebsiella pneumoniae, is responsible for causing a spectrum of community-acquired and nosocomial infections and typically infects patients with indwelling medical devices, especially urinary catheters, on which this microorganism is able to grow as a biofilm. The increasingly frequent acquisition of antibiotic resistance by K. pneumoniae strains has given rise to a global spread of this multidrug-resistant pathogen, mostly at the hospital level. This scenario is exacerbated when it is noted that intrinsic resistance to antimicrobial agents dramatically increases when K. pneumoniae strains grow as a biofilm. This review will summarize the findings about the antibiotic resistance related to biofilm formation in K. pneumoniae.

  3. Adult human metapneumonovirus (hMPV) pneumonia mimicking Legionnaire's disease.

    PubMed

    Cunha, Burke A; Irshad, Nadia; Connolly, James J

    2016-01-01

    In adults hospitalized with viral pneumonias the main differential diagnostic consideration is influenza pneumonia. The respiratory viruses causing viral influenza like illnesses (ILIs), e.g., RSV may closely resemble influenza. Rarely, extrapulmonary findings of some ILIs may resemble Legionnaire's disease (LD), e.g., adenovirus, human parainfluenza virus (HPIV-3). We present a most unusual case of human metapneumonovirus pneumonia (hMPV) with some characteristic extrapulmonary findings characteristic of LD, e.g., relative bradycardia, as well as mildly elevated serum transaminases and hyphosphatemia. We believe this is the first reported case of hMPV pneumonia in a hospitalized adult that had some features of LD. PMID:26988110

  4. Pneumonia in older residents of long-term care facilities.

    PubMed

    Furman, Christian Davis; Rayner, Abi V; Tobin, Elisabeth Pelcher

    2004-10-15

    Compared with community-dwelling persons, residents in long-term care facilities have more functional disabilities and underlying medical illnesses and are at increased risk of acquiring infectious diseases. Pneumonia is the leading cause of morbidity and mortality in this group. Risk factors include unwitnessed aspiration, sedative medication, and comorbidity. Recognition may be delayed because, in this population, pneumonia often presents without fever, cough, or dyspnea. Accurate identification of the etiologic agent is hampered because most patients cannot produce a suitable sputum specimen. It is difficult to distinguish colonization from infection. Colonization by Staphylococcus aureus and gram-negative organisms can result from aspiration of oral or gastric contents, which could lead to pneumonia. Aspiration of gastric contents also can produce aspiration pneumonitis. This condition is not infectious initially and may resolve without antibiotics. Antibiotics for the treatment of pneumonia should cover Streptococcus pneumoniae, Haemophilus influenzae, gram-negative rods, and S. aureus. Acceptable choices include quinolones or an extended-spectrum beta-lactam plus a macrolide. Treatment should last 10 to 14 days. Pneumonia is associated with significant mortality for up to two years. Dementia is related independently to the death rate within the first week after pneumonia, regardless of treatment. Prevention strategies include vaccination against S. pneumoniae and influenza on admission to the care facility. This article focuses on recent recommendations for the recognition of respiratory symptoms and criteria for the designation of probable pneumonia, and provides a guide to hospitalization, antibiotic use, and prevention.

  5. Percutaneous CT-Guided Core Needle Biopsy Versus Fine Needle Aspiration in Diagnosing Pneumonia and Mimics of Pneumonia

    SciTech Connect

    Thanos, Loukas; Galani, Panagiota Mylona, Sophia; Pomoni, Maria; Mpatakis, Nikolaos

    2004-08-15

    The purpose of this study was to determine the diagnostic value of percutaneous core needle biopsy (CNB) relative to fine needle aspiration (FNA) in patients with pneumonia and pneumonia mimics. In this prospective study we present our experience with 48 thoracic FNAs and CNBs carried out on 48 patients with pneumonia and pneumonia mimics. Samples were obtained from all patients using both CNB (with an automated 18-G core biopsy needle and a gun) and FNA (with a 22-G needle). A specific diagnosis was made in 10/48 cases (20.83%) by FNA and in 42/48 (87.5%) by CNB. The main complications encountered were pneumothorax (n = 4) and hemoptysis (n = 2), yielding a total complication rate of 12.5%. We concluded that CNB using an automated biopsy gun results in a higher diagnostic accuracy for pneumonia and pneumonia mimic biopsies than FNA. Complications should be considered and proper patient observation should follow the procedure.

  6. Ventilator-associated pneumonia caused by colistin-resistant KPC-producing Klebsiella pneumoniae: a case report and literature review.

    PubMed

    Viaggi, Bruno; Sbrana, Francesco; Malacarne, Paolo; Tascini, Carlo

    2015-05-01

    Klebsiella pneumoniae producing KPC-type carbapenemase causes severe nosocomial infection at a high mortality rate. Nosocomial pneumonia in particular is associated with high mortality, likely due to the unfavorable pulmonary pharmacokinetics of the antibiotics used against this agent. Therefore, early and accurate microbiological identification and susceptibility evaluation are crucial in order to optimize antibiotic therapy. We report a case of ventilator-associated pneumonia caused by colistin-resistant K. pneumoniae producing KPC-type carbapenemase treated using a carbapenem-sparing therapy and tailored according to the serum procalcitonin concentration in order to limit the duration of antibiotic therapy.

  7. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    PubMed

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%).

  8. [Differential diagnosis of pulmonary tuberculosis and community-acquired pneumonia].

    PubMed

    Deĭkina, O N; Mishin, V Iu; Demikhova, O V

    2007-01-01

    The purpose of this investigation was to enhance the efficiency of differential diagnosis of pneumonia and pulmonary tuberculosis. A hundred and fifty-nine adult patients were examined. These included 78 patients with pulmonary tuberculosis and 81 with community-acquired p neumonia. The clinical features of infiltrative pulmonary tuberculosis (n = 48) and mild community-acquired pneumonia (n = 51) were compared. The course of caseous pneumonia (n = 30) was compared with that of moderate and severe community-acquired pneumonia (n = 30). Significant differences in the manifestations of the intoxication and bronchopulmonary syndrome were not found in patients with community-acquired pneumonia and infiltrative pulmonary tuberculosis. Physical studies showed that in patients with community-acquired pneumonia, moist rale (54.9%) and crepitation (11.8%) were prevalent, but in those with infiltrative tuberculosis rale was absent in 60.4% of cases and the pattern of respiration was unchanged in 79.2%. Chest X-ray studies indicated that in patients with community-acquired pneumonia, lower lobar inflammatory changes were predominant in 62.8% of cases whereas in those with infiltrative pulmonary tuberculosis the process was mainly bilateral (43.8%) with the presence of destructive changes (83.3%) and bronchogenic dissemination (66.7%). In patients with caseous pneumonia, the intoxication syndrome was more significant than in those with severe community-acquired pneumonia. Chest X-ray studies demonstrated that in patients with caseous pneumonia, specific changes were bilateral with the involvement of 2 lobes or more, with destruction and bronchogenic dissemination while in those with community-acquired pneumonia, the pulmonary processes were predominantly bilateral (76.6%) at the lower lobar site (36.7%). PMID:17338353

  9. Characterisation of an oxidative response inhibitor produced by Streptococcus pneumoniae.

    PubMed Central

    Perry, F. E.; Elson, C. J.; Mitchell, T. J.; Andrew, P. W.; Catterall, J. R.

    1994-01-01

    BACKGROUND--Pneumonia caused by infection with Streptococcus pneumoniae is still a major clinical problem. Reactive oxygen species contribute to the killing of these bacteria by polymorphonuclear leucocytes (PMNs). Defence mechanisms of Str pneumoniae which counter reactive oxygen species are characterised. METHODS--PMNs were stimulated with phorbol myristate acetate (PMA) in the presence and absence of Str pneumoniae and supernatants from them, and superoxide (O2-) production was measured by the reduction of ferricytochrome c. RESULTS--Streptococcus pneumoniae, but not Klebsiella pneumoniae or Staphylococcus aureus, inhibited PMA stimulated superoxide production by PMNs. Washed PMNs which had been preincubated with Str pneumoniae autolysis phase supernatants also exhibited depressed H2O2 production in response to PMA. The inhibitory activity was not attributable to non-specific cytotoxicity as assessed by release of the cytoplasmic enzyme lactate dehydrogenase, nor did the supernatants inhibit PMA stimulated degranulation of PMNs. Fractionation of the autolysis phase supernatants revealed inhibitory activity in both the fractions greater than and less than 10 kD. Like pneumolysin the inhibitory activity was heat sensitive. However, both a parent and pneumolysin negative mutant Str pneumoniae, and autolysis phase supernatants from them, inhibited PMN superoxide production. Antisera to pneumolysin failed to abrogate the inhibitory effect of intact Str pneumoniae or autolysis phase supernatants from types 1 or 14 Str pneumoniae. CONCLUSIONS--The inhibitory effect of Str pneumoniae on the respiratory burst of PMNs is not shared by two other common lung pathogens. The existence of a novel inhibitor of the PMN respiratory burst, distinct from pneumolysin, has been demonstrated. The inhibitor is specific for the respiratory burst and is active both in the logarithmic phase of growth and during autolysis. PMID:8066562

  10. Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series *

    PubMed Central

    Cillóniz, Catia; Rangel, Ernesto; Barlascini, Cornelius; Piroddi, Ines Maria Grazia; Torres, Antoni; Nicolini, Antonello

    2015-01-01

    Abstract Objective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular. Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity. Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis. Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis. PMID:26398760

  11. Treatment of experimental pneumonia due to penicillin-resistant Streptococcus pneumoniae in immunocompetent rats.

    PubMed Central

    Gavaldà, J; Capdevila, J A; Almirante, B; Otero, J; Ruiz, I; Laguarda, M; Allende, H; Crespo, E; Pigrau, C; Pahissa, A

    1997-01-01

    A model of pneumonia due to Streptococcus pneumoniae resistant to penicillin was developed in immunocompetent Wistar rats and was used to evaluate the efficacies of different doses of penicillin, cefotaxime, cefpirome, and vancomycin. Adult Wistar rats were challenged by intratracheal inoculation with 3 x 10(9) CFU of one strain of S. pneumoniae resistant to penicillin (MICs of penicillin, cefotaxime, cefpirome, and vancomycin, 2, 1, 0.5, and 0.5 microg/ml, respectively) suspended in brain heart broth supplemented with 0.7% agar. The rats experienced a fatal pneumonia, dying within 5 days and with peak mortality (70 to 80%) occurring 48 to 72 h after infection, and the bacterial counts in the lungs persisted from 8.87 +/- 0.3 log10 CFU/g of lung at 24 h of the infection to 9.1 +/- 0.3 log10 CFU/g at 72 h. Four hours after infection the animals were randomized into the following treatment groups: (i) control without treatment, (ii) penicillin G at 100,000 IU/kg of body weight every 2 h, (iii) penicillin G at 250,000 IU/kg every 2 h, (iv) cefotaxime at 100 mg/kg every 2 h, (v) cefpirome at 200 mg/kg every 2 h, and (vi) vancomycin at 50 mg/kg every 8 h. Two different protocols were used for the therapeutic efficacy studies: four doses of beta-lactams and one dose of vancomycin or eight doses of beta-lactams and two doses of vancomycin. Results of the therapy for experimental pneumonia caused by penicillin-resistant S. pneumoniae showed that initially, all the antimicrobial agents tested had similar efficacies, but when we prolonged the treatment, higher doses of penicillin, cefotaxime, and cefpirome were more effective than penicillin at lower doses in decreasing the residual bacterial titers in the lungs. Also, when we extended the treatment, vancomycin was more efficacious than penicillin at lower doses but was less efficacious than higher doses of penicillin or cefpirome. The model that we have developed is simple and amenable for inducing pneumonia in

  12. Clinical features and outcomes of aspiration pneumonia compared with non-aspiration pneumonia: a retrospective cohort study.

    PubMed

    Hayashi, Makoto; Iwasaki, Takuya; Yamazaki, Yohei; Takayasu, Hiromi; Tateno, Hidetsugu; Tazawa, Sakiko; Kato, Eisuke; Wakabayashi, Aya; Yamaguchi, Fumihiro; Tsuchiya, Yutaka; Yamashita, Jun; Takeda, Norikazu; Matsukura, Satoshi; Kokubu, Fumio

    2014-07-01

    Pneumonia is a leading cause of death among elderly patients. Although aspiration pneumonia (AP) commonly occurs with aging, its clinical features and outcomes are still uncertain. The aims of this study were to describe the clinical features and outcomes of AP and to assess whether presence of AP affects clinical outcomes in patients with community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). We retrospectively analyzed patients with CAP and HCAP hospitalized in our institution in Japan from October 2010 to March 2012. We compared clinical features and outcomes between AP and non-AP, and investigated risk factors for recurrence of pneumonia and death. Of 214 consecutive patients, 100 (46.7%) were diagnosed as having aspiration pneumonia. These patients were older and had lower body mass index, more comorbidities, and poorer Eastern Cooperative Oncology Group performance status (ECOG PS) than the patients with non-AP. Patients with AP had more severe disease, required longer hospital stays, and had a frequent recurrence rate of pneumonia and higher mortality. In multivariate analyses, AP, age, and ECOG PS were related to recurrence of pneumonia, and the prognostic factors were CURB-65 score and ECOG PS. AP was not a significant indicator for prognosis but was the strongest risk factor for recurrence of pneumonia. Clinical background and outcomes including recurrence and mortality of AP were obviously different from those of non-AP; therefore AP should be considered as a distinct subtype of pneumonia, and it is important to prevent the recurrence of pneumonia in the patients with AP.

  13. Hypervirulent Klebsiella pneumoniae induced ventilator-associated pneumonia in mechanically ventilated patients in China.

    PubMed

    Yan, Q; Zhou, M; Zou, M; Liu, W-e

    2016-03-01

    The purpose of this study was to investigate the clinical characteristics of hypervirulent K. pneumoniae (hvKP) induced ventilator-associated pneumonia (VAP) and the microbiological characteristics and epidemiology of the hvKP strains. A retrospective study of 49 mechanically ventilated patients with K. pneumoniae induced VAP was conducted at a university hospital in China from January 2014 to December 2014. Clinical characteristics and K. pneumoniae antimicrobial susceptibility and biofilm formation were analyzed. Genes of capsular serotypes K1, K2, K5, K20, K54 and K57 and virulence factors plasmid rmpA(p-rmpA), iroB, iucA, mrkD, entB, iutA, ybtS, kfu and allS were also evaluated. Multilocus sequence typing (MLST) and random amplified polymorphic DNA (RAPD) analyses were used to study the clonal relationship of the K. pneumoniae strains. Strains possessed p-rmpA and iroB and iucA were defined as hvKP. Of 49 patients, 14 patients (28.6 %) were infected by hvKP. Antimicrobial resistant rate was significantly higher in cKP than that in hvKP. One ST29 K54 extended-spectrum-beta-lactamase (ESBL) producing hvKP strain was detected. The prevalence of K1 and K2 in hvKP was 42.9 % and 21.4 %, respectively. The incidences of K1, K2, K20, p-rmpA, iroB, iucA, iutA, Kfu and alls were significantly higher in hvKP than those in cKP. ST23 was dominant among hvKP strains, and all the ST23 strains had identical RAPD pattern. hvKP has become a common pathogen of VAP in mechanically ventilated patients in China. Clinicians should increase awareness of hvKP induced VAP and enhance epidemiologic surveillance.

  14. Pneumocystis jirovecii pneumonia in developing countries*

    PubMed Central

    De Armas Rodríguez, Y.; Wissmann, G.; Müller, A.L.; Pederiva, M.A.; Brum, M.C.; Brackmann, R.L.; Capó De Paz, V.; Calderón, E.J.

    2011-01-01

    Pneumocystis pneumonia (PcP) is a serious fungal infection among immunocompromised patients. In developed countries, the epidemiology and clinical spectrum of PcP have been clearly defined and well documented. However, in most developing countries, relatively little is known about the prevalence of pneumocystosis. Several articles covering African, Asian and American countries were reviewed in the present study. PcP was identified as a frequent opportunistic infection in AIDS patients from different geographic regions. A trend to an increasing rate of PcP was apparent in developing countries from 2002 to 2010. PMID:21894262

  15. [A case of bettolepsy in acute pneumonia].

    PubMed

    Valenkevich, L N; Markelova, N N

    1992-03-01

    Literature lists more than 300 case reports of bettolepsy developing mainly in chronic diseases of the respiratory organs (chronic bronchitis, bronchial asthma, pulmonary emphysema, cor pulmonale) as well as in patients with epilepsy and organic brain diseases. The authors describe a case of bettolepsy in a patient with acute (croupous) pneumonia without respiratory diseases in the anamnesis and without a burdened neurological status. The role of nicotin and alcohol in the development of bettolepsy is shown. The problems of pathogenesis, clinical picture, differential diagnosis and treatment of bettolepsy are discussed. PMID:1413706

  16. Colonisation endpoints in Streptococcus pneumoniae vaccine trials.

    PubMed

    Auranen, Kari; Rinta-Kokko, Hanna; Goldblatt, David; Nohynek, Hanna; O'Brien, Katherine L; Satzke, Catherine; Simell, Birgit; Tanskanen, Antti; Käyhty, Helena

    2013-12-17

    Evaluating vaccine efficacy for protection against colonisation (VEcol) with bacterial pathogens is an area of growing interest. In this article, we consider estimation of VEcol for colonisation with Streptococcus pneumoniae (the pneumococcus). Colonisation is a common, recurrent and multi-type endpoint that requires both careful definition of the vaccine efficacy parameter and the corresponding method of estimation. We review recent developments in the area and provide practical guidelines for choosing the estimand and the estimation method in trials with a colonisation endpoint. We concentrate on methods that are based on a cross-sectional study design, in which only one nasopharyngeal sample is obtained per study subject.

  17. [Management of pneumonia in the elderly].

    PubMed

    Piette, François; Bornand, Anne; Cotto, Elise

    2011-10-01

    Pneumonias in elderly are frequent and severe. They require an accurate assessment following clinical, biological and radiological steps. Each of them can contribute to give answers to the following questions: does this patient need emergency hospitalisation? Is the infection really bacterial and pulmonary? Should antibiotics be started? Which others treatments should be associated for the infection itself and for comorbid conditions? Concerning prevention, every effort must be done to decrease the incidence of these infections, especially vaccination. Pulmonary infections in nursing home need specific attention: cumulation of bad prognosis factors, risk of epidemic propagation, and vaccination of all people caring patients when required.

  18. Focal organizing pneumonia mimicking lung cancer: a surgeon's view.

    PubMed

    Zheng, Zhi; Pan, Youmin; Song, Chaoguo; Wei, Hao; Wu, Shimin; Wei, Xiang; Pan, Tiecheng; Li, Jun

    2012-01-01

    Focal organizing pneumonia is a unique form of organizing pneumonia. Little is known regarding its clinical and radiological feature, diagnosis, management, and outcome. Twenty patients with focal organizing pneumonia were investigated and compared with 40 patients with bronchogenic carcinoma. There were 38 men (63.3%) and 22 women (36.7%). The mean age was 55 ± 9.9 years. No specific feature in clinical and radiological manifestation was found to distinguish between focal organizing pneumonia and bronchogenic carcinoma. In patients with focal organizing pneumonia, wedge resection was performed in 12 cases and lobectomy in eight cases. Follow-up was complete with a median period of 26 months (range, 6 to 104 months). All patients were free from recurrence of organizing pneumonia. Clinical and radiologic findings of focal organizing pneumonia are nonspecific, and this unique form of organizing pneumonia is difficult to differentiate from lung cancer. Surgical resection allows both diagnosis and cure. However, considering the benign nature of this disease, major pulmonary resections should be avoided.

  19. A 54-year-old man referred with nonresolving pneumonia.

    PubMed

    Catteeuw, Julie; Koegelenberg, Coenraad F N; Bruwer, Johannes W; Sissolak, Gerhard; Schroeter, Leocardea; Mohamed, Nooroudien; Irusen, Elvis M

    2014-09-01

    A 54-year-old man was referred with nonresolving pneumonia. He had been treated for community-acquired pneumonia 6 weeks earlier. He reported grade 2 dyspnea, malaise, and a nonproductive cough. He had also experienced three episodes of minimal hemoptysis but denied weight loss, fever, or any other constitutional symptoms. He was a nonsmoker and was being treated for dyslipidemia. PMID:25180750

  20. Spontaneous rupture of the spleen associated with Legionella pneumonia

    PubMed Central

    Casanova-Roman, Manuel; Casas, Javier; Sanchez-Porto, Antonio; Nacle, Belen

    2010-01-01

    Spontaneous rupture of the spleen associated with Legionella pneumonia is a rare and life-threatening complication; only three cases have been reported to date. The authors describe a case of a 47-year-old man who presented with pneumonia and abdominal pain. He underwent a splenectomy, and was successfully treated with clarithromycin and levofloxacin. PMID:21886641

  1. Bronchiolitis obliterans organising pneumonia secondary to amiodarone treatment.

    PubMed

    Antón Aranda, E; Alkiza Basañez, R; Laplaza Jiménez, Y

    1998-09-01

    One of the most serious side effects of amiodarone (an antiarrhythmic drug) is pulmonary toxicity. Bronchiolitis obliterans organising pneumonia has only very rarely been described as associated with treatment with amiodarone. In this article we describe a case of bronchiolitis obliterans organising pneumonia secondary to amiodarone.

  2. Pneumonia Frequencies with Different Enteral Tube Feeding Access Sites.

    ERIC Educational Resources Information Center

    Taylor, Henry M.

    2002-01-01

    Over a 24-month period, 25 adults with mental retardation being fed via a gastrostomy tube experienced 40 cases of pneumonia during 508 person-months of observations, whereas 5 individuals being fed via a jejunostromy tube did not experience any pneumonia during 96 person-months of observation. (Contains references.) (Author/CR)

  3. [Mycoplasma pneumoniae: a cause of febrile hemolytic anemia in travelers].

    PubMed

    Ficko, C; Andriamanantena, D; Flateau, F; Mangouka, L; Soler, C; Carmoi, T; Rapp, C

    2012-01-01

    Mycoplasma pneumoniae can cause varied hematologic manifestations that are frequently associated with lower respiratory tract infections. Acute febrile hemolysis without respiratory symptoms is quite rare. We describe the case of a 25-year-old man, admitted for acute fever with hemolysis, after returning from Djibouti. M. pneumoniae infection was proved by serological testing. A favorable outcome followed macrolide treatment. PMID:23352983

  4. Interference with the oxidative response of neutrophils by Streptococcus pneumoniae.

    PubMed Central

    Perry, F E; Elson, C J; Greenham, L W; Catterall, J R

    1993-01-01

    BACKGROUND--Pneumococcal infections are still a major clinical problem. Polymorphonuclear leucocytes (neutrophils) are considered to have a key role in the host's defence against Streptococcus pneumoniae but the mechanisms by which they kill the pneumococcus remain unclear. As reactive oxygen species are regarded as a major antimicrobial defence of phagocytes an attempt has been made to establish their role in the response of neutrophils to S pneumoniae. METHODS--S pneumoniae isolated from patients with bacteraemic pneumococcal pneumonia were incubated with neutrophils in suspension and superoxide production was measured by reduction of ferricytochrome c. RESULTS--S pneumoniae did not stimulate superoxide production alone or in the presence of normal human serum. Spontaneous superoxide production by neutrophils was actually abrogated by S pneumoniae, as was the powerful respiratory burst stimulated by phorbol myristate acetate. This phenomenon depended on both the dose and the viability of the bacteria. With S pneumoniae in the logarithmic phase of growth inhibitory activity was confined to the organisms themselves but with organisms undergoing autolysis it was also present in filtered supernatants, suggesting that the inhibitory activity can be attributed to a factor released during autolysis. CONCLUSIONS--S pneumoniae can interfere with the respiratory burst of neutrophils. This property may help to explain the pathogenicity of the organism. PMID:8390109

  5. Community-acquired bacterial pneumonia requiring admission to hospital.

    PubMed

    Klimek, J J; Ajemian, E; Fontecchio, S; Gracewski, J; Klemas, B; Jimenez, L

    1983-06-01

    Patients who develop bacterial pneumonia in the community often require admission to acute-care hospitals. Knowledge of the incidence of pneumonia due to different pathogens that are brought into an institution from the community may play a role in determining the patterns of infecting organisms responsible for hospital-acquired pneumonia. For 1 year, we prospectively reviewed the records of patients admitted to our 1000-bed community hospital with community-acquired bacterial pneumonia (CABP). Patients had clinical signs and symptoms, positive radiologic findings, and pure cultures of potential pathogens from sputum, blood, pleural fluid, lung aspirate, lung biopsy, or transtracheal aspirate. Pneumonia due to Legionella pneumophila was diagnosed by serum indirect fluorescent antibody (IFA) titer greater than or equal to 1:256 and clinical signs and symptoms along with response to erythromycin. Of 204 patients with bacterial pneumonia, the following pathogens were implicated: Streptococcus pneumoniae, Haemophilus species, L. pneumophila, Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, oral anaerobic bacteria, Psuedomonas aeruginosa, Serratia marcescens, and others. Most patients were more than 50 years of age and many had evidence of underlying pulmonary disease. The etiology of CABP may not be as predictable as in the past. Empiric antimicrobial therapy for CABP should include agents with activity against the pathogens prevalent in the community.

  6. Predictors of aspiration pneumonia: how important is dysphagia?

    PubMed

    Langmore, S E; Terpenning, M S; Schork, A; Chen, Y; Murray, J T; Lopatin, D; Loesche, W J

    1998-01-01

    Aspiration pneumonia is a major cause of morbidity and mortality among the elderly who are hospitalized or in nursing homes. Multiple risk factors for pneumonia have been identified, but no study has effectively compared the relative risk of factors in several different categories, including dysphagia. In this prospective outcomes study, 189 elderly subjects were recruited from the outpatient clinics, inpatient acute care wards, and the nursing home care center at the VA Medical Center in Ann Arbor, Michigan. They were given a variety of assessments to determine oropharyngeal and esophageal swallowing and feeding status, functional status, medical status, and oral/dental status. The subjects were followed for up to 4 years for an outcome of verified aspiration pneumonia. Bivariate analyses identified several factors as significantly associated with pneumonia. Logistic regression analyses then identified the significant predictors of aspiration pneumonia. The best predictors, in one or more groups of subjects, were dependent for feeding, dependent for oral care, number of decayed teeth, tube feeding, more than one medical diagnosis, number of medications, and smoking. The role that each of the significant predictors might play was described in relation to the pathogenesis of aspiration pneumonia. Dysphagia was concluded to be an important risk for aspiration pneumonia, but generally not sufficient to cause pneumonia unless other risk factors are present as well. A dependency upon others for feeding emerged as the dominant risk factor, with an odds ratio of 19.98 in a logistic regression model that excluded tube-fed patients.

  7. Chlamydia pneumoniae Promotes Dysfunction of Pancreatic Beta Cells

    PubMed Central

    Rodriguez, Annette R.; Plascencia-Villa, Germán; Witt, Colleen M.; Yu, Jieh-Juen; José-Yacamán, Miguel; Chambers, James P.; Perry, George; Guentzel, M. Neal; Arulanandam, Bernard P.

    2015-01-01

    The human pathogen Chlamydia pneumoniae has been implicated in chronic inflammatory diseases including type 2 diabetes. Therefore, we designed a study to evaluate pancreatic beta cells and mast cells during chlamydial infection. Our study revealed that C. pneumoniae infected mast cells significantly (p< 0.005) decreased beta cell ATP and insulin production, in contrast to uninfected mast cells co-cultured with beta cells. Infected mast cells exhibited pyknotic nuclei and active caspase-3 and caspase-1 expression. Additionally, ex vivo analyses of tissues collected from C. pneumoniae infected mice showed increased interleukin-1β production in splenocytes and pancreatic tissues as was observed with in vitro mast cell-beta cell co-cultures during C. pneumoniae infection. Notably, infected mast cells promoted beta cell destruction. Our findings reveal the negative effect of C. pneumoniae on mast cells, and the consequential impact on pancreatic beta cell function and viability. PMID:25863744

  8. Hospital study of adult community-acquired pneumonia.

    PubMed

    Macfarlane, J T; Finch, R G; Ward, M J; Macrae, A D

    1982-07-31

    The cause of primary pneumonia was diagnosed in 124 of 127 consecutive adult patients admitted to hospital with community-acquired illness. Pneumococcal infection was found in 96 (76%) patients and legionnaries' disease was the second commonest infection identified (15%). Other bacterial infections were uncommon. 11 patients had atypical pneumonia, including 7 with psittacosis. There were several mixed infections and most of the 11 patients with viral infections also had bacterial pneumonia. 19 patients died (15%) and mortality was associated with increasing age, the presence of coexisting disease, and the cause of the pneumonia. Recognition of the most likely causes of severe pneumonia allows logical initial antibiotic treatment for such patients admitted to hospital. PMID:6124681

  9. Pneumonia caused by Aeromonas species in Taiwan, 2004-2011.

    PubMed

    Chao, C M; Lai, C C; Tsai, H Y; Wu, C J; Tang, H J; Ko, W C; Hsueh, P-R

    2013-08-01

    We investigated the clinical characteristics of patients with pneumonia caused by Aeromonas species. Patients with pneumonia caused by Aeromonas species during the period 2004 to 2011 were identified from a computerized database of a regional hospital in southern Taiwan. The medical records of these patients were retrospectively reviewed. Of the 84 patients with pneumonia due to Aeromonas species, possible Aeromonas pneumonia was diagnosed in 58 patients, probable Aeromonas pneumonia was diagnosed in 18 patients, and pneumonia due to Aeromonas was conclusively diagnosed in 8 patients. Most of the cases of Aeromonas pneumonia developed in men and in patients of advanced age. A. hydrophila (n = 50, 59.5 %) was the most common pathogen, followed by A. caviae (n = 24, 28.6 %), A. veronii biovar sobria (n = 7, 8.3 %), and A. veronii biovar veronii (n = 3, 3.6 %). Cancer (n = 37, 44.0 %) was the most common underlying disease, followed by diabetes mellitus (n = 27, 32.1 %). Drowning-associated pneumonia developed in 6 (7.1 %) patients. Of 47 patients who were admitted to the intensive care ward, 42 patients developed acute respiratory failure and 24 of those patients died. The overall in-hospital mortality rate was significantly associated with liver cirrhosis, cancer, initial presentation of shock, and usage of mechanical ventilation. In conclusion, Aeromonas species should be considered as one of the causative pathogens of severe pneumonia, especially in immunocompromised patients, and should be recognized as a cause of drowning-associated pneumonia. Cirrhosis, cancer, and shock as the initial presenting symptom are associated with poor outcome.

  10. Lung dendritic cells facilitate extrapulmonary bacterial dissemination during pneumococcal pneumonia

    PubMed Central

    Rosendahl, Alva; Bergmann, Simone; Hammerschmidt, Sven; Goldmann, Oliver; Medina, Eva

    2013-01-01

    Streptococcus pneumoniae is a leading cause of bacterial pneumonia worldwide. Given the critical role of dendritic cells (DCs) in regulating and modulating the immune response to pathogens, we investigated here the role of DCs in S. pneumoniae lung infections. Using a well-established transgenic mouse line which allows the conditional transient depletion of DCs, we showed that ablation of DCs resulted in enhanced resistance to intranasal challenge with S. pneumoniae. DCs-depleted mice exhibited delayed bacterial systemic dissemination, significantly reduced bacterial loads in the infected organs and lower levels of serum inflammatory mediators than non-depleted animals. The increased resistance of DCs-depleted mice to S. pneumoniae was associated with a better capacity to restrict pneumococci extrapulmonary dissemination. Furthermore, we demonstrated that S. pneumoniae disseminated from the lungs into the regional lymph nodes in a cell-independent manner and that this direct way of dissemination was much more efficient in the presence of DCs. We also provide evidence that S. pneumoniae induces expression and activation of matrix metalloproteinase-9 (MMP-9) in cultured bone marrow-derived DCs. MMP-9 is a protease involved in the breakdown of extracellular matrix proteins and is critical for DC trafficking across extracellular matrix and basement membranes during the migration from the periphery to the lymph nodes. MMP-9 was also significantly up-regulated in the lungs of mice after intranasal infection with S. pneumoniae. Notably, the expression levels of MMP-9 in the infected lungs were significantly decreased after depletion of DCs suggesting the involvement of DCs in MMP-9 production during pneumococcal pneumonia. Thus, we propose that S. pneumoniae can exploit the DC-derived proteolysis to open tissue barriers thereby facilitating its own dissemination from the local site of infection. PMID:23802100

  11. Wavelet augmented cough analysis for rapid childhood pneumonia diagnosis.

    PubMed

    Kosasih, Keegan; Abeyratne, Udantha R; Swarnkar, Vinayak; Triasih, Rina

    2015-04-01

    Pneumonia is the cause of death for over a million children each year around the world, largely in resource poor regions such as sub-Saharan Africa and remote Asia. One of the biggest challenges faced by pneumonia endemic countries is the absence of a field deployable diagnostic tool that is rapid, low-cost and accurate. In this paper, we address this issue and propose a method to screen pneumonia based on the mathematical analysis of cough sounds. In particular, we propose a novel cough feature inspired by wavelet-based crackle detection work in lung sound analysis. These features are then combined with other mathematical features to develop an automated machine classifier, which can separate pneumonia from a range of other respiratory diseases. Both cough and crackles are symptoms of pneumonia, but their existence alone is not a specific enough marker of the disease. In this paper, we hypothesize that the mathematical analysis of cough sounds allows us to diagnose pneumonia with sufficient sensitivity and specificity. Using a bedside microphone, we collected 815 cough sounds from 91 patients with respiratory illnesses such as pneumonia, asthma, and bronchitis. We extracted wavelet features from cough sounds and combined them with other features such as Mel Cepstral coefficients and non-Gaussianity index. We then trained a logistic regression classifier to separate pneumonia from other diseases. As the reference standard, we used the diagnosis by physicians aided with laboratory and radiological results as deemed necessary for a clinical decision. The methods proposed in this paper achieved a sensitivity and specificity of 94% and 63%, respectively, in separating pneumonia patients from non-pneumonia patients based on wavelet features alone. Combining the wavelets with features from our previous work improves the performance further to 94% and 88% sensitivity and specificity. The performance far surpasses that of the WHO criteria currently in common use in

  12. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients.

    PubMed

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, P<0.0005). Highly similar differences were observed between microbiota profiles of young adult pneumonia patients and their healthy controls. Clustering resulted in 11 (sub)clusters including 95% (386/405) of samples. We observed three microbiota profiles strongly associated with pneumonia (P<0.05) and either dominated by lactobacilli (n=11), Rothia (n=51) or Streptococcus (pseudo)pneumoniae (n=42). In contrast, three other microbiota clusters (in total n=183) were correlated with health (P<0.05) and were all characterized by more diverse profiles containing higher abundances of especially Prevotella melaninogenica, Veillonella and Leptotrichia. For the remaining clusters (n=99), the association with health or disease was less clear. A decision tree model based on the relative abundance of five bacterial community members in URT microbiota showed high specificity of 95% and sensitivity of 84% (89% and 73%, respectively, after cross-validation) for differentiating pneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with

  13. Dysbiosis of upper respiratory tract microbiota in elderly pneumonia patients.

    PubMed

    de Steenhuijsen Piters, Wouter A A; Huijskens, Elisabeth G W; Wyllie, Anne L; Biesbroek, Giske; van den Bergh, Menno R; Veenhoven, Reinier H; Wang, Xinhui; Trzciński, Krzysztof; Bonten, Marc J; Rossen, John W A; Sanders, Elisabeth A M; Bogaert, Debby

    2016-01-01

    Bacterial pneumonia is a major cause of morbidity and mortality in elderly. We hypothesize that dysbiosis between regular residents of the upper respiratory tract (URT) microbiome, that is balance between commensals and potential pathogens, is involved in pathogen overgrowth and consequently disease. We compared oropharyngeal microbiota of elderly pneumonia patients (n=100) with healthy elderly (n=91) by 16S-rRNA-based sequencing and verified our findings in young adult pneumonia patients (n=27) and young healthy adults (n=187). Microbiota profiles differed significantly between elderly pneumonia patients and healthy elderly (PERMANOVA, P<0.0005). Highly similar differences were observed between microbiota profiles of young adult pneumonia patients and their healthy controls. Clustering resulted in 11 (sub)clusters including 95% (386/405) of samples. We observed three microbiota profiles strongly associated with pneumonia (P<0.05) and either dominated by lactobacilli (n=11), Rothia (n=51) or Streptococcus (pseudo)pneumoniae (n=42). In contrast, three other microbiota clusters (in total n=183) were correlated with health (P<0.05) and were all characterized by more diverse profiles containing higher abundances of especially Prevotella melaninogenica, Veillonella and Leptotrichia. For the remaining clusters (n=99), the association with health or disease was less clear. A decision tree model based on the relative abundance of five bacterial community members in URT microbiota showed high specificity of 95% and sensitivity of 84% (89% and 73%, respectively, after cross-validation) for differentiating pneumonia patients from healthy individuals. These results suggest that pneumonia in elderly and young adults is associated with dysbiosis of the URT microbiome with bacterial overgrowth of single species and absence of distinct anaerobic bacteria. Whether the observed microbiome changes are a cause or a consequence of the development of pneumonia or merely coincide with

  14. Limited Utility of Culture for Mycoplasma pneumoniae and Chlamydophila pneumoniae for Diagnosis of Respiratory Tract Infections ▿

    PubMed Central

    She, Rosemary C.; Thurber, Andy; Hymas, Weston C.; Stevenson, Jeffery; Langer, Janine; Litwin, Christine M.; Petti, Cathy A.

    2010-01-01

    We assessed the utility of culture for Mycoplasma pneumoniae and Chlamydophila pneumoniae to diagnose respiratory tract infections. Compared to PCR and IgM serology, culture was less sensitive and had extremely low yield. Culture is not recommended for these pathogens, and this method should be eliminated from routine practice. PMID:20610673

  15. [Pneumonia, when sound waves mix things up].

    PubMed

    Wachters, C; Hildebrand, M

    2011-01-01

    A 29-year old man is admitted in our hospital for a dry cough which appeared a few weeks earlier and is now associated with a breath depending thoracic pain. As an engineer, he is realizing a thesis about the sound waves produced by coughing and is therefore frequently exposed to patients with various pulmonary infections. The chest X-ray, presents predominant pulmonary infiltrates on the periphery of the upper fields of the lungs. Blood analysis revealed a hypereosinophilia of 4.650/microl. The various bacteriological, parasitic and viral investigation tests are negative. The bronchioalveolar washing reveals more than 50% eosinophils. Exclusive pulmonary impairment and lack of autoantibody moved us to the diagnosis of chronic eosinophilic pneumonia (or Carrington syndrome). Corticosteroids were started at the dosis of 0,5 mg/kg of methyl-prednisolone. Clinical and biological features improved amazingly within 48 hours. This case report illustrates the overlap between the chronic eosinophilic pneumonia and the Churg-Strauss desease who can be considered as variants of the hypereosinophilic syndrome (HES). Therefore, the use of anti-interleukin-5 antibodies, already used in the SHE and Churg-Strauss syndrome, might be useful in this case. PMID:22279854

  16. Acute interstitial pneumonia: report of a series.

    PubMed

    Bonaccorsi, A; Cancellieri, A; Chilosi, M; Trisolini, R; Boaron, M; Crimi, N; Poletti, V

    2003-01-01

    Four cases of acute interstitial pneumonia (AIP) are described with special emphasis on clinical background, lung imaging and bronchoalveolar lavage findings. A retrospective chart review of four patients with histologically-proven AIP, diagnosed between 1998 and 2000, was carried out. Clinical data, bronchoalveolar lavage (BAL) findings, high-resolution computed tomography (HRCT) and histological features were analysed. Three patients died and only one is in follow-up. HRCT showed areas of ground glass attenuation and alveolar consolidation in all patients. Histology, documented by open lung biopsy or autopsy specimens, was consistent with the organising form of diffuse alveolar damage pattern. BAL findings were characteristic, with a huge neutrophilia associated with scattered atypical type II pneumocytes collected in clusters with extracellular amorphous material (fragments of hyaline membranes) observed in two out of three cases. In this paper, four cases of acute interstitial pneumonia are reported in detail. The poor prognosis associated with this entity has been confirmed and the possible diagnostic role of the bronchoalveolar lavage is emphasised.

  17. An unusual cause of fungal pneumonia.

    PubMed

    Dharmic, S; Nair, Shraddha; Harish, M

    2015-04-01

    A 65 year old female, known asthmatic on steroids intermittently, with no other co-morbidity presented with fever, breathlessness and cough with mucoid expectoration of ten days duration with bilateral crepts, went for Type II respiratory failure and was intubated followed by tracheostomy in view of prolonged ventilator support. In spite of high end antibiotics as per sputum culture sensitivity, weaning off the ventilator was not possible. Blood investigations revealed leucocytosis with neutrophilic predominance and IgE levels were within normal limits. CT chest showed multiple patchy consolidations of the right upper, middle and lower lobes with ground glass appearance and enlarged mediastinal lymph nodes. Work up for retrovirus, tuberculosis and Sputum for KOH mount was negative. No evidence of sputum and blood eosinophilia. BAL sample grew Curvularia species. Fluconazole 150mg OD was added. Serial imaging of the chest showed resolution of the consolidation and was weaned off the ventilator and was comfortable on room air. Pneumonia caused by Curvularia, in an immune competent patient is very rare. Even in broncho pulmonary involvement these fungi usually occur in allergic conditions as in ABPA than appearing as a solitary cause for lung infection. But if diagnosed and treated early, will respond well to triazoles. This case report highlights a unilateral fungal pneumonia with dramatic clinical improvement post treatment once the rare causative organism was identified. PMID:26015753

  18. [Pneumonia, when sound waves mix things up].

    PubMed

    Wachters, C; Hildebrand, M

    2011-01-01

    A 29-year old man is admitted in our hospital for a dry cough which appeared a few weeks earlier and is now associated with a breath depending thoracic pain. As an engineer, he is realizing a thesis about the sound waves produced by coughing and is therefore frequently exposed to patients with various pulmonary infections. The chest X-ray, presents predominant pulmonary infiltrates on the periphery of the upper fields of the lungs. Blood analysis revealed a hypereosinophilia of 4.650/microl. The various bacteriological, parasitic and viral investigation tests are negative. The bronchioalveolar washing reveals more than 50% eosinophils. Exclusive pulmonary impairment and lack of autoantibody moved us to the diagnosis of chronic eosinophilic pneumonia (or Carrington syndrome). Corticosteroids were started at the dosis of 0,5 mg/kg of methyl-prednisolone. Clinical and biological features improved amazingly within 48 hours. This case report illustrates the overlap between the chronic eosinophilic pneumonia and the Churg-Strauss desease who can be considered as variants of the hypereosinophilic syndrome (HES). Therefore, the use of anti-interleukin-5 antibodies, already used in the SHE and Churg-Strauss syndrome, might be useful in this case.

  19. Cytomegalovirus pneumonia in transplant patients: CT findings

    SciTech Connect

    Eun-Young Kang; Patz, E.F. Jr.; Mueller, N.L.

    1996-03-01

    Our goal was to assess the CT findings of cytomegalovirus (CMV) pneumonia in transplant patients. The study included 10 transplant patients who had chest CT scan and pathologically proven isolated pulmonary CMV infection. Five patients had bone marrow transplant and five had solid organ transplant. The CT scans were retrospectively reviewed for pattern and distribution of disease and the CT findings compared with the findings on open lung biopsy (n = 9) and autopsy (n = 1). Nine of 10 patients had parenchymal abnormalities apparent at CT and I had normal CT scans. The findings in the nine patients included small nodules (n = 6), consolidation (n = 4), ground-glass attenuation (n = 4), and irregular lines (n = 1). The nodules had a bilateral and symmetric distribution and involved all lung zones. The consolidation was most marked in the lower lung zones. The CT findings of CMV pneumonia in transplant patients are heterogeneous. The most common patterns include small nodules and areas of consolidation. 13 refs., 4 figs., 1 tab.

  20. [Ceftaroline fosamil in community-acquired and nosocomial pneumonia].

    PubMed

    Calbo, Esther; Zaragoza, Rafael

    2014-03-01

    Community-acquired pneumonia (CAP) is a common infection in developed countries and causes a large number of hospital admissions and deaths. In recent years, the incidence of this disease has increased, caused by progressive population aging. Following the introduction of the conjugate vaccine against Streptococcus pneumoniae, there have been significant epidemiological changes that require close monitoring because of the possible emergence of new patterns of resistance. This article aims to review the role of ceftaroline fosamil, a new parenteral cephalosporin with antibacterial activity against Gram-negative and Gram-positive pathogens, in the treatment of pneumonia. Several in vitro and in vivo studies have shown the efficacy of ceftaroline fosamil against penicillin-resistant S. pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA). Additionally, ceftaroline has shown similar efficacy and safety to ceftriaxone in the treatment of community-acquired pneumonia with severe prognosis (prognostic severity index III and IV) in two phase III clinical trials. Although a non-inferiority design was used for these clinical trials, some data suggest a superior efficacy of ceftaroline, with earlier clinical response and higher cure rate in infections caused by S. pneumoniae, making this drug particularly interesting for critically-ill patients admitted to the intensive care unit. Ceftaroline may also be considered for empirical and directed treatment of MRSA pneumonia.

  1. [Ceftaroline fosamil in community-acquired and nosocomial pneumonia].

    PubMed

    Calbo, Esther; Zaragoza, Rafael

    2014-03-01

    Community-acquired pneumonia (CAP) is a common infection in developed countries and causes a large number of hospital admissions and deaths. In recent years, the incidence of this disease has increased, caused by progressive population aging. Following the introduction of the conjugate vaccine against Streptococcus pneumoniae, there have been significant epidemiological changes that require close monitoring because of the possible emergence of new patterns of resistance. This article aims to review the role of ceftaroline fosamil, a new parenteral cephalosporin with antibacterial activity against Gram-negative and Gram-positive pathogens, in the treatment of pneumonia. Several in vitro and in vivo studies have shown the efficacy of ceftaroline fosamil against penicillin-resistant S. pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA). Additionally, ceftaroline has shown similar efficacy and safety to ceftriaxone in the treatment of community-acquired pneumonia with severe prognosis (prognostic severity index III and IV) in two phase III clinical trials. Although a non-inferiority design was used for these clinical trials, some data suggest a superior efficacy of ceftaroline, with earlier clinical response and higher cure rate in infections caused by S. pneumoniae, making this drug particularly interesting for critically-ill patients admitted to the intensive care unit. Ceftaroline may also be considered for empirical and directed treatment of MRSA pneumonia. PMID:24702978

  2. [Community acquired pneumonia - treatment options according to the international recommendations].

    PubMed

    Lewandowska, Katarzyna; Kuś, Jan

    2016-01-01

    Pneumonia remains one of the main reasons of heath care system utilization. Quick diagnosis and prompt treatment initiation determine favorable outcome. Empirical antibiotic treatment allows to achieve treatment success in most patients. Treatment recommendations are based on big epidemiological trials. Nevertheless, it is sometimes necessary to know the definite etiologic factor of pneumonia. In these cases microbiological diagnostics is useful, i.e. sputum microscopy and culture, blood culture, bronchial lavage culture, bacterial antigen tests in urine, molecular tests. Serological tests do not help much in everyday clinical practice. The most common microorganisms causing community acquired pneumonia (CAP) are: Streptococcus pneumoniae, atypical bacteria (Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumophila), Haemophilus influenzae, influenza virus. Staphylococcus aureus and Pseudomonas aeruginosa rarely are etiologic factors of CAP. First line antibiotics in pneumonia treatment are beta - lactams. In case of allergy or intolerance of beta - lactams, new fluorochinolones should be used. Macrolides are useful if the atypical etiology is suspected. Duration of treatment in most cases should not exceed 7 days, sometimes it may be even shorter. PMID:27421128

  3. Klebsiella pneumoniae survives within macrophages by avoiding delivery to lysosomes.

    PubMed

    Cano, Victoria; March, Catalina; Insua, Jose Luis; Aguiló, Nacho; Llobet, Enrique; Moranta, David; Regueiro, Verónica; Brennan, Gerard P; Millán-Lou, Maria Isabel; Martín, Carlos; Garmendia, Junkal; Bengoechea, José A

    2015-11-01

    Klebsiella pneumoniae is an important cause of community-acquired and nosocomial pneumonia. Evidence indicates that Klebsiella might be able to persist intracellularly within a vacuolar compartment. This study was designed to investigate the interaction between Klebsiella and macrophages. Engulfment of K. pneumoniae was dependent on host cytoskeleton, cell plasma membrane lipid rafts and the activation of phosphoinositide 3-kinase (PI3K). Microscopy studies revealed that K. pneumoniae resides within a vacuolar compartment, the Klebsiella-containing vacuole (KCV), which traffics within vacuoles associated with the endocytic pathway. In contrast to UV-killed bacteria, the majority of live bacteria did not co-localize with markers of the lysosomal compartment. Our data suggest that K. pneumoniae triggers a programmed cell death in macrophages displaying features of apoptosis. Our efforts to identify the mechanism(s) whereby K. pneumoniae prevents the fusion of the lysosomes to the KCV uncovered the central role of the PI3K-Akt-Rab14 axis to control the phagosome maturation. Our data revealed that the capsule is dispensable for Klebsiella intracellular survival if bacteria were not opsonized. Furthermore, the environment found by Klebsiella within the KCV triggered the down-regulation of the expression of cps. Altogether, this study proves evidence that K. pneumoniae survives killing by macrophages by manipulating phagosome maturation that may contribute to Klebsiella pathogenesis.

  4. Nonspecific interstitial pneumonia overlaps organizing pneumonia in lung-dominant connective tissue disease.

    PubMed

    Li, Xue-Ren; Peng, Shou-Chun; Wei, Lu-Qing

    2015-01-01

    Here, we reported two cases of nonspecific interstitial pneumonia overlap organizing pneumonia (NSIP/OP) with lung-dominant connective tissue disease (LD-ILD). The first case is a patient with hands of chapped skin, right-sided pleuritic chest discomfort, weakness, positive ANA and antibodies to Ro/SS-A (+++) and Ro-52 (++). In the second case, there were Reynaud's disease, and nucleolus-ANA increased (1:800). Chest high resolution CT scan in both cases showed ground-glass opacifications, predominantly in basal and subpleural region and the pathologic manifestation were correlated with NSIP/OP, which were previously discovered in Sjogren syndrome, PM/DM and other rheumatic diseases. The two cases of NSIP/OP with LD-CTD we reported expand disease spectrum of NSIP/OP pathological types in ILD. However, it is necessary to process large-scale studies.

  5. Ultrasound in Rheumatologic Interstitial Lung Disease: A Case Report of Nonspecific Interstitial Pneumonia in Rheumatoid Arthritis.

    PubMed

    Laria, A; Lurati, A; Scarpellini, M

    2015-01-01

    According to the American Thoracic Society (ATS)/European Respiratory Society consensus classification, idiopathic interstitial pneumonias (IIPs) include several clinic-radiologic-pathologic entities: idiopathic pulmonary fibrosis (IPF), usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis-associated ILD, desquamative interstitial pneumonia, and lymphoid interstitial pneumonia. Ultrasound Lung Comets (ULCs) are an echographic chest-sonography hallmark of pulmonary interstitial fibrosis. We describe the ultrasound (US) findings in the follow-up of a NSIP's case in rheumatoid arthritis (RA). PMID:26240772

  6. Chronic eosinophilic pneumonia due to radiographic contrast administration: an orphan disease?

    PubMed Central

    Hohenforst-Schmidt, Wolfgang; Riedel, Andreas; Zarogoulidis, Paul; Franke, Christian; Gschwendtner, Andreas; Huang, Haidong; Machairiotis, Nikolaos; Dramba, Vasiliki; Zarogoulidis, Konstantinos; Brachmann, Johnannes

    2012-01-01

    Pulmonary eosinophilia comprises a heterogeneous group of diseases that are defined by eosinophilia in pulmonary infiltrates or in tissue. Drugs can cause almost all histopathologic patterns of interstitial pneumonias, such as cellular and fibrotic nonspecific interstitial pneumonia, pulmonary infiltrates and eosinophilia, organizing pneumonia, lymphocytic interstitial pneumonia, desquamative interstitial pneumonia, a pulmonary granulomatosis-like reaction, and a usual interstitial pneumonia-like pattern. We present a very rare case of chronic eosinophilic pneumonia due to radiographic contrast infusion diagnosed with video-assisted thoracoscopy. The patient after 1 year is still under corticosteroid treatment with the disease stabilized. PMID:23251088

  7. Emerging resistant serotypes of invasive Streptococcus pneumoniae

    PubMed Central

    Elshafie, Sittana; Taj-Aldeen, Saad J

    2016-01-01

    Background Streptococcus pneumoniae is the leading cause of meningitis and sepsis. The aim of the study was to analyze the distribution, vaccine serotype coverage, and antibiotic resistance of S. pneumoniae serotypes isolated from patients with invasive diseases, after the introduction of pneumococcal 7-valent conjugated vaccine (PCV-7). Methods A total of 134 isolates were collected from blood and cerebrospinal fluid specimens at Hamad Hospital during the period from 2005 to 2009. Isolate serotyping was done using the Quellung reaction. The prevaccination period was considered before 2005. Results The most common serotypes for all age groups were 3 (12.70%), 14 (11.90%), 1 (11.90%), 19A (9.00%), 9V (5.20%), 23F (5.20%), and 19F (4.50%). Coverage rates for infant <2 years for PCV-7, the 10-valent conjugated vaccine (PCV-10), and the 13-valent conjugated vaccine (PCV-13) were 34.78%, 52.17%, and 78.26%, respectively. Coverage rates of these vaccines were 50%, 67.86%, and 75% for the 2–5 years age group; 27.12%, 40.68%, and 64.41% for the age group 6–64 years; and 25%, 33.33%, and 66.67% for the ≥65 years age group, respectively. The percentage of nonsusceptible isolates to penicillin, cefotaxime, and erythromycin were 43.86%, 16.66%, and 22.81%, respectively. Thirty-seven isolates (32.46%) were multidrug resistant (MDR) and belonged to serotypes 14, 19A, 19F, 23F, 1, 9V, 12F, 4, 6B, 3, and 15A. Compared to previous results before the introduction of PCV-7, there was a significant reduction in penicillin-nonsusceptable S. pneumoniae from 66.67% to 43.86%, and a slight insignificant reduction in erythromycin nonsusceptible strains from 27.60% to 22.8%, while there was a significant increase in cefotaxime nonsusceptible strains from 3.55% to 16.66%. Conclusion Invasive pneumococcal strains and the emergence of MDR serotypes is a global burden that must be addressed through multiple strategies, including vaccination, antibiotic stewardship, and continuous

  8. Serum zinc and pneumonia in nursing home elderly

    PubMed Central

    Meydani, Simin N.; Barnett, Junaidah B.; Dallal, Gerard E.; Fine, Basil C.; Jacques, Paul F.; Leka, Lynette S.; Hamer, Davidson H.

    2008-01-01

    Background Zinc plays an important role in immune function. The association between serum zinc and pneumonia in the elderly has not been studied. Objective To determine if serum zinc concentrations in nursing home elderly are associated with incidence and duration of pneumonia, total and duration of antibiotic use, and pneumonia-associated and overall deaths. Design This observational study was conducted in residents from 33 nursing homes in Boston, MA, who participated in a one-year randomized, double-blind, and placebo controlled vitamin E supplementation trial; all were given daily doses of ½ RDA of essential vitamins and minerals including zinc. Participants with baseline (N=578) or final (N=420) serum zinc concentrations were categorized as having low (<70 μg/dL) or normal (≥70 μg/dL) serum zinc concentrations. Outcome measures included incidence and number of days with pneumonia, number of new antibiotic prescriptions, days of antibiotic use, death due to pneumonia, and, all-cause mortality. Results Subjects with normal final serum zinc concentrations had lower pneumonia incidence, total antibiotic use (by almost 50%), and shorter duration of pneumonia and antibiotic use (by 3.9 and 2.6 days, respectively) (all p-values ≤0.004) relative to those with low zinc concentrations. Normal baseline serum zinc concentrations were associated with decreased all-cause mortality (p=0.049). Conclusion Normal serum zinc concentrations in nursing home elderly were associated with decreased incidence and duration of pneumonia, and decreased use and duration of antimicrobial therapy. Zinc supplementation to maintain normal serum zinc concentrations in the elderly may help reduce pneumonia incidence and associated morbidity. PMID:17921398

  9. Pneumonia's second wind? A case study of the global health network for childhood pneumonia.

    PubMed

    Berlan, David

    2016-04-01

    Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues. Through document review and interviews with current, former and potential network members, this case study identifies five distinct eras of activity against childhood pneumonia: a period of isolation (post WWII to 1984), the duration of WHO's Acute Respiratory Infections (ARI) Programme (1984-1995), Integrated Management of Childhood illness's (IMCI) early years (1995-2003), a brief period of network re-emergence (2003-2008) and recent accelerating progress (2008 on). Analysis of these eras reveals the critical importance of building a shared identity in order to form an effective network and take advantage of emerging opportunities. During the ARI era, an initial network formed around a relatively narrow shared identity focused on community-level care. The shift to IMCI led to the partial dissolution of this network, stalled progress on addressing pneumonia in communities and missed opportunities. Frustrated with lack of progress on the issue, actors began forming a network and shared identity that included a broad spectrum of those whose interests overlap with pneumonia. As the network coalesced and expanded, its members coordinated and collaborated on conducting and sharing research on severity and tractability, crafting comprehensive strategies and conducting advocacy. These network activities exerted indirect influence leading to increased attention, funding, policies and some implementation.

  10. Late increase of interleukin-18 levels in blood during Mycoplasma pneumoniae pneumonia.

    PubMed

    Narita, Mitsuo; Tanaka, Hiroshi

    2012-07-01

    To the Editor, we read with great interest the article by Chung et al. which appeared recently in the journal. In that paper the authors reported that the decreased IL-18 response in severe pneumonia group vs. non-severe group was observed regardless of asthma status of the patients, whose findings were somewhat different from ours on non-asthmatic patients which showed higher serum levels of IL-18 in severe cases of pneumonia than in mild cases in terms of both in children and in adults. In this point, the timing of venous sampling must be an important factor in explaining the discrepant results. Our previous results suggest that the level of IL-18 in blood as a marker of disease severity should cautiously be interpreted considering a timing of sampling; a value of IL-18 in a blood sample which is obtained at the first visit to the hospital does not always represent the highest level of IL-18 because of the fact that the time which elapsed from the onset of illness to the blood sampling may vary among patients. Analyses on sequential samples, therefore, must be necessary to fully understand the perplexing nature of cytokine activation during Mycoplasma pneumoniae infection.

  11. Influenza A (H1N1) organising pneumonia.

    PubMed

    Torrego, Alfons; Pajares, Virginia; Mola, Anna; Lerma, Enrique; Franquet, Tomás

    2010-04-27

    In November 2009, countries around the world reported confirmed cases of pandemic influenza H1N1, including over 6000 deaths. No peak in activity has been seen. The most common causes of death are pneumonia and acute respiratory distress syndrome. We report a case of a 55-year-old woman who presented with organising pneumonia associated with influenza A (H1N1) infection confirmed by transbronchial lung biopsy. Organising pneumonia should also be considered as a possible complication of influenza A (H1N1) infection, given that these patients can benefit from early diagnosis and appropriate specific management.

  12. Spontaneous regression of bronchogenic cyst accompanied by pneumonia.

    PubMed

    Himuro, Naoya; Minakata, Takao; Oshima, Yutaka; Kataoka, Daisuke; Yamamoto, Shigeru; Kadokura, Mitsutaka

    2015-12-01

    Bronchogenic cysts arise from abnormal budding of the ventral diverticulum of the foregut or tracheobronchial tree during embryogenesis, are the most common cystic masses in the mediastinum, and are generally asymptomatic. A spontaneous regression in a mediastinal bronchogenic cyst (MBC) with pneumonia is rare. A 30-year-old male had a tumor shadow in the middle mediastinum. When he visited our hospital, he had a mild fever with coughing and sputum. A chest computed tomography (CT) scan showed a decrease in the tumor size and the existence of right pneumonia. MBC may be involved in the etiology of pneumonia; therefore, bronchogenic cysts need to be resected as soon as possible. PMID:26943430

  13. Fatal hemorrhagic pneumonia: Don't forget Stenotrophomonas maltophilia.

    PubMed

    Gutierrez, Cristina; Pravinkumar, Egbert; Balachandran, Dave; Schneider, Virginia

    2016-01-01

    We present a case of fatal hemorrhagic pneumonia secondary to Stenotrophomonas maltophilia in a patient with acute myeloid leukemia. S. maltophilia is commonly a non-virulent pathogen. However, in the immunocompromised, it is generally associated with bacteremia after central venous catheter placement or pneumonia. Hemorrhagic pneumonia is a rare presentation of this bacteria, with only 31 cases reported in the literature, and has 100% mortality within 72 hours. Rapid recognition and early suspicion should be key in the treatment of these patients. PMID:27358764

  14. Assessing Pneumonia Identification from Time-Ordered Narrative Reports

    PubMed Central

    Bejan, Cosmin A.; Vanderwende, Lucy; Wurfel, Mark M.; Yetisgen-Yildiz, Meliha

    2012-01-01

    In this paper, we present a natural language processing system that can be used in hospital surveillance applications with the purpose of identifying patients with pneumonia. For this purpose, we built a sequence of supervised classifiers, where the dataset corresponding to each classifier consists of a restricted set of time-ordered narrative reports. In this way the pneumonia surveillance application will be able to invoke the most suitable classifier for each patient based on the period of time that has elapsed since the patient was admitted into the hospital. Our system achieves significantly better results when compared with a baseline previously proposed for pneumonia identification. PMID:23304388

  15. Exophiala Pneumonia Presenting with a Cough Productive of Black Sputum

    PubMed Central

    Cohen, Yehuda Z.; Stead, Wendy

    2015-01-01

    Exophiala species are black, yeast-like molds that can cause subcutaneous cysts as well as disseminated disease. Isolated pneumonia due to Exophiala species is extremely uncommon. We report a case of isolated Exophiala pneumonia in a patient with bronchiectasis who presented with worsening dyspnea and a cough productive of black sputum. The production of black sputum, known as melanoptysis, is an uncommon physical finding with a limited differential diagnosis. To our knowledge, this is the first reported case of Exophiala pneumonia presenting with a cough productive of black sputum. PMID:26075119

  16. Exophiala Pneumonia Presenting with a Cough Productive of Black Sputum.

    PubMed

    Cohen, Yehuda Z; Stead, Wendy

    2015-01-01

    Exophiala species are black, yeast-like molds that can cause subcutaneous cysts as well as disseminated disease. Isolated pneumonia due to Exophiala species is extremely uncommon. We report a case of isolated Exophiala pneumonia in a patient with bronchiectasis who presented with worsening dyspnea and a cough productive of black sputum. The production of black sputum, known as melanoptysis, is an uncommon physical finding with a limited differential diagnosis. To our knowledge, this is the first reported case of Exophiala pneumonia presenting with a cough productive of black sputum. PMID:26075119

  17. Absence of Streptococcus pneumoniae in pharyngeal swabs of geriatric inpatients.

    PubMed

    Jomrich, Nina; Kellner, Silvia; Djukic, Marija; Eiffert, Helmut; Nau, Roland

    2015-07-01

    Colonization of the pharynx by Streptococcus pneumoniae was studied in 185 in-hospital geriatric patients (median age 81 years) from 29 March 2011 to 22 June 2011. Swabs were plated on blood agar plates. Colonies with a morphology suggesting S. pneumoniae were further analyzed. Surprisingly, pneumococci were not found in any of the samples. Pneumococci chronically colonizing the pharynx of elderly people may be much rarer than previously thought and probably are not the source of pneumococcal pneumonia in old age. PMID:25746605

  18. Haemoptysis as a primary manifestation of cryptogenic organizing pneumonia (COP).

    PubMed

    Chatzivasiloglou, Fotini; Katsenos, Stamatis; Psathakis, Konstantinos; Tsintiris, Konstantinos

    2015-01-01

    Cryptogenic organizing pneumonia (COP), previously called bronchiolitis obliterans organizing pneumonia (BOOP) is a clinicopathological disorder of unknown aetiology but increasingly reported. It usually presents with symptoms of dyspnea, cough, fever, weight loss accompanied by the presence of alveolar opacities on chest radiograph. Haemoptysis, described as blood streaking has only rarely been reported as primary presentation of COP. Herein, we report a case of COP in which submassive haemoptysis was the main clinical manifestation. The clinical, radiological, pathological, and therapeutic aspects of the disease are briefly discussed. Cryptogenic organizing pneumonia should be taken into consideration in the differential diagnosis of severe haemoptysis. PMID:27451594

  19. Pneumonia, lung cancer or Medlar's core?

    PubMed Central

    Luciani, Filippo; Fedele, Flavio; Corsonello, Andrea; Florio, Michele; De Santis, Salvatore; Guzzo, Elena; Perri, Mariarita; Caroleo, Maria Cristina; Cannataro, Roberto; Cione, Erika

    2015-01-01

    Here, we report a case of 57-year-old previously healthy man with six-months medical history of significant chronic cough and recurring episodes of fever. Cytology, bacteria, fungi and acid fast bacilli in the sputum were negative. CT scan, initially interpreted as suspected lung cancer, detected by chest x-ray, revealed pneumonia. Bronchoscopy is frequently necessary for the diagnosis as well as the treatment as a routine practice and in this case was applied. Our patient underwent to fiberoptic rigid bronchoscopy in the right upper lobe in general anaesthesia. Unexpectedly, a vegetal FB, Medlar's core instead a tumor, was removed. After two-months follow-up the patient was found healthy without any old or other symptoms. PMID:26744666

  20. Prevention of ventilator-associated pneumonia.

    PubMed

    Oliveira, J; Zagalo, C; Cavaco-Silva, P

    2014-01-01

    Invasive mechanical ventilation (IMV) represents a risk factor for the development of ventilator-associated pneumonia (VAP), which develops at least 48h after admission in patients ventilated through tracheostomy or endotracheal intubation. VAP is the most frequent intensive-care-unit (ICU)-acquired infection among patients receiving IMV. It contributes to an increase in hospital mortality, duration of MV and ICU and length of hospital stay. Therefore, it worsens the condition of the critical patient and increases the total cost of hospitalization. The introduction of preventive measures has become imperative, to ensure control and to reduce the incidence of VAP. Preventive measures focus on modifiable risk factors, mediated by non-pharmacological and pharmacological evidence based strategies recommended by guidelines. These measures are intended to reduce the risk associated with endotracheal intubation and to prevent microaspiration of pathogens to the lower airways.

  1. Organising pneumonia in common variable immunodeficiency.

    PubMed

    Boujaoude, Ziad; Arya, Rohan; Rafferty, William; Dammert, Pedro

    2013-06-07

    Common variable immunodeficiency (CVID) is the most common of the primary immunodeficiency disorders. Pulmonary manifestations are characterised by recurrent rhinosinusitis, respiratory tract infections and bronchiectasis. Less commonly the lung may be affected by lymphoid disorders and sarcoid-like granulomas. Organising pneumonia (OP) is a rare pulmonary manifestation. We report the case of a 32-year-old woman with CVID who presented with fever, dyspnoea and persistent lung infiltrates despite antibiotic therapy. CT of the chest showed bilateral patchy alveolar infiltrates. Pulmonary function tests revealed moderate restriction and reduction in diffusion capacity. Initial bronchoscopy with transbronchial biopsies did not yield a diagnosis but surgical lung biopsies identified OP. Significant clinical, radiographic and physiological improvement was achieved after institution of corticosteroid therapy.

  2. Acute Mastoiditis Caused by Streptococcus pneumoniae.

    PubMed

    Obringer, Emily; Chen, Judy L

    2016-05-01

    Acute mastoiditis (AM) is a relatively rare complication of acute otitis media (AOM). The most common pathogens include Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus. Pneumococcal vaccination and changes in antibiotic prescribing recommendations for AOM may change the incidence of AM in the future. Diagnosis of AM can be made based on clinical presentation, but computed tomography of the temporal bone with contrast should be considered if there is concern for complicated AM. Both extracranial and intracranial complications of AM may occur. Previously, routine cortical mastoidectomy was recommended for AM treatment, but new data suggest that a more conservative treatment approach can be considered, including intravenous (IV) antibiotics alone or IV antibiotics with myringotomy. [Pediatr Ann. 2016;45(5):e176-e179.]. PMID:27171806

  3. Capillary precipitin typing of Streptococcus pneumoniae.

    PubMed Central

    Russell, H; Facklam, R R; Padula, J F; Cooksey, R

    1978-01-01

    The Neufeld test is presently the method of choice for typing Streptococcus pneumoniae. Although the test is reliable and relatively easy to perform, a simpler test, not requiring microscopic examination, would facilitate large-scale testing. A capillary precipitine test has been designed and tested for its usefulness in typing pneumococci. The type-specific carbohydrate antigens were obtained from broth culture supernatants. The antigens were reacted with type-specific antisera in glass capillary pipettes. Results from 82 reference antigens and 166 antigens from diagnostic pneumococcal strains showed that the reactions ere specific, and the results agreed with Neufeld test results. These results indicate that the precipitin test is as specific as the Neufeld test. The test is easy to perform, requires small amounts of antiserum, and can be completed in a short period of time. PMID:31369

  4. Respiratory infections: community-acquired pneumonia and newer microbes.

    PubMed

    Reynolds, H Y

    1996-01-01

    Respiratory infections, especially community-acquired forms of pneumonia (CAP), are challenging for clinicians because (1) a causative microorganism can only be found in about 50% of cases; (2) initial therapy, therefore, must be based on a probable or most likely etiology in the context of the patient's overall medical condition; and (3) new microbes or those considered previously as normal flora or less virulent forms seem responsible for some cases. It is important to be acquainted with new causes of infection which include Legionella species, Chlamydia pneumoniae, diphtheroids in certain instances (Corynebacterium pseudodiphtheriticum), and viruses such as the Hanta strains. Infections with Bordetella pertussis are increasing. However, the ever present and most common cause of CAP, Streptococcus pneumoniae, continues to present problems because of increasing antibiotic resistance, the high case fatality rate when bacteremia accompanies pneumonia, and the inability to give prophylactic immunization to all people with risk factors for this infection.

  5. Osteopathic lymphatic pump techniques to enhance immunity and treat pneumonia

    PubMed Central

    Hodge, Lisa M.

    2012-01-01

    Pneumonia is a common cause of morbidity and mortality worldwide. While antibiotics are generally effective for the treatment of infection, the emergence of resistant strains of bacteria threatens their success. The osteopathic medical profession has designed a set of manipulative techniques called lymphatic pump techniques (LPT), to enhance the flow of lymph through the lymphatic system. Clinically, LPT is used to treat infection and oedemaand might be an effective adjuvant therapy in patients with pneumonia.The immune system uses the lymphatic and blood systems to survey to rid the body of pathogens; however, only recently have the effects of LPT on the lymphatic and immune systems been investigated. This short review highlightsclinical and basic science research studies that support the use of LPT to enhance the lymphatic and immune systems and treat pneumonia, and discusses the potential mechanisms by which LPT benefits patients with pneumonia. PMID:22977459

  6. Pulmonary cavity due to chronic eosinophilic pneumonia associated with arsenicosis.

    PubMed

    Sengupta, A; Saha, K; Jash, D; Bandyopadhyay, A

    2012-01-01

    In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent.

  7. Antibiotic Resistance Related to Biofilm Formation in Klebsiella pneumoniae

    PubMed Central

    Vuotto, Claudia; Longo, Francesca; Balice, Maria Pia; Donelli, Gianfranco; Varaldo, Pietro E.

    2014-01-01

    The Gram-negative opportunistic pathogen, Klebsiella pneumoniae, is responsible for causing a spectrum of community-acquired and nosocomial infections and typically infects patients with indwelling medical devices, especially urinary catheters, on which this microorganism is able to grow as a biofilm. The increasingly frequent acquisition of antibiotic resistance by K. pneumoniae strains has given rise to a global spread of this multidrug-resistant pathogen, mostly at the hospital level. This scenario is exacerbated when it is noted that intrinsic resistance to antimicrobial agents dramatically increases when K. pneumoniae strains grow as a biofilm. This review will summarize the findings about the antibiotic resistance related to biofilm formation in K. pneumoniae. PMID:25438022

  8. Pulmonary cavity due to chronic eosinophilic pneumonia associated with arsenicosis.

    PubMed

    Sengupta, A; Saha, K; Jash, D; Bandyopadhyay, A

    2012-01-01

    In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent. PMID:23279770

  9. Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding

    PubMed Central

    Chen, Liang; Mathema, Barun; Chavda, Kalyan D.; DeLeo, Frank R.; Bonomo, Robert A.; Kreiswirth, Barry N.

    2015-01-01

    Klebsiella pneumoniae carbapenemases (KPCs) were first identified in 1996 in the USA. Since then, regional outbreaks of KPC-producing K. pneumoniae have occurred in the USA, and have spread internationally. Dissemination of blaKPC involves both horizontal transfer of blaKPC genes and plasmids, and clonal spread. Of epidemiological significance, the international spread of KPC-producing K. pneumoniae is primarily associated with a single multilocus sequence type (ST), ST258, and its related variants. However, the molecular factors contributing to the success of ST258 largely remain unclear. Here, we review the recent progresses in understanding KPC-producing K. pneumoniae that is contributing to our knowledge of plasmid and genome composition and structure among the KPC epidemic clone, and identify possible factors that influence its epidemiological success. PMID:25304194

  10. Exogenous lipoid pneumonia caused by facial application of petrolatum.

    PubMed

    Cohen, Mark A; Galbut, Brian; Kerdel, Francisco A

    2003-12-01

    Exogenous lipoid pneumonia is a well-described entity in the literature. To our knowledge, this is the first reported case that occurred secondary to external application of petrolatum to the face for erythrodermic psoriasis.

  11. Pneumonia in South-East Asia Region: Public health perspective

    PubMed Central

    Ghimire, M.; Bhattacharya, S.K.; Narain, J.P.

    2012-01-01

    Globally, pneumonia is the leading cause of death in young children and burden of disease is disproportionately high in South-East Asia Region of WHO. This review article presents the current status of pneumonia disease burden, risk factors and the ability of health infrastructure to deal with the situation. Literature survey was done for the last 20 years and data from country offices were also collected. The estimated incidence of pneumonia in under five children is 0.36 episodes per child, per year. Risk factors are malnutrition (40% in India), Indoor air pollution, non-breast feeding, chronic obstructive pulmonary disease, etc. Strengthening of health care delivery system for early detection and treatment and as well as minimization of preventable risk factors can avert a large proportion of death due to pneumonia. PMID:22664492

  12. Fatal pneumonia due to Serratia proteamaculans subsp. quinovora.

    PubMed Central

    Bollet, C; Grimont, P; Gainnier, M; Geissler, A; Sainty, J M; De Micco, P

    1993-01-01

    Serratia proteamaculans subsp. quinovora was isolated from several samples (blood cultures, tracheal aspirates, pleural effusion) from a patient with pneumonia. This is the first clinical isolate and the first documented human infection caused by this organism. PMID:8432835

  13. Reversed halo sign in pneumocystis pneumonia: a case report

    PubMed Central

    2010-01-01

    Background The reversed halo sign may sometimes be seen in patients with cryptogenic organizing pneumonia, but is rarely associated with other diseases. Case presentation We present a case study of a 32-year-old male patient with acquired immunodeficiency syndrome, who had previously been treated with chemotherapy for non-Hodgkin's lymphoma. A chest X-ray showed bilateral patchy infiltrates. High-resolution computed tomography revealed the reversed halo sign in both upper lobes. The patient was diagnosed with pneumocystis pneumonia, which was successfully treated with sulfamethoxazole trimethoprim; the reversed halo sign disappeared, leaving cystic lesions. Cases such as this one are rare, but show that the reversed halo sign may occur in patients who do not have cryptogenic organizing pneumonia. Conclusion Physicians can avoid making an incorrect diagnosis and prescribing the wrong treatment by carefully evaluating all clinical criteria rather than assuming that the reversed halo sign only occurs with cryptogenic organizing pneumonia. PMID:21092271

  14. An important cause of non-resolving pneumonia.

    PubMed

    Shoki, Alborz; Gomes, Marcio M; Gupta, Ashish; Kify, Omar; Pakhale, Smita; Mulpuru, Sunita

    2016-01-01

    We describe the case of a young patient with a history of non-resolving pneumonia. She was diagnosed with a limited form of Granulomatosis with Polyangiitis (GPA), by percutaneous core needle lung biopsy. In this report, we discuss the definition and clinical implications of limited GPA, treatment options, and highlight the importance of considering vasculitis in the differential diagnosis of non-resolving pneumonia. PMID:27482510

  15. [Impact of vaccination on the epidemiology of childhood pneumonia].

    PubMed

    Crisinel, Pierre-Alex

    2016-02-17

    The impact of vaccination on non-bacteremic Haemophilus influenza pneumonia is difficult to appreciate, in the absence of proper microbiological documentation. It has certainly been largely underestimated. Vaccination has reduced the incidence of pneumococcal pneumonia. However, the increase of incidence of empyema due to nonvaccine serotypes was observed in several countries. The replacement of Prevenar 7 by Prevenar 13 portends a decrease in the occurrence of these infections, but, unfortunately, without eliminating them completely.

  16. Detection of Chlamydia pneumoniae by polymerase chain reaction.

    PubMed

    Campbell, L A; Perez Melgosa, M; Hamilton, D J; Kuo, C C; Grayston, J T

    1992-02-01

    While criteria for serodiagnosis of Chlamydia pneumoniae infection are well established, isolation of the organism is often difficult. To increase detection of this organism, C. pneumoniae-specific sequences were identified to permit amplification of C. pneumoniae by polymerase chain reaction (PCR). A cloned C. pneumoniae 474-bp PstI fragment was shown by dot blot and Southern hybridization to differentiate C. pneumoniae from the other Chlamydia spp., react with all C. pneumoniae isolates tested, and not recognize DNA from normal throat flora or common respiratory tract agents. This cloned fragment was sequenced and primers for use in PCR were chosen on the bases of GenBank analysis, G + C ratio, and absence of secondary structure. All C. pneumoniae isolates tested were amplified by the HL-1-HR-1 primer pair or the HM-1-HR-1 primer pair, producing the expected 437- and 229-bp amplification products, respectively. None of the Chlamydia trachomatis serovars (B/TW-5/OT, C/TW-3/OT, D/UW-3/Cx, E/UW-5/Cx, F/UW-6/Cx, H/UW-4/Cx, I/UW-12/Ur, and L2/434/Bu), Chlamydia psittaci strains (Mn, 6BC, GPIC, FP, and OA), HeLa cells, or other organisms tested were amplified. Reaction conditions including MgCl2, oligonucleotides, and primer concentrations and temperature were optimized before application to clinical samples. Clinical specimens from patients from whom C. pneumoniae was isolated were also positive by PCR, while samples from patients with known C. trachomatis or C. psittaci infection were not amplified by PCR.

  17. KPC-producing Klebsiella pneumoniae, finally targeting Turkey

    PubMed Central

    Labarca, J; Poirel, L; Özdamar, M; Turkoglü, S; Hakko, E; Nordmann, P

    2014-01-01

    We report here the first identification of the worldwide spread of Klebsiella pneumoniae carbapenemase-2-producing and carbapenem-resistant K. pneumoniae clone ST258 in Turkey, a country where the distantly-related carbapenemase OXA-48 is known to be endemic. Worryingly, this isolate was also resistant to colistin, now considered to be the last-resort antibiotic for carbapenem-resistant isolates. PMID:25356342

  18. Chemical-shift MRI of exogenous lipoid pneumonia

    SciTech Connect

    Cox, J.E.; Choplin, R.H.; Chiles, C.

    1996-05-01

    Exogenous lipoid pneumonia results from the aspiration or inhalation of fatty substances, such as mineral oil found in laxatives or nasal medications containing liquid paraffin. We present standard and lipid-sensitive (chemical-shift) MR findings in a patient with histologically confirmed lipoid pneumonia. The loss of signal intensity in an area of airspace disease on opposed-phase imaging was considered specific for the presence of lipid. 14 refs., 3 figs.

  19. Two Cases of Mycoplasma pneumoniae Pneumonia with A2063G Mutation in the 23S rRNA Gene in Siblings

    PubMed Central

    Hong, Joo Hee; Chun, Jin Kyong; Oh, Ki Jin; Kim, Juwon; Yoon, Kap Jun

    2013-01-01

    We describe 2 cases of pneumonia caused by the same macrolide-resistant Mycoplasma pneumoniae in siblings. M. pneumoniae was identified using real-time PCR. Direct sequence analysis of the 23S rRNA gene revealed a point mutation in V domain (A2063G) of the 23S rRNA gene. PMID:23301225

  20. The role of influenza in the epidemiology of pneumonia

    PubMed Central

    Shrestha, Sourya; Foxman, Betsy; Berus, Joshua; van Panhuis, Willem G.; Steiner, Claudia; Viboud, Cécile; Rohani, Pejman

    2015-01-01

    Interactions arising from sequential viral and bacterial infections play important roles in the epidemiological outcome of many respiratory pathogens. Influenza virus has been implicated in the pathogenesis of several respiratory bacterial pathogens commonly associated with pneumonia. Though clinical evidence supporting this interaction is unambiguous, its population-level effects—magnitude, epidemiological impact and variation during pandemic and seasonal outbreaks—remain unclear. To address these unknowns, we used longitudinal influenza and pneumonia incidence data, at different spatial resolutions and across different epidemiological periods, to infer the nature, timing and the intensity of influenza-pneumonia interaction. We used a mechanistic transmission model within a likelihood-based inference framework to carry out formal hypothesis testing. Irrespective of the source of data examined, we found that influenza infection increases the risk of pneumonia by ~100-fold. We found no support for enhanced transmission or severity impact of the interaction. For model-validation, we challenged our fitted model to make out-of-sample pneumonia predictions during pandemic and non-pandemic periods. The consistency in our inference tests carried out on several distinct datasets, and the predictive skill of our model increase confidence in our overall conclusion that influenza infection substantially enhances the risk of pneumonia, though only for a short period. PMID:26486591

  1. Contribution of IL-1 to resistance to Streptococcus pneumoniae infection.

    PubMed

    Kafka, Daniel; Ling, Eduard; Feldman, Galia; Benharroch, Daniel; Voronov, Elena; Givon-Lavi, Noga; Iwakura, Yoichiro; Dagan, Ron; Apte, Ron N; Mizrachi-Nebenzahl, Yaffa

    2008-09-01

    The role of IL-1 in susceptibility to Streptococcus pneumoniae infection was studied in mice deficient in genes of the IL-1 family [i.e. IL-1alpha-/-, IL-1beta-/-, IL-1alpha/beta-/- and IL-1R antagonist (IL-1Ra)-/- mice] following intra-nasal inoculation. Intra-nasal inoculation of S. pneumoniae of IL-1beta-/- and IL-1alpha/beta-/- mice displayed significantly lower survival rates and higher nasopharyngeal and lung bacterial load as compared with control, IL-1alpha-/- and IL-1Ra-/- mice. Treatment of IL-1beta-/- mice with rIL-1beta significantly improved their survival. A significant increase in blood neutrophils was found in control, IL-1alpha-/- and IL-1Ra-/- but not in IL-1beta-/- and IL-1alpha/beta-/- mice. Local infiltrates of neutrophils and relatively preserved organ architecture were observed in the lungs of IL-1alpha-/- and control mice. However, S. pneumoniae-infected IL-1beta-/-, IL-1alpha/beta-/- and IL-1Ra-/- mice demonstrated diffuse pneumonia and tissue damage. Altogether, all three isoforms contribute to protection against S. pneumoniae; our results point to differential role of IL-1alpha and IL-1beta in the pathogenesis and control of S. pneumoniae infection and suggest that IL-1beta has a major role in resistance to primary pneumococcal infection while the role of IL-1alpha is less important.

  2. Pneumocystis Pneumonia Presenting as an Enlarging Solitary Pulmonary Nodule

    PubMed Central

    Diacovo, Maria Julia; Martinez-Galvez, Nydia

    2016-01-01

    Pneumocystis pneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatous Pneumocystis pneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatous Pneumocystis pneumonia infection. This case is the third documented report of Pneumocystis pneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. Although Pneumocystis pneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present. PMID:27648318

  3. Microbiological and serological studies on caprine pneumonias in Oman.

    PubMed

    Jones, G E; Wood, A R

    1988-01-01

    Eight of 10 typical cases of contagious caprine pleuro-pneumonia in Oman yielded strain F38-like mycoplasmas from the lungs in high titre, but no other mycoplasmas: both negative animals had been treated with tylosin shortly before death. Among 21 other lungs examined three of six cases of acute pneumonia yielded Mycoplasma ovipneumoniae; one also yielded M capricolum. M ovipneumoniae was also isolated from all eight cases of chronic pneumonia sampled from an abattoir, and from the lungs of three animals which died without overt signs of pneumonia. A single isolate of M arginini and three of unidentified mycoplasmas were also obtained from goats with and without pneumonia. Various bacterial species were isolated, none of which predominated. Antibodies to M mycoides subspecies capri (M m capri) and strain F38 were detected in sera from eight different sources. Assuming titres of 1 in 40 or more as positive in the indirect haemagglutination test used, 29 per cent of 422 serum samples had antibodies to M m capri alone, 2.6 per cent to strain F38 alone and 3.6 per cent to both organisms. These results confirm the presence of F38-like mycoplasmas in Oman, and indicate also widespread infection with M m capri. The role of the latter in caprine pneumonias in Oman requires elucidation.

  4. [National consensus for management of community acquired pneumonia in adults].

    PubMed

    Saldías P, Fernando; Pérez C, Carlos

    2005-01-01

    Community acquired pneumonia (CAP) is an acute respiratory infection that affects pulmonary parenchyma, and is caused by community acquired microorganisms. In Chile, pneumonia represents the main cause of death due to infectious diseases and is the third specific cause of mortality in adults. In 1999, an experts committee in representation of "Sociedad Chilena de Enfermedades Respiratorias", presented the first National Guidelines for the Treatment of Adult Community Acquired Pneumonia, mainly based in foreign experience and documents, and adapted it to our National Health System Organization. During the last decade, impressive epidemiological and technological changes have occurred, making the update of guidelines for treatment of NAC by several international scientific societies, necessary. These changes include: new respiratory pathogens that are being identified in CAP and affect adult patients (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila); the increasing senescent adult population that carries multiple co-morbidities; the emergence of antimicrobial resistance among respiratory pathogens associated to massive antibiotic prescription; the development by the pharmaceutical industry of new drugs that are effective for pneumonia treatment (macrolides, ketolides and respiratory fluorquinolones); and the development of new diagnostic techniques for detection of antigens, antibodies, and bacterial DNA by molecular biology, useful in respiratory infections. Based on these antecedents, an Advisory Committee of "Sociedad Chilena de Enfermedades Respiratorias" and "Sociedad Chilena de Infectología" has reviewed the national and international evidence about CAP management in adults in order to update clinical recommendations for our country. PMID:16163422

  5. Klebsiella pneumoniae triggers a cytotoxic effect on airway epithelial cells

    PubMed Central

    2009-01-01

    Background Klebsiella pneumoniae is a capsulated Gram negative bacterial pathogen and a frequent cause of nosocomial infections. Despite its clinical relevance, little is known about the features of the interaction between K. pneumoniae and lung epithelial cells on a cellular level, neither about the role of capsule polysaccharide, one of its best characterised virulence factors, in this interaction. Results The interaction between Klebsiella pneumoniae and cultured airway epithelial cells was analysed. K. pneumoniae infection triggered cytotoxicity, evident by cell rounding and detachment from the substrate. This effect required the presence of live bacteria and of capsule polysaccharide, since it was observed with isolates expressing different amounts of capsule and/or different serotypes but not with non-capsulated bacteria. Cytotoxicity was analysed by lactate dehydrogenase and formazan measurements, ethidium bromide uptake and analysis of DNA integrity, obtaining consistent and complementary results. Moreover, cytotoxicity of non-capsulated strains was restored by addition of purified capsule during infection. While a non-capsulated strain was avirulent in a mouse infection model, capsulated K. pneumoniae isolates displayed different degrees of virulence. Conclusion Our observations allocate a novel role to K. pneumoniae capsule in promotion of cytotoxicity. Although this effect is likely to be associated with virulence, strains expressing different capsule levels were not equally virulent. This fact suggests the existence of other bacterial requirements for virulence, together with capsule polysaccharide. PMID:19650888

  6. Diagnosis of Pneumonia in Children with Dehydrating Diarrhoea

    PubMed Central

    Ronan, Anne; Khan, Wasif Ali; Salam, Mohammed Abdus

    2014-01-01

    The World Health Organization (WHO) guidelines for diagnosis of pneumonia are based on the history of cough or difficult breathing and age-adjusted respiration rates. Metabolic acidosis associated with dehydrating diarrhoea also influences the respiration rate. Two hundred and four children, aged 2 to 59 months, with dehydrating diarrhoea and a history of cough and/or fast breathing, were enrolled in a prospective study. Pneumonia diagnoses were made on enrollment and again 6 hours post-enrollment (after initial rehydration), using the WHO guidelines. These were compared with investigators’ clinical diagnosis based on history and findings of physical examination and a chest x-ray at the same time points. Using the WHO guidelines, 149/152 (98%) infants in the 2-11 months age-group and 38/40 (95%) children in the 12-59 months age-group were diagnosed to have pneumonia on enrollment, which dropped to 107 (70%) and 30 (75%) respectively at 6 hours post-enrollment. The specificity of the WHO guidelines for diagnosis of pneumonia was very low (6.9%) at enrollment but increased to 65.5% at 6 hours post-enrollment, after initial rehydration. The specificity of the WHO guidelines for diagnosis of pneumonia in young children is significantly reduced in dehydrating diarrhoea. For young children with dehydrating diarrhoea, rehydration, clinical and radiological assessments are useful in identifying those with true pneumonia. PMID:24847588

  7. Pneumocystis Pneumonia Presenting as an Enlarging Solitary Pulmonary Nodule.

    PubMed

    Patel, Krunal Bharat; Gleason, James Benjamin; Diacovo, Maria Julia; Martinez-Galvez, Nydia

    2016-01-01

    Pneumocystis pneumonia is a life threatening infection that usually presents with diffuse bilateral ground-glass infiltrates in immunocompromised patients. We report a case of a single nodular granulomatous Pneumocystis pneumonia in a male with diffuse large B-cell lymphoma after R-CHOP therapy. He presented with symptoms of productive cough, dyspnea, and right-sided pleuritic chest pain that failed to resolve despite treatment with multiple antibiotics. Chest X-ray revealed right lower lobe atelectasis and CT of chest showed development of 2 cm nodular opacity with ground-glass opacities. Patient underwent bronchoscopy and biopsy that revealed granulomatous inflammation in a background of organizing pneumonia pattern with negative cultures. Respiratory symptoms resolved but the solitary nodular opacity increased in size prompting a surgical wedge resection which revealed granulomatous Pneumocystis pneumonia infection. This case is the third documented report of Pneumocystis pneumonia infection within a solitary pulmonary nodule in an individual with hematologic neoplasm. Although Pneumocystis pneumonia most commonly occurs in patients with HIV/acquired immunodeficiency syndrome and with diffuse infiltrates, the diagnosis should not be overlooked when only a solitary nodule is present. PMID:27648318

  8. The role of influenza in the epidemiology of pneumonia.

    PubMed

    Shrestha, Sourya; Foxman, Betsy; Berus, Joshua; van Panhuis, Willem G; Steiner, Claudia; Viboud, Cécile; Rohani, Pejman

    2015-10-21

    Interactions arising from sequential viral and bacterial infections play important roles in the epidemiological outcome of many respiratory pathogens. Influenza virus has been implicated in the pathogenesis of several respiratory bacterial pathogens commonly associated with pneumonia. Though clinical evidence supporting this interaction is unambiguous, its population-level effects-magnitude, epidemiological impact and variation during pandemic and seasonal outbreaks-remain unclear. To address these unknowns, we used longitudinal influenza and pneumonia incidence data, at different spatial resolutions and across different epidemiological periods, to infer the nature, timing and the intensity of influenza-pneumonia interaction. We used a mechanistic transmission model within a likelihood-based inference framework to carry out formal hypothesis testing. Irrespective of the source of data examined, we found that influenza infection increases the risk of pneumonia by ~100-fold. We found no support for enhanced transmission or severity impact of the interaction. For model-validation, we challenged our fitted model to make out-of-sample pneumonia predictions during pandemic and non-pandemic periods. The consistency in our inference tests carried out on several distinct datasets, and the predictive skill of our model increase confidence in our overall conclusion that influenza infection substantially enhances the risk of pneumonia, though only for a short period.

  9. Isothermal Detection of Mycoplasma pneumoniae Directly from Respiratory Clinical Specimens

    PubMed Central

    Petrone, Brianna L.; Wolff, Bernard J.; DeLaney, Alexandra A.; Diaz, Maureen H.

    2015-01-01

    Mycoplasma pneumoniae is a leading cause of community-acquired pneumonia (CAP) across patient populations of all ages. We have developed a loop-mediated isothermal amplification (LAMP) assay that enables rapid, low-cost detection of M. pneumoniae from nucleic acid extracts and directly from various respiratory specimen types. The assay implements calcein to facilitate simple visual readout of positive results in approximately 1 h, making it ideal for use in primary care facilities and resource-poor settings. The analytical sensitivity of the assay was determined to be 100 fg by testing serial dilutions of target DNA ranging from 1 ng to 1 fg per reaction, and no cross-reactivity was observed against 17 other Mycoplasma species, 27 common respiratory agents, or human DNA. We demonstrated the utility of this assay by testing nucleic acid extracts (n = 252) and unextracted respiratory specimens (n = 72) collected during M. pneumoniae outbreaks and sporadic cases occurring in the United States from February 2010 to January 2014. The sensitivity of the LAMP assay was 88.5% tested on extracted nucleic acid and 82.1% evaluated on unextracted clinical specimens compared to a validated real-time PCR test. Further optimization and improvements to this method may lead to the availability of a rapid, cost-efficient laboratory test for M. pneumoniae detection that is more widely available to primary care facilities, ultimately facilitating prompt detection and appropriate responses to potential M. pneumoniae outbreaks and clusters within the community. PMID:26179304

  10. [National consensus for management of community acquired pneumonia in adults].

    PubMed

    Saldías P, Fernando; Pérez C, Carlos

    2005-01-01

    Community acquired pneumonia (CAP) is an acute respiratory infection that affects pulmonary parenchyma, and is caused by community acquired microorganisms. In Chile, pneumonia represents the main cause of death due to infectious diseases and is the third specific cause of mortality in adults. In 1999, an experts committee in representation of "Sociedad Chilena de Enfermedades Respiratorias", presented the first National Guidelines for the Treatment of Adult Community Acquired Pneumonia, mainly based in foreign experience and documents, and adapted it to our National Health System Organization. During the last decade, impressive epidemiological and technological changes have occurred, making the update of guidelines for treatment of NAC by several international scientific societies, necessary. These changes include: new respiratory pathogens that are being identified in CAP and affect adult patients (Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila); the increasing senescent adult population that carries multiple co-morbidities; the emergence of antimicrobial resistance among respiratory pathogens associated to massive antibiotic prescription; the development by the pharmaceutical industry of new drugs that are effective for pneumonia treatment (macrolides, ketolides and respiratory fluorquinolones); and the development of new diagnostic techniques for detection of antigens, antibodies, and bacterial DNA by molecular biology, useful in respiratory infections. Based on these antecedents, an Advisory Committee of "Sociedad Chilena de Enfermedades Respiratorias" and "Sociedad Chilena de Infectología" has reviewed the national and international evidence about CAP management in adults in order to update clinical recommendations for our country.

  11. Bacteriophage-loaded nanostructured lipid carrier: improved pharmacokinetics mediates effective resolution of Klebsiella pneumoniae-induced lobar pneumonia.

    PubMed

    Singla, Saloni; Harjai, Kusum; Katare, Om Prakash; Chhibber, Sanjay

    2015-07-15

    This study examined the therapeutic and prophylactic potential of bacteriophages in a mouse model of Klebsiella pneumoniae lobar pneumonia. Phages were administered intraperitoneally. Liposome-entrapped phages (LP) were effective in treating infection, even when therapy was delayed by 3 days after the induction of pneumonia. In contrast, nonliposomal phages provided protection when administered 24 hours after infection. Administration of nonliposomal phages 6 hours prior to intranasal bacterial challenge resulted in complete protection, compared with LP, which was effective even when administered 48 hours prior to infection. Increased reduction and a greater increment in the levels of proinflammatory and antiinflammatory cytokines, respectively, in homogenates of lung from LP-treated mice were suggestive of increased efficacy of LP in the treatment of pneumonia. This is the first study to assess liposomes as a delivery vehicle for phage, and the results confirm the superiority of LP for both therapeutic and prophylactic applications.

  12. Comparative genomic analysis of human Chlamydia pneumoniae isolates from respiratory, brain and cardiac tissues.

    PubMed

    Roulis, Eileen; Bachmann, Nathan L; Myers, Garry S A; Huston, Wilhelmina; Summersgill, James; Hudson, Alan; Dreses-Werringloer, Ute; Polkinghorne, Adam; Timms, Peter

    2015-12-01

    Chlamydia pneumoniae is an obligate intracellular bacterium implicated in a wide range of human diseases including atherosclerosis and Alzheimer's disease. Efforts to understand the relationships between C. pneumoniae detected in these diseases have been hindered by the availability of sequence data for non-respiratory strains. In this study, we sequenced the whole genomes for C. pneumoniae isolates from atherosclerosis and Alzheimer's disease, and compared these to previously published C. pneumoniae genomes. Phylogenetic analyses of these new C. pneumoniae strains indicate two sub-groups within human C. pneumoniae, and suggest that both recombination and mutation events have driven the evolution of human C. pneumoniae. Further fine-detailed analyses of these new C. pneumoniae sequences show several genetically variable loci. This suggests that similar strains of C. pneumoniae are found in the brain, lungs and cardiovascular system and that only minor genetic differences may contribute to the adaptation of particular strains in human disease.

  13. Inhibition of pulmonary nuclear factor kappa-B decreases the severity of acute Escherichia coli pneumonia but worsens prolonged pneumonia

    PubMed Central

    2013-01-01

    Introduction Nuclear factor (NF)-κB is central to the pathogenesis of inflammation in acute lung injury, but also to inflammation resolution and repair. We wished to determine whether overexpression of the NF-κB inhibitor IκBα could modulate the severity of acute and prolonged pneumonia-induced lung injury in a series of prospective randomized animal studies. Methods Adult male Sprague-Dawley rats were randomized to undergo intratracheal instillation of (a) 5 × 109 adenoassociated virus (AAV) vectors encoding the IκBα transgene (5 × 109 AAV-IκBα); (b) 1 × 1010 AAV-IκBα; (c) 5 × 1010 AAV-IκBα; or (d) vehicle alone. After intratracheal inoculation with Escherichia coli, the severity of the lung injury was measured in one series over a 4-hour period (acute pneumonia), and in a second series after 72 hours (prolonged pneumonia). Additional experiments examined the effects of IκBα and null-gene overexpression on E. coli-induced and sham pneumonia. Results In acute pneumonia, IκBα dose-dependently decreased lung injury, improving arterial oxygenation and lung static compliance, reducing alveolar protein leak and histologic injury, and decreasing alveolar IL-1β concentrations. Benefit was maximal at the intermediate (1 × 1010) IκBα vector dose; however, efficacy was diminished at the higher (5 × 1010) IκBα vector dose. In contrast, IκBα worsened prolonged pneumonia-induced lung injury, increased lung bacterial load, decreased lung compliance, and delayed resolution of the acute inflammatory response. Conclusions Inhibition of pulmonary NF-κB activity reduces early pneumonia-induced injury, but worsens injury and bacterial load during prolonged pneumonia. PMID:23622108

  14. Evaluation of the efficacy of a bacteriophage in the treatment of pneumonia induced by multidrug resistance Klebsiella pneumoniae in mice.

    PubMed

    Cao, Fang; Wang, Xitao; Wang, Linhui; Li, Zhen; Che, Jian; Wang, Lili; Li, Xiaoyu; Cao, Zhenhui; Zhang, Jiancheng; Jin, Liji; Xu, Yongping

    2015-01-01

    Multidrug-resistant Klebsiella pneumoniae (MRKP) has steadily grown beyond antibiotic control. However, a bacteriophage is considered to be a potential antibiotic alternative for treating bacterial infections. In this study, a lytic bacteriophage, phage 1513, was isolated using a clinical MRKP isolate KP 1513 as the host and was characterized. It produced a clear plaque with a halo and was classified as Siphoviridae. It had a short latent period of 30 min, a burst size of 264 and could inhibit KP 1513 growth in vitro with a dose-dependent pattern. Intranasal administration of a single dose of 2×10(9) PFU/mouse 2 h after KP 1513 inoculation was able to protect mice against lethal pneumonia. In a sublethal pneumonia model, phage-treated mice exhibited a lower level of K. pneumoniae burden in the lungs as compared to the untreated control. These mice lost less body weight and exhibited lower levels of inflammatory cytokines in their lungs. Lung lesion conditions were obviously improved by phage therapy. Therefore, phage 1513 has a great effect in vitro and in vivo, which has potential to be used as an alternative to an antibiotic treatment of pneumonia that is caused by the multidrug-resistant K. pneumoniae.

  15. The Definition of Pneumonia, the Assessment of Severity, and Clinical Standardization in the Pneumonia Etiology Research for Child Health Study

    PubMed Central

    Wonodi, Chizoba; Moïsi, Jennifer C.; Deloria-Knoll, Maria; DeLuca, Andrea N.; Karron, Ruth A.; Bhat, Niranjan; Murdoch, David R.; Crawley, Jane; Levine, Orin S.; O’Brien, Katherine L.; Feikin, Daniel R.

    2012-01-01

    To develop a case definition for the Pneumonia Etiology Research for Child Health (PERCH) project, we sought a widely acceptable classification that was linked to existing pneumonia research and focused on very severe cases. We began with the World Health Organization’s classification of severe/very severe pneumonia and refined it through literature reviews and a 2-stage process of expert consultation. PERCH will study hospitalized children, aged 1–59 months, with pneumonia who present with cough or difficulty breathing and have either severe pneumonia (lower chest wall indrawing) or very severe pneumonia (central cyanosis, difficulty breastfeeding/drinking, vomiting everything, convulsions, lethargy, unconsciousness, or head nodding). It will exclude patients with recent hospitalization and children with wheeze whose indrawing resolves after bronchodilator therapy. The PERCH investigators agreed upon standard interpretations of the symptoms and signs. These will be maintained by a clinical standardization monitor who conducts repeated instruction at each site and by recurrent local training and testing. PMID:22403224

  16. Immunoprotective potential of polysaccharide-tetanus toxoid conjugate in Klebsiella pneumoniae induced lobar pneumonia in rats.

    PubMed

    Chhibber, S; Rani, Mamta; Vanashree, Yadav

    2005-01-01

    The polysaccharide (PS) derived from K. pneumoniae NCTC 5055 lipopolysaccharide (LPS) was covalently linked to tetanus toxoid by using carbodimide with adipic acid dihydrazide as a spacer molecule. The conjugate was found to be non-toxic and non-pyrogenic at 100 microg dose level. At a similar dose, the conjugate did not elicit any local skin reaction on intradermal preparatory injection in rabbits. The conjugate was immunoprotective as was evident from the decrease in relative colonization of bacteria in lungs of immunized rats as compared to the control animals. Immunization with the conjugate resulted in alveolar macrophage activation in terms of their ability to phagocytose bacteria in vitro. PMID:15691064

  17. Spatio-temporal dynamics of pneumonia in bighorn sheep

    USGS Publications Warehouse

    Cassirer, E. Frances; Plowright, Raina K.; Manlove, Kezia R.; Cross, Paul C.; Dobson, Andrew P.; Potter, Kathleen A.; Hudson, Peter J.

    2013-01-01

    Bighorn sheep mortality related to pneumonia is a primary factor limiting population recovery across western North America, but management has been constrained by an incomplete understanding of the disease. We analysed patterns of pneumonia-caused mortality over 14 years in 16 interconnected bighorn sheep populations to gain insights into underlying disease processes. 2. We observed four age-structured classes of annual pneumonia mortality patterns: all-age, lamb-only, secondary all-age and adult-only. Although there was considerable variability within classes, overall they differed in persistence within and impact on populations. Years with pneumonia-induced mortality occurring simultaneously across age classes (i.e. all-age) appeared to be a consequence of pathogen invasion into a naïve population and resulted in immediate population declines. Subsequently, low recruitment due to frequent high mortality outbreaks in lambs, probably due to association with chronically infected ewes, posed a significant obstacle to population recovery. Secondary all-age events occurred in previously exposed populations when outbreaks in lambs were followed by lower rates of pneumonia-induced mortality in adults. Infrequent pneumonia events restricted to adults were usually of short duration with low mortality. 3. Acute pneumonia-induced mortality in adults was concentrated in fall and early winter around the breeding season when rams are more mobile and the sexes commingle. In contrast, mortality restricted to lambs peaked in summer when ewes and lambs were concentrated in nursery groups. 4. We detected weak synchrony in adult pneumonia between adjacent populations, but found no evidence for landscape-scale extrinsic variables as drivers of disease. 5. We demonstrate that there was a >60% probability of a disease event each year following pneumonia invasion into bighorn sheep populations. Healthy years also occurred periodically, and understanding the factors driving these

  18. Modeling risk of pneumonia epizootics in bighorn sheep

    USGS Publications Warehouse

    Sells, Sarah N.; Mitchell, Michael S.; Nowak, J. Joshua; Lukacs, Paul M.; Anderson, Neil J.; Ramsey, Jennifer M.; Gude, Justin A.; Krausman, Paul R.

    2015-01-01

    Pneumonia epizootics are a major challenge for management of bighorn sheep (Ovis canadensis) affecting persistence of herds, satisfaction of stakeholders, and allocations of resources by management agencies. Risk factors associated with the disease are poorly understood, making pneumonia epizootics hard to predict; such epizootics are thus managed reactively rather than proactively. We developed a model for herds in Montana that identifies risk factors and addresses biological questions about risk. Using Bayesian logistic regression with repeated measures, we found that private land, weed control using domestic sheep or goats, pneumonia history, and herd density were positively associated with risk of pneumonia epizootics in 43 herds that experienced 22 epizootics out of 637 herd-years from 1979–2013. We defined an area of high risk for pathogen exposure as the area of each herd distribution plus a 14.5-km buffer from that boundary. Within this area, the odds of a pneumonia epizootic increased by >1.5 times per additional unit of private land (unit is the standardized % of private land where global  = 25.58% and SD = 14.53%). Odds were >3.3 times greater if domestic sheep or goats were used for weed control in a herd's area of high risk. If a herd or its neighbors within the area of high risk had a history of a pneumonia epizootic, odds of a subsequent pneumonia epizootic were >10 times greater. Risk greatly increased when herds were at high density, with nearly 15 times greater odds of a pneumonia epizootic compared to when herds were at low density. Odds of a pneumonia epizootic also appeared to decrease following increased spring precipitation (odds = 0.41 per unit increase, global  = 100.18% and SD = 26.97%). Risk was not associated with number of federal sheep and goat allotments, proximity to nearest herds of bighorn sheep, ratio of rams to ewes, percentage of average winter precipitation, or whether herds were of native versus mixed

  19. Three Streptococcus pneumoniae sialidases: three different products.

    PubMed

    Xu, Guogang; Kiefel, Milton J; Wilson, Jennifer C; Andrew, Peter W; Oggioni, Marco R; Taylor, Garry L

    2011-02-16

    Streptococcus penumoniae is a major human pathogen responsible for respiratory tract infections, septicemia, and meningitis and continues to produce numerous cases of disease with relatively high mortalities. S. pneumoniae encodes up to three sialidases, NanA, NanB, and NanC, that have been implicated in pathogenesis and are potential drug targets. NanA has been shown to be a promiscuous sialidase, hydrolyzing the removal of Neu5Ac from a variety of glycoconjugates with retention of configuration at the anomeric center, as we confirm by NMR. NanB is an intramolecular trans-sialidase producing 2,7-anhydro-Neu5Ac selectively from α2,3-sialosides. Here, we show that the first product of NanC is 2-deoxy-2,3-didehydro-N-acetylneuraminic acid (Neu5Ac2en) that can be slowly hydrated by the enzyme to Neu5Ac. We propose that the three pneumococcal sialidases share a common catalytic mechanism up to the final product formation step, and speculate on the roles of the enzymes in the lifecycle of the bacterium.

  20. [Acute interstitial pneumonia: diagnostic approach and management].

    PubMed

    Feuillet, S; Tazi, A

    2011-06-01

    Acute interstitial pneumonia (AIP) encompasses a spectrum of pulmonary disorders characterized by involvement of the lung interstitium and distal airways (bronchioles and alveoli). The onset of respiratory symptoms is acute, most often within two weeks. Most AIP take place de novo, but sometimes represent an acute exacerbation of chronic lung disease. The clinical presentation of AIP comprises rapidly progressive dyspnoea, associated sometimes with cough, fever, myalgia and asthenia. Chest radiography shows diffuse pulmonary opacities. The associated hypoxemia may be severe enough to cause acute respiratory failure. Underlying aetiologies are numerous and variable, particularly in relation to the underlying immune status of the host. Various histopathological entities may be responsible for AIP although diffuse alveolar damage is the predominant pattern. The diagnostic approach to a patient presenting with AIP is to try to determine the most likely underlying histopathological pattern and to search for a precise aetiology. It relies mainly on a meticulous clinical evaluation and accurate biological investigation, essentially guided by the results of bronchoalveolar lavage performed in an area identified by abnormalities on high resolution computed tomography of the lungs. Initial therapeutic management includes symptomatic measures, broad-spectrum antibiotic treatment adapted to the clinical context, frequently combined with systemic corticosteroid therapy.

  1. Community-acquired Pneumonia and its Complications.

    PubMed

    Qin, Qiang; Shen, Kun-ling

    2015-08-01

    Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality worldwide in developing and developed countries, and its incidence is highest among children less than 5-y-old. Over the last five years, several international and local guidelines have been updated with new evidence concerning the epidemiology, etiology, pathogenesis, treatment and prevention of pediatric CAP, but there are still several major problems that need to be standardised. The aim of this review is to consider the available data concerning the termination, epidemiology, microbiology and pathogenesis, clinical features, diagnosis and differential diagnosis, treatment, and complications of pediatric CAP. There still are many unanswered questions concerning the management of CAP, including its definition, the difficulty to identify its etiological agents, the emergence of drug, and the lack of introduction of vaccines against respiratory pathogens in developing countries. More research is required in various areas (including therapy of atypical agents), and further efforts are needed to increase vaccination in order to reduce the incidence of the disease. PMID:25976616

  2. Gluconic acid production by gad mutant of Klebsiella pneumoniae.

    PubMed

    Wang, Dexin; Wang, Chenhong; Wei, Dong; Shi, Jiping; Kim, Chul Ho; Jiang, Biao; Han, Zengsheng; Hao, Jian

    2016-08-01

    Klebsiella pneumoniae produces many economically important chemicals. Using glucose as a carbon source, the main metabolic product in K. pneumoniae is 2,3-butanediol. Gluconic acid is an intermediate of the glucose oxidation pathway. In the current study, a metabolic engineering strategy was used to develop a gluconic acid-producing K. pneumoniae strain. Deletion of gad, resulting in loss of gluconate dehydrogenase activity, led to the accumulation of gluconic acid in the culture broth. Gluconic acid accumulation by K. pneumoniae Δgad was an acid-dependent aerobic process, with accumulation observed at pH 5.5 or lower, and at higher levels of oxygen supplementation. Under all other conditions tested, 2,3-butanediol was the main metabolic product of the process. In fed batch fermentation, a final concentration of 422 g/L gluconic acid was produced by K. pneumoniae Δgad, and the conversion ratio of glucose to gluconic acid reached 1 g/g. The K. pneumoniae Δgad described in this study is the first genetically modified strain used for gluconic acid production, and this optimized method for gluconic acid production may have important industrial applications. Gluconic acid is an intermediate of this glucose oxidation pathway. Deletion of gad, resulting in loss of gluconate dehydrogenase activity, led to the accumulation of gluconic acid in the culture broth. In fed batch fermentation, a final concentration of 422 g/L gluconic acid was produced by the K. pneumoniae Δgad strain, and the conversion ratio of glucose to gluconic acid reached 1 g/g.

  3. Gluconic acid production by gad mutant of Klebsiella pneumoniae.

    PubMed

    Wang, Dexin; Wang, Chenhong; Wei, Dong; Shi, Jiping; Kim, Chul Ho; Jiang, Biao; Han, Zengsheng; Hao, Jian

    2016-08-01

    Klebsiella pneumoniae produces many economically important chemicals. Using glucose as a carbon source, the main metabolic product in K. pneumoniae is 2,3-butanediol. Gluconic acid is an intermediate of the glucose oxidation pathway. In the current study, a metabolic engineering strategy was used to develop a gluconic acid-producing K. pneumoniae strain. Deletion of gad, resulting in loss of gluconate dehydrogenase activity, led to the accumulation of gluconic acid in the culture broth. Gluconic acid accumulation by K. pneumoniae Δgad was an acid-dependent aerobic process, with accumulation observed at pH 5.5 or lower, and at higher levels of oxygen supplementation. Under all other conditions tested, 2,3-butanediol was the main metabolic product of the process. In fed batch fermentation, a final concentration of 422 g/L gluconic acid was produced by K. pneumoniae Δgad, and the conversion ratio of glucose to gluconic acid reached 1 g/g. The K. pneumoniae Δgad described in this study is the first genetically modified strain used for gluconic acid production, and this optimized method for gluconic acid production may have important industrial applications. Gluconic acid is an intermediate of this glucose oxidation pathway. Deletion of gad, resulting in loss of gluconate dehydrogenase activity, led to the accumulation of gluconic acid in the culture broth. In fed batch fermentation, a final concentration of 422 g/L gluconic acid was produced by the K. pneumoniae Δgad strain, and the conversion ratio of glucose to gluconic acid reached 1 g/g. PMID:27339313

  4. Vaccines to prevent pneumonia and improve child survival.

    PubMed

    Madhi, Shabir A; Levine, Orin S; Hajjeh, Rana; Mansoor, Osman D; Cherian, Thomas

    2008-05-01

    For more than 30 years, vaccines have played an important part in pneumonia prevention. Recent advances have created opportunities for further improving child survival through prevention of childhood pneumonia by vaccination. Maximizing routine immunization with pertussis and measles vaccines, coupled with provision of a second opportunity for measles immunization, has rapidly reduced childhood deaths in low-income countries especially in sub-Saharan Africa. Vaccines against the two leading bacterial causes of child pneumonia deaths, Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (pneumococcus), can further improve child survival by preventing about 1,075,000 child deaths per year. Both Hib and pneumococcal conjugate vaccines have proven safety and effectiveness for prevention of radiologically confirmed pneumonia in children, including in low-income and industrializing countries. Both are recommended by WHO for inclusion in national programmes, and, at sharply tiered prices, these vaccines generally meet international criteria of cost-effectiveness for low-income countries. Vaccines only target selected pneumonia pathogens and are less than 100% effective, so they must be complemented by curative care and other preventative strategies. As part of a comprehensive child survival package, the particular advantages of vaccines include the ability to reach a high proportion of all children, including those who are difficult to reach with curative health services, and the ability to rapidly scale up coverage with new vaccines. In this review, we discuss advances made in optimizing the use of established vaccines and the potential issues related to newer bacterial conjugate vaccines in reducing childhood pneumonia morbidity and mortality.

  5. Towards a sensible comprehension of severe community-acquired pneumonia.

    PubMed

    Ewig, Santiago; Woodhead, Mark; Torres, Antoni

    2011-02-01

    Four different rules have been suggested and validated for intensive care unit (ICU) admission for community-acquired pneumonia: modified American Thoracic Society (ATS) rule, Infectious Diseases Society of America (IDSA)/ATS rule, España rule, and SMART-COP. Their performance varies, with sensitivity of around 70% and specificity of around 80-90%. Only negative predictive values are consistently high. Critical methodological issues include the appropriate reference for derivation, the populations studied, the variables included, and the time course of pneumonia. Severe community-acquired pneumonia (SCAP) may evolve because of acute respiratory failure or/and severe sepsis/septic shock. Pneumonia-related complications and decompensated comorbidities may be additional or independent reasons for a severe course. All variables included in predictive rules relate to the two principal reasons for SCAP. However, taken as major criteria, they are of little value for clinical assessment. Instead, a limited set of minor criteria reflecting severity seems appropriate. However, predictive rules may not meet principal needs of severity assessment because of failure in sensitivity, ignorance of the potential contribution of complications or decompensated comorbidity to pneumonia severity, and poor sensitivity for the lower extreme in the spectrum of severe pneumonia, i.e., patients at risk of SCAP. We therefore advocate an approach that refers to the evaluation of the need for intensified treatment rather than ICU, based on a set of minor criteria and sensitive to the dynamic nature of pneumonia. Intensified treatment such as monitoring and treatment of acute respiratory failure or/and severe sepsis/septic shock is thought to improve management and possibly outcomes by setting the focus on both patients with severity criteria at admission and those at risk for SCAP.

  6. Clinical practice guidelines for hospital-acquired pneumonia and ventilator-associated pneumonia in adults

    PubMed Central

    Rotstein, Coleman; Evans, Gerald; Born, Abraham; Grossman, Ronald; Light, R Bruce; Magder, Sheldon; McTaggart, Barrie; Weiss, Karl; Zhanel, George G

    2008-01-01

    Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are important causes of morbidity and mortality, with mortality rates approaching 62%. HAP and VAP are the second most common cause of nosocomial infection overall, but are the most common cause documented in the intensive care unit setting. In addition, HAP and VAP produce the highest mortality associated with nosocomial infection. As a result, evidence-based guidelines were prepared detailing the epidemiology, microbial etiology, risk factors and clinical manifestations of HAP and VAP. Furthermore, an approach based on the available data, expert opinion and current practice for the provision of care within the Canadian health care system was used to determine risk stratification schemas to enable appropriate diagnosis, antimicrobial management and nonantimicrobial management of HAP and VAP. Finally, prevention and risk-reduction strategies to reduce the risk of acquiring these infections were collated. Future initiatives to enhance more rapid diagnosis and to effect better treatment for resistant pathogens are necessary to reduce morbidity and improve survival. PMID:19145262

  7. Application of factorial designs for optimization of cyclodextrin glycosyltransferase production from Klebsiella pneumoniae pneumoniae AS-22.

    PubMed

    Gawande, B N; Patkar, A Y

    1999-07-20

    Production of cyclodextrin glycosyltransferase (CGTase) from Klebsiella pneumoniae pneumoniae AS-22 was optimized in shake flasks using a statistical experimental design approach. Effect of various components in the basal medium, like carbon, nitrogen, phosphorus, and mineral sources as well as initial pH and temperature, were tested on enzyme production. The optimum concentrations of the selected media components were determined using statistical experimental designs. Two level fractional factorial designs in five variables, namely, dextrin, peptone, yeast extract, ammonium dihydrogen orthophosphate, and magnesium sulphate concentrations were constructed. The optimum medium composition thus found consisted of 49.3 g/L dextrin, 20.6 g/L peptone, 18.3 g/L yeast extract, 6.7 g/L ammonium dihydrogen orthophosphate, and 0.5 g/L magnesium sulphate. The maximum CGTase activity obtained was 21.4 U/mL in 28 h of incubation. The cell growth and CGTase production profiles were studied with the optimized medium in shake flasks and in 1-L fermenters. It was observed that the enzyme production was growth associated both in shake flask and in fermenter, although it was slower in shake flask. The maximum CGTase activity obtained in the fermenter was 32.5 U/mL in 16 h. The optimized medium resulted in about 9-fold increase in the enzyme activity as compared to that obtained in the basal medium in shake flask as well as in fermenter. PMID:10397852

  8. Distinct Contributions of Neutrophils and CCR2+ Monocytes to Pulmonary Clearance of Different Klebsiella pneumoniae Strains.

    PubMed

    Xiong, Huizhong; Carter, Rebecca A; Leiner, Ingrid M; Tang, Yi-Wei; Chen, Liang; Kreiswirth, Barry N; Pamer, Eric G

    2015-09-01

    Klebsiella pneumoniae is a common respiratory pathogen, with some strains having developed broad resistance to clinically available antibiotics. Humans can become infected with many different K. pneumoniae strains that vary in genetic background, antibiotic susceptibility, capsule composition, and mucoid phenotype. Genome comparisons have revealed differences between K. pneumoniae strains, but the impact of genomic variability on immune-mediated clearance of pneumonia remains unclear. Experimental studies of pneumonia in mice have used the rodent-adapted 43816 strain of K. pneumoniae and demonstrated that neutrophils are essential for optimal host defense. It remains unclear, however, whether CCR2(+) monocytes contribute to K. pneumoniae clearance from the lung. We selectively depleted neutrophils, CCR2(+) monocytes, or both from immunocompetent mice and determined susceptibility to infection by the 43816 strain and 4 newly isolated clinical K. pneumoniae strains. The clinical K. pneumoniae strains, including one carbapenem-resistant ST258 strain, are less virulent than 43816. Optimal clearance of each of the 5 strains required either neutrophils or CCR2(+) monocytes. Selective neutrophil depletion markedly worsened infection with K. pneumoniae strain 43816 and three clinical isolates but did not increase susceptibility of mice to infection with the carbapenem-resistant K. pneumoniae ST258 strain. Depletion of CCR2(+) monocytes delayed recovery from infection with each of the 5 K. pneumoniae strains, revealing a contribution of these cells to bacterial clearance from the lung. Our findings demonstrate strain-dependent variation in the contributions of neutrophils and CCR2(+) monocytes to clearance of K. pneumoniae pulmonary infection.

  9. RESULTS OF PROPHYLACTIC VACCINATION AGAINST PNEUMONIA AT CAMP WHEELER.

    PubMed

    Cecil, R L; Vaughan, H F

    1919-05-01

    1. 13,460 men, or about 80 per cent of the entire camp strength, were vaccinated against pneumonia with pneumococcus lipovaccine. 2. The dosage employed in all cases was 1 cc. of the lipovaccine containing approximately 10 billion each of Pneumococcus Types I, II, and III. 3. Both the local and general reactions produced by the vaccine were usually mild. Only 0.7 per cent of those who received the vaccine were sufficiently affected to need hospital care. None of these was seriously ill, and a majority of them returned to duty on the 2nd or 3rd day after admission. 4. Most of the troops inoculated were under observation for 2 or 3 months after vaccination. During this period there were 32 cases of Pneumococcus Type I, II, and III pneumonia among the vaccinated four-fifths of camp, and 42 cases of pneumonia of these types among the unvaccinated one-fifth of camp. If, however, all cases of pneumonia that developed within 1 week after vaccination are excluded from the vaccinated group, there remain only 8 cases of pneumonia produced by fixed types, and these were all secondary to severe attacks of influenza. This exclusion is justified by the fact that protective bodies do not begin to appear in the serum until the 8th day after injection of pneumococcus lipovaccine. 5. There is no evidence whatever that pneumococcus vaccine predisposes the individual even temporarily toward either pneumococcus or streptococcus pneumonia. 6. The weekly incidence rate for pneumonia (all types) among the vaccinated troops was conspicuously lower than that for the unvaccinated troops. 7. The pneumonia incidence rate per 1,000 men during the period of the experiment was twice as high for unvaccinated recruits as for vaccinated recruits, and nearly seven times as high for unvaccinated seasoned men as for vaccinated seasoned men. 8. Influenza causes a marked reduction in resistance to pneumonia even among vaccinated men. Of the 155 cases of pneumonia (all types) developing 1 week or more

  10. Molecular Epidemiology of Colonizing and Infecting Isolates of Klebsiella pneumoniae

    PubMed Central

    Martin, Rebekah M.; Cao, Jie; Brisse, Sylvain; Passet, Virginie; Wu, Weisheng; Zhao, Lili; Malani, Preeti N.; Rao, Krishna

    2016-01-01

    ABSTRACT Klebsiella pneumoniae is among the most common causes of hospital-acquired infections and has emerged as an urgent threat to public health due to carbapenem antimicrobial resistance. K. pneumoniae commonly colonizes hospitalized patients and causes extraintestinal infections such as urinary tract infection, bloodstream infection (septicemia), and pneumonia. If colonization is an intermediate step before infection, then detection and characterization of colonizing isolates could enable strategies to prevent or empirically treat K. pneumoniae infections in hospitalized patients. However, the strength of the association between colonization and infection is unclear. To test the hypothesis that hospitalized patients become infected with their colonizing strain, 1,765 patients were screened for rectal colonization with K. pneumoniae, and extraintestinal isolates from these same patients were collected over a 3-month period in a cohort study design. The overall colonization prevalence was 23.0%. After adjustment for other patient factors, colonization was significantly associated with subsequent infection: 21 of 406 (5.2%) colonized patients later had extraintestinal infection, compared to 18 of 1,359 (1.3%) noncolonized patients (adjusted odds ratio [OR], 4.01; 95% confidence interval, 2.08 to 7.73; P < 0.001). Despite a high diversity of colonizing isolates, 7/7 respiratory, 4/4 urinary, and 2/5 bloodstream isolates from colonized patients matched the patient corresponding rectal swab isolates, based on wzi capsular typing, multilocus sequence typing (MLST), and whole-genome sequence analysis. These results suggest that K. pneumoniae colonization is directly associated with progression to extraintestinal infection. IMPORTANCE K. pneumoniae commonly infects hospitalized patients, and these infections are increasingly resistant to carbapenems, the antibiotics of last resort for life-threatening bacterial infections. To prevent and treat these infections, we

  11. Recombinant expression of Streptococcus pneumoniae capsular polysaccharides in Escherichia coli

    PubMed Central

    Kay, Emily J.; Yates, Laura E.; Terra, Vanessa S.; Cuccui, Jon; Wren, Brendan W.

    2016-01-01

    Currently, Streptococcus pneumoniae is responsible for over 14 million cases of pneumonia worldwide annually, and over 1 million deaths, the majority of them children. The major determinant for pathogenesis is a polysaccharide capsule that is variable and is used to distinguish strains based on their serotype. The capsule forms the basis of the pneumococcal polysaccharide vaccine (PPV23) that contains purified capsular polysaccharide from 23 serotypes, and the pneumococcal conjugate vaccine (PCV13), containing 13 common serotypes conjugated to CRM197 (mutant diphtheria toxin). Purified capsule from S. pneumoniae is required for pneumococcal conjugate vaccine production, and costs can be prohibitively high, limiting accessibility of the vaccine in low-income countries. In this study, we demonstrate the recombinant expression of the capsule-encoding locus from four different serotypes of S. pneumoniae within Escherichia coli. Furthermore, we attempt to identify the minimum set of genes necessary to reliably and efficiently express these capsules heterologously. These E. coli strains could be used to produce a supply of S. pneumoniae serotype-specific capsules without the need to culture pathogenic bacteria. Additionally, these strains could be applied to synthetic glycobiological applications: recombinant vaccine production using E. coli outer membrane vesicles or coupling to proteins using protein glycan coupling technology. PMID:27110302

  12. IVIG-mediated protection against necrotizing pneumonia caused by MRSA.

    PubMed

    Diep, Binh An; Le, Vien T M; Badiou, Cedric; Le, Hoan N; Pinheiro, Marcos Gabriel; Duong, Au H; Wang, Xing; Dip, Etyene Castro; Aguiar-Alves, Fábio; Basuino, Li; Marbach, Helene; Mai, Thuy T; Sarda, Marie N; Kajikawa, Osamu; Matute-Bello, Gustavo; Tkaczyk, Christine; Rasigade, Jean-Philippe; Sellman, Bret R; Chambers, Henry F; Lina, Gerard

    2016-09-21

    New therapeutic approaches are urgently needed to improve survival outcomes for patients with necrotizing pneumonia caused by Staphylococcus aureus One such approach is adjunctive treatment with intravenous immunoglobulin (IVIG), but clinical practice guidelines offer conflicting recommendations. In a preclinical rabbit model, prophylaxis with IVIG conferred protection against necrotizing pneumonia caused by five different epidemic strains of community-associated methicillin-resistant S. aureus (MRSA) as well as a widespread strain of hospital-associated MRSA. Treatment with IVIG, either alone or in combination with vancomycin or linezolid, improved survival outcomes in this rabbit model. Two specific IVIG antibodies that neutralized the toxic effects of α-hemolysin (Hla) and Panton-Valentine leukocidin (PVL) conferred protection against necrotizing pneumonia in the rabbit model. This mechanism of action of IVIG was uncovered by analyzing loss-of-function mutant bacterial strains containing deletions in 17 genes encoding staphylococcal exotoxins, which revealed only Hla and PVL as having an impact on necrotizing pneumonia. These results demonstrate the potential clinical utility of IVIG in the treatment of severe pneumonia induced by S. aureus. PMID:27655850

  13. The Role of Postmortem Studies in Pneumonia Etiology Research

    PubMed Central

    Bunthi, Charatdao; Wonodi, Chizoba B.; Morpeth, Susan C.; Molyneux, Catherine S.; Zaki, Sherif R.; Levine, Orin S.; Murdoch, David R.; Scott, J. Anthony G.

    2012-01-01

    The diagnosis of etiology in severe pneumonia remains a challenging area. Postmortem lung tissue potentially increases the sensitivity of investigations for identification of causative pathogens in fatal cases of pneumonia and can confirm antemortem microbiological diagnoses. Tissue sampling allows assessment of histological patterns of disease and ancillary immunohistochemical or molecular diagnostic techniques. It may also enhance the recognition of noninfectious conditions that clinically simulate acute pneumonia. Biobanking of lung tissue or postmortem culture isolates offers opportunities for new pathogen discovery and research into host-pathogen interactions. The Pneumonia Etiology Research for Child Health study proposes a percutaneous needle biopsy approach to obtain postmortem samples, rather than a full open autopsy. This has the advantage of greater acceptability to relatives, but risks greater sampling error. Both approaches may be susceptible to microbiological contamination or pathogen degradation. However, previous autopsy studies have confirmed the value of histological examination in revealing unsuspected pathogens and influencing clinical guidelines for the diagnosis and treatment of future pneumonia cases. PMID:22403232

  14. Community-acquired pneumonia related to intracellular pathogens.

    PubMed

    Cillóniz, Catia; Torres, Antoni; Niederman, Michael; van der Eerden, Menno; Chalmers, James; Welte, Tobias; Blasi, Francesco

    2016-09-01

    Community-acquired pneumonia (CAP) is associated with high rates of morbidity and mortality worldwide; the annual incidence of CAP among adults in Europe has ranged from 1.5 to 1.7 per 1000 population. Intracellular bacteria are common causes of CAP. However, there is considerable variation in the reported incidence between countries and change over time. The intracellular pathogens that are well established as causes of pneumonia are Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, and Coxiella burnetii. Since it is known that antibiotic treatment for severe CAP is empiric and includes coverage of typical and atypical pathogens, microbiological diagnosis bears an important relationship to prognosis of pneumonia. Factors such as adequacy of initial antibiotic or early de-escalation of therapy are important variables associated with outcomes, especially in severe cases. Intracellular pathogens sometimes appear to cause more severe disease with respiratory failure and multisystem dysfunction associated with fatal outcomes. The clinical relevance of intracellular pathogens in severe CAP has not been specifically investigated. We review the prevalence, general characteristics, and outcomes of severe CAP cases caused by intracellular pathogens. PMID:27276986

  15. Time course of lung function changes in atypical pneumonia.

    PubMed Central

    Benusiglio, L N; Stalder, H; Junod, A F

    1980-01-01

    We measured pulmonary function in each of 21 patients suffering from "atypical", non-bacterial pneumonia during the acute illness and during convalescence (two to 18 months) to study the course and the nature of functional impairment at different stages of the disease. In six patients, no aetiological agent was found. An aetiological agent was identified in 15 of the patients: Mycoplasma pneumoniae (seven patients), influenza A (three patients), parainfluenza 3 (one patient), varicella (two patients), Q fever (one patient), coxsackie B3 (one patient). At the time of admission we observed a restrictive pattern in 52%, an obstructive pattern (decreased FEV1/FVC ratio) in 52% abnormalities in distribution of ventilation (abnormal slope of phase 3) in 63%, and abnormalities in gas exchange (increased AaDO2) in 75% of the patients. The frequency of abnormalities in these pulmonary function tests decreased dramatically after two to four weeks and nearly disappeared in most patients during convalescence. The only major residual abnormality was a decreased FEV1/FVC ratio in five subjects, four of whom were smokers. However, when MMEF and V75 were measured at this stage, their average value for all the groups of patients with the exclusion of the Mycoplasma pneumoniae group, was markedly reduced. These data suggest that small airways involvement can be demonstrated during the convalescence of patients recovering from various types of atypical pneumonia other than those caused by Mycoplasma pneumoniae. PMID:7444825

  16. Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia.

    PubMed

    Spindler, C; Ortqvist, A

    2006-10-01

    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.

  17. [Organising Pneumonia - a review and results from Icelandic studies].

    PubMed

    Sveinsson, Olafur A; Isaksson, Helgi J; Gudmundsson, Gunnar

    2008-01-01

    Organising pneumonia (OP) is a relatively rare interstitial lung disease. It s definition is based on a characteristic histological pattern in the presence of certain clinical and radiological features. Organising pneumonia represents also what has been called Bronchiolitis Obliterans Organising Pneumonia (BOOP). Recently it has been recommended to call OP cryptogenic organising pneumonia (COP) when no definite cause or characteristic clinical context is found and secondary organising pneumonia (SOP) when causes can be identified such as infection or it occurs in a characteristic clinical context such as connective tissue disorder. The most common clinical symptoms are dyspnea, cough, fever and general malaise. It is common that symptoms have been present for some weeks before the diagnosis is made. Patients commonly have lowered PO2 and a mildly restrictive spirometry. Radiographic features are most often patchy bilateral airspace opacities but an interstitial pattern or focal opacities can also be seen. Most of patients respond well to steroids but relapses are quite common. The aim of this paper is to present an overview of the disease and the main results from studies on OP in Iceland. The mean annual incidence for OP in Iceland was 1.97/100,000 inhabitants. Annual incidence for COP was 1.10/100,000 and 0.87/100,000 for SOP. This is higher than in most other studies. In Iceland patients with OP had a higher standardized mortality ratio than the general population despite good clinical responses. No clinical symptoms could separate between SOP and COP.

  18. A systemic network for Chlamydia pneumoniae entry into human cells.

    PubMed

    Wang, Anyou; Johnston, S Claiborne; Chou, Joyce; Dean, Deborah

    2010-06-01

    Bacterial entry is a multistep process triggering a complex network, yet the molecular complexity of this network remains largely unsolved. By employing a systems biology approach, we reveal a systemic bacterial-entry network initiated by Chlamydia pneumoniae, a widespread opportunistic pathogen. The network consists of nine functional modules (i.e., groups of proteins) associated with various cellular functions, including receptor systems, cell adhesion, transcription, and endocytosis. The peak levels of gene expression for these modules change rapidly during C. pneumoniae entry, with cell adhesion occurring at 5 min postinfection, receptor and actin activity at 25 min, and endocytosis at 2 h. A total of six membrane proteins (chemokine C-X-C motif receptor 7 [CXCR7], integrin beta 2 [ITGB2], platelet-derived growth factor beta polypeptide [PDGFB], vascular endothelial growth factor [VEGF], vascular cell adhesion molecule 1 [VCAM1], and GTP binding protein overexpressed in skeletal muscle [GEM]) play a key role during C. pneumoniae entry, but none alone is essential to prevent entry. The combination knockdown of three genes (coding for CXCR7, ITGB2, and PDGFB) significantly inhibits C. pneumoniae entry, but the entire network is resistant to the six-gene depletion, indicating a resilient network. Our results reveal a complex network for C. pneumoniae entry involving at least six key proteins.

  19. Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998.

    PubMed Central

    Baine, W B; Yu, W; Summe, J P

    2001-01-01

    OBJECTIVES: This study determined hospitalization rates of elderly Americans for pneumonia from 1991 through 1998. METHODS: Epidemiologic data were described for 273,143 pneumonia hospitalizations. RESULTS: Annual hospitalizations for aspiration pneumonia increased by 93.5%. Pneumonia hospitalization rates increased steeply with age, especially among men. Black men were at highest risk for aspiration, unspecified, Klebsiella, "other gram-negative," and staphylococcal pneumonia; White men had the highest Haemophilus and pneumococcal pneumonia rates. Among women, Blacks predominated in aspiration and Klebsiella pneumonia; Whites had the highest Haemophilus and bronchopneumonia rates. CONCLUSIONS: An epidemic of hospitalization for aspiration pneumonia smoldered over 8 years. Significant disparities existed in hospitalization risks by race, sex, and principal diagnosis. PMID:11441742

  20. Nonencapsulated Streptococcus pneumoniae: Emergence and Pathogenesis

    PubMed Central

    Keller, Lance E.; Robinson, D. Ashley

    2016-01-01

    ABSTRACT While significant protection from pneumococcal disease has been achieved by the use of polysaccharide and polysaccharide-protein conjugate vaccines, capsule-independent protection has been limited by serotype replacement along with disease caused by nonencapsulated Streptococcus pneumoniae (NESp). NESp strains compose approximately 3% to 19% of asymptomatic carriage isolates and harbor multiple antibiotic resistance genes. Surface proteins unique to NESp enhance colonization and virulence despite the lack of a capsule even though the capsule has been thought to be required for pneumococcal pathogenesis. Genes for pneumococcal surface proteins replace the capsular polysaccharide (cps) locus in some NESp isolates, and these proteins aid in pneumococcal colonization and otitis media (OM). NESp strains have been isolated from patients with invasive and noninvasive pneumococcal disease, but noninvasive diseases, specifically, conjunctivitis (85%) and OM (8%), are of higher prevalence. Conjunctival strains are commonly of the so-called classical NESp lineages defined by multilocus sequence types (STs) ST344 and ST448, while sporadic NESp lineages such as ST1106 are more commonly isolated from patients with other diseases. Interestingly, sporadic lineages have significantly higher rates of recombination than classical lineages. Higher rates of recombination can lead to increased acquisition of antibiotic resistance and virulence factors, increasing the risk of disease and hindering treatment. NESp strains are a significant proportion of the pneumococcal population, can cause disease, and may be increasing in prevalence in the population due to effects on the pneumococcal niche caused by pneumococcal vaccines. Current vaccines are ineffective against NESp, and further research is necessary to develop vaccines effective against both encapsulated and nonencapsulated pneumococci. PMID:27006456

  1. Smoking-related idiopathic interstitial pneumonia.

    PubMed

    Flaherty, Kevin R; Fell, Charlene; Aubry, Marie-Christine; Brown, Kevin; Colby, Thomas; Costabel, Ulrich; Franks, Teri J; Gross, Barry H; Hansell, David M; Kazerooni, Ella; Kim, Dong Soon; King, Talmadge E; Kitachi, Masanori; Lynch, David; Myers, Jeff; Nagai, Sonoko; Nicholson, Andrew G; Poletti, Venerino; Raghu, Ganesh; Selman, Moises; Toews, Galen; Travis, William; Wells, Athol U; Vassallo, Robert; Martinez, Fernando J

    2014-09-01

    Cigarette smoking is a key factor in the development of numerous pulmonary diseases. An international group of clinicians, radiologists and pathologists evaluated patients with previously identified idiopathic interstitial pneumonia (IIP) to determine unique features of cigarette smoking. Phase 1 (derivation group) identified smoking-related features in patients with a history of smoking (n=41). Phase 2 (validation group) determined if these features correctly predicted the smoking status of IIP patients (n=100) to participants blinded to smoking history. Finally, the investigators sought to determine if a new smoking-related interstitial lung disease phenotype could be defined. Phase 1 suggested that preserved forced vital capacity with disproportionately reduced diffusing capacity of the lung for carbon monoxide, and various radiographic and histopathological findings were smoking-related features. In phase 2, the kappa coefficient among clinicians was 0.16 (95% CI 0.11-0.21), among the pathologists 0.36 (95% CI 0.32-0.40) and among the radiologists 0.43 (95% CI 0.35-0.52) for smoking-related features. Eight of the 100 cases were felt to represent a potential smoking-related interstitial lung disease. Smoking-related features of interstitial lung disease were identified in a minority of smokers and were not specific for smoking. This study is limited by its retrospective design, the potential for recall bias in smoking history and lack of information on second-hand smoke exposure. Further research is needed to understand the relationship between smoking and interstitial lung disease. PMID:25063244

  2. Idiopathic non-specific interstitial pneumonia.

    PubMed

    Belloli, Elizabeth A; Beckford, Rosemarie; Hadley, Ryan; Flaherty, Kevin R

    2016-02-01

    Non-specific interstitial pneumonia (NSIP) is an interstitial lung disease that may be idiopathic or secondary to connective tissue disease, toxins or numerous other causes. Idiopathic NSIP is a rare diagnosis and requires exclusion of these other possible causes. Patients typically present in mid-adulthood with dyspnoea, cough and often constitutional symptoms including fever and fatigue. The disease has a female predominance, and more than 50% of patients have never smoked. Physical exam features mild hypoxaemia and inspiratory rales. Pulmonary function tests demonstrate restriction and a low diffusing capacity for carbon monoxide. High-resolution computed tomography abnormalities include predominantly lower lobe subpleural reticular changes, traction bronchiectasis and ground-glass opacities; honeycombing is rarely seen. An evaluation of the underlying pathology is necessary for a firm diagnosis. Histologically, alveolar and interstitial mononuclear cell inflammation and fibrosis are seen in a temporally uniform pattern with preserved underlying alveolar architecture. NSIP must be differentiated from other parenchymal lung diseases including idiopathic pulmonary fibrosis and hypersensitivity pneumonitis. A thorough exposure history and assessment for underlying connective tissue diseases are highly important, as positive findings in these categories would likely denote a case of secondary NSIP. A multi-disciplinary discussion that includes pulmonologist(s), radiologist(s) and pathologist(s) assists in reaching a consensus diagnosis and improves diagnostic accuracy. Treatment of idiopathic NSIP, although not well proven, is generally instituted in the form of immunosuppression. Prognosis is favourable compared with idiopathic pulmonary fibrosis, although the diagnosis still carries an attributable mortality. Herein we will summarize the clinical characteristics and management of idiopathic NSIP. PMID:26564810

  3. Clonal dissemination of multilocus sequence type 11 Klebsiella pneumoniae carbapenemase - producing K. pneumoniae in a Chinese teaching hospital.

    PubMed

    Sun, Kangde; Chen, Xu; Li, Chunsheng; Yu, Zhongmin; Zhou, Qi; Yan, Yuzhong

    2015-02-01

    Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae has disseminated rapidly in China. We aimed to analyze the molecular epidemiology of four KPC-producing K. pneumoniae strains isolated from a suspected clonal outbreak during a 3-month period and to track the dissemination of KPC-producing K. pneumonia retrospectively. We created antimicrobial susceptibility profiles using an automated broth microdilution system and broth microdilution methods. We screened carbapenemase and KPC phenotypes using the modified Hodge test and meropenem-boronic acid (BA) disk test, respectively. We identified β-lactamase genes with PCR and sequencing. We investigated clonal relatedness for epidemiological comparison using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). All isolates expressed multidrug resistance and yielded positive results for the modified Hodge and meropenem-BA disk tests. The isolates all carried blaKPC -2 , and coproduced CTX-M-type extended-spectrum β-lactamase. PFGE and MLST showed that the isolates were clonally related. The PFGE patterns of these isolates had ≥90% similarity. We found a single clone, sequence type (ST) 11, and its typical dissemination mode resembled clonal spread. The dissemination of KPC-producing K. pneumoniae is clonally related and there is probable local transmission of a successful ST11 clone.

  4. Rare idiopathic interstitial pneumonias: LIP and PPFE and rare histologic patterns of interstitial pneumonias: AFOP and BPIP.

    PubMed

    Kokosi, Maria A; Nicholson, Andrew G; Hansell, David M; Wells, Athol U

    2016-05-01

    In the 2013 reclassification of the idiopathic interstitial pneumonias (IIPs), two rare IIPs (idiopathic lymphoid interstitial pneumonia (LIP), idiopathic pleuroparenchymal fibroelastosis (IPPFE)) and two rare histologic patterns (acute fibrinous and organizing pneumonia (AFOP), bronchiolocentric pattern of interstitial pneumonia (BPIP)) are described. All these entities are rare with small series published to date, mostly containing primary and secondary forms of disease. LIP is histologically characterized by diffuse polyclonal lymphoid cell infiltrate surrounding the airways and expanding the interstitium. Thin-walled cysts and diffuse ground glass are considered the typical radiologic features. The clinical course is highly variable with corticosteroid responsiveness evident in approximately half of cases. IPPFE is defined histologically by coexisting upper lobe pleural and intra-alveolar fibrosis with elastosis. Dense subpleural irregular fibrosis and consolidation are the cardinal radiologic features. A history of recurrent lower respiratory tract infection is frequent. Responses to immunomodulation have not been reported and the rate of progression appears to be highly variable. AFOP is a rare histologic pattern lying within the spectrum of acute/subacute lung injury, characterized by organizing pneumonia and intra-alveolar fibrin deposition without hyaline membranes. BPIP is characterized histologically by fibrosis and/or inflammation confined to the alveolar interstitium around bronchovascular bundles, overlapping with peribronchial metaplasia and fibrosis in some series. Currently, AFOP and BPIP are both best viewed as histological entities rather than true clinical disorders, in the absence of characteristic associated imaging patterns and clinical features. PMID:26627191

  5. Dynamics of Lung Defense in Pneumonia: Resistance, Resilience, and Remodeling

    PubMed Central

    Quinton, Lee J.; Mizgerd, Joseph P.

    2015-01-01

    Pneumonia is initiated by microbes in the lung, but physiological processes integrating responses across diverse cell types and organ systems dictate the outcome of respiratory infection. Resistance, or actions of the host to eradicate living microbes, in the lungs involves a combination of innate and adaptive immune responses triggered by air-space infection. Resilience, or the ability of the host tissues to withstand the physiologically damaging effects of microbial and immune activities, is equally complex, precisely regulated, and determinative. Both immune resistance and tissue resilience are dynamic and change throughout the lifetime, but we are only beginning to understand such remodeling and how it contributes to the incidence of severe pneumonias, which diminishes as childhood progresses and then increases again among the elderly. Here, we review the concepts of resistance, resilience, and remodeling as they apply to pneumonia, highlighting recent advances and current significant knowledge gaps. PMID:25148693

  6. Organising pneumonia caused by transtuzumab (Herceptin) therapy for breast cancer.

    PubMed

    Radzikowska, E; Szczepulska, E; Chabowski, M; Bestry, I

    2003-03-01

    The case of a 49-yr-old female, who developed fever, effort dyspnoea and cough, with patchy migratory bilateral pulmonary infiltrates 6 weeks after starting transtuzumab therapy, following breast-conserving surgery with adjuvant chemoradiotherapy and hormone therapy for breast carcinoma, is reported here. Chest radiograph and thin section computed tomography demonstrated alveolar opacities with air bronchogram in both lungs. A lung biopsy was performed in a nonirradiated area of the contralateral lung and revealed a typical histological pattern of organising pneumonia (previously known as bronchiolitis obliterans organising pneumonia). Transtuzumab therapy was discontinued and subsequent gradual clinical and radiological improvement was observed. After 3 months, complete resolution of symptoms and radiographical abnormalities were noted. This is the first case report that suggests that transtuzumab therapy might induce the development of lung infiltrates with the histological appearance of organising pneumonia.

  7. Mycoplasma pneumoniae induces cytotoxic activity in guinea pig bronchoalveolar cells

    SciTech Connect

    Kist, M.; Koester, H.; Bredt, W.

    1985-06-01

    Precultured guinea pig alveolar macrophages (AM) and freshly harvested alveolar cells (FHAC) activated by interaction with Mycoplasma pneumoniae were cytotoxic for xenogeneic /sup 75/selenomethionine-labeled tumor target cells. Phagocytosis of whole opsonized or nonopsonized M. pneumoniae cells was more effective in eliciting cytotoxicity than uptake of sonicated microorganisms. The addition of living mycoplasma cells to the assay system enhanced the cytotoxic effect considerably. Target cells were significantly more susceptible to the cytotoxic action of phagocytes if they were coated with mycoplasma antigen or cocultured together with M. pneumoniae. The activation of the phagocytes could be inhibited by 2-deoxy-D-glucose but not by antimicrobial substances suppressing mycoplasma protein synthesis. It was accompanied by /sup 51/Cr release without detectable signs of cell damage. The supernatants of activated cells were cytotoxic for approximately 24 h. Inhibition, release, and cytotoxic activity indicate the necessity of an intact metabolism of the effector cells and suggest a secretion of cytotoxic substances.

  8. Reducing the incidence of nosocomial pneumonia in cardiovascular surgery patients.

    PubMed

    Houston, Susan; Gentry, Layne O; Pruitt, Vicki; Dao, Thanh; Zabaneh, Firas; Sabo, John

    2003-01-01

    Outcomes management provides a mechanism to foster development of patient-driven services through revision of practice and measurement of outcomes. Because nosocomial pneumonia is the most common hospital-acquired infection in intensive care units, reducing the rate of nosocomial pneumonia became on area of intense scrutiny at our institution. This article shares an outcome initiative that focused on reducing the incidence of nosocomial pneumonia in a hospital setting. Strategies used such as multidisciplinary team formation, case/control study, quality improvement activities, risk tool development, and protocol implementation, are discussed. Process and outcome data are provided to demonstrate the initiative's positive impact. The benefits of this outcome effort are easily identified and well-illustrated. The backbone of the initiative--proactive identification of problems and the methodical, reasoned search for answers--is universally applicable.

  9. [Serrapeptase-induced lung injury manifesting as acute eosiniphilic pneumonia].

    PubMed

    Sasaki, S; Kawanami, R; Motizuki, Y; Nakahara, Y; Kawamura, T; Tanaka, A; Watanabe, S

    2000-07-01

    An 84-year-old man was referred to our hospital because of fever, cough, and hemoptysis. The patient had acute respiratory failure (PaO2 < 40 mmHg) on admission, with diffuse interstitial infiltration and bilateral pleural effusion. The bronchoalveolar lavage fluid was bloody, and contained a high percentage of eosinophils (32%). A diagnosis of acute eosinophilic pneumonia was established, and the patient made a rapid recovery after corticosteroids were administered. When the DLST (drug lymphocyte stimulation test) was performed after the corticosteroid therapy was stopped, it was positive for serrapeptase, which had been prescribed for chronic cystitis for 3 months before the onset of the pneumonia. This was a case of drug (serrapeptase)-induced pneumonitis manifesting as acute eosinophilic pneumonia.

  10. Community-acquired pneumonia: 2012 history, mythology, and science.

    PubMed

    Donowitz, Gerald R

    2013-01-01

    Pneumonia remains one of the major disease entities practicing physicians must manage. It is a leading cause of infection-related morbidity and mortality in all age groups, and a leading cause of death in those older than 65 years of age. Despite its frequency and importance, clinical questions have remained in the therapy of community-acquired pneumonia including when to start antibiotics, when to stop them, who to treat, and what agents to use. Answers to these questions have involved historical practice, mythology, and science-sometimes good science, and sometimes better science. How clinical decisions are made for patients with community-acquired pneumonia serves as an illustrative model for other problem areas of medicine and allows for insight as to how clinical decisions have been made and clinical practice established.

  11. Measles pneumonia in young adults. An analysis of 106 cases.

    PubMed

    Gremillion, D H; Crawford, G E

    1981-10-01

    Measles occurred in 3,220 Air Force recruits between January 1976 and July 1979 and was complicated by pneumonia in 106 cases (3.3 percent). Although no deaths occurred, the illness was characterized as clinically severe with high fever and prolonged hospitalization (mean, 14.5 days). Bacterial superinfection as documented by transtracheal aspiration occurred in 35 cases (30.3 percent) and was caused by Hemophilus influenzae (18), Hemophilus parainfluenzae (two), Neisseria meningitidis (nine), Streptococcus pneumoniae (three), Streptococcus pyogenes (two) and Moraxella kingae (one). Clinical evidence of bronchospasm was present in 18 patients (17 percent) and required bronchodilators in six. Other complications included liver function abnormalities (31 percent), otitis media (29 percent) and sinusitis (25 percent). Measles pneumonia in adolescents is clinically severe with a generally benign outcome.

  12. Metabolism of benzonitrile and butyronitrile by Klebsiella pneumoniae

    SciTech Connect

    Nawaz, M.S.; Heinze, T.M.; Cerniglia, C.E. )

    1992-01-01

    A strain of Klebsiella pneumoniae that used aliphatic nitriles as the sole source of nitrogen was adapted to benzonitrile as the sole source of carbon and nitrogen. Gas chromatographic and mass spectral analyses of culture filtrates indicated that K. pneumoniae metabolized 8.4 mM benzonitrile to 4.0 mM benzoic acid and 2.7 mM ammonia. In addition, butyronitrile was metabolized to butyramide and ammonia. The isolate also degraded mixtures of benzonitrile and aliphatic nitriles. Cell extracts contained nitrile hydratase and amidase activities. The enzyme activities were higher with butyronitrile and butyramide than with benzonitrile and benzamide, and amidase activities were twofold higher than nitrile hydratase activities. K. pneumoniae appears promising for the bioremediation of sites contaminated with aliphatic and aromatic nitriles.

  13. Manifestations and complications of Mycoplasma pneumoniae disease: a review.

    PubMed Central

    Lind, K.

    1983-01-01

    Over the past 20 years the annual number of reports on extrapulmonary symptoms during Mycoplasma (M.) pneumoniae disease has increased. Clinical and epidemiological data indicate that symptoms from the skin and mucous membranes, from the central nervous system, from the heart, and perhaps from other organs as well are not quite uncommon manifestations of M. pneumoniae disease. Reports on unusual courses of the disease have also accumulated, including cases of severe respiratory symptoms, sometimes seen in patients with underlying disease or with a concomitant viral infection. Serious extrapulmonary manifestations have been common in fatal cases of M. pneumoniae disease. Some observations and experimental data on these manifestations and on the possible pathogenic mechanisms are dealt with. The conclusion is that such mechanisms are still largely unknown. PMID:6433567

  14. Systemic steroid treatment for severe expanding pneumococcal pneumonia.

    PubMed

    Lavi, Eran; Shoseyov, David; Simanovsky, Natalia; Brooks, Rebecca

    2015-01-01

    The treatment of bacterial community-acquired pneumonia (CAP) is based on appropriate antibiotic therapy and supportive care such as intravenous fluids and supplemental oxygen. There is no available data regarding the use of steroids in CAP in children. We present an unusual case of a child with severe respiratory distress, on the brink of mechanical ventilation, due to a rapidly expanding pneumococcal pneumonia. The administration of systemic steroids resulted in a dramatic response with rapid improvement of clinical and radiological abnormalities followed by improvement of laboratory abnormalities. This case report should raise the awareness of the potential benefits of steroids in the treatment of severe pneumonia in children. Prospective randomized trials are needed to confirm the efficacy of steroids in this setting and to determine which patients would benefit most from this. PMID:25815231

  15. Prevention of aspiration pneumonia (AP) with oral care.

    PubMed

    Tada, Akio; Miura, Hiroko

    2012-01-01

    AP is a major cause of morbidity and mortality in elderly patients, especially frail elderly patients. The aim of this article is to review effect of oral care, including oral hygiene and improvement of oral function, on the prevention of AP among elderly people in hospitals and nursing homes. There is now a substantial body of work studying the effect of oral care on the prevention of respiratory diseases. Oral hygiene, consisting of oral decontamination and mechanical cleaning by dental professionals, has resulted in significant clinical effects (decreased incidence of pneumonia and decreased mortality from respiratory diseases) in clinical randomized trials. Moreover, studies examining oral colonization by pneumonia pathogens have shown the effect of oral hygiene on eliminating these pathogens. In addition, swallowing training has been shown to improve the movement and function of swallowing-related muscles, also resulting in decreased incidence of pneumonia. These findings support the contention that oral care is effective in the prevention of AP.

  16. mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings.

    PubMed

    Ginsburg, Amy Sarah; Delarosa, Jaclyn; Brunette, Waylon; Levari, Shahar; Sundt, Mitch; Larson, Clarice; Tawiah Agyemang, Charlotte; Newton, Sam; Borriello, Gaetano; Anderson, Richard

    2015-01-01

    Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings--using the World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and relying on a health care provider's ability to manually count respiratory rate--has proven inadequate. Furthermore, hypoxemia--a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death--is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers' ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop "mPneumonia," an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing mortality from

  17. mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings

    PubMed Central

    Ginsburg, Amy Sarah; Delarosa, Jaclyn; Brunette, Waylon; Levari, Shahar; Sundt, Mitch; Larson, Clarice; Tawiah Agyemang, Charlotte; Newton, Sam; Borriello, Gaetano; Anderson, Richard

    2015-01-01

    Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings—using the World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and relying on a health care provider’s ability to manually count respiratory rate—has proven inadequate. Furthermore, hypoxemia—a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death—is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop “mPneumonia,” an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing mortality

  18. mPneumonia: Development of an Innovative mHealth Application for Diagnosing and Treating Childhood Pneumonia and Other Childhood Illnesses in Low-Resource Settings.

    PubMed

    Ginsburg, Amy Sarah; Delarosa, Jaclyn; Brunette, Waylon; Levari, Shahar; Sundt, Mitch; Larson, Clarice; Tawiah Agyemang, Charlotte; Newton, Sam; Borriello, Gaetano; Anderson, Richard

    2015-01-01

    Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings--using the World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and relying on a health care provider's ability to manually count respiratory rate--has proven inadequate. Furthermore, hypoxemia--a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death--is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers' ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop "mPneumonia," an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing mortality from

  19. Klebsiella pneumoniae: characteristics of carbapenem resistance and virulence factors.

    PubMed

    Candan, Esra Deniz; Aksöz, Nilüfer

    2015-01-01

    Klebsiella pneumoniae, known as a major threat to public health, is the most common factor of nosocomial and community acquired infections. In this study, 50 K. pneumoniae clinical specimens isolated from bronchial, urea, blood, catheter, rectal, bile, tracheal and wound cultures were collected. These isolates were identified and carbapenem resistance was determined via an automated system, CHROMagar Orientation and CHROMagar KPC. The carbapenemase gene regions (blaIMP, blaVIM, blaOXA, blaNDM and blaKPC) and presence of virulence factors (magA, k2A, rmpA, wabG, uge, allS, entB, ycfM, kpn, wcaG, fimH, mrkD, iutA, iroN, hly ve cnf-1) of these isolates were determined by using Multiplex-PCR. The OXA-48 carbapenemase gene regions were determined in 33 of 50 K. pneumoniae strains. In addition, NDM-1 resistance in one, OXA-48 and NDM-1 resistance in four unusual K. pneumoniae isolates were detected. Virulence gene regions that were encountered among K. pneumoniae isolates were 88% wabG, 86% uge, 80% ycfM and 72% entB, related with capsule, capsule lipoprotein and external membrane protein, responsible for enterobactin production, respectively. Even though there was no significant difference between resistant and sensitive strains due to the virulence gene regions (P≥0.05), virulence factors in carbapenem resistant isolates were found to be more diverse. This study is important for both, to prevent the spread of carbapenem resistant infections and to plan for developing effective treatments. Moreover, this study is the first detailed study of the carbapenem resistance and virulence factors in K. pneumoniae strains.

  20. Kinase activity profiling of gram-negative pneumonia.

    PubMed

    Hoogendijk, Arie J; Diks, Sander H; Peppelenbosch, Maikel P; Van Der Poll, Tom; Wieland, Catharina W

    2011-01-01

    Pneumonia is a severe disease with high morbidity and mortality. A major causative pathogen is the Gram-negative bacterium Klebsiella (K.) pneumoniae. Kinases play an integral role in the transduction of intracellular signaling cascades and regulate a diverse array of biological processes essential to immune cells. The current study explored signal transduction events during murine Gram-negative pneumonia using a systems biology approach. Kinase activity arrays enable the analysis of 1,024 consensus sequences of protein kinase substrates. Using a kinase activity array on whole lung lysates, cellular kinase activities were determined in a mouse model of K. pneumoniae pneumonia. Notable kinase activities also were validated with phospho-specific Western blots. On the basis of the profiling data, mitogen-activated protein kinase (MAPK) signaling via p42 mitogen-activated protein kinase (p42) and p38 mitogen-activated protein kinase (p38) and transforming growth factor β (TGFβ) activity were reduced during infection, whereas v-src sarcoma (Schmidt-Ruppin A-2) viral oncogene homolog (avian) (SRC) activity generally was enhanced. AKT signaling was represented in both metabolic and inflammatory (mitogen-activated protein kinase kinase 2 [MKK], apoptosis signal-regulating kinase/mitogen-activated protein kinase kinase kinase 5 [ASK] and v-raf murine sarcoma viral oncogene homolog B1 [b-RAF]) context. This study reaffirms the importance of classic inflammation pathways, such as MAPK and TGFβ signaling and reveals less known involvement of glycogen synthase kinase 3β (GSK-3β), AKT and SRC signaling cassettes in pneumonia.

  1. Draft Genome Sequence of Klebsiella pneumoniae Strain AS Isolated from Zhejiang Provincial Hospital of TCM, China.

    PubMed

    Yang, Xue-Jing; Wang, Sai; Cao, Jun-Min; Hou, Jia-Hui

    2016-01-01

    Klebsiella pneumoniae is a Gram-negative, nonmotile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. Here we present draft genome assemblies of Klebsiella pneumoniae AS, which was isolated in China. The genomic information will provide a better understanding of the physiology, adaptation, and evolution of K. pneumoniae. PMID:27660770

  2. Complete genome sequence of a Klebsiella pneumoniae strain isolated from a known cotton insect boll vector

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Klebsiella pneumoniae (associated with bacterial pneumonia) was previously isolated from Nezara viridula, a significant vector of cotton boll-rot pathogens. We provide the first annotated genome sequence of the cotton opportunistic strain K. pneumoniae 5-1. This data provides guidance to study the...

  3. Draft Genome Sequence of Klebsiella pneumoniae Strain AS Isolated from Zhejiang Provincial Hospital of TCM, China.

    PubMed

    Yang, Xue-Jing; Wang, Sai; Cao, Jun-Min; Hou, Jia-Hui

    2016-09-22

    Klebsiella pneumoniae is a Gram-negative, nonmotile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. Here we present draft genome assemblies of Klebsiella pneumoniae AS, which was isolated in China. The genomic information will provide a better understanding of the physiology, adaptation, and evolution of K. pneumoniae.

  4. Draft Genome Sequence of Klebsiella pneumoniae Strain AS Isolated from Zhejiang Provincial Hospital of TCM, China

    PubMed Central

    Yang, Xue-Jing; Wang, Sai; Hou, Jia-Hui

    2016-01-01

    Klebsiella pneumoniae is a Gram-negative, nonmotile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. Here we present draft genome assemblies of Klebsiella pneumoniae AS, which was isolated in China. The genomic information will provide a better understanding of the physiology, adaptation, and evolution of K. pneumoniae. PMID:27660770

  5. Delineation of immunodominant and cytadherence segment(s) of Mycoplasma pneumoniae P1 gene

    PubMed Central

    2014-01-01

    Background Adhesion of Mycoplasma pneumoniae (M. pneumoniae) to host epithelial cells requires several adhesin proteins like P1, P30 and P116. Among these proteins, P1 protein has been inedited as one of the major adhesin and immunogenic protein present on the attachment organelle of M. pneumoniae. In the present study, we scanned the entire sequence of M. pneumoniae P1 protein to identify the immunodominant and cytadherence region(s). M. pneumoniae P1 gene was synthesized in four segments replacing all the UGA codons to UGG codons. Each of the four purified P1 protein fragment was analyzed for its immunogenicity with anti-M. pneumoniae M129 antibodies (Pab M129) and sera of M. pneumoniae infected patients by western blotting and ELISA. Antibodies were produced against all the P1 protein fragments and these antibodies were used for M. pneumoniae adhesion, M. pneumoniae adhesion inhibition and M. pneumoniae surface exposure assays using HEp-2 cells lines. Results Our results show that the immunodominant regions are distributed throughout the entire length of P1 protein, while only the N- and C- terminal region(s) of P1 protein are surface exposed and block cytadhesion to HEp-2 cells, while antibodies to two middle fragments failed to block cytadhesion. Conclusions These results have important implications in designing strategies to block the attachment of M. pneumoniae to epithelial cells, thus preventing the development of atypical pneumonia. PMID:24774062

  6. Trends in Pneumonia Mortality Rates and Hospitalizations by Organism, United States, 2002–20111

    PubMed Central

    Wuerth, Brandon A.; Bonnewell, John P.; Wiemken, Timothy L.

    2016-01-01

    Because the epidemiology of pneumonia is changing, we performed an updated, population-based analysis of hospitalization and case-fatality rates for pneumonia patients in the United States. From 2002 to 2011, hospitalization rates decreased significantly for pneumonia caused by pneumococcus and Haemophilus influenzae but increased significantly for Pseudomonas spp., Staphylococcus aureus, and influenza virus. PMID:27532154

  7. Critical issues for Klebsiella pneumoniae KPC-carbapenemase producing K. pneumoniae infections: a critical agenda.

    PubMed

    De Rosa, Francesco G; Corcione, Silvia; Cavallo, Rossana; Di Perri, Giovanni; Bassetti, Matteo

    2015-01-01

    The wide dissemination of carbapenemase producing K. pneumoniae (KPC-Kp) has caused a public health crisis of global dimensions, due to the serious infections in hospitalized patients associated with high mortality. In 2014, we aim to review clinical data on KPC-Kp at a time when a pro-active strategy (combating the problem before it is established) is no longer useful, focusing on epidemiology, patient risk profile, infection control, digestive tract colonization and treatment issues such as the role of carbapenems or carbapenem sparing strategies, colistin and resistance, dual carbapenem administration and the role of tigecycline. All these issues are illustrated prospectively to provide a forum for a Consensus strategy when not only intensive care units but also medical and surgical wards are affected by the epidemics. PMID:25689539

  8. Structure and Inhibition of Quorum Sensing Target from Streptococcus pneumoniae

    SciTech Connect

    Singh,V.; Shi, W.; Almo, S.; Evans, G.; Furneaux, R.; Tyler, P.; Painter, G.; Lenz, D.; Mee, S.; et al.

    2006-01-01

    Streptococcus pneumoniae 5'-methylthioadenosine/S-adenosylhomocysteine hydrolase (MTAN) catalyzes the hydrolytic deadenylation of its substrates to form adenine and 5-methylthioribose or S-ribosylhomocysteine (SRH). MTAN is not found in mammals but is involved in bacterial quorum sensing. MTAN gene disruption affects the growth and pathogenicity of bacteria, making it a target for antibiotic design. Kinetic isotope effects and computational studies have established a dissociative S{sub N}1 transition state for Escherichia coli MTAN, and transition state analogues resembling the transition state are powerful inhibitors of the enzyme [Singh, V., Lee, J. L., Nunez, S., Howell, P. L., and Schramm, V. L. (2005) Biochemistry 44, 11647-11659]. The sequence of MTAN from S. pneumoniae is 40% identical to that of E. coli MTAN, but S. pneumoniae MTAN exhibits remarkably distinct kinetic and inhibitory properties. 5'-Methylthio-Immucillin-A (MT-ImmA) is a transition state analogue resembling an early S{sub N}1 transition state. It is a weak inhibitor of S. pneumoniae MTAN with a K{sub i} of 1.0 {mu}M. The X-ray structure of S. pneumoniae MTAN with MT-ImmA indicates a dimer with the methylthio group in a flexible hydrophobic pocket. Replacing the methyl group with phenyl (PhT-ImmA), tolyl (p-TolT-ImmA), or ethyl (EtT-ImmA) groups increases the affinity to give K{sub i} values of 335, 60, and 40 nM, respectively. DADMe-Immucillins are geometric and electrostatic mimics of a fully dissociated transition state and bind more tightly than Immucillins. MT-DADMe-Immucillin-A inhibits with a K{sub i} value of 24 nM, and replacing the 5'-methyl group with p-Cl-phenyl (p-Cl-PhT-DADMe-ImmA) gave a K{sub i}* value of 0.36 nM. The inhibitory potential of DADMe-Immucillins relative to the Immucillins supports a fully dissociated transition state structure for S. pneumoniae MTAN. Comparison of active site contacts in the X-ray crystal structures of E. coli and S. pneumoniae MTAN with MT

  9. [Features of morbidity community-acquired pneumonia among young recruits].

    PubMed

    Serdukov, D U; Gordienko, A V; Kozlov, M S; Mikhailov, A A; Davydov, P A

    2015-10-01

    Were examined 3338 military personnel of the combined training center. 183 of them diagnosed community-acquired pneumonia, in 3155 focal and infiltrative changes in lung tissue were not identified. The analisys of prevalence been made among young recruits of the acute respiratory illness before arriving in part and at the assembly point, foci of chronic infection, smoking, low body weight. 511 military personnel arrived at the training center in the disease state with symptoms of acute respiratory illness. Examined the relationship these risk factor to the development of community-acquired pneumonia in this category of servicemen. PMID:26827502

  10. Cryptococcus neoformans as a cause of bronchiolitis obliterans organizing pneumonia.

    PubMed

    Kessler, Alexander T; Al Kharrat, Tamim; Kourtis, Athena P

    2010-06-01

    The most frequent manifestations of Cryptococcus neoformans (CN) disease are systemic infections in immunocompromised patients and localized pulmonary disease in immunocompetent individuals. Such pulmonary cryptococcosis can range from asymptomatic infection to frank pneumonia that can be severe. Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare severe form of pneumonitis caused by a variety of infectious and toxic agents or connective tissue diseases. BOOP due to Cryptococcus neoformans has very rarely been reported; there have been only five such case reports, mostly in immunocompromised patients. We report herein on a case of CN-associated BOOP in an immunocompetent individual and discuss the diagnosis and treatment of this entity. PMID:20169387

  11. Toxocara canis-Associated Myelitis with Eosinophilic Pneumonia

    PubMed Central

    Park, Kee Hong; Kim, Young-Soo; Kim, Soo-Kyung; Choi, Nack-Cheon; Kwon, Oh-Young; Lim, ByeongHoon

    2016-01-01

    The existence of Toxocara canis-specific antibodies has recently been reported in patients with atopic myelitis. Here, we report the case of a 35-year-old male patient admitted with a chief complaint of right lower limb hypoesthesia lasting for a month. The patient was diagnosed with eosinophilic pneumonia 3 months ago, and a spine MRI revealed the presence of myelitis in the cervicothoracic cord. After confirming the presence of hyper-IgE-emia and Toxocara canis antibodies, the patient was treated with steroids and albendazole treatment, which improved his symptoms. To our knowledge, this is the first case of Toxocara canis-associated myelitis with eosinophilic pneumonia. PMID:27358582

  12. Prevention and Control of Childhood Pneumonia and Diarrhea.

    PubMed

    Leung, Daniel T; Chisti, Mohammod J; Pavia, Andrew T

    2016-02-01

    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.

  13. The Missing Tooth: A Curious Case of Postobstructive Pneumonia

    PubMed Central

    Holmes, Ian; Gajurel, Kiran; Montoya, Jose

    2016-01-01

    Foreign body aspirations that are not recognized at the time of aspiration can lead to insidious symptoms that can present a diagnostic challenge. We report the case of a 70-year-old man presenting with postobstructive pneumonia 2 months after aspirating his own tooth during a meal. He had been mistakenly diagnosed with asthma and treated with bronchodilators before a computed tomography scan of the thorax revealed the impacted tooth in his left bronchus. We review the clinical features and microbiology of postobstructive pneumonia and discuss the rationale of its treatment. PMID:27419162

  14. Catalase Enhances Growth and Biofilm Production of Mycoplasma pneumoniae.

    PubMed

    Simmons, Warren L; Dybvig, Kevin

    2015-08-01

    Mycoplasma pneumoniae causes chronic respiratory disease in humans. Factors thought to be important for colonization include the ability of the mycoplasma to form a biofilm on epithelial surfaces and the production of hydrogen peroxide to damage host tissue. Almost all of the mycoplasmas, including M. pneumoniae, lack superoxide dismutase and catalase and a balance should exist between peroxide production and growth. We show here that the addition of catalase to cultures enhanced the formation of biofilms and altered the structure. The incorporation of catalase in agar increased the number of colony-forming units detected and hence could improve the clinical diagnosis of mycoplasmal diseases.

  15. Toxocara canis-Associated Myelitis with Eosinophilic Pneumonia.

    PubMed

    Park, Kee Hong; Kim, Young-Soo; Kim, Soo-Kyung; Choi, Nack-Cheon; Kwon, Oh-Young; Lim, ByeongHoon; Park, Ki-Jong

    2016-06-01

    The existence of Toxocara canis-specific antibodies has recently been reported in patients with atopic myelitis. Here, we report the case of a 35-year-old male patient admitted with a chief complaint of right lower limb hypoesthesia lasting for a month. The patient was diagnosed with eosinophilic pneumonia 3 months ago, and a spine MRI revealed the presence of myelitis in the cervicothoracic cord. After confirming the presence of hyper-IgE-emia and Toxocara canis antibodies, the patient was treated with steroids and albendazole treatment, which improved his symptoms. To our knowledge, this is the first case of Toxocara canis-associated myelitis with eosinophilic pneumonia. PMID:27358582

  16. Organizing Pneumonia in a Patient with Quiescent Crohn's Disease

    PubMed Central

    Ozeki, Keiji; Katano, Takahito; Shimura, Takaya; Mori, Yoshinori; Joh, Takashi

    2016-01-01

    A 64-year-old man with Crohn's disease (CD) was admitted to our hospital due to moderate risk of pneumonia while receiving scheduled adalimumab maintenance therapy. Symptoms remained virtually unchanged following administration of antibiotics. A final diagnosis of organizing pneumonia (OP) was made based on findings of intra-alveolar buds of granulation tissue and fibrous thickening of the alveolar walls on pathological examination and patchy consolidations and ground glass opacities on computed tomography. Immediate administration of prednisolone provided rapid, sustained improvement. Although a rare complication, OP is a pulmonary manifestation that requires attention in CD patients. PMID:27413560

  17. Exogenous lipoid pneumonia (ELP): when radiologist makes the difference

    PubMed Central

    Rea, G; Perna, F; Calabrese, G; Molino, A; Valente, T; Vatrella, A

    2016-01-01

    Lipoid pneumonia is an uncommon disorder characterized by accumulation of lipid components into the interstitial and alveolar compartment. The usual classification distinguishes endogenous and exogenous and acute or chronic forms, related to the type of fats, the amount of damage and the time of exposure. We describe a case of exogenous lipoid pneumonia by inhalation of vaseline used for cleaning of the tracheostoma in a 63-year-old female, presenting as cough, worsening dyspnea in few weeks. The diagnosis was finally established with a re-evaluation of BAL with specific staining for lipids, revealing the presence of foamy macrophages lipids rich, according to HRCT findings. PMID:27326397

  18. Copper intoxication inhibits aerobic nucleotide synthesis in Streptococcus pneumoniae

    PubMed Central

    Johnson, Michael D. L.; Kehl-Fie, Thomas E.; Rosch, Jason W.

    2015-01-01

    Copper is universally toxic in excess, a feature exploited by the human immune system to facilitate bacterial clearance. The mechanism of copper intoxication remains unknown for many bacterial species. Here, we demonstrate that copper toxicity in Streptococcus pneumoniae is independent from oxidative stress but, rather, is the result of copper inhibiting the aerobic dNTP biosynthetic pathway. Furthermore, we show that copper-intoxicated S. pneumoniae is rescued by manganese, which is an essential metal in the aerobic nucleotide synthesis pathway. These data provide insight into new targets to enhance copper-mediated toxicity during bacterial clearance. PMID:25730343

  19. Use of gallium scanning in predicting resolution of Legionnaires' pneumonia

    SciTech Connect

    Imbriano, L.J.; Mandel, P.R.; Cordaro, A.F.

    1983-01-01

    The value of Ga-67 scanning to detect acute infectious lung disease has been described. We present a patient who apparently improved both clinically and radiographically after acute Legionnaires' pneumonia. Five months later a relapse developed. During his relapse the pulmonary uptake of Ga-67 and the appearance of chest x-rays were disparate. We suggest that pulmonary Ga-67 uptake may be a more sensitive indicator of the resolution of pneumonia than is chest radiography. Therapeutic success may be assumed when pulmonary Ga-67 uptake is absent.

  20. Polymicrobial community-acquired pneumonia: An emerging entity.

    PubMed

    Cillóniz, Catia; Civljak, Rok; Nicolini, Antonello; Torres, Antoni

    2016-01-01

    Polymicrobial aetiology in community-acquired pneumonia (CAP) is more common than previously recognized. This growing new entity can influence inflammation, host immunity and disease outcomes in CAP patients. However, the true incidence is complicated to determine and probably underestimated due mainly to many cases going undetected, particularly in the outpatient setting, as the diagnostic yield is restricted by the sensitivity of currently available microbiologic tests and the ability to get certain types of clinical specimens. The observed rate of polymicrobial cases may also lead to new antibiotic therapy considerations. In this review, we discuss the pathogenesis, microbial interactions in pneumonia, epidemiology, biomarkers and antibiotic therapy for polymicrobial CAP.

  1. Care Seeking Behaviour for Children with Suspected Pneumonia in Countries in Sub-Saharan Africa with High Pneumonia Mortality

    PubMed Central

    Noordam, Aaltje Camielle; Carvajal-Velez, Liliana; Sharkey, Alyssa B.; Young, Mark; Cals, Jochen W. L.

    2015-01-01

    Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as ‘appropriate’ providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16–18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3–39.3) more likely to be brought for care than children from the poorest households, after controlling for the child’s age, sex, caregiver’s education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses. PMID:25706531

  2. Care seeking behaviour for children with suspected pneumonia in countries in sub-Saharan Africa with high pneumonia mortality.

    PubMed

    Noordam, Aaltje Camielle; Carvajal-Velez, Liliana; Sharkey, Alyssa B; Young, Mark; Cals, Jochen W L

    2015-01-01

    Pneumonia is the leading cause of childhood mortality in sub-Saharan Africa (SSA). Because effective antibiotic treatment exists, timely recognition of pneumonia and subsequent care seeking for treatment can prevent deaths. For six high pneumonia mortality countries in SSA we examined if children with suspected pneumonia were taken for care, and if so, from which type of care providers, using national survey data of 76530 children. We also assessed factors independently associated with care seeking from health providers, also known as 'appropriate' providers. We report important differences in care seeking patterns across these countries. In Tanzania 85% of children with suspected pneumonia were taken for care, whereas this was only 30% in Ethiopia. Most of the children living in these six countries were taken to a primary health care facility; 86, 68 and 59% in Ethiopia, Tanzania and Burkina Faso respectively. In Uganda, hospital care was sought for 60% of children. 16-18% of children were taken to a private pharmacy in Democratic Republic of Congo (DRC), Tanzania and Nigeria. In Tanzania, children from the richest households were 9.5 times (CI 2.3-39.3) more likely to be brought for care than children from the poorest households, after controlling for the child's age, sex, caregiver's education and urban-rural residence. The influence of the age of a child, when controlling for sex, urban-rural residence, education and wealth, shows that the youngest children (<2 years) were more likely to be brought to a care provider in Nigeria, Ethiopia and DRC. Urban-rural residence was not significantly associated with care seeking, after controlling for the age and sex of the child, caregivers education and wealth. The study suggests that it is crucial to understand country-specific care seeking patterns for children with suspected pneumonia and related determinants using available data prior to planning programmatic responses.

  3. Chlamydia pneumoniae infection-related hemophagocytic lymphohistiocytosis and acute encephalitis and poliomyelitis-like flaccid paralysis.

    PubMed

    Yagi, Kanae; Kano, Gen; Shibata, Mayumi; Sakamoto, Izumi; Matsui, Hirofumi; Imashuku, Shinsaku

    2011-05-01

    A 3-year-old male presented with Chlamydia pneumoniae infection-related hemophagocytic lymphohistiocytosis (HLH). The patient developed an episode of HLH with severe skin eruption following C. pneumoniae pneumonia. Symptoms responded to steroid/cyclosporine A therapy, but the patient slowly lost consciousness and developed systemic flaccid paralysis. He was diagnosed with encephalitis/myelitis by brain and spinal MRI. Neurological symptoms and signs gradually resolved. We thought that the immune response to C. pneumoniae infection triggered the development of HLH, associated with unusual neurological complications. This report describes a novel case of C. pneumoniae-associated HLH and with poliomyelitis like flaccid paralysis. PMID:21370423

  4. Identification of Bacterial and Viral Codetections With Mycoplasma pneumoniae Using the TaqMan Array Card in Patients Hospitalized With Community-Acquired Pneumonia.

    PubMed

    Diaz, Maureen H; Cross, Kristen E; Benitez, Alvaro J; Hicks, Lauri A; Kutty, Preeta; Bramley, Anna M; Chappell, James D; Hymas, Weston; Patel, Anami; Qi, Chao; Williams, Derek J; Arnold, Sandra R; Ampofo, Krow; Self, Wesley H; Grijalva, Carlos G; Anderson, Evan J; McCullers, Jonathan A; Pavia, Andrew T; Wunderink, Richard G; Edwards, Kathryn M; Jain, Seema; Winchell, Jonas M

    2016-03-01

    Mycoplasma pneumoniae was detected in a number of patients with community-acquired pneumonia in a recent prospective study. To assess whether other pathogens were also detected in these patients, TaqMan Array Cards were used to test 216 M pneumoniae-positive respiratory specimens for 25 additional viral and bacterial respiratory pathogens. It is interesting to note that 1 or more codetections, predominantly bacterial, were identified in approximately 60% of specimens, with codetections being more common in children. PMID:27191004

  5. Identification of Bacterial and Viral Codetections With Mycoplasma pneumoniae Using the TaqMan Array Card in Patients Hospitalized With Community-Acquired Pneumonia

    PubMed Central

    Diaz, Maureen H.; Cross, Kristen E.; Benitez, Alvaro J.; Hicks, Lauri A.; Kutty, Preeta; Bramley, Anna M.; Chappell, James D.; Hymas, Weston; Patel, Anami; Qi, Chao; Williams, Derek J.; Arnold, Sandra R.; Ampofo, Krow; Self, Wesley H.; Grijalva, Carlos G.; Anderson, Evan J.; McCullers, Jonathan A.; Pavia, Andrew T.; Wunderink, Richard G.; Edwards, Kathryn M.; Jain, Seema; Winchell, Jonas M.

    2016-01-01

    Mycoplasma pneumoniae was detected in a number of patients with community-acquired pneumonia in a recent prospective study. To assess whether other pathogens were also detected in these patients, TaqMan Array Cards were used to test 216 M pneumoniae-positive respiratory specimens for 25 additional viral and bacterial respiratory pathogens. It is interesting to note that 1 or more codetections, predominantly bacterial, were identified in approximately 60% of specimens, with codetections being more common in children. PMID:27191004

  6. Chlamydia pneumoniae CPj0783 interaction with Huntingtin-protein14.

    PubMed

    Yanatori, Izumi; Yasui, Yumiko; Ouchi, Kazunobu; Kishi, Fumio

    2015-12-01

    Chlamydia pneumoniae is a Gram-negative, obligate intracellular pathogen that causes community-acquired respiratory infections. After C. pneumoniae invades host cells, it disturbs the vesicle transport system to escape host lysosomal or autophagosomal degradation. By using a yeast mis-sorting assay, we found 10 C. pneumoniae candidate genes involved in aberrant vesicular trafficking in host cells. One of the candidate genes, CPj0783, was recognized by antibodies from C. pneumoniae-infected patients. The expression of CPj0783 was detected at mid to late-cycle time points and increased during the inclusion maturation. Two-hybrid screening in yeast cells revealed that CPj0783 interacted with Huntingtin-interacting protein 14 (HIP14). The specific interaction between CPj0783 and HIP14 could be demonstrated by an in vivo co-immunoprecipitation assay and an in vitro GST pull-down assay. It was also demonstrated that HIP14 was localized in the Golgi apparatus and colocalized with CPj0783. HIP14 has a palmitoyl transferase activity that is involved in the palmitoylation-dependent vesicular trafficking of several acylated proteins. These findings suggest that CPj0783 might cause abnormal vesicle-mediated transport by interacting with HIP14. [Int Microbiol 18(4):225-233 (2015)]. PMID:27611675

  7. Natural transformation and genome evolution in Streptococcus pneumoniae.

    PubMed

    Straume, Daniel; Stamsås, Gro Anita; Håvarstein, Leiv Sigve

    2015-07-01

    Streptococcus pneumoniae is a frequent colonizer of the human nasopharynx that has the potential to cause severe infections such as pneumonia, bacteremia and meningitis. Despite considerable efforts to reduce the burden of pneumococcal disease, it continues to be a major public health problem. After the Second World War, antimicrobial therapy was introduced to fight pneumococcal infections, followed by the first effective vaccines more than half a century later. These clinical interventions generated a selection pressure that drove the evolution of vaccine-escape mutants and strains that were highly resistant against antibiotics. The remarkable ability of S. pneumoniae to acquire drug resistance and evade vaccine pressure is due to its recombination-mediated genetic plasticity. S. pneumoniae is competent for natural genetic transformation, a property that enables the pneumococcus to acquire new traits by taking up naked DNA from the environment and incorporating it into its genome through homologous recombination. In the present paper, we review current knowledge on pneumococcal transformation, and discuss how the pneumococcus uses this mechanism to adapt and survive under adverse and fluctuating conditions. PMID:25445643

  8. [Legionella pneumonia after the use of CPAP equipment].

    PubMed

    Stolk, Jaap M; Russcher, Anne; van Elzakker, Erika P M; Schippers, Emile F

    2016-01-01

    Continuous positive airway pressure (CPAP) equipment can be colonised by Legionellae and might cause Legionella pneumonia in the user. However, there is no reported case of Legionella pneumonia related to CPAP equipment in which an identical Legionella was found in both the patient and the CPAP equipment. A 51-year-old man came to the Emergency Department with fever, confusion and dyspnoea that had been present for 3 days. His medical history included obstructive sleep apnoea, for which he had been using CPAP therapy at home for 10 weeks. The CPAP equipment showed signs of poor maintenance. Chest X-ray revealed a pulmonary consolidation. Laboratory investigation resulted in a positive urine antigen test for Legionella. Water from the CPAP equipment and sputum from the patient revealed Legionella pneumophila. Serotyping and sequence-based typing showed an identical L. pneumophila serotype 1 ST37. It is important to be aware that CPAP equipment can be colonised with Legionellae and might cause Legionella pneumonia. It is therefore necessary to ask about CPAP therapy in a patient with community-acquired pneumonia.

  9. Bordetella bronchiseptica and fatal pneumonia of dogs and cats

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Bordetella bronchiseptica frequently causes nonfatal tracheobronchitis, but its role in fatal pneumonia is less well-studied. The objectives of this study were to identify the frequency of Bordetella bronchiseptica infection in fatal cases of bronchopneumonia in dogs and cats and to compare the diag...

  10. CRYSTAL STRUCTURE ANALYSIS OF A PUTATIVE OXIDOREDUCTASE FROM KLEBSIELLA PNEUMONIAE

    SciTech Connect

    Baig, M.; Brown, A.; Eswaramoorthy, S.; Swaminathan, S.

    2009-01-01

    Klebsiella pneumoniae, a gram-negative enteric bacterium, is found in nosocomial infections which are acquired during hospital stays for about 10% of hospital patients in the United States. The crystal structure of a putative oxidoreductase from K. pneumoniae has been determined. The structural information of this K. pneumoniae protein was used to understand its function. Crystals of the putative oxidoreductase enzyme were obtained by the sitting drop vapor diffusion method using Polyethylene glycol (PEG) 3350, Bis-Tris buffer, pH 5.5 as precipitant. These crystals were used to collect X-ray data at beam line X12C of the National Synchrotron Light Source (NSLS) at Brookhaven National Laboratory (BNL). The crystal structure was determined using the SHELX program and refi ned with CNS 1.1. This protein, which is involved in the catalysis of an oxidation-reduction (redox) reaction, has an alpha/beta structure. It utilizes nicotinamide adenine dinucleotide phosphate (NADP) or nicotine adenine dinucleotide (NAD) to perform its function. This structure could be used to determine the active and co-factor binding sites of the protein, information that could help pharmaceutical companies in drug design and in determining the protein’s relationship to disease treatment such as that for pneumonia and other related pathologies.

  11. A Case of Pneumonia Caused by Raoultella planticola

    PubMed Central

    Cho, Young Jun; Seong, Ji Seok; Woo, Yong Moon; Jeong, Beom Jin; Kang, Yeong Mo; Lee, Eun

    2016-01-01

    Raoultella species are gram-negative, non-motile, aerobic bacilli that are primarily considered as environmental bacteria. Raoultella planticola is reportedly a rare cause of human infections. Also, the definite pathological mechanism of Raoultella planticola is currently unknown. We report a case of pneumonia caused by Raoultella planticola. PMID:26770234

  12. A Case of Pneumonia Caused by Raoultella planticola.

    PubMed

    Cho, Young Jun; Jung, Eun Jung; Seong, Ji Seok; Woo, Yong Moon; Jeong, Beom Jin; Kang, Yeong Mo; Lee, Eun

    2016-01-01

    Raoultella species are gram-negative, non-motile, aerobic bacilli that are primarily considered as environmental bacteria. Raoultella planticola is reportedly a rare cause of human infections. Also, the definite pathological mechanism of Raoultella planticola is currently unknown. We report a case of pneumonia caused by Raoultella planticola.

  13. Activity of faropenem against resistant isolates of Streptococcus pneumoniae.

    PubMed

    Black, J A; Moland, E S; Chartrand, S A; Thomson, K S

    2001-01-01

    An in vitro study of the activity of 9 agents against 181 US pediatric isolates of Streptococcus pneumoniae identified imipenem and faropenem as the most active agents. Overall, faropenem was the most potent oral agent inhibiting 98% of isolates at 1 microg/mL. PMID:11687320

  14. Sendai viral pneumonia in aged BALB/c mice.

    PubMed

    Jacoby, R O; Bhatt, P N; Barthold, S W; Brownstein, D G

    1994-01-01

    Sendai virus (SV) infection in aged BALB/c mice was evaluated as a natural model for age-associated susceptibility to viral pneumonia. Young (2 month-old) and aged (22-24 month-old) BALB/c mice were inoculated intranasally with 100 median pneumonia doses (PD50) of SV and examined at 6, 10, and 20 days by virus titration, immunohistochemistry, histopathology, and serology. The aged mice had significantly higher virus titers in lung, prolonged infection, delayed development, and resolution of pneumonia and significantly lower serum antibody titers. In a second experiment, the responses of young mice were compared to intermediate-aged mice (11-13 and 17-18 months old). The intermediate-aged mice had some characteristics of young mice and others of aged mice. The results indicate that SV infection can be used to study aging-associated susceptibility to a pneumotropic virus in a natural host, and that susceptibility of mice to viral pneumonia increases gradually during aging.

  15. Bordetella bronchiseptica pneumonia in a patient with AIDS.

    PubMed Central

    de la Fuente, J; Albo, C; Rodríguez, A; Sopeña, B; Martínez, C

    1994-01-01

    Bordetella bronchiseptica is recognised as a respiratory tract pathogen in many mammalian species, but has rarely been implicated in human infection. A case is reported of pneumonia caused by B bronchiseptica in a patient suffering from acquired immunodeficiency syndrome (AIDS). Images PMID:8066571

  16. Mycoplasma pneumoniae and Its Role as a Human Pathogen

    PubMed Central

    Waites, Ken B.; Talkington, Deborah F.

    2004-01-01

    Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur. PMID:15489344

  17. [CAPNETZ. The competence network for community-acquired pneumonia (CAP)].

    PubMed

    Suttorp, Norbert; Welte, Tobias; Marre, Reinhard; Stenger, Steffen; Pletz, Mathias; Rupp, Jan; Schütte, Hartwig; Rohde, Gernot

    2016-04-01

    CAPNETZ is a medical competence network for community-acquired pneumonia (CAP), which was funded by the German Ministry for Education and Research. It has accomplished seminal work on pneumonia over the last 15 years. A unique infrastructure was established which has so far allowed us to recruit and analyze more than 11,000 patients. The CAPNETZ cohort is the largest cohort worldwide and the results obtained relate to all relevant aspects of CAP management (epidemiology, risk stratification via biomarkers or clinical scores, pathogen spectrum, pathogen resistance, antibiotic management, prevention and health care research). Results were published in more than 150 journals and informed the preparation and update of the national S3-guideline. CAPNETZ was also the foundation for further networks like the Pneumonia Research Network on Genetic Resistance and Susceptibility for the Evolution of Severe Sepsis) (PROGRESS), the Systems Medicine of Community Acquired Pneumonia Network (CAPSyS) and SFB-TR84 (Sonderforschungsbereich - Transregio 84). The main recipients (Charité Berlin, University Clinic Ulm and the Hannover Medical School) founded the CAPNETZ foundation and transferred all data and materials rights to this foundation. Moreover, the ministry granted the CAPNETZ foundation the status of being eligible to apply for research proposals and receive research funds. Since 2013 the CAPNETZ foundation has been an associated member of the German Center for Lung Research (DZL). Thus, a solid foundation has been set up for CAPNETZ to continue its success story. PMID:26984399

  18. Organized Pneumonia Secondary to Increasing Doses of Temozolomide

    PubMed Central

    Consuegra Vanegas, Angélica; Matachana Martínez, María; Cordero Lorenzana, Lourdes; Vidal García, Iria; Montero Martínez, Carmen

    2015-01-01

    Surgery, radiotherapy (RT), and chemotherapy have a role in the control of tumor growth, progression, and recurrence in high-grade gliomas. Temozolomide has been incorporated as the main chemotherapy agent for managing these tumors. Here, we present a case of a patient who developed a severe organizing pneumonia after increasing doses of temozolomide for a high-grade glioma. PMID:26487994

  19. Pulmonary interstitial emphysema complicating pneumonia in an unventilated term infant.

    PubMed

    Lee, Hyun Seung; Im, Soo Ah

    2010-09-01

    A case of pulmonary interstitial emphysema with pneumothorax and pneumomediastinum complicating pneumonia in a 6-week-old infant is reported. The patient had no history of resuscitation, bag and mask ventilation, nasal continuous positive airway pressure or mechanical ventilation. PMID:20799076

  20. Following the equator: division site selection in Streptococcus pneumoniae.

    PubMed

    Bramkamp, Marc

    2015-03-01

    The mechanisms that spatially regulate cytokinesis are more diverse than initially thought. In two recent publications a positive regulator of FtsZ positioning has been identified in Streptococcus pneumoniae. MapZ (LocZ) connects the division machinery with cell wall elongation, providing a simple mechanism to ensure correct division site selection.

  1. The power of data mining in diagnosis of childhood pneumonia

    PubMed Central

    Howie, Stephen; Casals-Pascual, Climent; De Vos, Maarten

    2016-01-01

    Childhood pneumonia is the leading cause of death of children under the age of 5 years globally. Diagnostic information on the presence of infection, severity and aetiology (bacterial versus viral) is crucial for appropriate treatment. However, the derivation of such information requires advanced equipment (such as X-rays) and clinical expertise to correctly assess observational clinical signs (such as chest indrawing); both of these are often unavailable in resource-constrained settings. In this study, these challenges were addressed through the development of a suite of data mining tools, facilitating automated diagnosis through quantifiable features. Findings were validated on a large dataset comprising 780 children diagnosed with pneumonia and 801 age-matched healthy controls. Pneumonia was identified via four quantifiable vital signs (98.2% sensitivity and 97.6% specificity). Moreover, it was shown that severity can be determined through a combination of three vital signs and two lung sounds (72.4% sensitivity and 82.2% specificity); addition of a conventional biomarker (C-reactive protein) further improved severity predictions (89.1% sensitivity and 81.3% specificity). Finally, we demonstrated that aetiology can be determined using three vital signs and a newly proposed biomarker (lipocalin-2) (81.8% sensitivity and 90.6% specificity). These results suggest that a suite of carefully designed machine learning tools can be used to support multi-faceted diagnosis of childhood pneumonia in resource-constrained settings, compensating for the shortage of expensive equipment and highly trained clinicians. PMID:27466436

  2. Chlamydia Pneumoniae Infections and Sudden Unexpected Deaths in Denmark.

    ERIC Educational Resources Information Center

    Johannsen, Finn

    1993-01-01

    Blood samples from 38 runners on the Danish national orienteering team revealed no ongoing chlamydia pneumoniae, although 42% had an earlier infection, similar to the incidence in the general population. However, over 2% had an ongoing lyme borreliosis infection, and 18% had an earlier infection, which is a higher incidence than in the general…

  3. Bronchiolitis obliterans organizing pneumonia and Sjögren's syndrome.

    PubMed

    Matteson, E L; Ike, R W

    1990-05-01

    A 52-year-old man developed a systemic illness with fever, malaise, cough, dry eyes and mouth. Investigation revealed bronchiolitis obliterans organizing pneumonia associated with retinal vasculitis, hepatic and renal involvement, lymphocytic sialoadenitis and symptoms of the sicca complex. High dose steroid treatment resulted in resolution of his symptoms and prolonged remission. PMID:2359080

  4. Chlamydia pneumoniae encodes a functional aromatic amino acid hydroxylase.

    PubMed

    Abromaitis, Stephanie; Hefty, P Scott; Stephens, Richard S

    2009-03-01

    Chlamydia pneumoniae is a community-acquired respiratory pathogen that has been associated with the development of atherosclerosis. Analysis of the C. pneumoniae genome identified a gene (Cpn1046) homologous to eukaryotic aromatic amino acid hydroxylases (AroAA-Hs). AroAA-Hs hydroxylate phenylalanine, tyrosine, and tryptophan into tyrosine, dihydroxyphenylalanine, and 5-hydroxytryptophan, respectively. Sequence analysis of Cpn1046 demonstrated that residues essential for AroAA-H enzymatic function are conserved and that a subset of Chlamydia species contain an AroAA-H homolog. The chlamydial AroAA-Hs are transcriptionally linked to a putative bacterial membrane transport protein. We determined that recombinant Cpn1046 is able to hydroxylate phenylalanine, tyrosine, and tryptophan with roughly equivalent activity for all three substrates. Cpn1046 is expressed within 24 h of infection, allowing C. pneumoniae to hydroxylate host stores of aromatic amino acids during the period of logarithmic bacterial growth. From these results we can conclude that C. pneumoniae, as well as a subset of other Chlamydia species, encode an AroAA-H that is able to use all three aromatic amino acids as substrates. The maintenance of this gene within a number of Chlamydia suggests that the enzyme may have an important role in shaping the metabolism or overall pathogenesis of these bacteria. PMID:19141112

  5. Atmospheric pollutants and hospital admissions due to pneumonia in children

    PubMed Central

    Negrisoli, Juliana; Nascimento, Luiz Fernando C.

    2013-01-01

    OBJECTIVE: To analyze the relationship between exposure to air pollutants and hospitalizations due to pneumonia in children of Sorocaba, São Paulo, Brazil. METHODS: Time series ecological study, from 2007 to 2008. Daily data were obtained from the State Environmental Agency for Pollution Control for particulate matter, nitric oxide, nitrogen dioxide, ozone, besides air temperature and relative humidity. The data concerning pneumonia admissions were collected in the public health system of Sorocaba. Correlations between the variables of interest using Pearson cofficient were calculated. Models with lags from zero to five days after exposure to pollutants were performed to analyze the association between the exposure to environmental pollutants and hospital admissions. The analysis used the generalized linear model of Poisson regression, being significant p<0.05. RESULTS: There were 1,825 admissions for pneumonia, with a daily mean of 2.5±2.1. There was a strong correlation between pollutants and hospital admissions, except for ozone. Regarding the Poisson regression analysis with the multi-pollutant model, only nitrogen dioxide was statistically significant in the same day (relative risk - RR=1.016), as well as particulate matter with a lag of four days (RR=1.009) after exposure to pollutants. CONCLUSIONS: There was an acute effect of exposure to nitrogen dioxide and a later effect of exposure to particulate matter on children hospitalizations for pneumonia in Sorocaba. PMID:24473956

  6. [ANEMIC SYNDROME IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA].

    PubMed

    Budnevsky, A V; Esaulenko, I E; Ovsyannikov, E S; Labzhaniya, N B; Voronina, E V; Chernov, A V

    2016-01-01

    Community-acquired pneumonia remains a most widespread acute infectious disease of socio-economic significance all over the world. Up to 30% of the patients present with anemia responsible for the unfavourable prognosis and elevated mortality. Not infrequently, anemia is not diagnosed during the hospital stay und therefore remains uncorrected. Severe anemia results in enhanced hypercapnia and slowed maturation of red blood cells in the bone marrow which facilitates the development of ischemic syndrome. Hepcidin, a mediator of inflammation and iron-regulatory hormone, plays an important role in the clinical course of community-acquired pneumonia. Hepsidin production increases during inflammation; it suppresses erythtropoiesis and depletes the iron depot leading to so-called anemia of inflammation. Hypoxia and anemia activate erythtropoiesis, and the released erythropoietin inhibits hepsidin production. During pneumonia resolution, hepsidin promotes recovery from anemia by activating iron absorption. The curreni literature contains few data on the use of hepcidin as a diagnostic marker of anemia. The necessity oftreating anemia in patients with pneumonia under hospital conditions is a matter of discussion. Direct involvement of hepcidin in iron metabolism creates a prerequisite for the treatment of anemia. Medicamental suppression of its activity by stimulating erythtropoiesis can facilitate normalization of iron metabolism and restoration of hemoglobin level.

  7. Multiple biotypes of Klebsiella pneumoniae in single clinical specimens.

    PubMed

    de Silva, M I; Rubin, S J

    1977-01-01

    The occurence of multiple biotypes of Klebsiella pneumoniae within single specimens was determined in 59 clinical specimens. Biotyping was performed on five colonies of K. pneumoniae from each specimen, using the API 20E system (Analytab, Inc., New York) for identification of Enterobacteriaceae with strict adherence to the manufacturer's instructions. Multiple biotypes of K. pneumoniae were present in 31% (18) of the clinical specimens. Twenty-eight colonies representative of specimens with single and multiple biotypes were tested further for biotype reproducibility. Whereas genus and species identification was 100% reproducible, variation of one or more biochemical tests on serial transfers resulted in biotype reproducibility of only 64%. The greatest variation in biochemical tests occurred with urease (14%), indole production (10%) and citrate utilization (9%). Multiple biotypes in single specimens appear to be due to both inherent differences among the colonies in the specimen and variability in the system used to determine biochemical reactions. The presence of multiple biotypes limits the usefulness of biochemical typing for epidemiological surveilance of K. pneumoniae.

  8. Oxygen effects on mortality of mice infected with Diplococcus pneumoniae

    NASA Technical Reports Server (NTRS)

    Angrick, E. J.; Somerson, N. L.; Weiss, H. S.

    1974-01-01

    Mice infected by intraperitoneal injection of Diplococcus pneumoniae were held at 1 atm in either hypoxic (12%), hyperoxic (75%), or a normal (21%) oxygen environment. Mortality rates indicated prolongation of survival in hypoxia and shortened survival in hyperoxia. Exposure of mice to the experimental gas mixtures prior to inoculation did not alter the results.

  9. Feasibility and Safety of Local Treatment with Recombinant Human Tissue Factor Pathway Inhibitor in a Rat Model of Streptococcus pneumoniae Pneumonia

    PubMed Central

    van den Boogaard, Florry E.; Hofstra, Jorrit J.; van ‘t Veer, Cornelis; Levi, Marcel M.; Roelofs, Joris J. T. H.; van der Poll, Tom; Schultz, Marcus J.

    2015-01-01

    Pulmonary coagulopathy is intrinsic to pulmonary injury including pneumonia. Anticoagulant strategies could benefit patients with pneumonia, but systemic administration of anticoagulant agents may lead to suboptimal local levels and may cause systemic hemorrhage. We hypothesized nebulization to provide a safer and more effective route for local administration of anticoagulants. Therefore, we aimed to examine feasibility and safety of nebulization of recombinant human tissue factor pathway inhibitor (rh-TFPI) in a well-established rat model of Streptococcus (S.) pneumoniae pneumonia. Thirty minutes before and every 6 hours after intratracheal instillation of S. pneumonia causing pneumonia, rats were subjected to local treatment with rh-TFPI or placebo, and sacrificed after 42 hours. Pneumonia was associated with local as well as systemic activation of coagulation. Nebulization of rh-TFPI resulted in high levels of rh-TFPI in bronchoalveolar lavage fluid, which was accompanied by an attenuation of pulmonary coagulation. Systemic rh-TFPI levels remained undetectable, and systemic TFPI activity and systemic coagulation were not affected. Histopathology revealed no bleeding in the lungs. We conclude that nebulization of rh-TFPI seems feasible and safe; local anticoagulant treatment with rh-TFPI attenuates pulmonary coagulation, while not affecting systemic coagulation in a rat model of S. pneumoniae pneumonia. PMID:25992779

  10. Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia

    PubMed Central

    Yao, Sheldon; Hassani, John; Gagne, Martin; George, Gebe; Gilliar, Wolfgang

    2014-01-01

    Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 20071 and resulted in the hospitalization of 1.1 million patients2. With an average length of in-patient hospital stay of five days2, pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 20053. Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence4. (Figure 1) Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients’ length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone5. The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians6. When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems7,8, 9, 10. The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and lymphatic systems

  11. Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment

    PubMed Central

    Pereyre, Sabine; Goret, Julien; Bébéar, Cécile

    2016-01-01

    Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults. These infections occur both endemically and epidemically worldwide. M. pneumoniae lacks cell wall and is subsequently resistant to beta-lactams and to all antimicrobials targeting the cell wall. This mycoplasma is intrinsically susceptible to macrolides and related antibiotics, to tetracyclines and to fluoroquinolones. Macrolides and related antibiotics are the first-line treatment of M. pneumoniae respiratory tract infections mainly because of their low MIC against the bacteria, their low toxicity and the absence of contraindication in young children. The newer macrolides are now the preferred agents with a 7-to-14 day course of oral clarithromycin or a 5-day course of oral azithromycin for treatment of community-acquired pneumonia due to M. pneumoniae, according to the different guidelines worldwide. However, macrolide resistance has been spreading for 15 years worldwide, with prevalence now ranging between 0 and 15% in Europe and the USA, approximately 30% in Israel and up to 90–100% in Asia. This resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides. Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens. Because this resistance has clinical outcomes such as longer duration of fever, cough and hospital stay, alternative antibiotic treatment can be required, including tetracyclines such as doxycycline and minocycline or fluoroquinolones, primarily levofloxacin, during 7–14 days, even though fluoroquinolones and tetracyclines are contraindicated in all children and in children < 8 year-old, respectively. Acquired resistance to tetracyclines and fluoroquinolones has never been reported in M. pneumoniae clinical isolates but reduced susceptibility was reported

  12. Osteopathic manipulative treatment as a useful adjunctive tool for pneumonia.

    PubMed

    Yao, Sheldon; Hassani, John; Gagne, Martin; George, Gebe; Gilliar, Wolfgang

    2014-05-06

    Pneumonia, the inflammatory state of lung tissue primarily due to microbial infection, claimed 52,306 lives in the United States in 2007 (1) and resulted in the hospitalization of 1.1 million patients (2). With an average length of in-patient hospital stay of five days (2), pneumonia and influenza comprise significant financial burden costing the United States $40.2 billion in 2005 (3). Under the current Infectious Disease Society of America/American Thoracic Society guidelines, standard-of-care recommendations include the rapid administration of an appropriate antibiotic regiment, fluid replacement, and ventilation (if necessary). Non-standard therapies include the use of corticosteroids and statins; however, these therapies lack conclusive supporting evidence (4). (Figure 1) Osteopathic Manipulative Treatment (OMT) is a cost-effective adjunctive treatment of pneumonia that has been shown to reduce patients' length of hospital stay, duration of intravenous antibiotics, and incidence of respiratory failure or death when compared to subjects who received conventional care alone (5). The use of manual manipulation techniques for pneumonia was first recorded as early as the Spanish influenza pandemic of 1918, when patients treated with standard medical care had an estimated mortality rate of 33%, compared to a 10% mortality rate in patients treated by osteopathic physicians (6). When applied to the management of pneumonia, manual manipulation techniques bolster lymphatic flow, respiratory function, and immunological defense by targeting anatomical structures involved in the these systems(7,8, 9, 10). The objective of this review video-article is three-fold: a) summarize the findings of randomized controlled studies on the efficacy of OMT in adult patients with diagnosed pneumonia, b) demonstrate established protocols utilized by osteopathic physicians treating pneumonia, c) elucidate the physiological mechanisms behind manual manipulation of the respiratory and

  13. Mycoplasma pneumoniae: Current Knowledge on Macrolide Resistance and Treatment.

    PubMed

    Pereyre, Sabine; Goret, Julien; Bébéar, Cécile

    2016-01-01

    Mycoplasma pneumoniae causes community-acquired respiratory tract infections, particularly in school-aged children and young adults. These infections occur both endemically and epidemically worldwide. M. pneumoniae lacks cell wall and is subsequently resistant to beta-lactams and to all antimicrobials targeting the cell wall. This mycoplasma is intrinsically susceptible to macrolides and related antibiotics, to tetracyclines and to fluoroquinolones. Macrolides and related antibiotics are the first-line treatment of M. pneumoniae respiratory tract infections mainly because of their low MIC against the bacteria, their low toxicity and the absence of contraindication in young children. The newer macrolides are now the preferred agents with a 7-to-14 day course of oral clarithromycin or a 5-day course of oral azithromycin for treatment of community-acquired pneumonia due to M. pneumoniae, according to the different guidelines worldwide. However, macrolide resistance has been spreading for 15 years worldwide, with prevalence now ranging between 0 and 15% in Europe and the USA, approximately 30% in Israel and up to 90-100% in Asia. This resistance is associated with point mutations in the peptidyl-transferase loop of the 23S rRNA and leads to high-level resistance to macrolides. Macrolide resistance-associated mutations can be detected using several molecular methods applicable directly from respiratory specimens. Because this resistance has clinical outcomes such as longer duration of fever, cough and hospital stay, alternative antibiotic treatment can be required, including tetracyclines such as doxycycline and minocycline or fluoroquinolones, primarily levofloxacin, during 7-14 days, even though fluoroquinolones and tetracyclines are contraindicated in all children and in children < 8 year-old, respectively. Acquired resistance to tetracyclines and fluoroquinolones has never been reported in M. pneumoniae clinical isolates but reduced susceptibility was reported in in

  14. Mothers' Perception and Healthcare Seeking Behavior of Pneumonia Children in Rural Bangladesh

    PubMed Central

    Ferdous, Farzana; Dil Farzana, Fahmida; Ahmed, Shahnawaz; Das, Sumon Kumar; Malek, Mohammad Abdul; Das, Jui; Faruque, Abu Syed Golam; Chisti, Mohammod Jobayer

    2014-01-01

    We describe mothers' perception about signs and symptoms, causes of the illness, and healthcare seeking behaviors related to pneumonia and express the major modifiable barriers to seeking timely treatment when their under-5 children had pneumonia in rural Bangladesh. Using focus group discussion, we understood mothers' perception and healthcare seeking behavior of childhood pneumonia. Although mothers described pneumonia as a serious life threatening disease in young children but most of the mothers (n = 24) could not diagnose whether their child had pneumonia or not. Environmental factors such as dust particles, spread from coughing mother, and drinking cold water or playing with water were perceived as the causes for pneumonia. Three common barriers noted were as follows: illness was not perceived as serious enough or distance from healthcare facility or lack of money at household for seeking treatment outside. Most of the rural mothers did not have knowledge about severity of childhood pneumonia. PMID:24967328

  15. Molecular characterization of clinical multidrug-resistant Klebsiella pneumoniae isolates

    PubMed Central

    2014-01-01

    Background Klebsiella pneumoniae is a frequent nosocomial pathogen, with the multidrug-resistant (MDR) K. pneumoniae being a major public health concern, frequently causing difficult-to-treat infections worldwide. The aim of this study was to investigate the molecular characterization of clinical MDR Klebsiella pneumoniae isolates. Methods A total of 27 non-duplicate MDR K. pneumoniae isolates with a CTX-CIP-AK resistance pattern were investigated for the prevalence of antimicrobial resistance genes including extended spectrum β-lactamase genes (ESBLs), plasmid-mediated quinolone resistance (PMQR) genes, 16S rRNA methylase (16S-RMTase) genes, and integrons by polymerase chain reaction (PCR) amplification and DNA sequencing. Plasmid replicons were typed by PCR-based replicon typing (PBRT). Multi-locus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were carried out to characterize the strain relatedness. Results All the isolates co-harbored 3 or more resistance determinants. OqxAB, CTX-M-type ESBLs and RmtB were the most frequent determinants, distributed among19 (70.4%),18 (66.7%) and 8 (29.6%) strains. Fourteen isolates harbored class 1 integrons, with orfD-aacA4 being the most frequent gene cassette array. Class 3 integrons were less frequently identified and contained the gene cassette array of blaGES-1-blaOXA-10-aac(6′)-Ib. IncFII replicon was most commonly found in this collection. One cluster was observed with ≥80% similarity among profiles obtained by PFGE, and one sequence type (ST) by MLST, namely ST11, was observed in the cluster. Conclusion K. pneumoniae carbapenemase (KPC)–producing ST11 was the main clone detected. Of particular concern was the high prevalence of multiple resistance determinants, classs I integrons and IncFII plasmid replicon among these MDR strains, which provide advantages for the rapid development of MDR strains. PMID:24884610

  16. Early non-invasive ventilation treatment for severe influenza pneumonia.

    PubMed

    Masclans, J R; Pérez, M; Almirall, J; Lorente, L; Marqués, A; Socias, L; Vidaur, L; Rello, J

    2013-03-01

    The role of non-invasive ventilation (NIV) in acute respiratory failure caused by viral pneumonia remains controversial. Our objective was to evaluate the use of NIV in a cohort of (H1N1)v pneumonia. Usefulness and success of NIV were assessed in a prospective, observational registry of patients with influenza A (H1N1) virus pneumonia in 148 Spanish intensive care units (ICUs) in 2009-10. Significant variables for NIV success were included in a multivariate analysis. In all, 685 patients with confirmed influenza A (H1N1)v viral pneumonia were admitted to participating ICUs; 489 were ventilated, 177 with NIV. The NIV was successful in 72 patients (40.7%), the rest required intubation. Low Acute Physiology and Chronic Health Evaluation (APACHE) II, low Sequential Organ Failure Assessment (SOFA) and absence of renal failure were associated with NIV success. Success of NIV was independently associated with fewer than two chest X-ray quadrant opacities (OR 3.5) and no vasopressor requirement (OR 8.1). However, among patients with two or more quadrant opacities, a SOFA score ≤7 presented a higher success rate than those with SOFA score >7 (OR 10.7). Patients in whom NIV was successful required shorter ventilation time, shorter ICU stay and hospital stay than NIV failure. In patients in whom NIV failed, the delay in intubation did not increase mortality (26.5% versus 24.2%). Clinicians used NIV in 25.8% of influenza A (H1N1)v viral pneumonia admitted to ICU, and treatment was effective in 40.6% of them. NIV success was associated with shorter hospital stay and mortality similar to non-ventilated patients. NIV failure was associated with a mortality similar to those who were intubated from the start.

  17. Resveratrol ameliorates Serratia marcescens-induced acute pneumonia in rats.

    PubMed

    Lu, Chia-Chen; Lai, Hsin-Chih; Hsieh, Shang-Chen; Chen, Jan-Kan

    2008-04-01

    Serratia marcescens is an important nosocomial pathogen, which has been especially problematic as a cause of hospital-acquired pneumonia in the past two decades. Treatment of S. marcescens-related infections has been limited by emergence of multiple drug-resistant strains. Thus, the development of alternative agents for the prevention and treatment of Serratia infection is urgently needed. Resveratrol (RSV) is a compound with diverse biological effects including anti-cancer, anti-inflammation, anti-diabetes, and cancer chemoprevention. Whether RSV has in vivo prophylactic or therapeutic potential against infection remains uncharacterized. In the present study, we used a murine acute pneumonia model initiated by intratracheal application of S. marcescens to evaluate whether RSV possesses anti-infection properties. We showed that pretreatment with RSV for 3 days markedly increased alveolar macrophage infiltration, elevated NK cell activity, and decreased bacterial burden in the infected lung with a subsequent decrease in mortality. These effects were associated with significantly less-severe inflammatory phenotypes in lung tissue and bronchoalveolar lavage fluid, including reduced neutrophil infiltration of the lungs, reduced phagocytosis activity, and reduced secretion of cytokines such as TNF-alpha, IL-1beta, and IL-6. To further characterize the underlying mechanism responsible for these effects of RSV, LPS derived from S. marcescens was used to induce acute pneumonia in rats, with or without RSV pretreatment. RSV was shown to ameliorate acute pneumonia via inhibition of the NF-kappaB signaling pathway, including inhibition of IkappaBalpha phosphorylation and subsequent NF-kappaB activation. These findings suggest that RSV might be beneficial as a prophylactic treatment in patients at risk of an episode of S. marcescens-induced acute pneumonia.

  18. Asthma after childhood pneumonia: six year follow up study

    PubMed Central

    Clark, Christopher E; Coote, Jacqueline M; Silver, David A T; Halpin, David M G

    2000-01-01

    Objective To establish the long term cumulative prevalence of asthma in children admitted to hospital with pneumonia and to examine the hypothesis that some children admitted to hospital with pneumonia may be presenting with undiagnosed asthma. Design Prospective study of a cohort of children previously admitted to hospital with pneumonia, followed up by postal questionnaires to their general practitioners and the children or their parents. Setting General practices in southwest England. Participants 78 children admitted to the Royal Devon and Exeter Hospital between 1989 and 1991 with a diagnosis of pneumonia confirmed on independent review of x ray films. Main outcome measures Any diagnosis of asthma, use of any treatment for asthma, and asthma symptom scores. Results On the basis of a 100% response rate from general practitioners and 86% from patients or parents, the cumulative prevalence of asthma was 45%. A diagnosis of asthma was associated with a family history of asthma (odds ratio 11.23; 95% confidence interval 2.57 to 56.36; P=0.0002). Mean symptom scores were higher for all children with asthma (mean score 2.4; χ2=14.88; P=0.0001) and for children with asthma not being treated (mean 1.4; χ2=6.2; P=0.01) than for those without asthma (mean 0.2) . Conclusions A considerable proportion of children presenting to a district general hospital with pneumonia either already have unrecognised asthma or subsequently develop asthma. The high cumulative prevalence of asthma suggests that careful follow up of such children is worth while. Asthma is undertreated in these children; a structured symptom questionnaire may help to identify and reduce morbidity due to undertreatment. PMID:10834897

  19. Metabolomic Profiling of Infectious Parapneumonic Effusions Reveals Biomarkers for Guiding Management of Children with Streptococcus pneumoniae Pneumonia

    PubMed Central

    Chiu, Chih-Yung; Lin, Gigin; Cheng, Mei-Ling; Chiang, Meng-Han; Tsai, Ming-Han; Lai, Shen-Hao; Wong, Kin-Sun; Hsieh, Sen-Yung

    2016-01-01

    Metabolic markers in biofluids represent an attractive tool for guiding clinical management. The aim of this study was to identify metabolic mechanisms during the progress of pleural infection in children with Streptococcus pneumoniae pneumonia. Forty children diagnosed with pneumococcal pneumonia were enrolled and analysis of pleural fluid metabolites categorized by complicated parapneumonic effusions (CPE) and non-CPE was assessed by using 1H-NMR spectroscopy. Multivariate statistical analysis including principal components analysis (PCA) and partial least-squares discriminant analysis (PLS-DA) were performed. Metabolites identified were studied in relation to subsequent intervention procedures by receiver operating characteristic (ROC) curve analysis. Ten metabolites significantly different between CPE and non-CPE were identified. A significantly lower level of glucose for glycolysis was found in CPE compared to non-CPE. Six metabolites involving bacterial biosynthesis and three metabolites involving bacterial fermentation were significantly higher in CPE compared to non-CPE. Glucose and 3-hydroxybutyric acid were the metabolites found to be useful in discriminating from receiving intervention procedures. Metabolic profiling of pleural fluid using 1H-NMR spectroscopy provides direct observation of bacterial metabolism in the progress of pneumococcal pneumonia. An increase in the metabolism of butyric acid fermentation of glucose could potentially lead to the need of aggressive pleural drainage. PMID:27103079

  20. Destruction of single-species biofilms of Escherichia coli or Klebsiella pneumoniae subsp. pneumoniae by dextranase, lactoferrin, and lysozyme

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The activity of dextranase, lactoferrin, lysozyme, and nisin against biofilms composed of either Klebsiella pneumonia or Escherichia coli was examined using the MBEC Assay™. Mature biofilms were treated and then sonicated to remove the adherent biofilm. This material was quantified using a lumines...

  1. [Autopsy case of pulmonary zygomycosis and pneumocystis pneumonia in a patient with interstitial pneumonia treated by corticosteroid therapy].

    PubMed

    Mukasa, Yosuke; Ichiyasu, Hidenori; Akaike, Kimitaka; Okamoto, Shinichiro; Komohara, Yoshihiro; Kohrogi, Hirotsugu

    2010-11-01

    We report a 75-year-old man with pneumoconiosis, interstitial pneumonia and diabetes mellitus, who had carcinoma of the buccal mucosa. After resection of the carcinoma, he was given corticosteroids for the deterioration of interstitial pneumonia, but 38 days after initiating steroid therapy, he was admitted to our hospital with severe hypoxemia and multiple cavitary lesions superimposed on ground-glass attenuation in both lung fields. The Aspergillus antigen was positive in his serum and examination of his bronchoalveolar lavage (BAL) fluid revealed mixed infections with filamentous fungus and Pneumocystis jirovecii. Pulmonary aspergillosis and pneumocystis pneumonia with an immunocompromised state was diagnosed, and voriconazole, sulfamethoxazole-trimethoprim and high-dose corticosteroids were given. At 20 days after these treatments he developed bloody sputum, and Cunninghamella bertholletiae was isolated from the BAL fluid obtained at admission. A diagnosis of pulmonary zygomycosis was finally established. Amphotericin B therapy was started, and the dose was increased thereafter. Despite intensive treatment he died 18 days later. Histological examination of lung tissue obtained at autopsy showed invasive growth of zygomycetes in the necrotic tissue and the cavity wall. To the best of our knowledge, this is the first report of concurrent Cunninghamella bertholletiae and Pneumocystis jirovecii infection during steroid therapy for interstitial pneumonia. PMID:21141065

  2. A protein-based pneumococcal vaccine protects rhesus macaques from pneumonia after experimental infection with Streptococcus pneumoniae

    PubMed Central

    Denoël, Philippe; Philipp, Mario T; Doyle, Lara; Martin, Dale; Carletti, Georges; Poolman, Jan T

    2016-01-01

    Infections caused by Streptococcus pneumoniae are a major cause of mortality throughout the world. Protein-based pneumococcal vaccines are envisaged to replace or complement the current polysaccharide-based vaccines. In this context, detoxified pneumolysin (dPly) and pneumococcal histidine triad protein D (PhtD) are two potential candidates for incorporation into pneumococcal vaccines. In this study, the protective efficacy of a PhtD-dPly vaccine was evaluated in a rhesus macaque (Macaca mulatta) model of pneumonia. The animals were immunized twice with 10 µg of PhD and 10 µg of dPly formulated in the Adjuvant System AS02 or with AS02 alone, before they were challenged with a 19F pneumococcal strain. The survival was significantly higher in the protein-vaccinated group and seemed to be linked to the capacity to greatly reduce bacterial load within the first week post-challenge. Vaccination elicited high concentrations of anti-PhtD and anti-Ply antibodies and a link was found between survival and antibody levels. In conclusion, AS02-adjuvanted PhtD-dPly vaccine protects against S. pneumoniae-induced pneumonia. It is probable that the protection is at least partially mediated by PhtD- and Ply-specific antibodies. PMID:21624422

  3. Retrospective investigation of the clinical effects of tazobactam/piperacillin and sulbactam/ampicillin on aspiration pneumonia caused by Klebsiella pneumoniae.

    PubMed

    Tsukada, Hiroki; Sakai, Kunihiko; Cho, Hiromi; Kimura, Yuka; Tetsuka, Takafumi; Nakajima, Haruhiko; Ito, Kazuhiko

    2012-10-01

    Klebsiella pneumoniae is an important causative bacterium of aspiration pneumonia in many elderly patients. We retrospectively investigated the clinical effects of the early treatment of aspiration pneumonia and background factors in 24 patients from whom Klebsiella pneumoniae was isolated. Sulbactam/ampicillin (SBT/ABPC) was selected for early treatment in 12 of the 24 patients diagnosed with aspiration pneumonia, and tazobactam/piperacillin (TAZ/PIPC) was selected for the other patients. The effective rates and success rates of early treatment were significantly higher in the TAZ/PIPC group than in the SBT/ABPC group (p = 0.003 and 0.027, respectively). Although no significant difference was noted because of the limited number of cases, the survival rates after 30 days were 91.7 and 58.3 % in the TAZ/PIPC and SBT/ABPC groups, respectively. Several bacteria isolated with Klebsiella pneumoniae were resistant bacteria, such as methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, and no anaerobe or extended-spectrum β-lactamase-producing Klebsiella pneumoniae was isolated. Thirteen and 11 of the 24 cases were classified as healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), respectively, with no case classified as community-acquired pneumonia (CAP). As population aging progresses, the frequency of aspiration pneumonia classified as HCAP will increase. To cover anaerobes, it is necessary to select antibacterial drugs, such as TAZ/PIPC, for early treatment in consideration of resistant gram-negative bacteria to improve the outcome, and not drugs with weak activity against these bacteria.

  4. The role of telavancin in hospital-acquired pneumonia and ventilator-associated pneumonia.

    PubMed

    Sandrock, Christian E; Shorr, Andrew F

    2015-09-15

    Hospital-acquired pneumonia (HAP) due to gram-positive pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) continues to be a major cause of morbid conditions and death. Telavancin is a lipoglycopeptide antibiotic with potent in vitro activity against a range of gram-positive pathogens, including MRSA, methicillin-susceptible S. aureus, and Streptococcus species. In 2 phase 3 clinical trials, telavancin was noninferior to vancomycin in patients with HAP due to gram-positive pathogens. Clinically evaluable patients with S. aureus as the sole pathogen or S. aureus with a vancomycin minimum inhibitory concentration >1 µg/mL, however, had higher cure rates with telavancin than with vancomycin. In patients with bacteremic HAP, telavancin resulted in clearance of blood cultures. It was associated with increased serum creatinine levels and higher mortality rates in patients with moderate to severe renal impairment at baseline; however, on subsequent analysis, the outcomes seemed to have been at least partially affected by the adequacy of empiric gram-negative antimicrobial therapy. Thus, clinicians need to consider the risk-benefit balance when choosing telavancin in patients with severe renal impairment at baseline. Overall, these data support the use of telavancin in the treatment of HAP due to S. aureus, including MRSA and strains with elevated vancomycin minimum inhibitory concentrations, but clinicians should always weigh the risks and benefits of various treatment options. PMID:26316561

  5. Molecular characterization of multidrug-resistant Klebsiella pneumoniae isolates.

    PubMed

    Hou, Xiang-hua; Song, Xiu-yu; Ma, Xiao-bo; Zhang, Shi-yang; Zhang, Jia-qin

    2015-01-01

    Klebsiella pneumoniae is an important cause of healthcare-associated infections worldwide. Selective pressure, the extensive use of antibiotics, and the conjugational transmission of antibiotic resistance genes across bacterial species and genera facilitate the emergence of multidrug-resistant (MDR) K. pneumoniae. Here, we examined the occurrence, phenotypes and genetic features of MDR K. pneumoniae isolated from patients in intensive care units (ICUs) at the First Affiliated Hospital of Xiamen University in Xiamen, China, from January to December 2011. Thirty-eight MDR K. pneumoniae strains were collected. These MDR K. pneumoniae isolates possessed at least seven antibiotic resistance determinants, which contribute to the high-level resistance of these bacteria to aminoglycosides, macrolides, quinolones and β-lactams. Among these isolates, 24 strains were extended-spectrum β-lactamase (ESBL) producers, 2 strains were AmpC producers, and 12 strains were both ESBL and AmpC producers. The 38 MDR isolates also contained class I (28/38) and class II integrons (10/38). All 28 class I-positive isolates contained aacC1, aacC4, orfX, orfX' and aadA1 genes. β-lactam resistance was conferred through bla SHV (22/38), bla TEM (10/38), and bla CTX-M (7/38). The highly conserved bla KPC-2 (37/38) and bla OXA-23(1/38) alleles were responsible for carbapenem resistance, and a gyrAsite mutation (27/38) and the plasmid-mediated qnrB gene (13/38) were responsible for quinolone resistance. Repetitive-sequence-based PCR (REP-PCR) fingerprinting of these MDR strains revealed the presence of five groups and sixteen patterns. The MDR strains from unrelated groups showed different drug resistance patterns; however, some homologous strains also showed different drug resistance profiles. Therefore, REP-PCR-based analyses can provide information to evaluate the epidemic status of nosocomial infection caused by MDR K. pneumoniae; however, this test lacks the power to discriminate some

  6. Molecular characterization of multidrug-resistant Klebsiella pneumoniae isolates

    PubMed Central

    Hou, Xiang-hua; Song, Xiu-yu; Ma, Xiao-bo; Zhang, Shi-yang; Zhang, Jia-qin

    2015-01-01

    Klebsiella pneumoniae is an important cause of healthcare-associated infections worldwide. Selective pressure, the extensive use of antibiotics, and the conjugational transmission of antibiotic resistance genes across bacterial species and genera facilitate the emergence of multidrug-resistant (MDR) K. pneumoniae. Here, we examined the occurrence, phenotypes and genetic features of MDR K. pneumoniae isolated from patients in intensive care units (ICUs) at the First Affiliated Hospital of Xiamen University in Xiamen, China, from January to December 2011. Thirty-eight MDR K. pneumoniae strains were collected. These MDR K. pneumoniae isolates possessed at least seven antibiotic resistance determinants, which contribute to the high-level resistance of these bacteria to aminoglycosides, macrolides, quinolones and β-lactams. Among these isolates, 24 strains were extended-spectrum β-lactamase (ESBL) producers, 2 strains were AmpC producers, and 12 strains were both ESBL and AmpC producers. The 38 MDR isolates also contained class I (28/38) and class II integrons (10/38). All 28 class I-positive isolates contained aacC1, aacC4, orfX, orfX’ and aadA1 genes. β-lactam resistance was conferred through bla SHV (22/38), bla TEM (10/38), and bla CTX-M (7/38). The highly conserved bla KPC-2 (37/38) and bla OXA-23(1/38) alleles were responsible for carbapenem resistance, and a gyrAsite mutation (27/38) and the plasmid-mediated qnrB gene (13/38) were responsible for quinolone resistance. Repetitive-sequence-based PCR (REP-PCR) fingerprinting of these MDR strains revealed the presence of five groups and sixteen patterns. The MDR strains from unrelated groups showed different drug resistance patterns; however, some homologous strains also showed different drug resistance profiles. Therefore, REP-PCR-based analyses can provide information to evaluate the epidemic status of nosocomial infection caused by MDR K. pneumoniae; however, this test lacks the power to discriminate some

  7. An evaluation of oxygen systems for treatment of childhood pneumonia

    PubMed Central

    2011-01-01

    Background Oxygen therapy is recommended for all of the 1.5 – 2.7 million young children who consult health services with hypoxemic pneumonia each year, and the many more with other serious conditions. However, oxygen supplies are intermittent throughout the developing world. Although oxygen is well established as a treatment for hypoxemic pneumonia, quantitative evidence for its effect is lacking. This review aims to assess the utility of oxygen systems as a method for reducing childhood mortality from pneumonia. Methods Aiming to improve priority setting methods, The Child Health and Nutrition Research Initiative (CHNRI) has developed a common framework to score competing interventions into child health. That framework involves the assessment of 12 different criteria upon which interventions can be compared. This report follows the proposed framework, using a semi-systematic literature review and the results of a structured exercise gathering opinion from experts (leading basic scientists, international public health researchers, international policy makers and representatives of pharmaceutical companies), to assess and score each criterion as their “collective optimism” towards each, on a scale from 0 to 100%. Results A rough estimate from an analysis of the literature suggests that global strengthening of oxygen systems could save lives of up to 122,000 children from pneumonia annually. Following 12 CHNRI criteria, the experts expressed very high levels of optimism (over 80%) for answerability, low development cost and low product cost; high levels of optimism (60-80%) for low implementation cost, likelihood of efficacy, deliverability, acceptance to end users and health workers; and moderate levels of optimism (40-60%) for impact on equity, affordability and sustainability. The median estimate of potential effectiveness of oxygen systems to reduce the overall childhood pneumonia mortality was ~20% (interquartile range: 10-35%, min. 0%, max. 50%). However

  8. Molecular characterization of multidrug-resistant Klebsiella pneumoniae isolates.

    PubMed

    Hou, Xiang-hua; Song, Xiu-yu; Ma, Xiao-bo; Zhang, Shi-yang; Zhang, Jia-qin

    2015-01-01

    Klebsiella pneumoniae is an important cause of healthcare-associated infections worldwide. Selective pressure, the extensive use of antibiotics, and the conjugational transmission of antibiotic resistance genes across bacterial species and genera facilitate the emergence of multidrug-resistant (MDR) K. pneumoniae. Here, we examined the occurrence, phenotypes and genetic features of MDR K. pneumoniae isolated from patients in intensive care units (ICUs) at the First Affiliated Hospital of Xiamen University in Xiamen, China, from January to December 2011. Thirty-eight MDR K. pneumoniae strains were collected. These MDR K. pneumoniae isolates possessed at least seven antibiotic resistance determinants, which contribute to the high-level resistance of these bacteria to aminoglycosides, macrolides, quinolones and β-lactams. Among these isolates, 24 strains were extended-spectrum β-lactamase (ESBL) producers, 2 strains were AmpC producers, and 12 strains were both ESBL and AmpC producers. The 38 MDR isolates also contained class I (28/38) and class II integrons (10/38). All 28 class I-positive isolates contained aacC1, aacC4, orfX, orfX' and aadA1 genes. β-lactam resistance was conferred through bla SHV (22/38), bla TEM (10/38), and bla CTX-M (7/38). The highly conserved bla KPC-2 (37/38) and bla OXA-23(1/38) alleles were responsible for carbapenem resistance, and a gyrAsite mutation (27/38) and the plasmid-mediated qnrB gene (13/38) were responsible for quinolone resistance. Repetitive-sequence-based PCR (REP-PCR) fingerprinting of these MDR strains revealed the presence of five groups and sixteen patterns. The MDR strains from unrelated groups showed different drug resistance patterns; however, some homologous strains also showed different drug resistance profiles. Therefore, REP-PCR-based analyses can provide information to evaluate the epidemic status of nosocomial infection caused by MDR K. pneumoniae; however, this test lacks the power to discriminate some

  9. The role of respiratory viruses in the etiology of bacterial pneumonia: An ecological perspective.

    PubMed

    Lee, Kyu Han; Gordon, Aubree; Foxman, Betsy

    2016-01-01

    Pneumonia is the leading cause of death among children less than 5 years old worldwide. A wide range of viral, bacterial and fungal agents can cause pneumonia: although viruses are the most common etiologic agent, the severity of clinical symptoms associated with bacterial pneumonia and increasing antibiotic resistance makes bacterial pneumonia a major public health concern. Bacterial pneumonia can follow upper respiratory viral infection and complicate lower respiratory viral infection. Secondary bacterial pneumonia is a major cause of influenza-related deaths. In this review, we evaluate the following hypotheses: (i) respiratory viruses influence the etiology of pneumonia by altering bacterial community structure in the upper respiratory tract (URT) and (ii) respiratory viruses promote or inhibit colonization of the lower respiratory tract (LRT) by certain bacterial species residing in the URT. We conducted a systematic review of the literature to examine temporal associations between respiratory viruses and bacteria and a targeted review to identify potential mechanisms of interactions. We conclude that viruses both alter the bacterial community in the URT and promote bacterial colonization of the LRT. However, it is uncertain whether changes in the URT bacterial community play a substantial role in pneumonia etiology. The exception is Streptococcus pneumoniae where a strong link between viral co-infection, increased carriage and pneumococcal pneumonia has been established. PMID:26884414

  10. Use of exposure history to identify patterns of immunity to pneumonia in bighorn sheep (Ovis canadensis)

    USGS Publications Warehouse

    Plowright, Raina K.; Manlove, Kezia; Cassirer, E. Frances; Besser, Thomas H.; Hudson, Peter J.

    2013-01-01

    Individual host immune responses to infectious agents drive epidemic behavior and are therefore central to understanding and controlling infectious diseases. However, important features of individual immune responses, such as the strength and longevity of immunity, can be challenging to characterize, particularly if they cannot be replicated or controlled in captive environments. Our research on bighorn sheep pneumonia elucidates how individual bighorn sheep respond to infection with pneumonia pathogens by examining the relationship between exposure history and survival in situ. Pneumonia is a poorly understood disease that has impeded the recovery of bighorn sheep (Ovis canadensis) following their widespread extirpation in the 1900s. We analyzed the effects of pneumonia-exposure history on survival of 388 radio-collared adults and 753 ewe-lamb pairs. Results from Cox proportional hazards models suggested that surviving ewes develop protective immunity after exposure, but previous exposure in ewes does not protect their lambs during pneumonia outbreaks. Paradoxically, multiple exposures of ewes to pneumonia were associated with diminished survival of their offspring during pneumonia outbreaks. Although there was support for waning and boosting immunity in ewes, models with consistent immunizing exposure were similarly supported. Translocated animals that had not previously been exposed were more likely to die of pneumonia than residents. These results suggest that pneumonia in bighorn sheep can lead to aging populations of immune adults with limited recruitment. Recovery is unlikely to be enhanced by translocating nai¨ve healthy animals into or near populations infected with pneumonia pathogens.

  11. Use of Exposure History to Identify Patterns of Immunity to Pneumonia in Bighorn Sheep (Ovis canadensis)

    PubMed Central

    Plowright, Raina K.; Manlove, Kezia; Cassirer, E. Frances; Cross, Paul C.; Besser, Thomas E.; Hudson, Peter J.

    2013-01-01

    Individual host immune responses to infectious agents drive epidemic behavior and are therefore central to understanding and controlling infectious diseases. However, important features of individual immune responses, such as the strength and longevity of immunity, can be challenging to characterize, particularly if they cannot be replicated or controlled in captive environments. Our research on bighorn sheep pneumonia elucidates how individual bighorn sheep respond to infection with pneumonia pathogens by examining the relationship between exposure history and survival in situ. Pneumonia is a poorly understood disease that has impeded the recovery of bighorn sheep (Ovis canadensis) following their widespread extirpation in the 1900s. We analyzed the effects of pneumonia-exposure history on survival of 388 radio-collared adults and 753 ewe-lamb pairs. Results from Cox proportional hazards models suggested that surviving ewes develop protective immunity after exposure, but previous exposure in ewes does not protect their lambs during pneumonia outbreaks. Paradoxically, multiple exposures of ewes to pneumonia were associated with diminished survival of their offspring during pneumonia outbreaks. Although there was support for waning and boosting immunity in ewes, models with consistent immunizing exposure were similarly supported. Translocated animals that had not previously been exposed were more likely to die of pneumonia than residents. These results suggest that pneumonia in bighorn sheep can lead to aging populations of immune adults with limited recruitment. Recovery is unlikely to be enhanced by translocating naïve healthy animals into or near populations infected with pneumonia pathogens. PMID:23637929

  12. Susceptibility of Klebsiella pneumoniae on coriander leaves to liquid- and vapor-phase ethanol.

    PubMed

    Krusong, Warawut; Pornpukdeewatana, Soisuda; Teerarak, Montinee

    2016-05-01

    The bio-control of ethanol on Klebsiella pneumoniae on fresh coriander leaves for significantly reducing consumer health risk was investigated. Washed and sterilized leaves of coriander were inoculated with K. pneumoniae cultured in Trypticase Soy broth. Susceptibility of the K. pneumoniae to liquid- and evaporated vapor-phase ethanol (EVE) was then examined in vitro Complete inhibition of K. pneumoniae was found with 18% (v/v) liquid ethanol. Exposure for 15 min to EVE (9.00 ± 0.8 mmol L(-1)) completely destroyed K. pneumoniae (4.04 ± 0.02 log CFU/ml) spread on Mueller Hilton agar at 30 ± 2°C. The effect of EVE with and without evaporated water vapor (EWV) on the susceptibility of K. pneumoniae on fresh coriander leaves was examined. While exposure to EVE affected the survival of K. pneumoniae, the degree of reduction depended on both the inoculation level and the EWV. Complete reduction of K. pneumoniae was achieved for the low inoculation level by EVE alone (37 ± 2% relative humidity; RH) but susceptibility was reduced with EWV (high RH; 80 ± 2%). Scanning electron microscope (SEM) images of inoculated coriander leaves confirm the effects of EVE in reducing levels of K. pneumoniae Exposure to EVE alone proved an effective bio-control for K. pneumoniae on fresh coriander leaves.

  13. Susceptibility of Klebsiella pneumoniae on coriander leaves to liquid- and vapor-phase ethanol.

    PubMed

    Krusong, Warawut; Pornpukdeewatana, Soisuda; Teerarak, Montinee

    2016-05-01

    The bio-control of ethanol on Klebsiella pneumoniae on fresh coriander leaves for significantly reducing consumer health risk was investigated. Washed and sterilized leaves of coriander were inoculated with K. pneumoniae cultured in Trypticase Soy broth. Susceptibility of the K. pneumoniae to liquid- and evaporated vapor-phase ethanol (EVE) was then examined in vitro Complete inhibition of K. pneumoniae was found with 18% (v/v) liquid ethanol. Exposure for 15 min to EVE (9.00 ± 0.8 mmol L(-1)) completely destroyed K. pneumoniae (4.04 ± 0.02 log CFU/ml) spread on Mueller Hilton agar at 30 ± 2°C. The effect of EVE with and without evaporated water vapor (EWV) on the susceptibility of K. pneumoniae on fresh coriander leaves was examined. While exposure to EVE affected the survival of K. pneumoniae, the degree of reduction depended on both the inoculation level and the EWV. Complete reduction of K. pneumoniae was achieved for the low inoculation level by EVE alone (37 ± 2% relative humidity; RH) but susceptibility was reduced with EWV (high RH; 80 ± 2%). Scanning electron microscope (SEM) images of inoculated coriander leaves confirm the effects of EVE in reducing levels of K. pneumoniae Exposure to EVE alone proved an effective bio-control for K. pneumoniae on fresh coriander leaves. PMID:27020413

  14. The role of respiratory viruses in the etiology of bacterial pneumonia

    PubMed Central

    Lee, Kyu Han; Gordon, Aubree; Foxman, Betsy

    2016-01-01

    Pneumonia is the leading cause of death among children less than 5 years old worldwide. A wide range of viral, bacterial and fungal agents can cause pneumonia: although viruses are the most common etiologic agent, the severity of clinical symptoms associated with bacterial pneumonia and increasing antibiotic resistance makes bacterial pneumonia a major public health concern. Bacterial pneumonia can follow upper respiratory viral infection and complicate lower respiratory viral infection. Secondary bacterial pneumonia is a major cause of influenza-related deaths. In this review, we evaluate the following hypotheses: (i) respiratory viruses influence the etiology of pneumonia by altering bacterial community structure in the upper respiratory tract (URT) and (ii) respiratory viruses promote or inhibit colonization of the lower respiratory tract (LRT) by certain bacterial species residing in the URT. We conducted a systematic review of the literature to examine temporal associations between respiratory viruses and bacteria and a targeted review to identify potential mechanisms of interactions. We conclude that viruses both alter the bacterial community in the URT and promote bacterial colonization of the LRT. However, it is uncertain whether changes in the URT bacterial community play a substantial role in pneumonia etiology. The exception is Streptococcus pneumoniae where a strong link between viral co-infection, increased carriage and pneumococcal pneumonia has been established. PMID:26884414

  15. THE HIGH BURDEN OF PNEUMONIA ON US EMERGENCY DEPARTMENTS DURING THE 2009 INFLUENZA PANDEMIC

    PubMed Central

    Self, Wesley H.; Griffin, Marie R.; Zhu, Yuwei; Dupont, William D.; Barrett, Tyler W.; Grijalva, Carlos G.

    2013-01-01

    SUMMARY Objectives During the 2009 influenza A (H1N1) pandemic, unusual influenza activity outside the typical winter season provided a unique opportunity to evaluate the association between influenza and pneumonia incidence. We sought to quantify the impact of the 2009 pandemic on the incidence of emergency department (ED) visits for pneumonia in the United States (US). Methods Using the Nationwide Emergency Department Survey, we estimated monthly counts and rates of excess all-cause pneumonia ED visits in the US attributable to the pandemic by comparing observed pneumonia ED visits during the pandemic (April 2009–March 2010) to expected values modeled from the three prior years. Results The pandemic was associated with an excess of 180,560 pneumonia ED visits or 0.59 excess pneumonia visits per 1,000 US population (95% confidence interval: 0.55, 0.62). These excess visits accounted for 7.0% of all pneumonia ED visits during the pandemic year. The greatest excess occurred during months with highest influenza activity (September - November 2009). Persons aged <65 years accounted for 94% of the excess pneumonia visits. Conclusions ED visits for pneumonia increased substantially during the 2009 pandemic, especially during peak influenza activity, suggesting a strong association between influenza activity and pneumonia incidence during the pandemic period. PMID:24140066

  16. The Regulation of Proresolving Lipid Mediator Profiles in Baboon Pneumonia by Inhaled Carbon Monoxide.

    PubMed

    Dalli, Jesmond; Kraft, Bryan D; Colas, Romain A; Shinohara, Masakazu; Fredenburgh, Laura E; Hess, Dean R; Chiang, Nan; Welty-Wolf, Karen; Choi, Augustine M; Piantadosi, Claude A; Serhan, Charles N

    2015-09-01

    Strategies for the treatment of bacterial pneumonia beyond traditional antimicrobial therapy have been limited. The recently discovered novel genus of lipid mediators, coined "specialized proresolving mediators" (SPMs), which orchestrate clearance of recruited leukocytes and restore epithelial barrier integrity, have offered new insight into the resolution of inflammation. We performed lipid mediator (LM) metabololipidomic profiling and identification of LMs on peripheral blood leukocytes and plasma from a baboon model of Streptococcus pneumoniae pneumonia. Leukocytes and plasma were isolated from whole blood of S. pneumoniae-infected (n = 5-6 per time point) and control, uninfected baboons (n = 4 per time point) at 0, 24, 48, and 168 hours. In a subset of baboons with pneumonia (n = 3), we administered inhaled carbon monoxide (CO) at 48 hours (200-300 ppm for 60-90 min). Unstimulated leukocytes from control animals produced a proresolving LM signature with elevated resolvins and lipoxins. In contrast, serum-treated, zymosan-stimulated leukocytes and leukocytes from baboons with S. pneumoniae pneumonia produced a proinflammatory LM signature profile with elevated leukotriene B4 and prostaglandins. Plasma from baboons with S. pneumoniae pneumonia also displayed significantly reduced LM-SPM levels, including eicosapentaenoic acid-derived E-series resolvins (RvE) and lipoxins. CO inhalation increased levels of plasma RvE and lipoxins relative to preexposure levels. These results establish the leukocyte and plasma LM profiles biosynthesized during S. pneumoniae pneumonia in baboons and provide evidence for pneumonia-induced dysregulation of these proresolution programs. Moreover, these SPM profiles are partially restored with inhaled low-dose CO and SPM, which may shorten the time to pneumonia resolution.

  17. Development of Real-Time Multiplex Nucleic Acid Sequence-Based Amplification for Detection of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella spp. in Respiratory Specimens▿

    PubMed Central

    Loens, K.; Beck, T.; Ursi, D.; Overdijk, M.; Sillekens, P.; Goossens, H.; Ieven, M.

    2008-01-01

    Real-time multiplex isothermal nucleic acid sequence-based amplification (NASBA) was developed to detect Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella spp. in respiratory specimens using the NucliSens Basic Kit (bioMérieux, Boxtel, The Netherlands). Oligonucleotide primers were derived from the M. pneumoniae, C. pneumoniae, and Legionella pneumophila 16S rRNA. For real-time detection, molecular beacons were used. Specificity was established on a panel of bacterial strains. The analytical sensitivity of the assay was determined by testing dilutions of wild-type in vitro-generated RNA in water and dilutions of reference strains in lysis buffer or added to pools of respiratory specimens. Subsequently, a limited number of M. pneumoniae-, C. pneumoniae-, and L. pneumophila-positive and -negative clinical specimens were analyzed. Specific detection of the 16S rRNA of the three organisms was achieved. The analytical sensitivity of the multiplex NASBA on spiked respiratory specimens was slightly diminished compared to the results obtained with the single-target (mono) real-time assays. We conclude that the proposed real-time multiplex NASBA assay, although less sensitive than the real-time mono NASBA assay, is a promising tool for the detection of M. pneumoniae, C. pneumoniae, and Legionella spp. in respiratory specimens, regarding handling, speed, and number of samples that can be analyzed in a single run. PMID:18032625

  18. MYCOBACTERIUM ABSCESSUS PNEUMONIA IN AN ATLANTIC BOTTLENOSE DOLPHIN (TURSIOPS TRUNCATUS)

    PubMed Central

    Clayton, Leigh Ann; Stamper, M. Andrew; Whitaker, Brent R.; Hadfield, Catherine A.; Simons, Brian; Mankowski, Joseph L.

    2013-01-01

    Mycobacterium abscessus pneumonia was diagnosed antemortem in a 23-yr-old male Atlantic bottlenose dolphin (Tursiops truncatus). Clinical signs included lethargy, hyporexia, coughing, and bloody respiratory discharge. Diagnostic findings included neutrophilic leukocytosis, anemia, elevated erythrocyte sedimentation rate, and repeated forceful exhaled breath (sputum) cytology, with acute inflammatory cells and acid-fast positive beaded rods. The bacteria were initially identified free in the sputum sample and subsequently were seen within neutrophils. A culture was positive for a rapidly growing, white, colony-forming organism confirmed as M. abscessus by polymerase chain reaction and DNA sequencing. Clinical signs initially resolved with multidrug therapy. Concurrent Pseudomonas aeruginosa infection complicated clinical management and contributed to terminal decline. The dolphin was euthanized 5 mo after initial diagnosis. Necropsy results demonstrated acid-fast positive bacteria in lung tissue and supported the diagnosis of M. abscessus pneumonia. Acid-fast stains and mycobacteria cultures should be considered when evaluating ill dolphins. PMID:23272373

  19. Middle East respiratory syndrome (MERS): a new zoonotic viral pneumonia.

    PubMed

    Cunha, Cheston B; Opal, Steven M

    2014-08-15

    Coronaviruses have traditionally been associated with mild upper respiratory tract infections throughout the world. In the fall of 2002, a new coronavirus emerged in in Asia causing severe viral pneumonia, i.e., severe acute respiratory syndrome (SARS). Nearly a decade following the SARS epidemic, a new coronavirus causing severe viral pneumonia has emerged, i.e., middle east respiratory syndrome (MERS). Since the initial case of MERS-CoV occurred in June of 2012 in Saudi Arabia there have been 688 confirmed cases and 282 deaths in 20 countries. Although both SARS and MERS are caused by coronaviruses, SARS was characterized by efficient human transmission and relatively low mortality rate. In contrast, MERS is relatively inefficiently transmitted to humans but has a high mortality rate. Given the potential overlap in presentation and manifestation, it is important to understand the clinical and epidemiologic differences between MERS, SARS and influenza.

  20. Radiological findings in nine AIDS patients with Rhodococcus equi pneumonia.

    PubMed

    Wicky, S; Cartei, F; Mayor, B; Frija, J; Gevenois, P A; Giron, J; Laurent, F; Perri, G; Schnyder, P

    1996-01-01

    Rhodococcus equi (R. equi) infections have been incidentally reported as a cause of pulmonary infection in severely immunocompromised hosts, including AIDS patients. Our purpose is to describe the radiological findings in nine AIDS patients with R. equi pneumonia assessed by bronchoalveolar lavage (BAL), biopsies, cultures of sputum, and hemocultures. All patients were examined by chest radiographs and contrast-medium-enhanced chest CT. Dense pulmonary consolidations with or without cavitations accounted for the most striking radiological patterns. Chest CT also revealed six mediastinal involvements, strongly mimicking a lymphoma. Two of them had multiple bilateral pulmonary nodular opacities. Pleural effusion was not identified. Although intensive therapies were administered, seven among nine patients died within few months. In an AIDS patient living in a rural area or exposed to horses and presenting these radiological patterns, the possibility of R. equi pneumonia should be considered in the differential diagnosis along with other infectious diseases or lymphomas. PMID:8972317

  1. Potential role for mucosally active vaccines against pneumococcal pneumonia

    PubMed Central

    Jambo, Kondwani C.; Sepako, Enoch; Heyderman, Robert S.; Gordon, Stephen B.

    2010-01-01

    Pneumococcal pneumonia is a life-threatening disease with high mortality and morbidity among children under 5 years of age, the elderly and immunocompromised individuals worldwide. Protection against pneumococcal pneumonia relies on successful regulation of colonisation in the nasopharynx and a brisk alveolar macrophage-mediated immune response in the lung. Therefore, enhancing pulmonary mucosal immunity (which includes a combination of innate, humoral and cell-mediated immunity) through mucosal vaccination might be the key to prevention of pneumococcal infection. Current challenges include a lack of information in humans on mucosal immunity against pneumococci and a lack of suitable adjuvants for new vaccines. Data from mouse models, however, suggest that mucosally active vaccines will enhance mucosal and systemic immunity for protection against pneumococcal infection. PMID:20031415

  2. A chronic eosinophilic pneumonia case with long exposure to isocyanates.

    PubMed

    Yalcin, Funda; Sak, Zafer Hasan Ali; Boyaci, Nurefsan; Gencer, Mehmet

    2014-10-01

    Chronic eosinophilic pneumonia (CEP) is a disease with unknown etiology, characterized by peripheral blood eosinophilia and abnormal eosinophil accumulation in the lungs. A 43-year-old male with 30 years history of exposure to isocyanates was admitted with the complaint of sputum, cough, progressive dyspnoea, and weight loss. Physical examination revealed bilaterally decreased breath sounds and extensive rales. On laboratory analysis; leukocytosis (12.3 10(3)/proportional variant L), hypereosinophilia (30%), elevated CRP and RF (1000 IU/ml), and IgE levels (1160 IU/ml) in the serum were observed. Chest radiograph and computed tomography on admission showed reticulonodular pattern at both lung fields. Pulmonary function tests assumed a restrictive pattern and a low diffusing capacity. Bronchoalveolar lavage revealed a marked eosinophilia (50%). Transbronchial lung biopsy indicated eosinophilic pneumonia. In this case we aimed to describe a rare case of CEP probably caused by exposure to isocyanate.

  3. [A case of Legionella pneumonia with multiple organ failure].

    PubMed

    Li, Jiali; Wen, Rui; Deng, Hong; Li, Qian

    2016-06-28

    Legionella pneumonia (LP) is a rare systemic infectious disease, which is often misdiagnosed by clinicians due to the atypical symptoms. A middle-aged man who suffered from fever and dyspnea was diagnosed as community acquired pneumonia (CAP) in Changsha Central Hospital in March 2015. The treatment was unsatisfied firstly. The patients showed further symptoms of rhabdomyolysis, acute liver and renal failure, and impaired neural functions, who was diagnosed as LP with multiple organ failure based on a positive test for Legionella antibody. The patient was recovered after treated with moxifloxacin combined with azithromycin and continuous renal replacement therapy. LP should be paid attention when patient was diagnosed as CAP and failed to be treated. The satisfied outcome is achieved after application of macrolide, quinolones and comprehensive treatments. PMID:27374453

  4. Klebsiella pneumoniae liver abscess in an immunocompetent child.

    PubMed

    Kwon, Jang-Mi; Jung, Hye Lim; Shim, Jae Won; Kim, Deok Soo; Shim, Jung Yeon; Park, Moon Soo

    2013-09-01

    Klebsiella pneumoniae has emerged as a leading pathogen that causes pyogenic liver abscesses (PLAs) in Korea. K. pneumoniae liver abscess (KLA) is potentially life threatening, and the diagnosis is difficult. In developed countries, PLA is rarely observed in children and is frequently associated with disorders of granulocyte function and previous abdominal infection. We observed a case of KLA in a healthy 12-year-old boy. To our knowledge, this is the first reported case of KLA in an immunocompetent child without an underlying disease in Korea. The patient was treated with percutaneous catheter drainage and antibiotics. The catheter was placed in the intrahepatic abscess for 3 weeks and parenteral antibiotics (ceftriaxone and amikacin) were administered for 4 weeks, followed by oral antibiotics (cefixime) for 2 weeks. We reported this case to raise awareness of KLA in immunocompetent children among physicians, and to review the diagnosis, risk factors, potential complications, and appropriate treatment of KLA.

  5. Hydropneumothorax in Children: A Rare Complication of a Bacterial Pneumonia

    PubMed Central

    Ortega, Carolina; Gonzales, Carla; Soto-Martinez, Manuel E.

    2016-01-01

    Hydropneumothorax is an uncommon presentation of a complicated pneumonia, and very few cases in the pediatric population have been reported. This is a case of a 5-month-old patient who presented to the emergency department (ED) with a three-day history of fever, diarrhea, and respiratory distress. His initial assessment suggested a lower respiratory tract infection and because of his respiratory distress and hypoxia a chest X-ray was performed. Other clinical information and radiologic studies will be discussed further, but his chest X-ray suggested a right-sided hydropneumothorax secondary to a complicated pneumonia. He completed 12 days of IV antibiotic treatment and required a chest tube for drainage. Patient was discharged home with a full recovery. PMID:27247819

  6. Eosinophilic Pneumonia in a Patient with Bronchial Myiasis

    PubMed Central

    Aich, Arindom; Al-Ismaili, Suad; Ramadhan, Fatma A.; Al-Wardi, Talal H. M.; Al-Salmi, Quasem; Al-Hashami, Hilal

    2015-01-01

    Pulmonary myiasis is an unusual form of myiasis in humans and has been recently identified as a cause of eosinophilic pneumonia. We report the case of a 13-year-old Omani boy who presented to the Royal Hospital, Muscat, Oman, in October 2014 with respiratory distress. Bronchial aspirates revealed features of eosinophilic pneumonia. Possible larvae identified in the cytology report, a high immunoglobulin E level and the patient history all indicated bronchial myiasis. The patient was treated with steroids and ventilation and has since been disease-free with no long-term side-effects. To the best of the authors’ knowledge, this is the first case of bronchial myiasis in Oman. PMID:26629385

  7. Mycobacterium abscessus pneumonia in an Atlantic bottlenose dolphin (Tursiops truncatus).

    PubMed

    Clayton, Leigh Ann; Stamper, M Andrew; Whitaker, Brent R; Hadfield, Catherine A; Simons, Brian; Mankowski, Joseph L

    2012-12-01

    Mycobacterium abscessus pneumonia was diagnosed antemortem in a 23-yr-old male Atlantic bottlenose dolphin (Tursiops truncatus). Clinical signs included lethargy, hyporexia, coughing, and bloody respiratory discharge. Diagnostic findings included neutrophilic leukocytosis, anemia, elevated erythrocyte sedimentation rate, and repeated forceful exhaled breath (sputum) cytology, with acute inflammatory cells and acid-fast positive beaded rods. The bacteria were initially identified free in the sputum sample and subsequently were seen within neutrophils. A culture was positive for a rapidly growing, white, colony-forming organism confirmed as M. abscessus by polymerase chain reaction and DNA sequencing. Clinical signs initially resolved with multidrug therapy. Concurrent Pseudomonas aeruginosa infection complicated clinical management and contributed to terminal decline. The dolphin was euthanized 5 mo after initial diagnosis. Necropsy results demonstrated acid-fast positive bacteria in lung tissue and supported the diagnosis of M. abscessus pneumonia. Acid-fast stains and mycobacteria cultures should be considered when evaluating ill dolphins. PMID:23272373

  8. Cavity Forming Pneumonia Due to Staphylococcus aureus Following Dengue Fever.

    PubMed

    Miyata, Nobuyuki; Yoshimura, Yukihiro; Tachikawa, Natsuo; Amano, Yuichiro; Sakamoto, Yohei; Kosuge, Youko

    2015-11-01

    While visiting Malaysia, a 22-year-old previously healthy Japanese man developed myalgia, headache, and fever, leading to a diagnosis of classical dengue fever. After improvement and returning to Japan after a five day hospitalization, he developed productive cough several days after defervescing from dengue. Computed tomography (CT) thorax scan showed multiple lung cavities. A sputum smear revealed leukocytes with phagocytized gram-positive cocci in clusters, and grew an isolate Staphylococcus aureus sensitive to semi-synthetic penicillin; he was treated successfully with ceftriaxone and cephalexin. This second reported case of pneumonia due to S. aureus occurring after dengue fever, was associated both with nosocomial exposure and might have been associated with dengue-associated immunosuppression. Clinicians should pay systematic attention to bacterial pneumonia following dengue fever to establish whether such a connection is causally associated. PMID:26304914

  9. Pneumonia and bacteremia in a golden-headed lion tamarin (Leontopithecus chrysomelas) caused by Klebsiella pneumoniae subsp. pneumoniae during a translocation program of free-ranging animals in Brazil.

    PubMed

    Bueno, Marina G; Iovine, Renata O; Torres, Luciana N; Catão-Dias, José L; Pissinatti, Alcides; Kierulff, Maria C M; Carvalho, Vania M

    2015-05-01

    Klebsiella pneumoniae is an important emerging pathogen in humans, particularly the invasive hypermucoviscosity (HMV) phenotype. In addition, the organism is an important public health concern because of nosocomial infections and antimicrobial resistance. Nonhuman primates in captivity are susceptible to Klebsiella, particularly when a stress factor is involved. Infections vary depending on the species but can cause significant morbidity and mortality in these animals. The objective of this study was to describe a case of bronchopneumonia and bacteremia caused by Klebsiella pneumoniae in a free-ranging golden-headed lion tamarin (Leontopithecus chrysomelas) caught and maintained in quarantine during a translocation program for conservation purposes. An adult male, that had showed emaciation and apathy, was clinically examined and, despite being provided supportive therapy, died 2 days after onset of clinical signs. At postmortem examination, generalized bilateral pneumonia and pericarditis were observed. Tissue samples were fixed in 10% formalin for histology, and pulmonary tissues and cardiac blood were collected for microbiologic diagnostic procedures. Bacteria that were shown to be HMV K. pneumoniae subsp. pneumoniae strains were isolated from the pulmonary fluids and cardiac blood in pure cultures. Severe bronchopneumonia was the main pathological finding. The consequences of the confirmed presence of the HMV phenotype of K. pneumoniae subsp. pneumoniae in this wildlife species for human, animal, and ecosystem health should be determined. These results demonstrate the importance of quarantine and potential pathogen screening during wildlife translocation procedures.

  10. Emergence of OXA-48-Producing Klebsiella pneumoniae in Taiwan

    PubMed Central

    Ma, Ling; Wang, Jann-Tay; Wu, Tsu-Lan; Siu, L. Kristopher; Chuang, Yin-Ching; Lin, Jung-Chung; Lu, Min-Chi; Lu, Po-Liang

    2015-01-01

    The isolation of OXA-48-producing Enterobacteriaceae has increased dramatically in Mediterranean countries in the past 10 years, and has recently emerged in Asia. Between January 2012 and May 2014, a total of 760 carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) isolates were collected during a Taiwan national surveillance. Carbapenemases were detected in 210 CnSKP isolates (27.6%), including 162 KPC-2 (n = 1), KPC-3, KPC-17, and NDM-1 (n = 1 each), OXA-48 (n = 4), IMP-8 (n = 18), and VIM-1 (n = 24). The four blaOXA-48 CnSKP isolates were detected in late 2013. Herein we report the emergence OXA-48-producing K. pneumoniae isolates in Taiwan. PFGE analysis revealed that the four isolates belonged to three different pulsotypes. Three isolates harboured blaCTX-M genes and belonged to MLST type ST11. In addition, the plasmids belonged to the incompatibility group, IncA/C. One isolate belonged to ST116 and the plasmid incompatibility group was non-typeable. The sequence upstream of the blaOXA-48 gene in all four isolates was identical to pKPOXA-48N1, a blaOXA-48-carrying plasmid. This is the first report of OXA-48-producing Enterobacteriaceae in Taiwan and the second report to identify blaOXA-48 on an IncA/C plasmid in K. pneumoniae. Given that three isolates belong to the same pandemic clone (ST11) and possess the IncA/C plasmid and similar plasmid digestion profile that indicated the role of clonal spread or plasmid for dissemination of blaOXA-48 gene, the emergence of OXA-48-producing K. pneumoniae in Taiwan is of great concern. PMID:26414183

  11. Identification of Antigenic Proteins of the Nosocomial Pathogen Klebsiella pneumoniae

    PubMed Central

    Hoppe, Sebastian; Bier, Frank F.; von Nickisch-Rosenegk, Markus

    2014-01-01

    The continuous expansion of nosocomial infections around the globe has become a precarious situation. Key challenges include mounting dissemination of multiple resistances to antibiotics, the easy transmission and the growing mortality rates of hospital-acquired bacterial diseases. Thus, new ways to rapidly detect these infections are vital. Consequently, researchers around the globe pursue innovative approaches for point-of-care devices. In many cases the specific interaction of an antigen and a corresponding antibody is pivotal. However, the knowledge about suitable antigens is lacking. The aim of this study was to identify novel antigens as specific diagnostic markers. Additionally, these proteins might be aptly used for the generation of vaccines to improve current treatment options. Hence, a cDNA-based expression library was constructed and screened via microarrays to detect novel antigens of Klebsiella pneumoniae, a prominent agent of nosocomial infections well-known for its extensive antibiotics resistance, especially by extended-spectrum beta-lactamases (ESBL). After screening 1536 clones, 14 previously unknown immunogenic proteins were identified. Subsequently, each protein was expressed in full-length and its immunodominant character examined by ELISA and microarray analyses. Consequently, six proteins were selected for epitope mapping and three thereof possessed linear epitopes. After specificity analysis, homology survey and 3d structural modelling, one epitope sequence GAVVALSTTFA of KPN_00363, an ion channel protein, was identified harboring specificity for K. pneumoniae. The remaining epitopes showed ambiguous results regarding the specificity for K. pneumoniae. The approach adopted herein has been successfully utilized to discover novel antigens of Campylobacter jejuni and Salmonella enterica antigens before. Now, we have transferred this knowledge to the key nosocomial agent, K. pneumoniae. By identifying several novel antigens and their linear

  12. Emergence of OXA-48-Producing Klebsiella pneumoniae in Taiwan.

    PubMed

    Ma, Ling; Wang, Jann-Tay; Wu, Tsu-Lan; Siu, L Kristopher; Chuang, Yin-Ching; Lin, Jung-Chung; Lu, Min-Chi; Lu, Po-Liang

    2015-01-01

    The isolation of OXA-48-producing Enterobacteriaceae has increased dramatically in Mediterranean countries in the past 10 years, and has recently emerged in Asia. Between January 2012 and May 2014, a total of 760 carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) isolates were collected during a Taiwan national surveillance. Carbapenemases were detected in 210 CnSKP isolates (27.6%), including 162 KPC-2 (n = 1), KPC-3, KPC-17, and NDM-1 (n = 1 each), OXA-48 (n = 4), IMP-8 (n = 18), and VIM-1 (n = 24). The four blaOXA-48 CnSKP isolates were detected in late 2013. Herein we report the emergence OXA-48-producing K. pneumoniae isolates in Taiwan. PFGE analysis revealed that the four isolates belonged to three different pulsotypes. Three isolates harboured blaCTX-M genes and belonged to MLST type ST11. In addition, the plasmids belonged to the incompatibility group, IncA/C. One isolate belonged to ST116 and the plasmid incompatibility group was non-typeable. The sequence upstream of the blaOXA-48 gene in all four isolates was identical to pKPOXA-48N1, a blaOXA-48-carrying plasmid. This is the first report of OXA-48-producing Enterobacteriaceae in Taiwan and the second report to identify blaOXA-48 on an IncA/C plasmid in K. pneumoniae. Given that three isolates belong to the same pandemic clone (ST11) and possess the IncA/C plasmid and similar plasmid digestion profile that indicated the role of clonal spread or plasmid for dissemination of blaOXA-48 gene, the emergence of OXA-48-producing K. pneumoniae in Taiwan is of great concern. PMID:26414183

  13. Oral care and nosocomial pneumonia: a systematic review

    PubMed Central

    Vilela, Maria Carolina Nunes; Ferreira, Gustavo Zanna; Santos, Paulo Sérgio da Silva; de Rezende, Nathalie Pepe Medeiros

    2015-01-01

    To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units. PMID:25946053

  14. Transfer of plasmids by conjugation in Streptococcus pneumoniae

    SciTech Connect

    Smith, M.D.; Shoemaker, N.B.; Burdett, V.; Guild, W.R.

    1980-01-01

    Transfer of resistance plasmids occurred by conjugation in Streptococcus pneumoniae (pneumococcus) similiarly to the process in other streptococcal groups. The 20-megadalton plasmid pIP501 mediated its own DNase-resistant transfer by filter mating and mobilized the 3.6-megadalton non-self-transmissible pMV158. Pneumococcal strains acted as donors or as recipients for intraspecies transfers and for interspecific transfers with Streptococcus faecalis. Transfer-deficient mutants of pIP501 have been found.

  15. Promoter of the Mycoplasma pneumoniae rRNA operon.

    PubMed Central

    Hyman, H C; Gafny, R; Glaser, G; Razin, S

    1988-01-01

    RNA transcripts starting from the 5' end of the single Mycoplasma pneumoniae rRNA operon were analyzed by several methods. By primer extension analysis a start site was found 62 nucleotides upstream from the start site of the 16S rRNA. This site was preceded by a putative Pribnow box; however, a defined -35 recognition region was absent. The cloned rRNA operon was transcribed in vitro by using purified RNA polymerase of Escherichia coli. A single start site could be demonstrated within a few nucleotides of the start site found by primer extension analysis of M. pneumoniae transcripts. When fragments from the cloned operon were used as hybridization probes, S1 nuclease mapping yielded a single transcript extending approximately 193 nucleotides upstream from the 16S rRNA start site. The region surrounding this endpoint did not resemble any known promoter sequence. Dot blot hybridization of M. pneumoniae RNA to three oligonucleotides consisting of nucleotides -5 to -21, -38 to -54, and -112 to -132 (from the start of the 16S rRNA gene) indicated that most rRNA transcripts were processed at the stem site preceding the 16S rRNA gene. The majority of the longer precursor transcripts, extending beyond this point, did not extend further upstream to an oligonucleotide consisting of nucleotides -112 to -132. It was concluded that transcription of the rRNA operon of M. pneumoniae is initiated by a single promoter. The nucleotide sequence of the region is presented. Images PMID:2838465

  16. A serological investigation of Mycoplasma pneumoniae infection on the Witwatersrand.

    PubMed

    Joosting, A C; Harwin, R M; Coppin, A; Battaglia, P; van der Hoef, P

    1976-12-18

    Sera from patients with respiratory disease were examined for antibody to Mycoplasma pneumoniae by complement fixation test. During the study period of about 6 years, a 3-year cycle of infection was observed, which coincided with some epidemics in the UK and USA, suggesting the possibility of an approximately simultaneous world-wide spread. The epidemics lasted about 18 months each, during which the incidence of infection was over 10 times that of the interepidemic periods.

  17. Citrobacter koseri Pneumonia As Initial Presentation of Underlying Pulmonary Adenocarcinoma

    PubMed Central

    Pennington, Kelly; Van Zyl, Martin; Escalante, Patricio

    2016-01-01

    Citrobacter koseri is a motile, gram-negative rod traditionally known to cause infection in individuals with significant comorbidities and immunocompromised status. While most cases represent nosocomial infections, rarely community-acquired infections have been reported. We present a previously healthy man in his 60s with C. koseri pneumonia who was subsequently found to have underlying pulmonary adenocarcinoma, illustrating the need for further investigation for immunodeficiency and/or intrapulmonary pathology. PMID:27746678

  18. Complete Genome Sequence of Klebsiella pneumoniae YH43

    PubMed Central

    Ogura, Yoshitoshi; Hayashi, Tetsuya; Mizunoe, Yoshimitsu

    2016-01-01

    We report here the complete genome sequence of Klebsiella pneumoniae strain YH43, isolated from sweet potato. The genome consists of a single circular chromosome of 5,520,319 bp in length. It carries 8 copies of rRNA operons, 86 tRNA genes, 5,154 protein-coding genes, and the nif gene cluster for nitrogen fixation. PMID:27081127

  19. Isolation and characterization of Klebsiella pneumoniae unencapsulated mutants

    SciTech Connect

    Benedi, V.J.; Ciurana, B.; Tomas, J.M.

    1989-01-01

    Klebsiella pneumoniae mutants were obtained after UV irradiation and negative selection with anticapsular serum. Unencapsulation, rather than expression of a structurally altered capsule, was found in the mutants. The mutant strains showed no alterations in their outer membrane proteins and lipopolysaccharide, and a great similarity with the wild type in the properties tested (serum resistance, antimicrobial sensitivity, and lipopolysaccharide-specific bacteriophage sensitivity), with the exception of a higher cell surface hydrophobicity and resistance to bacteriophage FC3-9.

  20. Mouse models for the study of fungal pneumonia

    PubMed Central

    Muhammed, Maged; Feldmesser, Marta; Shubitz, Lisa F.; Lionakis, Michail S.; Sil, Anita; Wang, Yan; Glavis-Bloom, Justin; Lewis, Russell E.; Galgiani, John N.; Casadevall, Arturo; Kontoyiannis, Dimitrios P.; Mylonakis, Eleftherios

    2012-01-01

    Mouse models have facilitated the study of fungal pneumonia. In this report, we present the working protocols of groups that are working on the following pathogens: Aspergillus, Coccidioides, Cryptococcus, Fusarium, Histoplasma and Rhizopus. We describe the experimental procedures and the detailed methods that have been followed in the experienced laboratories to study pulmonary fungal infection; we also discuss the anticipated results and technical notes, and provide the practical advices that will help the users of these models. PMID:22546902

  1. Occupationally acquired Pasteurella multocida pneumonia in a healthy abattoir worker.

    PubMed

    Pradeepan, Shyamala; Tun Min, Sandy; Lai, Katy

    2016-01-01

    An otherwise healthy male abbatoir worker presented to his general practitioner with acute hypoxemia due to bronchopneumonia. His only occupational exposure was cleaning cow carcasses being prepared for consumption. Blood cultures were eventually positive for Pasteurella multocida. To our knowledge, this is the first reported case of Pasteurella multocida pneumonia in an abattoir worker, and illustrates the importance of considering this infection in patients with animal exposures. PMID:27536550

  2. Microorganisms associated with pneumonia in slaughter weight swine.

    PubMed Central

    Morrison, R B; Pijoan, C; Hilley, H D; Rapp, V

    1985-01-01

    The lungs of 334 pigs were obtained from two slaughter plants in Minnesota and examined in detail. Macroscopic and microscopic evaluation, direct fluorescence for Mycoplasma hyopneumoniae and bacterial culture were done on all of them and a subsample of 50 were selected for virus culture. Mycoplasma hyopneumoniae, Pasteurella multocida and Haemophilus spp. were detected in 24.0%, 34.1% and 27.0% of the lungs, commonly in conjunction with each other. One isolate of Haemophilus pleuropneumoniae serotype 2 was detected and this represents the first report of its presence in the United States. No virus was detected in any of the lungs. Lungs with both M. hyopneumoniae and Pasteurella multocida had the greatest amount of macroscopic pneumonia (9.8% of the lung). Lungs with M. hyopneumoniae or P. multocida alone had 4.9% and 5.2% of the lung involved with pneumonia respectively. Lungs with Haemophilus sp. Taxon "minor group" had 3.8% of the lung involved which was not significantly different from lungs with none of these organisms being detected (1.6%). There was a positive correlation between the extent of M. hyopneumoniae infection, as scored by FAT and the amount of macroscopic pneumonia present (r = 0.46; P less than 0.001). Likewise, there was a positive correlation between the estimated concentration of P. multocida present, as scored by the relative number of colonies on blood agar and the amount of macroscopic pneumonia present (r = 0.60; P less than 0.001). Microscopically, the amount of lymphoreticular proliferation, polymorphonuclear cells and alveolar macrophages were evaluated.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:4016578

  3. Oral care and nosocomial pneumonia: a systematic review.

    PubMed

    Vilela, Maria Carolina Nunes; Ferreira, Gustavo Zanna; Santos, Paulo Sérgio da Silva; Rezende, Nathalie Pepe Medeiros de

    2015-01-01

    To perform a systematic review of the literature on the control of oral biofilms and the incidence of nosocomial pneumonia, in addition to assessing and classifying studies as to the grade of recommendation and level of evidence. The review was based on PubMed, LILACS, and Scopus databases, from January 1st, 2000 until December 31st, 2012. Studies evaluating oral hygiene care related to nosocomial infections in patients hospitalized in intensive care units were selected according to the inclusion criteria. Full published articles available in English, Spanish, or Portuguese, which approached chemical or mechanical oral hygiene techniques in preventing pneumonia, interventions performed, and their results were included. After analysis, the articles were classified according to level of evidence and grade of recommendation according to the criteria of the Oxford Centre for Evidence-Based Medicine. A total of 297 abstracts were found, 14 of which were full articles that met our criteria. Most articles included a study group with chlorhexidine users and a control group with placebo users for oral hygiene in the prevention of pneumonia. All articles were classified as B in the level of evidence, and 12 articles were classified as 2B and two articles as 2C in grade of recommendation. It was observed that the control of oral biofilm reduces the incidence of nosocomial pneumonia, but the fact that most articles had an intermediate grade of recommendation makes clear the need to conduct randomized controlled trials with minimal bias to establish future guidelines for oral hygiene in intensive care units.

  4. Intrapulmonary protein leakage in immunocompromised children and adults with pneumonia

    PubMed Central

    Ratjen, F; Havers, W; Braun, J

    1999-01-01

    BACKGROUND—Pulmonary infections are associated with an increase in capillary permeability but information regarding age related differences in the local inflammatory response is lacking. To quantify the degree of capillary leakage during inflammation, the concentrations of the plasma proteins albumin, α1-antitrypsin, α2-macroglobulin and the locally produced proteins elastase, myeloperoxidase, lactoferrin and fibronectin were studied in the bronchoalveolar lavage (BAL) fluid of immunosuppressed children and adults with pneumonia.
METHODS—Sixteen children aged 2-16 years and 15 adults who developed pneumonia while receiving immunosuppressive therapy for haematological malignancies were included in the study. Bronchoalveolar lavage was performed via a flexible bronchoscope with three aliquots of 1 ml/kg body weight in children and 200 ml in adults. Protein concentrations in BAL fluid were determined using highly sensitive immunoluminometric assays.
RESULTS—Despite considerable variability, the median concentrations of all proteins in BAL fluid were significantly higher in both patient populations than in previously collected age adjusted reference values. The concentrations of serum derived proteins were significantly higher in children with pneumonia than in adult patients. In contrast, no differences were observed between the two groups for locally produced proteins.
CONCLUSIONS—These data suggest that the degree of protein exudation is more pronounced in immunosuppressed children with pneumonia than in adults in a similar clinical situation. This is in agreement with our studies in healthy individuals and may reflect a greater permeability of the alveolar-capillary membrane in children, regardless of disease status.

 PMID:10212109

  5. Acute Necrotizing Pancreatitis Associated with Mycoplasma pneumoniae Infection in a Child.

    PubMed

    Yang, Aram; Kang, Ben; Choi, So Yoon; Cho, Joong Bum; Kim, Yae-Jean; Jeon, Tae Yeon; Choe, Yon Ho

    2015-09-01

    Mycoplasma pneumoniae is responsible for approximately 20% to 30% of community-acquired pneumonia, and is well known for its diverse extrapulmonary manifestations. However, acute necrotizing pancreatits is an extremely rare extrapulmonary manifestation of M. pneumoniae infection. A 6-year-old girl was admitted due to abdominal pain, vomiting, fever, and confused mentality. Acute necrotizing pancreatitis was diagnosed according to symptoms, laboratory test results, and abdominal computed tomography scans. M. pneumoniae infection was diagnosed by a 4-fold increase in antibodies to M. pneumoniae between acute and convalescent sera by particle agglutination antibody assay. No other etiologic factors or pathogens were detected. Despite the occurrence of a large infected pseudocyst during the course, the patient was able to discharge without morbidity by early aggressive supportive care. This is the first case in Korea of a child with acute necrotizing pancreatitis associated with M. pneumoniae infection. PMID:26473143

  6. [The changing epidemiology of extended spectrum β-lactamase-producing Klebsiella pneumoniae].

    PubMed

    Elhani, Dalèle; Bakir, Leila; Aouni, Mahjoub

    2011-01-01

    In the last two decades, Klebsiella pneumoniae demonstrated some characteristics of acquisition of plasmids coding extended spectrum β-lactamases (ESBL). The review data showed an increase in worldwide prevalence of ESBL and a temporal shift in the prevalence of ESBL types in K. pneumoniae during this last decade. CTX-M-15 seems to be the predominant ESBL type in K. pneumoniae in some parts of the world. The dissemination of several nosocomial CTX-M-15-producing K. pneumoniae clones was reported unlike the worldwide dissemination of a single virulent ST131 CTX-M-15 producing Escherichia coli clone. The diversity of plasmids carrying the bla(CTX-M-15) gene in K. pneumoniae suggested the frequent transfer of this gene between different replicons. The acquisition of the bla(CTX-M-15) gene by K. pneumoniae was probably occurred via horizontal transfer from E. coli.

  7. Structure of a conjugative element in Streptococcus pneumoniae

    SciTech Connect

    Vijayakumar, M.N.; Priebe, S.D.; Guild, W.R.

    1986-06-01

    The authors have cloned and mapped a 69-kilobase (kb) region of the chromosome of Streptococcus pneumoniae DP1322, which carries the conjugative Omega(cat-tet) insertion from S. pneumoniae BM6001. This element proved to be 65.5 kb in size. Location of the junctions was facilitated by cloning a preferred target region from the wild-type strain Rx1 recipient genome. This target site was preferred by both the BM6001 element and the cat-erm-tet element from Streptococcus agalactiae B109. Within the BM6001 element cat and tet were separated by 30 kb, and cat was flanked by two copies of a sequence that was also present in the recipient strain Rx1 DNA. Another sequence at least 2.4 kb in size was found inside the BM6001 element and at two places in the Rx1 genome. Its role is unknown. The ends of the BM6001 element appear to be the same as those of the B109 element, both as seen after transfer to S. pneumoniae and as mapped by others in pDP5 after transposition in Streptococcus faecalis. No homology is seen between the ends of the BM6001 element and no evidence found suggesting that it ever circularizes.

  8. Small regulatory RNAs in Streptococcus pneumoniae: discovery and biological functions

    PubMed Central

    Wilton, Joana; Acebo, Paloma; Herranz, Cristina; Gómez, Alicia; Amblar, Mónica

    2015-01-01

    Streptococcus pneumoniae is a prominent human pathogen responsible for many severe diseases and the leading cause of childhood mortality worldwide. The pneumococcus is remarkably adept at colonizing and infecting different niches in the human body, and its adaptation to dynamic host environment is a central aspect of its pathogenesis. In the last decade, increasing findings have evidenced small RNAs (sRNAs) as vital regulators in a number of important processes in bacteria. In S. pneumoniae, a small antisense RNA was first discovered in the pMV158 plasmid as a copy number regulator. More recently, genome-wide screens revealed that the pneumococcal genome also encodes multiple sRNAs, many of which have important roles in virulence while some are implicated in competence control. The knowledge of the sRNA-mediated regulation in pneumococcus remains very limited, and future research is needed for better understanding of functions and mechanisms. Here, we provide a comprehensive summary of the current knowledge on sRNAs from S. pneumoniae, focusing mainly on the trans-encoded sRNAs. PMID:25904932

  9. Fusobacterium necrophorum in North American Bighorn Sheep ( Ovis canadensis ) Pneumonia.

    PubMed

    Shanthalingam, Sudarvili; Narayanan, Sanjeevkumar; Batra, Sai Arun; Jegarubee, Bavananthasivam; Srikumaran, Subramaniam

    2016-07-01

    Fusobacterium necrophorum has been detected in pneumonic bighorn sheep (BHS; Ovis canadensis ) lungs, in addition to the aerobic respiratory pathogens Mannheimia haemolytica , Bibersteinia trehalosi , Pasteurella multocida , and Mycoplasma ovipneumoniae . Similar to M. haemolytica , F. necrophorum produces a leukotoxin. Leukotoxin-induced lysis and degranulation of polymorphonuclear leukocytes (PMNs) and macrophages are responsible for acute inflammation and lung tissue damage characteristic of M. haemolytica -caused pneumonia. As one approach in elucidating the role of F. necrophorum in BHS pneumonia, we determined the frequency of the presence of F. necrophorum in archived pneumonic BHS lung tissues, and susceptibility of BHS leukocytes to F. necrophorum leukotoxin. A species-specific PCR assay detected F. necrophorum in 37% of pneumonic BHS lung tissues (total tested n=70). Sequences of PCR amplicons were similar to the less virulent F. necrophorum subsp. funduliforme. Fusobacterium necrophorum leukotoxin exhibited cytotoxicity to BHS PMNs and peripheral blood mononuclear cells. As with the M. haemolytica leukotoxin, F. necrophorum leukotoxin was more toxic to BHS PMNs than domestic sheep PMNs. It is likely that F. necrophorum enters the lungs after M. haemolytica and other aerobic respiratory pathogens enter the lungs and initiate tissue damage, thereby creating a microenvironment that is conducive for anaerobic bacterial growth. In summary, Fusobacterium leukotoxin is highly toxic for BHS leukocytes; however, based on the PCR findings, it is unlikely to play a direct role in the development of BHS pneumonia.

  10. Acinetobacter community-acquired pneumonia in a healthy child.

    PubMed

    Moreira Silva, G; Morais, L; Marques, L; Senra, V

    2012-01-01

    Acinetobacter is involved in a variety of infectious diseases primarily associated with healthcare. Recently there has been increasing evidence of the important role these pathogens play in community acquired infections. We report on the case of a previously healthy child, aged 28 months, admitted for fever, cough and pain on the left side of the chest, which on radiographic examination corresponded to a lower lobe necrotizing pneumonia. After detailed diagnostic work-up, community acquired Acinetobacter lwoffii pneumonia was diagnosed. The child had frequently shared respiratory equipment with elderly relatives with chronic obstructive pulmonary disease. As there were no other apparent risk factors, it could be assumed that the sharing of the equipment was the source of infection. The authors wish to draw attention to this possibility, that a necrotising community-acquired pneumonia due to Acinetobacter lwoffii can occur in a previously healthy child and to the dangers of inappropriate use and poor sterilisation of nebulisers. This case is a warning of the dangers that these bacteria may pose in the future in a community setting.

  11. Epidemiology of Carbapenem Resistant Klebsiella pneumoniae Infections in Mediterranean Countries

    PubMed Central

    Girmenia, Corrado; Serrao, Alessandra; Canichella, Martina

    2016-01-01

    Infections by Carbapenem-Resistant Enterobacteriaceae (CRE), in particular, carbapenem-resistant Klebsiella pneumoniae (CRKp), are a significant public health challenge worldwide. Resistance to carbapenems in enterobacteriaceae is linked to different mechanisms, including the production of the various types of enzymes like KPC, VIM, IMP, NDM, and OXA-48. Despite several attempts to control the spread of these infections at the local and national level, the epidemiological situation for CRKp had worsened in the last years in the Mediterranean area. The rate and types of CRKp isolates greatly differ in the various Mediterranean countries. KPC-producing K. pneumoniae is diffused particularly in the European countries bordering the Mediterranean Sea and is endemic in Greece and Italy. On the contrary, OXA-48-producing K. pneumoniae is endemic in Turkey and Malta and diffused at inter-regional level particularly in some North African and Middle East countries. The spread of these multiresistant pathogens in the world and the Mediterranean countries has been related to various epidemiological factors including the international transfer of patients coming from endemic areas. PMID:27441063

  12. Acinetobacter community-acquired pneumonia in a healthy child.

    PubMed

    Moreira Silva, G; Morais, L; Marques, L; Senra, V

    2012-01-01

    Acinetobacter is involved in a variety of infectious diseases primarily associated with healthcare. Recently there has been increasing evidence of the important role these pathogens play in community acquired infections. We report on the case of a previously healthy child, aged 28 months, admitted for fever, cough and pain on the left side of the chest, which on radiographic examination corresponded to a lower lobe necrotizing pneumonia. After detailed diagnostic work-up, community acquired Acinetobacter lwoffii pneumonia was diagnosed. The child had frequently shared respiratory equipment with elderly relatives with chronic obstructive pulmonary disease. As there were no other apparent risk factors, it could be assumed that the sharing of the equipment was the source of infection. The authors wish to draw attention to this possibility, that a necrotising community-acquired pneumonia due to Acinetobacter lwoffii can occur in a previously healthy child and to the dangers of inappropriate use and poor sterilisation of nebulisers. This case is a warning of the dangers that these bacteria may pose in the future in a community setting. PMID:21963110

  13. [CT pathologic correlative study of bronchiolitis obliterans organizing pneumonia].

    PubMed

    Nishimura, K; Kitaichi, M; Izumi, T; Kanaoka, M; Itoh, H

    1989-01-01

    Though bronchiolitis obliterans organizing pneumonia (BOOP) was proposed as a new infiltrative lung disease in 1985, we think it has two radiologic problems. First, in spite of interstitial pneumonia, about half of chest radiographs of BOOP has been reported to show alveolar opacities. Second, because radiologic features of both some cases of BOOP and of usual interstitial pneumonia (UIP) show reticular shadows on chest radiographs, it is sometimes difficult to differentiate between two diseases. We correlated CT images with open lung biopsy specimens and evaluated CT's ability to differentiate BOOP from UIP. CT findings of all cases of BOOP were: (1) markedly increased dense infiltrates of various sizes which demarcated sharply from normal lung field. Air bronchogram was always present. (2) less dense images were seen which also stood out against the normal lung field. The former corresponded to air space consolidation formed by organized exudates and inflammatory cells within alveolar ducts and alveoli, while the latter indicated luminal and mural alveolitis. Both findings were sharply delineated from each other probably because of intervening interlobular septa. Conglomerated small cystic shadows and air bronchography within areas of intense lung density were seen in CT images of most of 28 patients with UIP. Those findings proved to correspond to macroscopic or microscopic honey combing which were not seen in our cases of BOOP. These radiologic and pathologic features of UIP were different. PMID:2724593

  14. Fusobacterium necrophorum in North American Bighorn Sheep ( Ovis canadensis ) Pneumonia.

    PubMed

    Shanthalingam, Sudarvili; Narayanan, Sanjeevkumar; Batra, Sai Arun; Jegarubee, Bavananthasivam; Srikumaran, Subramaniam

    2016-07-01

    Fusobacterium necrophorum has been detected in pneumonic bighorn sheep (BHS; Ovis canadensis ) lungs, in addition to the aerobic respiratory pathogens Mannheimia haemolytica , Bibersteinia trehalosi , Pasteurella multocida , and Mycoplasma ovipneumoniae . Similar to M. haemolytica , F. necrophorum produces a leukotoxin. Leukotoxin-induced lysis and degranulation of polymorphonuclear leukocytes (PMNs) and macrophages are responsible for acute inflammation and lung tissue damage characteristic of M. haemolytica -caused pneumonia. As one approach in elucidating the role of F. necrophorum in BHS pneumonia, we determined the frequency of the presence of F. necrophorum in archived pneumonic BHS lung tissues, and susceptibility of BHS leukocytes to F. necrophorum leukotoxin. A species-specific PCR assay detected F. necrophorum in 37% of pneumonic BHS lung tissues (total tested n=70). Sequences of PCR amplicons were similar to the less virulent F. necrophorum subsp. funduliforme. Fusobacterium necrophorum leukotoxin exhibited cytotoxicity to BHS PMNs and peripheral blood mononuclear cells. As with the M. haemolytica leukotoxin, F. necrophorum leukotoxin was more toxic to BHS PMNs than domestic sheep PMNs. It is likely that F. necrophorum enters the lungs after M. haemolytica and other aerobic respiratory pathogens enter the lungs and initiate tissue damage, thereby creating a microenvironment that is conducive for anaerobic bacterial growth. In summary, Fusobacterium leukotoxin is highly toxic for BHS leukocytes; however, based on the PCR findings, it is unlikely to play a direct role in the development of BHS pneumonia. PMID:27224212

  15. Steroid use is associated with pneumonia in pediatric chest trauma.

    PubMed

    Williams, M D; Reckard, P E; Knox, R; Petersen, S R; Schiller, W R

    1992-04-01

    A review of pediatric trauma focused on pediatric chest injuries was performed at a trauma center specializing in neurologic trauma. Eighty of 342 (23%) pediatric trauma patients admitted to the center had chest injuries. Age, gender, mechanism of injury, magnitude of injury, incidence of pulmonary infection, chest tube usage, endotracheal intubation, steroid or antibiotic usage, morbidity, and mortality data were reviewed. Sixteen of 78 children (20%) with chest injuries developed pulmonary infections and were compared with the noninfected group. Patients with pneumonia had a higher morbidity with significantly longer mean hospital stay (43.0 vs. 12.7 days; p = 0.001), duration of intubation (8.4 vs. 1.5 days; p = 0.001), and total days with chest tubes, (2.2 vs. 1.4 days; p = 0.02). Pneumonia was significantly associated with longer mean duration of steroid usage (6.4 vs. 0.8 days; p = 0.0001). Duration of steroid administration for the treatment of concomitant brain injury was a significant independent risk factor for the occurrence of pneumonia.

  16. [Usefulness of sputum Gram staining in community-acquired pneumonia].

    PubMed

    Sato, Tadashi; Aoshima, Masahiro; Ohmagari, Norio; Tada, Hiroshi; Chohnabayashi, Naohiko

    2002-07-01

    To evaluate the usefulness of sputum gram staining in community-acquired pneumonia (CAP), we reviewed 144 cases requiring hospitalization in the last 4 years. The sensitivity was 75.5%, specificity 68.2%, positive predictive value 74.1%, negative predictive value 69.8%, positive likelihood ratio 2.37, negative likelihood ratio 0.36 and accuracy 72.2% in 97 cases. Both sputum gram staining and culture were performed. Concerning bacterial pneumonia (65 cases), we compared the Gram staining group (n = 33), which received initial antibiotic treatment, based on sputum gram staining with the Empiric group (n = 32) that received antibiotics empirically. The success rates of the initial antibiotic treatment were 87.9% vs. 78.1% (P = 0.473); mean hospitalization periods were 9.67 vs. 11.75 days (P = 0.053); and periods of intravenous therapy were 6.73 vs. 7.91 days (P = 0.044), respectively. As for initial treatment, penicillins were used in the Gram staining group more frequently (P < 0.01). We conclude that sputum gram staining is useful for the shortening of the treatment period and the appropriate selection of initial antibiotics in bacterial pneumonia. We believe, therefore, that sputum gram staining is indispensable as a diagnostic tool CAP.

  17. Bacteriology of aspiration pneumonia in patients with acute coma.

    PubMed

    Lauterbach, Enise; Voss, Frederik; Gerigk, Roland; Lauterbach, Michael

    2014-12-01

    Loss of protective airway reflexes in patients with acute coma puts these patients at risk of aspiration pneumonia complicating the course of the primary disease. Available data vary considerably with regard to bacteriology, role of anaerobic bacteria, and antibiotic treatment. Our objective was to research the bacteriology of aspiration pneumonia in acute coma patients who were not pre-treated with antibiotics or hospitalized within 30 days prior to the event. We prospectively analyzed 127 patient records from adult patients admitted, intubated and ventilated to a tertiary medical intensive care unit with acute coma. Bacteriology and antibiotic resistance testing from tracheal aspirate sampled within 24 h after admission, blood cultures, ICU scores (APACHE II, SOFA), hematology, and clinical chemistry were assessed. Patients were followed up until death or hospital discharge. The majority of patients with acute coma suffered from acute cardiovascular disorders, predominantly myocardial infarction, followed by poisonings, and coma of unknown cause. In a majority of our patients, microaspiration resulted in overt infection. Most frequently S. aureus, H. influenzae, and S. pneumoniae were isolated. Anaerobic bacteria (Bacteroides spec., Fusobacteria, Prevotella spec.) were isolated from tracheal aspirate in a minority of patients, and predominantly as part of a mixed infection. Antibiotic monotherapy with a 2nd generation cephalosporin, or a 3rd generation gyrase inhibitor, was most effective in our patients regardless of the presence of anaerobic bacteria.

  18. [The ethiology structure of community-acquried pneumonia of young adults in closed communities].

    PubMed

    Nosach, E S; Skryl', S V; Kulakova, N V; Martynova, A V

    2012-01-01

    Despite of success in ethiology evaluation of community-acquired pneumonia (CAP) and instant improvement of diagnostic methods microbiological spectrum of CAP is still remaining underestimated and is still the problem for the routine clinical practice. In our study we estimated the role of fastidious bacteria which cause atypical CAP such as Chlamydophilla pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila. Furthermore we also defined the role of viral pathogens in ethiology of CAP.

  19. Emergence of a Streptococcus pneumoniae clinical isolate highly resistant to telithromycin and fluoroquinolones.

    PubMed

    Faccone, Diego; Andres, Patricia; Galas, Marcelo; Tokumoto, Marta; Rosato, Adriana; Corso, Alejandra

    2005-11-01

    Streptococcus pneumoniae is a major pathogen causing community-acquired pneumonia and acute bronchitis. Macrolides, fluoroquinolones (FQs), and, recently, telithromycin (TEL) constitute primary therapeutic options, and rare cases of resistance have been reported. In this report, we describe the emergence of an S. pneumoniae clinical isolate with high-level TEL resistance (MIC, 256 microg/ml) and simultaneous resistance to FQs. Ongoing studies are oriented to elucidate the precise mechanism of resistance to TEL.

  20. The Regulation of Proresolving Lipid Mediator Profiles in Baboon Pneumonia by Inhaled Carbon Monoxide

    PubMed Central

    Dalli, Jesmond; Kraft, Bryan D.; Colas, Romain A.; Shinohara, Masakazu; Fredenburgh, Laura E.; Hess, Dean R.; Chiang, Nan; Welty-Wolf, Karen; Choi, Augustine M.; Piantadosi, Claude A.

    2015-01-01

    Strategies for the treatment of bacterial pneumonia beyond traditional antimicrobial therapy have been limited. The recently discovered novel genus of lipid mediators, coined “specialized proresolving mediators” (SPMs), which orchestrate clearance of recruited leukocytes and restore epithelial barrier integrity, have offered new insight into the resolution of inflammation. We performed lipid mediator (LM) metabololipidomic profiling and identification of LMs on peripheral blood leukocytes and plasma from a baboon model of Streptococcus pneumoniae pneumonia. Leukocytes and plasma were isolated from whole blood of S. pneumoniae–infected (n = 5–6 per time point) and control, uninfected baboons (n = 4 per time point) at 0, 24, 48, and 168 hours. In a subset of baboons with pneumonia (n = 3), we administered inhaled carbon monoxide (CO) at 48 hours (200–300 ppm for 60–90 min). Unstimulated leukocytes from control animals produced a proresolving LM signature with elevated resolvins and lipoxins. In contrast, serum-treated, zymosan-stimulated leukocytes and leukocytes from baboons with S. pneumoniae pneumonia produced a proinflammatory LM signature profile with elevated leukotriene B4 and prostaglandins. Plasma from baboons with S. pneumoniae pneumonia also displayed significantly reduced LM–SPM levels, including eicosapentaenoic acid–derived E-series resolvins (RvE) and lipoxins. CO inhalation increased levels of plasma RvE and lipoxins relative to preexposure levels. These results establish the leukocyte and plasma LM profiles biosynthesized during S. pneumoniae pneumonia in baboons and provide evidence for pneumonia-induced dysregulation of these proresolution programs. Moreover, these SPM profiles are partially restored with inhaled low-dose CO and SPM, which may shorten the time to pneumonia resolution. PMID:25568926

  1. Activity of imipenem against Klebsiella pneumoniae biofilms in vitro and in vivo.

    PubMed

    Chen, Ping; Seth, Akhil K; Abercrombie, Johnathan J; Mustoe, Thomas A; Leung, Kai P

    2014-01-01

    Encapsulated Klebsiella pneumoniae has emerged as one of the most clinically relevant and more frequently encountered opportunistic pathogens in combat wounds as the result of nosocomial infection. In this report, we show that imipenem displayed potent activity against established K. pneumoniae biofilms under both static and flow conditions in vitro. Using a rabbit ear model, we also demonstrated that imipenem was highly effective against preformed K. pneumoniae biofilms in wounds.

  2. Detection of Haemophilus influenzae and Streptococcus pneumoniae DNA in blood culture by a single PCR assay.

    PubMed Central

    Hassan-King, M; Baldeh, I; Adegbola, R; Omosigho, C; Usen, S O; Oparaugo, A; Greenwood, B M

    1996-01-01

    A multiplex PCR assay was developed to screen blood cultures from children in The Gambia with suspected pneumonia for the simultaneous detection of Haemophilus influenzae type b and Streptococcus pneumoniae isolates. Analysis of 295 blood cultures showed that PCR detected the organisms in all samples positive by culture in two samples infected with H. influenzae type b and four samples infected with S. pneumoniae that were culture negative, indicating that this method is sensitive for detecting these organisms in blood cultures. PMID:8818907

  3. Semi-automated method to measure pneumonia severity in mice through computed tomography (CT) scan analysis

    NASA Astrophysics Data System (ADS)

    Johri, Ansh; Schimel, Daniel; Noguchi, Audrey; Hsu, Lewis L.

    2010-03-01

    Imaging is a crucial clinical tool for diagnosis and assessment of pneumonia, but quantitative methods are lacking. Micro-computed tomography (micro CT), designed for lab animals, provides opportunities for non-invasive radiographic endpoints for pneumonia studies. HYPOTHESIS: In vivo micro CT scans of mice with early bacterial pneumonia can be scored quantitatively by semiautomated imaging methods, with good reproducibility and correlation with bacterial dose inoculated, pneumonia survival outcome, and radiologists' scores. METHODS: Healthy mice had intratracheal inoculation of E. coli bacteria (n=24) or saline control (n=11). In vivo micro CT scans were performed 24 hours later with microCAT II (Siemens). Two independent radiologists scored the extent of airspace abnormality, on a scale of 0 (normal) to 24 (completely abnormal). Using the Amira 5.2 software (Mercury Computer Systems), a histogram distribution of voxel counts between the Hounsfield range of -510 to 0 was created and analyzed, and a segmentation procedure was devised. RESULTS: A t-test was performed to determine whether there was a significant difference in the mean voxel value of each mouse in the three experimental groups: Saline Survivors, Pneumonia Survivors, and Pneumonia Non-survivors. It was found that the voxel count method was able to statistically tell apart the Saline Survivors from the Pneumonia Survivors, the Saline Survivors from the Pneumonia Non-survivors, but not the Pneumonia Survivors vs. Pneumonia Non-survivors. The segmentation method, however, was successfully able to distinguish the two Pneumonia groups. CONCLUSION: We have pilot-tested an evaluation of early pneumonia in mice using micro CT and a semi-automated method for lung segmentation and scoring system. Statistical analysis indicates that the system is reliable and merits further evaluation.

  4. Aspiration-related organizing pneumonia complicating laparoscopic adjustable gastric banding: A lung cancer mimicker

    PubMed Central

    Aljohaney, Ahmed A.; Ajlan, Amr M.; Alghamdi, Fahad A.

    2016-01-01

    There are several described pulmonary complications due to laparoscopic adjustable gastric banding. We report a rare case of a 32-year-old male who presented with pulmonary symptoms and a solitary lung mass 12 years after laparoscopic adjustable gastric banding. A bronchoscopic lung biopsy showed organizing pneumonia that was induced by aspiration pneumonia. The atypical radiological appearance of the aspiration pneumonia may pose a diagnostic challenge, and clinicians' awareness regarding such an entity is needed to avoid unnecessary intervention. PMID:27803757

  5. [Differential magnetic resonance diagnosis of central lung cancer and acute pneumonia].

    PubMed

    Gamova, E V; Nudnov, N V

    2006-01-01

    The paper analyzes the authors' own data of chest magnetic resonance imaging (MRI) in 86 patients with verified central lung cancer and acute pneumonia. The MRI signs of lung cancer are systematized in exo-, endo-, and peribronchial forms of growth. The additional capacities of contrast enhancement are analyzed. The MRI semiotics of acute pneumonia has been developed. The differential diagnostic criteria for recognizing central lung cancer and acute pneumonia have been also elaborated.

  6. A comparison between time to clinical stability in community-acquired aspiration pneumonia and community-acquired pneumonia.

    PubMed

    Jaoude, Philippe; Badlam, Jessica; Anandam, Anil; El-Solh, Ali A

    2014-03-01

    Antimicrobial therapy has been the main stay of therapy of community-acquired aspiration pneumonia (CAAP), but the duration of treatment has not been established. The objective of this study was to describe the time to reach clinical stability in patients with aspiration pneumonia compared to community-acquired pneumonia (CAP). A retrospective case control study at two university affiliated centers encompassing 329 consecutive patients admitted with CAAP and 329 consecutive patients with CAP was conducted between 2007 and 2011. While the median time to stability for patients with CAP was distributed around a median of 4 days, there was a bimodal distribution for time to clinical stability in patients with CAAP with dual peaks at days 2 and 5, respectively. CAAP patients who required more than 2 days to achieve clinical stability had a higher mortality rate compared to those with 2 days or less [odds ratio (OR) 5.95, 95% CI 2.85-12.4], and a longer hospital stay (6.6 ± 5.8 vs. 3.9 ± 1.2 days; p < 0.001). None of the CAAP patients who achieved clinical stability in 2 days or less was transferred to a higher level of care. In a multivariate analysis, time to clinical stability was found to be an independent predictor of outcome in patients with CAAP (OR 2.59, 95% CI 2.02-3.32). Normalization of vital signs in aspiration pneumonia follows a distinct pattern from that of patients with CAP. Time to achieve clinical stability may assist in identifying CAAP patients who are likely to require a shorter hospital stay and a shorter course of antimicrobial therapy.

  7. Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae at a single institution: insights into endemicity from whole-genome sequencing.

    PubMed

    Mathers, Amy J; Stoesser, Nicole; Sheppard, Anna E; Pankhurst, Louise; Giess, Adam; Yeh, Anthony J; Didelot, Xavier; Turner, Stephen D; Sebra, Robert; Kasarskis, Andrew; Peto, Tim; Crook, Derrick; Sifri, Costi D

    2015-03-01

    The global emergence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) multilocus sequence type ST258 is widely recognized. Less is known about the molecular and epidemiological details of non-ST258 K. pneumoniae in the setting of an outbreak mediated by an endemic plasmid. We describe the interplay of blaKPC plasmids and K. pneumoniae strains and their relationship to the location of acquisition in a U.S. health care institution. Whole-genome sequencing (WGS) analysis was applied to KPC-Kp clinical isolates collected from a single institution over 5 years following the introduction of blaKPC in August 2007, as well as two plasmid transformants. KPC-Kp from 37 patients yielded 16 distinct sequence types (STs). Two novel conjugative blaKPC plasmids (pKPC_UVA01 and pKPC_UVA02), carried by the hospital index case, accounted for the presence of blaKPC in 21/37 (57%) subsequent cases. Thirteen (35%) isolates represented an emergent lineage, ST941, which contained pKPC_UVA01 in 5/13 (38%) and pKPC_UVA02 in 6/13 (46%) cases. Seven (19%) isolates were the epidemic KPC-Kp strain, ST258, mostly imported from elsewhere and not carrying pKPC_UVA01 or pKPC_UVA02. Using WGS-based analysis of clinical isolates and plasmid transformants, we demonstrate the unexpected dispersal of blaKPC to many non-ST258 lineages in a hospital through spread of at least two novel blaKPC plasmids. In contrast, ST258 KPC-Kp was imported into the institution on numerous occasions, with other blaKPC plasmid vectors and without sustained transmission. Instead, a newly recognized KPC-Kp strain, ST941, became associated with both novel blaKPC plasmids and spread locally, making it a future candidate for clinical persistence and dissemination. PMID:25561339

  8. Streptococcus pneumoniae arginine synthesis genes promote growth and virulence in pneumococcal meningitis.

    PubMed

    Piet, Jurgen R; Geldhoff, Madelijn; van Schaik, Barbera D C; Brouwer, Matthijs C; Valls Seron, Mercedes; Jakobs, Marja E; Schipper, Kim; Pannekoek, Yvonne; Zwinderman, Aeilko H; van der Poll, Tom; van Kampen, Antoine H C; Baas, Frank; van der Ende, Arie; van de Beek, Diederik

    2014-06-01

    Streptococcus pneumoniae (pneumococcus) is a major human pathogen causing pneumonia, sepsis and bacterial meningitis. Using a clinical phenotype based approach with bacterial whole-genome sequencing we identified pneumococcal arginine biosynthesis genes to be associated with outcome in patients with pneumococcal meningitis. Pneumococci harboring these genes show increased growth in human blood and cerebrospinal fluid (CSF). Mouse models of meningitis and pneumonia showed that pneumococcal strains without arginine biosynthesis genes were attenuated in growth or cleared, from lung, blood and CSF. Thus, S. pneumoniae arginine synthesis genes promote growth and virulence in invasive pneumococcal disease.

  9. Aetiology of community acquired pneumonia in Valencia, Spain: a multicentre prospective study.

    PubMed Central

    Blanquer, J; Blanquer, R; Borrás, R; Nauffal, D; Morales, P; Menéndez, R; Subías, I; Herrero, L; Redón, J; Pascual, J

    1991-01-01

    A year long multicentre prospective study was carried out in the Valencia region of Spain, to determine the cause of community acquired pneumonia. The study was based on 510 of 833 patients with pneumonia. Of these, 462 were admitted to hospital, where 31 patients died. A cause was established in only 281 cases--208 of bacterial, 60 of viral, and 13 of mixed infection. The most common microorganisms were Streptococcus pneumoniae (14.5%), Legionella sp (14%), Influenza virus (8%), and Mycoplasma pneumoniae (4%). There was a higher incidence of Legionella sp than in other studies. PMID:1908605

  10. Incidence of Hospitalized Pneumococcal Pneumonia among Adults in Guatemala, 2008-2012

    PubMed Central

    Contreras, Carmen Lucía; Verani, Jennifer R.; Lopez, María Renee; Paredes, Antonio; Bernart, Chris; Moscoso, Fabiola; Roldan, Aleida; Arvelo, Wences; Lindblade, Kim A.; McCracken, John P.

    2015-01-01

    Background Streptococcus pneumoniae is a leading cause of pneumonia worldwide. However, the burden of pneumococcal pneumonia among adults in low- and middle-income countries is not well described. Methods Data from 2008–2012 was analyzed from two surveillance sites in Guatemala to describe the incidence of pneumococcal pneumonia in adults. A case of hospitalized pneumococcal pneumonia was defined as a positive pneumococcal urinary antigen test or blood culture in persons aged ≥ 18 years hospitalized with an acute respiratory infection (ARI). Results Among 1595 adults admitted with ARI, 1363 (82%) had either urine testing (n = 1286) or blood culture (n = 338) performed. Of these, 188 (14%) had pneumococcal pneumonia, including 173 detected by urine only, 8 by blood culture only, and 7 by both methods. Incidence rates increased with age, with the lowest rate among 18–24 year-olds (2.75/100,000) and the highest among ≥65 year-olds (31.3/100,000). The adjusted incidence of hospitalized pneumococcal pneumonia was 18.6/100,000 overall, with in-hospital mortality of 5%. Conclusions An important burden of hospitalized pneumococcal pneumonia in adults was described, particularly for the elderly. However, even adjusted rates likely underestimate the true burden of pneumococcal pneumonia in the community. These data provide a baseline against which to measure the indirect effects of the 2013 introduction of the pneumococcal conjugate vaccine in children in Guatemala. PMID:26488871

  11. Mycoplasma pneumoniae: Current Knowledge on Nucleic Acid Amplification Techniques and Serological Diagnostics.

    PubMed

    Loens, Katherine; Ieven, Margareta

    2016-01-01

    Mycoplasma pneumoniae (M. pneumoniae) belongs to the class Mollicutes and has been recognized as a common cause of respiratory tract infections (RTIs), including community-acquired pneumonia (CAP), that occur worldwide and in all age groups. In addition, M. pneumoniae can simultaneously or sequentially lead to damage in the nervous system and has been associated with a wide variety of other acute and chronic diseases. During the past 10 years, the proportion of LRTI in children and adults, associated with M. pneumoniae infection has ranged from 0 to more than 50%. This variation is due to the age and the geographic location of the population examined but also due to the diagnostic methods used. The true role of M. pneumoniae in RTIs remains a challenge given the many limitations and lack of standardization of the applied diagnostic tool in most cases, with resultant wide variations in data from different studies. Correct and rapid diagnosis and/or management of M. pneumoniae infections is, however, critical to initiate appropriate antibiotic treatment and is nowadays usually done by PCR and/or serology. Several recent reviews, have summarized current methods for the detection and identification of M. pneumoniae. This review will therefore provide a look at the general principles, advantages, diagnostic value, and limitations of the most currently used detection techniques for the etiological diagnosis of a M. pneumoniae infection as they evolve from research to daily practice. PMID:27064893

  12. Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care

    PubMed Central

    Trinh, Vincent Q.; Ravi, Praful; Abd-El-Barr, Abd-El-Rahman M.; Jhaveri, Jay K.; Gervais, Mai-Kim; Meyer, Christian P.; Hanske, Julian; Sammon, Jesse D.; Trinh, Quoc-Dien

    2016-01-01

    Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS). Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS), a Healthcare Cost and Utilization Project (HCUP) subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC) of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P < 0.001); the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P = 0.01). Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality. PMID:27445554

  13. Pneumonia and Influenza Mortality Among American Indian and Alaska Native People, 1990–2009

    PubMed Central

    Hennessy, Thomas W.; Singleton, Rosalyn J.; Butler, Jay C.; Holve, Stephen; Cheek, James E.

    2014-01-01

    Objectives. We compared pneumonia and influenza death rates among American Indian/Alaska Native (AI/AN) people with rates among Whites and examined geographic differences in pneumonia and influenza death rates for AI/AN persons. Methods. We adjusted National Vital Statistics Surveillance mortality data for racial misclassification of AI/AN people through linkages with Indian Health Service (IHS) registration records. Pneumonia and influenza deaths were defined as those who died from 1990 through 1998 and 1999 through 2009 according to codes for pneumonia and influenza from the International Classification of Diseases, 9th and 10th Revision, respectively. We limited the analysis to IHS Contract Health Service Delivery Area counties, and compared pneumonia and influenza death rates between AI/ANs and Whites by calculating rate ratios for the 2 periods. Results. Compared with Whites, the pneumonia and influenza death rate for AI/AN persons in both periods was significantly higher. AI/AN populations in the Alaska, Northern Plains, and Southwest regions had rates more than 2 times higher than those of Whites. The pneumonia and influenza death rate for AI/AN populations decreased from 39.6 in 1999 to 2003 to 33.9 in 2004 to 2009. Conclusions. Although progress has been made in reducing pneumonia and influenza mortality, disparities between AI/AN persons and Whites persist. Strategies to improve vaccination coverage and address risk factors that contribute to pneumonia and influenza mortality are needed. PMID:24754620

  14. Anthropometric measurements may be informative for nursing home-acquired pneumonia

    PubMed Central

    Yardimci, Bulent; Aksoy, Sevki Murat; Ozkaya, Ismail; Demir, Tarik; Tezcan, Gulsen; Kaptanoglu, Aysegul Yildirim

    2016-01-01

    Objective: To evaluate the relationship between anthropometric measurements and Nursing Home-Acquired Pneumonia (NHAP) risk. Methods: Consecutive patients of 65 years or elderly who were living in the Balikli Rum Hospital Nursing Homes were included in this prospective study. At the beginning of this study, the patients’ anthropometrics values were measured. The patients were followed for one year, and any incidences of pneumonia attacks were recorded. The relationship between the anthropometric measurements and pneumonia occurrences was analyzed. Results: There were 133 inmates at the initial assessments. Of 108 patients who were eligible for the study, 77 (72.2%) were female and 37 (27.8%) were male. The mean age of the group was 79.8±10.5. Patients were assigned to a group according to the presence of pneumonia during the one -year follow-up. There were 74 (55.6%) patients who had suffered from at least one attack of pneumonia during the follow-up period. The mean triceps skinfold was significantly thinner in the pneumonia group, and the mean handgrip measurements in both the dominant and non-dominant hands were significantly weaker in the pneumonia group. Furthermore, the frequency of Chronic Obstructive Pulmonary Diseases (COPD) was significantly higher in this group (p < 0.001). Conclusions: The risk of pneumonia was high in the elderly population who live in nursing homes. Simple anthropometric values may be predictive of the potential for Nursing Home-Acquired Pneumonia. PMID:27375716

  15. Acute respiratory distress syndrome caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability: a case report

    PubMed Central

    Takahashi, Naoki; Oi, Rie; Ota, Muneyuki; Toriumi, Shinichi; Ogushi, Fumitaka

    2016-01-01

    Sporadic patients with acute respiratory distress syndrome (ARDS) caused by Mycoplasma pneumoniae have been reported. However, knowledge about the pathophysiology and pharmacological treatment of this condition is insufficient. Moreover, the pulmonary vascular permeability in ARDS related to M. pneumoniae infection has not been reported. We report a case of ARDS caused by Mycoplasma pneumoniae without elevated pulmonary vascular permeability, which was successfully treated using low-dose short-term hydrocortisone, suggesting that pulmonary infiltration in ARDS caused by Mycoplasma pneumoniae does not match the criteria of permeability edema observed in typical ARDS. PMID:27162691

  16. Idiopathic interstitial pneumonia following bone marrow transplantation: the relationship with total body irradiation

    SciTech Connect

    Keane, T.J.; Van Dyk, J.; Rider, W.D.

    1981-10-01

    Interstitial pneumonia is a frequent and often fatal complication of allogenic bone marrow transplantation. Thirty to 40 percent of such cases are of unknown etiology and have been labelled as cases of idiopathic interstitial pneumonia. Idiopathic cases are more commonly associated with the use of total body irradiation; their occurrence appears to be independent of immunosupression or graft versus host disease. Evidence is presented from the literature suggesting that the development of idiopathic interstitial pneumonia is related to the absolute absorbed dose of radiation to lung. The similarity of idiopathic pneumonia to radiation pneumonitis seen in a different clinical setting is described.

  17. [Fatal Panton-Valentine leukocidine-associated Staphylococcus aureus necrotizing pneumonia].

    PubMed

    Laverdure, F; Neulier, C; Sudant, J; Legriel, S; Bruneel, F

    2014-11-01

    Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia associated with a high fatality rate. The specificities of its presentation must be known by the critical care doctor, in order to quickly make the diagnosis and start the right antibiotics and discuss adjunctive therapy with intravenous immunoglobin. Moreover, the management of close contacts (household and healthcare workers) of patient with such a pneumonia is not well-known. The present case report underlines the clinical presentation of this pneumonia, the specificities of its treatment, and specifies the management of close contacts.

  18. Detection of extended-spectrum β-lactamases in Klebsiella pneumoniae: comparison of phenotypic characterization methods

    PubMed Central

    Ejaz, Hasan; ul-Haq, Ikram; Mahmood, Saqib; Zafar, Aizza; Mohsin Javed, Muhammad

    2013-01-01

    Objective: Extended-spectrum β-lactamase producing K. pneumoniae is a serious threat to the patients. This manuscript shows the comparison of phenotypic characterization methods used for ESBL K. pneumoniae and frequency distribution of these isolates in various clinical samples. Methodology: Eleven different types of pathological samples collected on various time intervals were analyzed. K. pneumoniae were identified with API 20E system (bioMerieux) and initial screening of ESBL K. pneumoniae was performed using the ceftazidime antimicrobial disc. Double-disc synergy test (DDST) and CLSI confirmatory test were compared for the phenotypic detection of ESBL K. pneumoniae. Results: A total number of 214 ESBL producing K. pneumoniae were isolated from various clinical samples. Frequency distribution of ESBL producing K. pneumoniae was found to be highest among blood 117 (54.7%) and urine 46 (21.5%) samples. Data regarding the use of various interventions among these patients showed most common presence of intravenous line 209 (97.7%) and urinary catheters 46 (21.5%). Comparison of DDST and CLSI confirmatory test showed that the DDST detected 145 (67.8%) isolates while 213 (99.5%) ESBL K. pneumoniae were characterized by CLSI confirmatory test. Conclusion: The use of CLSI confirmatory test is very efficient in the early detection of ESBL K. pneumoniae especially when the facilities for molecular characterization are not available. PMID:24353625

  19. Plasma-derived human C1-esterase inhibitor does not prevent mechanical ventilation-induced pulmonary complement activation in a rat model of Streptococcus pneumoniae pneumonia.

    PubMed

    de Beer, F M; Aslami, H; Hoeksma, J; van Mierlo, G; Wouters, D; Zeerleder, S; Roelofs, J J T H; Juffermans, N P; Schultz, M J; Lagrand, W K

    2014-11-01

    Mechanical ventilation has the potential to cause lung injury, and the role of complement activation herein is uncertain. We hypothesized that inhibition of the complement cascade by administration of plasma-derived human C1-esterase inhibitor (C1-INH) prevents ventilation-induced pulmonary complement activation, and as such attenuates lung inflammation and lung injury in a rat model of Streptococcus pneumoniae pneumonia. Forty hours after intratracheal challenge with S. pneumoniae causing pneumonia rats were subjected to ventilation with lower tidal volumes and positive end-expiratory pressure (PEEP) or high tidal volumes without PEEP, after an intravenous bolus of C1-INH (200 U/kg) or placebo (saline). After 4 h of ventilation blood, broncho-alveolar lavage fluid and lung tissue were collected. Non-ventilated rats with S. pneumoniae pneumonia served as controls. While ventilation with lower tidal volumes and PEEP slightly amplified pneumonia-induced complement activation in the lungs, ventilation with higher tidal volumes without PEEP augmented local complement activation more strongly. Systemic pre-treatment with C1-INH, however, failed to alter ventilation-induced complement activation with both ventilation strategies. In accordance, lung inflammation and lung injury were not affected by pre-treatment with C1-INH, neither in rats ventilated with lower tidal volumes and PEEP, nor rats ventilated with high tidal volumes without PEEP. Ventilation augments pulmonary complement activation in a rat model of S. pneumoniae pneumonia. Systemic administration of C1-INH, however, does not attenuate ventilation-induced complement activation, lung inflammation, and lung injury. PMID:24760631

  20. mPneumonia, an Innovation for Diagnosing and Treating Childhood Pneumonia in Low-Resource Settings: A Feasibility, Usability and Acceptability Study in Ghana

    PubMed Central

    Ginsburg, Amy Sarah; Tawiah Agyemang, Charlotte; Ambler, Gwen; Delarosa, Jaclyn; Brunette, Waylon; Levari, Shahar; Larson, Clarice; Sundt, Mitch; Newton, Sam; Borriello, Gaetano; Anderson, Richard

    2016-01-01

    Pneumonia is the leading cause of infectious disease mortality in children. Currently, health care providers (HCPs) are trained to use World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and manually assess respiratory rate to diagnose pneumonia in low-resource settings (LRS). However, this approach of relying on clinical signs alone has proven problematic. Hypoxemia, a diagnostic indicator of pneumonia severity associated with an increased risk of death, is not assessed because pulse oximetry is often not available in LRS. To improve HCPs’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, “mPneumonia” was developed. mPneumonia is a mobile health application that integrates a digital version of the IMCI algorithm with a software-based breath counter and a pulse oximeter. A design-stage qualitative pilot study was conducted to assess feasibility, usability, and acceptability of mPneumonia in six health centers and five community-based health planning and services centers in Ghana. Nine health administrators, 30 HCPs, and 30 caregivers were interviewed. Transcribed interview audio recordings were coded and analyzed for common themes. Health administrators reported mPneumonia would be feasible to implement with approval and buy-in from national and regional decision makers. HCPs felt using the mPneumonia application would be feasible to integrate into their work with the potential to improve accurate patient care. They reported it was “easy to use” and provided confidence in diagnosis and treatment recommendations. HCPs and caregivers viewed the pulse oximeter and breath counter favorably. Challenges included electricity requirements for charging and the time needed to complete the application. Some caregivers saw mPneumonia as a sign of modernity, increasing their trust in the care received. Other caregivers were hesitant or confused about the new technology. Overall, this

  1. Mapping pneumonia research: A systematic analysis of UK investments and published outputs 1997–2013

    PubMed Central

    Head, Michael G.; Fitchett, Joseph R.; Newell, Marie-Louise; Scott, J. Anthony G.; Harris, Jennifer N.; Clarke, Stuart C.; Atun, Rifat

    2015-01-01

    Background The burden of pneumonia continues to be substantial, particularly among the poorest in global society. We describe here the trends for UK pneumonia R&D investment and published outputs, and correlate with 2013 global mortality. Methods Data related to awards to UK institutions for pneumonia research from 1997 to 2013 were systematically sourced and categorised by disease area and type of science. Investment was compared to mortality figures in 2010 and 2013 for pneumonia, tuberculosis and influenza. Investment was also compared to publication data. Results Of all infectious disease research between 2011 and 2013 (£917.0 million), £28.8 million (3.1%) was for pneumonia. This was an absolute and proportionate increase from previous time periods. Translational pneumonia research (33.3%) received increased funding compared with 1997–2010 where funding was almost entirely preclinical (87.5%, here 30.9%), but high-burden areas such as paediatrics, elderly care and antimicrobial resistance received little investment. Annual investment remains volatile; publication temporal trends show a consistent increase. When comparing investment to global burden with a novel ‘investment by mortality observed’ metric, tuberculosis (£48.36) and influenza (£484.21) receive relatively more funding than pneumonia (£43.08), despite investment for pneumonia greatly increasing in 2013 compared to 2010 (£7.39). Limitations include a lack of private sector data and the need for careful interpretation of the comparisons with burden, plus categorisation is subjective. Conclusions There has been a welcome increase for pneumonia funding awarded to UK institutions in 2011–2013 compared with 1997–2010, along with increases for more translational research. Published outputs relating to pneumonia rose steadily from 1997 to 2013. Investment relative to mortality for pneumonia has increased, but it remains low compared to other respiratory infections and clear inequities remain

  2. Influence of temperature and relative humidity on the survival of Chlamydia pneumoniae in aerosols.

    PubMed Central

    Theunissen, H J; Lemmens-den Toom, N A; Burggraaf, A; Stolz, E; Michel, M F

    1993-01-01

    The survival of Chlamydia pneumoniae in aerosols was investigated by using a chamber with a capacity of 114.5 liters. We injected 5 x 10(7) inclusion-forming units (IFU) of C. pneumoniae in aerosols with a droplet size of 3 to 5 microns. Samples were taken after 30 s and every 1 min thereafter. The survival of C. pneumoniae was measured at four temperatures (8.5, 15, 25, and 35 degrees C) and at three different relative humidities (RH) of 5, 50, and 95% for each temperature. The survival rates of Streptococcus pneumoniae, Streptococcus faecalis, Klebsiella pneumoniae, Chlamydia trachomatis LGV2, and cytomegalovirus were also determined at 25 degrees C and 95% RH and compared with that of C. pneumoniae. At the mentioned temperatures and RH, a rapid decrease of C. pneumoniae IFU was observed in the first 30 s. After this the decrease in the number of IFU was more gradual. The survival of C. pneumoniae in aerosols were optimal at 15 to 25 degrees C and 95% RH; it was good compared with those of other microorganisms. A lower death rate was observed only in S. faecalis. In C. trachomatis, the death rate during the first 30 s was higher than that in C. pneumoniae (85 and 53.3%, respectively). After the first 30 s, the death rates in the two organisms were identical. It was concluded that transmission of C. pneumoniae via aerosols was possible. There is probably a direct transmission from person to person, taking into account the relatively short survival period of C. pneumoniae in aerosols. PMID:8368846

  3. Streptococcus pneumoniae secretes hydrogen peroxide leading to DNA damage and apoptosis in lung cells

    PubMed Central

    Rai, Prashant; Parrish, Marcus; Tay, Ian Jun Jie; Li, Na; Ackerman, Shelley; He, Fang; Kwang, Jimmy; Chow, Vincent T.; Engelward, Bevin P.

    2015-01-01

    Streptococcus pneumoniae is a leading cause of pneumonia and one of the most common causes of death globally. The impact of S. pneumoniae on host molecular processes that lead to detrimental pulmonary consequences is not fully understood. Here, we show that S. pneumoniae induces toxic DNA double-strand breaks (DSBs) in human alveolar epithelial cells, as indicated by ataxia telangiectasia mutated kinase (ATM)-dependent phosphorylation of histone H2AX and colocalization with p53-binding protein (53BP1). Furthermore, results show that DNA damage occurs in a bacterial contact-independent fashion and that Streptococcus pyruvate oxidase (SpxB), which enables synthesis of H2O2, plays a critical role in inducing DSBs. The extent of DNA damage correlates with the extent of apoptosis, and DNA damage precedes apoptosis, which is consistent with the time required for execution of apoptosis. Furthermore, addition of catalase, which neutralizes H2O2, greatly suppresses S. pneumoniae-induced DNA damage and apoptosis. Importantly, S. pneumoniae induces DSBs in the lungs of animals with acute pneumonia, and H2O2 production by S. pneumoniae in vivo contributes to its genotoxicity and virulence. One of the major DSBs repair pathways is nonhomologous end joining for which Ku70/80 is essential for repair. We find that deficiency of Ku80 causes an increase in the levels of DSBs and apoptosis, underscoring the importance of DNA repair in preventing S. pneumoniae-induced genotoxicity. Taken together, this study shows that S. pneumoniae-induced damage to the host cell genome exacerbates its toxicity and pathogenesis, making DNA repair a potentially important susceptibility factor in people who suffer from pneumonia. PMID:26080406

  4. Poor Growth and Pneumonia Seasonality in Infants in the Philippines: Cohort and Time Series Studies

    PubMed Central

    Paynter, Stuart; Ware, Robert S.; Lucero, Marilla G.; Tallo, Veronica; Nohynek, Hanna; Simões, Eric A. F.; Weinstein, Philip; Sly, Peter D.; Williams, Gail

    2013-01-01

    Children with poor nutrition are at increased risk of pneumonia. In many tropical settings seasonal pneumonia epidemics occur during the rainy season, which is often a period of poor nutrition. We have investigated whether seasonal hunger may be a driver of seasonal pneumonia epidemics in children in the tropical setting of the Philippines. In individual level cohort analysis, infant size and growth were both associated with increased pneumonia admissions, consistent with findings from previous studies. A low weight for age z-score in early infancy was associated with an increased risk of pneumonia admission over the following 12 months (RR for infants in the lowest quartile of weight for age z-scores 1.28 [95% CI 1.08 to 1.51]). Poor growth in smaller than average infants was also associated with an increased risk of pneumonia (RR for those in the lowest quartile of growth in early infancy 1.31 [95%CI 1.02 to 1.68]). At a population level, we found that seasonal undernutrition preceded the seasonal increase in pneumonia and respiratory syncytial virus admissions by approximately 10 weeks (pairwise correlation at this lag was −0.41 [95%CI −0.53 to −0.27] for pneumonia admissions, and −0.63 [95%CI −0.72 to −0.51] for respiratory syncytial virus admissions). This lag appears biologically plausible. These results suggest that in addition to being an individual level risk factor for pneumonia, poor nutrition may act as a population level driver of seasonal pneumonia epidemics in the tropics. Further investigation of the seasonal level association, in particular the estimation of the expected lag between seasonal undernutrition and increased pneumonia incidence, is recommended. PMID:23840731

  5. Poor growth and pneumonia seasonality in infants in the Philippines: cohort and time series studies.

    PubMed

    Paynter, Stuart; Ware, Robert S; Lucero, Marilla G; Tallo, Veronica; Nohynek, Hanna; Simões, Eric A F; Weinstein, Philip; Sly, Peter D; Williams, Gail

    2013-01-01

    Children with poor nutrition are at increased risk of pneumonia. In many tropical settings seasonal pneumonia epidemics occur during the rainy season, which is often a period of poor nutrition. We have investigated whether seasonal hunger may be a driver of seasonal pneumonia epidemics in children in the tropical setting of the Philippines. In individual level cohort analysis, infant size and growth were both associated with increased pneumonia admissions, consistent with findings from previous studies. A low weight for age z-score in early infancy was associated with an increased risk of pneumonia admission over the following 12 months (RR for infants in the lowest quartile of weight for age z-scores 1.28 [95% CI 1.08 to 1.51]). Poor growth in smaller than average infants was also associated with an increased risk of pneumonia (RR for those in the lowest quartile of growth in early infancy 1.31 [95%CI 1.02 to 1.68]). At a population level, we found that seasonal undernutrition preceded the seasonal increase in pneumonia and respiratory syncytial virus admissions by approximately 10 weeks (pairwise correlation at this lag was -0.41 [95%CI -0.53 to -0.27] for pneumonia admissions, and -0.63 [95%CI -0.72 to -0.51] for respiratory syncytial virus admissions). This lag appears biologically plausible. These results suggest that in addition to being an individual level risk factor for pneumonia, poor nutrition may act as a population level driver of seasonal pneumonia epidemics in the tropics. Further investigation of the seasonal level association, in particular the estimation of the expected lag between seasonal undernutrition and increased pneumonia incidence, is recommended. PMID:23840731

  6. Susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada.

    PubMed

    Patel, Samir N; McGeer, Allison; Melano, Roberto; Tyrrell, Gregory J; Green, Karen; Pillai, Dylan R; Low, Donald E

    2011-08-01

    Ciprofloxacin, the first fluoroquinolone to be used to treat lower respiratory tract infections (LRTI), demonstrates poor potency against Streptococcus pneumoniae, and its use has been associated with the emergence of resistance. During the last decade, fluoroquinolones with enhanced in vitro activity against S. pneumoniae have replaced ciprofloxacin for the treatment of LRTI. Here, we analyzed the impact of more active fluoroquinolone usage on pneumococci by examining the fluoroquinolone usage, prevalence of fluoroquinolone resistance, and mutations in the genes that encode the major target sites for the fluoroquinolones (gyrA and parC) in pneumococcal isolates collected in Canada-wide surveillance. A total of 26,081 isolates were collected between 1998 and 2009. During this time period, total per capita outpatient use of fluoroquinolones increased from 64 to 96 prescriptions per 1,000 persons per year. The proportion of prescriptions for respiratory tract infection that were for fluoroquinolones increased from 5.9% to 10.7%, but the distribution changed: the proportion of prescriptions for ciprofloxacin decreased from 5.3% to 0.5%, and those for levofloxacin or moxifloxacin increased from 1.5% in 1999 to 5.9% in 2009. The prevalence of ciprofloxacin resistance (MIC ≥ 4 μg/ml), levofloxacin resistance, and moxifloxacin resistance remained unchanged at <2%. Multivariable analyses showed that prevalence of mutations known to be associated with reduced susceptibility to fluoroquinolones did not change during the surveillance period. If fluoroquinolone therapy is required, the preferential use of fluoroquinolones with enhanced pneumococcal activity to treat pneumococcal infections may slow the emergence of resistance in S. pneumoniae.

  7. Susceptibility of Streptococcus pneumoniae to Fluoroquinolones in Canada▿

    PubMed Central

    Patel, Samir N.; McGeer, Allison; Melano, Roberto; Tyrrell, Gregory J.; Green, Karen; Pillai, Dylan R.; Low, Donald E.

    2011-01-01

    Ciprofloxacin, the first fluoroquinolone to be used to treat lower respiratory tract infections (LRTI), demonstrates poor potency against Streptococcus pneumoniae, and its use has been associated with the emergence of resistance. During the last decade, fluoroquinolones with enhanced in vitro activity against S. pneumoniae have replaced ciprofloxacin for the treatment of LRTI. Here, we analyzed the impact of more active fluoroquinolone usage on pneumococci by examining the fluoroquinolone usage, prevalence of fluoroquinolone resistance, and mutations in the genes that encode the major target sites for the fluoroquinolones (gyrA and parC) in pneumococcal isolates collected in Canada-wide surveillance. A total of 26,081 isolates were collected between 1998 and 2009. During this time period, total per capita outpatient use of fluoroquinolones increased from 64 to 96 prescriptions per 1,000 persons per year. The proportion of prescriptions for respiratory tract infection that were for fluoroquinolones increased from 5.9% to 10.7%, but the distribution changed: the proportion of prescriptions for ciprofloxacin decreased from 5.3% to 0.5%, and those for levofloxacin or moxifloxacin increased from 1.5% in 1999 to 5.9% in 2009. The prevalence of ciprofloxacin resistance (MIC ≥ 4 μg/ml), levofloxacin resistance, and moxifloxacin resistance remained unchanged at <2%. Multivariable analyses showed that prevalence of mutations known to be associated with reduced susceptibility to fluoroquinolones did not change during the surveillance period. If fluoroquinolone therapy is required, the preferential use of fluoroquinolones with enhanced pneumococcal activity to treat pneumococcal infections may slow the emergence of resistance in S. pneumoniae. PMID:21628545

  8. Mycoplasma pneumoniae, a trigger for Weston Hurst syndrome

    PubMed Central

    Verschoor, Chris P.; Bowdish, Dawn M.E.; Provias, John

    2016-01-01

    Objective: We report a case of Mycoplasma pneumoniae infection as one possible trigger for Weston Hurst syndrome (acute hemorrhagic leukoencephalitis), a rare disorder of microvascular injury often described as a postinfectious complication of an upper respiratory illness. Methods: This is a case of a 27-year-old man presenting with a Glasgow Coma Scale score of 3 and an acute head CT revealing extensive vasogenic edema in the right hemisphere associated with mass effect in the context of a recent upper respiratory illness. Right frontal biopsy was performed on day 2, which showed acute cerebritis, and the patient was aggressively treated with antibiotics. However, over the next 5 days from presentation, the vasogenic edema increased, leading ultimately to brain herniation and death. Results: A full autopsy was performed at 5 days from presentation, which showed areas of vessel wall fibrinoid necrosis throughout the right hemisphere as well as, but less so, in the left frontal lobe and pons. Chest x-ray on presentation revealed atypical pneumonia, blood tests were positive for cold agglutinins, and at full autopsy, there was myocarditis, all in keeping with recent M pneumoniae infection. DNA obtained from lung and diseased brain (postmortem) was positive for Mycoplasma providing more direct evidence for brain invasion by this organism as the ultimate trigger for Weston Hurst syndrome. Conclusions: This is a rare case report of Weston Hurst syndrome having both initial brain biopsy on day 2 and full autopsy results on day 5 of presentation revealing important clinical clues about the pathogenesis of this often fatal disorder. PMID:26819961

  9. Studies of an outbreak of Corynebacterium equi pneumonia in foals.

    PubMed

    Smith, B P; Robinson, R C

    1981-10-01

    Five out of 6 foals between 2 and 4 months old, on a ranch in northern California, developed pneumonia within a 3 week period in June and July 1978. Corynebacterium equi was recovered from each of the 5 foals by transtracheal aspiration. Clinical signs were variable but included increased respiratory rate, fever, cough, nasal discharge, harsh airway sounds over middle sized airways and wheezing over small airways. Cyanosis was present in the most severely affected foal. Radiographic findings included diffusely increased interstitial and peribronchial densities, areas of consolidation and, in 3 cases, dense focal areas indicating abscessation. Foals were treated with several different antimicrobial agents. Most were treated with penicillin and gentamicin. Four of the 5 affected foals recovered within 2 to 3 weeks but the first foal to be affected died 2 days after first receiving veterinary attention. At postmortem examination, pulmonary changes considered typical of C equi pneumonia were found, including wet, heavy dark red lungs which failed to collapse and numerous 1 to 7 cm thin-walled abscesses throughout the parenchyma, containing inspissated exudate. C equi was cultured from the exudate. Samples of soil and dust from 9 of 20 areas inhabited by infected foals yielded C equi of the same serological group as found in the foals. Eight paddocks in which foals had not been kept were negative for C equi. The organism was recovered from cobwebs in the stalls occupied by infected foals. Aerosol infection via dust was considered to be the route of infection. Pharyngeal, vaginal and faecal cultures from the dams of 3 affected foals were negative for C equi. Early diagnosis by transtracheal aspiration and appropriate therapy are considered to be extremely important in the successful treatment of C equi pneumonia. Preventive therapy should include control of environmental dust. PMID:7318800

  10. Histopathologic variability in usual and nonspecific interstitial pneumonias.

    PubMed

    Flaherty, K R; Travis, W D; Colby, T V; Toews, G B; Kazerooni, E A; Gross, B H; Jain, A; Strawderman, R L; Flint, A; Lynch, J P; Martinez, F J

    2001-11-01

    Findings of surgical lung biopsy (SLB) are important in categorizing patients with idiopathic interstitial pneumonia (IIP). We investigated whether histologic variability would be evident in SLB specimens from multiple lobes in patients with IIP. SLBs from 168 patients, 109 of whom had multiple lobes biopsied, were reviewed by three pathologists. A diagnosis was assigned to each lobe. A different diagnosis was found between lobes in 26% of the patients. Patients with usual interstitial pneumonia (UIP) in all lobes were categorized as concordant for UIP (n = 51) and those with UIP in at least one lobe were categorized as discordant for UIP (n = 28). Patients with nonspecific interstitial pneumonia (NSIP) in all lobes were categorized as having fibrotic (n = 25) or cellular NSIP (n = 5). No consistent distribution of lobar histology was noted. Patients concordant for UIP were older (63 +/- 9 [mean +/- SD] yr; p < 0.05 as compared with all other groups) than those discordant for UIP (57 +/- 12 yr) or with fibrotic NSIP (56 +/- 11 yr) or cellular NSIP (50 +/- 9 yr). Semiquantitative high-resolution computed tomography demonstrated a varied profusion of fibrosis (p < 0.05 for all group comparisons), with more fibrosis in concordant UIP (2.13 +/- 0.62) than in discordant UIP (1.42 +/- 0.73), fibrotic NSIP (0.83 +/- 0.58), or cellular NSIP (0.44 +/- 0.42). Survival was better for patients with NSIP than for those in both UIP groups (p < 0.001), although survival in the two UIP groups was comparable (p = 0.16). Lobar histologic variability is frequent in patients with IIP, patients with a histologic pattern of UIP in any lobe should be classified as having UIP.

  11. Aerobic exercise attenuates pulmonary inflammation induced by Streptococcus pneumoniae.

    PubMed

    Olivo, Clarice R; Miyaji, Eliane N; Oliveira, Maria Leonor S; Almeida, Francine M; Lourenço, Juliana D; Abreu, Rodrigo M; Arantes, Petra M M; Lopes, Fernanda Dtqs; Martins, Milton A

    2014-11-01

    Aerobic exercise has been recognized as a stimulator of the immune system, but its effect on bacterial infection has not been extensively evaluated. We studied whether moderate aerobic exercise training prior to Streptococcus pneumoniae infection influences pulmonary inflammatory responses. BALB/c mice were divided into four groups: Sedentary Untreated (sedentary without infection); Sedentary Infected (sedentary with infection); Trained Untreated (aerobic training without infection); and Trained Infected (aerobic training with infection). Animals underwent aerobic training for 4 wk, and 72 h after last exercise training, animals received a challenge with S. pneumoniae and were evaluated either 12 h or 10 days after instillation. In acute phase, Sedentary Infected group had an increase in respiratory system resistance and elastance; number of neutrophils, lymphocytes, and macrophages in bronchoalveolar lavage fluid (BAL); polymorphonuclear cells in lung parenchyma; and levels of keratinocyte-derived chemokine (KC), tumor necrosis factor-α (TNF-α), and interleukin (IL)-1β (IL-1β) in lung homogenates. Exercise training significantly attenuated the increase in all of these parameters and induced an increase in expression of antioxidant enzymes (CuZnSOD and MnSOD) in lungs. Trained Infected mice had a significant decrease in the number of colony-forming units of pneumococci in the lungs compared with Sedentary Infected animals. Ten days after infection, Trained Infected group exhibited lower numbers of macrophages in BAL, polymorphonuclear cells in lung parenchyma and IL-6 in lung homogenates compared with Sedentary Infected group. Our results suggest a protective effect of moderate exercise training against respiratory infection with S. pneumoniae. This effect is most likely secondary to an effect of exercise on oxidant-antioxidant balance.

  12. Organizing pneumonia after stereotactic ablative radiotherapy of the lung

    PubMed Central

    2012-01-01

    Background Organizing pneumonia (OP), so called bronchiolitis obliterans organizing pneumonia after postoperative irradiation for breast cancer has been often reported. There is little information about OP after other radiation modalities. This cohort study investigated the clinical features and risk factors of OP after stereotactic ablative radiotherapy of the lung (SABR). Methods Patients undergoing SABR between 2004 and 2010 in two institutions were investigated. Blood test and chest computed tomography were performed at intervals of 1 to 3 months after SABR. The criteria for diagnosing OP were: 1) mixture of patchy and ground-glass opacity, 2) general and/or respiratory symptoms lasting for at least 2 weeks, 3) radiographic lesion in the lung volume receiving < 0.5 Gy, and 4) no evidence of a specific cause. Results Among 189 patients (164 with stage I lung cancer and 25 with single lung metastasis) analyzed, nine developed OP. The incidence at 2 years was 5.2% (95% confidence interval; 2.6-9.3%). Dyspnea were observed in all patients. Four had fever. These symptoms and pulmonary infiltration rapidly improved after corticosteroid therapy. Eight patients had presented with symptomatic radiation pneumonitis (RP) around the tumor 2 to 7 months before OP. The prior RP history was strongly associated with OP (hazard ratio 61.7; p = 0.0028) in multivariate analysis. Conclusions This is the first report on OP after SABR. The incidence appeared to be relatively high. The symptoms were sometimes severe, but corticosteroid therapy was effective. When patients after SABR present with unusual pneumonia, OP should be considered as a differential diagnosis, especially in patients with prior symptomatic RP. PMID:22853821

  13. Care of the AIDS patient with Pneumocystis pneumonia.

    PubMed

    Carr, Rebecca Lamb; Dodge, Robert

    2009-01-01

    Pneumocystis pneumonia and AIDS have been linked together for many years. In the 1980s and 1990s, these diseases often resulted in admission to the critical care unit for many patients. Since the discovery of antiretroviral therapy and Pneumocystis prophylaxis, this has been a less frequent occurrence. Knowledge about caring for this patient in the critical care unit is often not available. Psychological and physiological needs common to this population are different from other populations and must be addressed. Pharmacological challenges are common and may go unrecognized until complications ensue. This article seeks to alleviate some of the mystery associated with these issues. PMID:19855202

  14. Peritoneal culture alters Streptococcus pneumoniae protein profiles and virulence properties

    NASA Technical Reports Server (NTRS)

    Orihuela, C. J.; Janssen, R.; Robb, C. W.; Watson, D. A.; Niesel, D. W.

    2000-01-01

    We have examined the properties of Streptococcus pneumoniae cultured in the murine peritoneal cavity and compared its virulence-associated characteristics to those of cultures grown in vitro. Analysis of mRNA levels for specific virulence factors demonstrated a 2.8-fold increase in ply expression and a 2.2-fold increase in capA3 expression during murine peritoneal culture (MPC). Two-dimensional gels and immunoblots using convalescent-phase patient sera and murine sera revealed distinct differences in protein production in vivo (MPC). MPC-grown pneumococci adhered to A549 epithelial cell lines at levels 10-fold greater than those cultured in vitro.

  15. Case of invasive mucinous adenocarcinoma mimicking chronic eosinophilic pneumonia

    PubMed Central

    Beom, Jong Wook; Lee, Jong Hoo

    2014-01-01

    Invasive mucinous carcinoma is difficult to distinguish from other lung diseases; therefore, confirmation of the diagnosis may be delayed. A 64-year-old woman was admitted with a six-month history of cough, febrile sensation, and shortness of breath, with worsening symptoms. A computed tomography scan of the chest revealed bilateral homogenous ground-glass opacities and consolidation with subpleural predominance. The percentage of eosinophils in the serum and induced sputum was elevated and a diagnosis of chronic eosinophilic pneumonia was established. Despite administration of a systemic steroid, she did not rapidly respond. We performed a percutaneous needle biopsy and finally confirmed invasive mucinous adenocarcinoma. PMID:26766997

  16. Endobronchial Echinococcosis Presenting as Non-Resolving Pneumonia

    PubMed Central

    Lev-Tzion, Raffi; Goldbart, Aviv D.

    2011-01-01

    Summary Hydatid disease of the lungs is caused by larval cysts of the Echinococcus tapeworm. Pulmonary cysts may occasionally invade bronchi or pleura as a result of coughing, trauma or elevated intra-abdominal pressure. We present the case of a patient evaluated for non-resolving pneumonia whose radiographic and bronchoscopic findings were strikingly similar to those seen in pulmonary tuberculosis with endobronchial invasion; he was ultimately diagnosed with pulmonary echinococcosis. This case underscores the importance of considering unusual diagnoses even when typical features of more common conditions are present. PMID:22162447

  17. Development of Streptococcus pneumoniae Vaccines Using Live Vectors

    PubMed Central

    Wang, Shifeng; Curtiss, Roy

    2014-01-01

    Streptococcus pneumoniae still causes severe morbidity and mortality worldwide, especially in young children and the elderly. Much effort has been dedicated to developing protein-based universal vaccines to conquer the current shortcomings of capsular vaccines and capsular conjugate vaccines, such as serotype replacement, limited coverage and high costs. A recombinant live vector vaccine delivering protective antigens is a promising way to achieve this goal. In this review, we discuss the researches using live recombinant vaccines, mainly live attenuated Salmonella and lactic acid bacteria, to deliver pneumococcal antigens. We also discuss both the limitations and the future of these vaccines. PMID:25309747

  18. A Case of Organizing Pneumonia (OP) Associated with Pembrolizumab

    PubMed Central

    Fragkou, Paraskevi; Souli, Maria; Theochari, Maria; Kontopoulou, Christina; Loukides, Stelios; Koumarianou, Anna

    2016-01-01

    Until recently, chemotherapy for metastatic melanoma had disappointing results. The identification of immune checkpoints such as CTLA-4 and PD-1/PD-L1 has led to the development of an array of monoclonal antibodies (Mabs). These immunologic approaches against tumoral cells come with a novel kind of side effects that the clinician needs to be familiarized with. Herein, we report for the first time a case of organizing pneumonia, based on imaging and cytological analyses of bronchoalveolar lavage, possibly associated with the use of pembrolizumab, an anti-PD-1 Mab recently approved for the treatment of metastatic melanoma. PMID:27257369

  19. Myopathy and eosinophilic pneumonia coincidentally induced by treatment with daptomycin.

    PubMed

    Hagiya, Hideharu; Hasegawa, Kou; Asano, Kikuko; Terasaka, Tomohiro; Kimura, Kosuke; Nada, Takahiro; Nakamura, Eri; Waseda, Koichi; Hanayama, Yoshihisa; Otsuka, Fumio

    2015-01-01

    A 34-year-old man with 22q11.2 deletion syndrome (DiGeorge syndrome) concurrently suffered from myopathy and eosinophilic pneumonia shortly after receiving daptomycin (DAP) for right-sided infective endocarditis. The simultaneous occurrence of these phenomena in relation to DAP therapy has not been previously well described. An allergic reaction was suspected as a possible etiology of these DAP-related complications. This case highlights the need for close observation in order to detect both musculoskeletal and respiratory disorders from the start of DAP therapy. Physicians should pay more attention to this new drug, which is expected to be frequently used in various clinical settings. PMID:25758082

  20. Pneumocystis carinii pneumonia in a Yorkshire terrier dog.

    PubMed

    Cabañes, F J; Roura, X; Majó, N; Bragulat, M R; Domingo, M

    2000-12-01

    A 14-month-old male Yorkshire terrier was presented to the Autonomous University of Barcelona Veterinary Teaching Hospital because of a history of chronic non-productive cough and acute dyspnea. A follow-up radiograph revealed a diffuse, bilaterally interstitial-alveolar lung disease with presence of air bronchograms. The dog died 5 h after admission with severe dyspnea. Histological sections of the necropsy specimens revealed the presence of characteristic Pneumocystis carinii cysts within alveolar spaces. A diagnosis of P. carinii pneumonia (PCP) was made on the basis of these results. To our knowledge, PCP has not been described in a Yorkshire terrier dog.