[Community acquired pneumonia. Reliability of the criteria for deciding ambulatory treatment]

Q fever in Japan: an update review

As neglected zoonosis for many years, Q fever is now ubiquitous in Japan. Similarly to elsewhere in the world, domestic animals are considered to be important reservoirs of the causal agent, Coxiella burnetii, a resistant intracellular bacterium. Infected animals shed bacteria in milk, feces, urine, vaginal mucous and birth products. Inhalation of bacteria present in the environment is the main route of animal and human infection. Shedding of C. burnetii in milk by domestic ruminants has a very limited impact as raw milk is seldom ingested by the Japanese population. The clinical expression of Q fever in Japan is similar to its clinical expression elsewhere. However clinical cases in children are more frequently reported in this country. Moreover, C. burnetii is specified as one of the causative organisms of atypical pneumonia in the Japanese Respiratory Society Guideline for the management of community-acquired pneumonia. In Japan, C. burnetii isolates are associated with acute illness and are mainly of moderate to low virulence. Cats are considered a significant source of C. burnetii responsible for human outbreaks in association with the presence of infected parturient cats. Since its recognition as a reportable disease in 1999, 7-46 clinical cases of Q fever have been reported by year. The epidemiology of Q fever in Japan remains to be elucidated and the exact modes of transmission are still unproven. Important further research is necessary to improve knowledge of the disease itself, the endogenous hosts and reservoirs, and the epidemiological cycle of coxiellosis in Japan.

[Respiratory infections in adults hospitalized in internal medicine and pneumology departments. DIRA (Adult Respiratory Infection Day) study]

INTRODUCTION

Respiratory tract infections (RIs) are frequent processes that can require hospitalization or affect already hospitalized patients. The Foundation for the Study of Infection has promoted the DIRA (Adult Respiratory Infection Day) Project, with the aim of investigating and assessing the impact of this problem, particularly in Internal Medicine and Pneumology Departments.

METHODS

Prospective prevalence study involving 158 physicians in 100 Internal Medicine and Pneumology Departments. Data were collected on predetermined days, once every three months (total of four data sets) and included information on number of patients attended, number of patients with infection, and epidemiologic, clinical, microbiologic and treatment characteristics of patients with RI.

RESULTS

A total of 3,596 patients were hospitalized at the four time points. Among these, 39.1% presented clinical symptoms consistent with infection and 34.3% of these were RIs. The mean age of RI patients was 65.6 years, 68.8% were males, 84.1% had an underlying disease (most frequently chronic obstructive pulmonary disease) and 25.1% had one or more predisposing factors. Pneumonia was the most frequent diagnosis (41.3% of RIs). RI was documented microbiologically in 15.8% of cases. Antibiotic treatment was applied in 99.7% of patients with acute bronchitis and 81.8% of those with upper respiratory tract infection; penicillins were the most frequent treatment. Data are presented by diagnosis.

CONCLUSIONS

A substantial rate of respiratory infections was found in patients admitted to hospital Internal Medicine and Pneumology Departments, with pneumonia being the most frequent. There was a paucity of microbiologic documentation. It is likely that antibiotic treatment was not justified in the majority of patients with upper respiratory tract infections. A combination of two or more antimicrobial agents was used in about half of cases.

[Prospective study of 221 community acquired pneumonias followed up in an outpatient clinic. Etiology and clinical-radiological progression]

BACKGROUND

All the community acquired pneumonia followed up in an outpatient clinic were prospectively studied in order to determine: etiology, clinical-radiological characteristics and its progression with diagnostic and therapeutic protocols.

PATIENTS AND METHOD

We arranged clinical evaluation protocols, etiological diagnosis by means of serology (in the first visit and three weeks later); and when necessary, by means of fiberbronchoscopy (protected microbiological brush), as well as clinical and radiological progression (up to three visits) after empirical treatment.

RESULTS

Initially, 240 patients were included, of which 221 were fully followed up. Etiological diagnosis was obtained in 86 patients (39%). The bacteria most frequently isolated was Coxiella burnetii (12.2%), followed up Mycoplasma pneumoniae and Legionella pneumophila. Two cases of Strepcococus pneumoniae were diagnosed. The most frequent radiological onset was alveolar infiltrate (86%). The initial empiric treatment were macrolids (71%) or second generation cephalosporines (22%). Most patients presented a favourable clinical and radiological progression. Only 2 patients needed admission to the hospital (< 1%).

CONCLUSIONS

In community acquired pneumonias studied in our outpatient clinic we found a high number of "atypical" agents. Treatment with macrolids or second generation cephalosporines are appropriate for these patients.