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Aviles-Solis JC, Jácome C, Davidsen A, Einarsen R, Vanbelle S, Pasterkamp H, Melbye H. Prevalence and clinical associations of wheezes and crackles in the general population: the Tromsø study. BMC Pulm Med 2019; 19:173. [PMID: 31511003 PMCID: PMC6739986 DOI: 10.1186/s12890-019-0928-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/26/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Wheezes and crackles are well-known signs of lung diseases, but can also be heard in apparently healthy adults. However, their prevalence in a general population has been sparsely described. The objective of this study was to determine the prevalence of wheezes and crackles in a large general adult population and explore associations with self-reported disease, smoking status and lung function. METHODS We recorded lung sounds in 4033 individuals 40 years or older and collected information on self-reported disease. Pulse oximetry and spirometry were carried out. We estimated age-standardized prevalence of wheezes and crackles and associations between wheezes and crackles and variables of interest were analyzed with univariable and multivariable logistic regressions. RESULTS Twenty-eight percent of individuals had wheezes or crackles. The age-standardized prevalence of wheezes was 18.6% in women and 15.3% in men, and of crackles, 10.8 and 9.4%, respectively. Wheezes were mostly found during expiration and crackles during inspiration. Significant predictors of expiratory wheezes in multivariable analyses were age (10 years increase - OR 1.18, 95%CI 1.09-1.30), female gender (1.45, 1.2-1.8), self-reported asthma (1.36, 1.00-1.83), and current smoking (1.70, 1.28-2.23). The most important predictors of inspiratory crackles were age (1.76, 1.57-1.99), current smoking, (1.94, 1.40-2.69), mMRC ≥2 (1.79, 1.18-2.65), SpO2 (0.88, 0.81-0.96), and FEV1 Z-score (0.86, 0.77-0.95). CONCLUSIONS Nearly over a quarter of adults present adventitious lung sounds on auscultation. Age was the most important predictor of adventitious sounds, particularly crackles. The adventitious sounds were also associated with self-reported disease, current smoking and measures of lung function. The presence of findings in two or more auscultation sites was associated with a higher risk of decreased lung function than solitary findings.
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Affiliation(s)
- J C Aviles-Solis
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway.
| | - C Jácome
- CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Davidsen
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - R Einarsen
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - S Vanbelle
- Department of methodology and statistics, University of Maastricht, Maastricht, The Netherlands
| | - H Pasterkamp
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - H Melbye
- General Practice Research Unit, Department of Community Medicine, UIT the Arctic University of Norway, Tromsø, Norway
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Valade S, Biard L, Lemiale V, Argaud L, Pène F, Papazian L, Bruneel F, Seguin A, Kouatchet A, Oziel J, Rouleau S, Bele N, Razazi K, Lesieur O, Boissier F, Megarbane B, Bigé N, Brulé N, Moreau AS, Lautrette A, Peyrony O, Perez P, Mayaux J, Azoulay E. Severe atypical pneumonia in critically ill patients: a retrospective multicenter study. Ann Intensive Care 2018; 8:81. [PMID: 30105627 PMCID: PMC6089852 DOI: 10.1186/s13613-018-0429-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure. METHODS Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs. RESULTS A total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44-67] years. MP was the causative agent for 76 (73%) patients and CP for 28 (27%) patients. Co-infection was documented for 18 patients (viruses for 8 [47%] patients). Median number of involved quadrants on chest X-ray was 2 [1-4], with alveolar opacities (n = 61, 75%), interstitial opacities (n = 32, 40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75 (72%) patients and vasopressors for 41 (39%) patients. ICU length of stay was 16.5 [9.5-30.5] days, and 11 (11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6 (8%) vs. 17 (22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP. MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation. CONCLUSION In this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia.
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Affiliation(s)
- S. Valade
- AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
| | - L. Biard
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
- AP-HP, DBIM, Hôpital Saint-Louis, Paris, France
| | - V. Lemiale
- AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
| | - L. Argaud
- Hôpital Edouard Herriot, Service de Réanimation Médicale, Hospices Civils de Lyon, Lyon, France
| | - F. Pène
- AP-HP, Réanimation médicale, Hôpital Cochin, Paris, France
| | - L. Papazian
- Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - F. Bruneel
- Service de Réanimation, Centre Hospitalier de Versailles, Le Chesnay, France
| | - A. Seguin
- Department of Medical Intensive Care, CHU de Caen, Caen, France
| | - A. Kouatchet
- Service de Réanimation Médicale et Médecine Hyperbare, Hôpital Angers, Angers, France
| | - J. Oziel
- AP-HP, Medical-Surgical Intensive Care Unit, Avicenne University Hospital, Bobigny, France
| | - S. Rouleau
- Service de Réanimation polyvalente, Angoulême, France
| | - N. Bele
- Intensive Care Unit, Draguignan Hospital, Draguignan, France
| | - K. Razazi
- AP-HP, Groupe Henri Mondor-Albert Chenevier, Service de Réanimation Médicale, Hôpital Henri Mondor, Créteil, France
| | - O. Lesieur
- Service de Réanimation, CH Saint-Louis, La Rochelle, France
| | - F. Boissier
- AP-HP, Réanimation médicale, Hôpital Européen Georges Pompidou, Paris, France
| | - B. Megarbane
- AP-HP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital, Paris, France
| | - N. Bigé
- AP-HP, Medical Intensive Care Unit, Hôpital Saint-Antoine, Paris, France
| | - N. Brulé
- Medical Intensive Care Unit, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - A. S. Moreau
- Centre de réanimation, Hôpital Salengro, CHU-Lille, Lille, France
| | - A. Lautrette
- Service de Réanimation Médicale Polyvalente, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - O. Peyrony
- AP-HP, Service des urgences, Hôpital Saint-Louis, Paris, France
| | - P. Perez
- Service de Réanimation médicale, Hôpital Brabois, Nancy, France
| | - J. Mayaux
- AP-HP, Pneumology and Critical Care Medicine Department, Universitary Hospital La Pitié Salpêtrière-Charles Foix, Paris, France
| | - E. Azoulay
- AP-HP, Medical ICU, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France
- UFR de Médecine, University Paris-7 Paris-Diderot, Paris, France
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5
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Kishaba T. Community-Acquired Pneumonia Caused by Mycoplasma pneumoniae: How Physical and Radiological Examination Contribute to Successful Diagnosis. Front Med (Lausanne) 2016; 3:28. [PMID: 27379238 PMCID: PMC4904022 DOI: 10.3389/fmed.2016.00028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/30/2016] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Tomoo Kishaba
- Department of Respiratory Medicine, Okinawa Chubu Hospital , Uruma City, Okinawa , Japan
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6
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Parrott GL, Kinjo T, Fujita J. A Compendium for Mycoplasma pneumoniae. Front Microbiol 2016; 7:513. [PMID: 27148202 PMCID: PMC4828434 DOI: 10.3389/fmicb.2016.00513] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 03/29/2016] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Gretchen L Parrott
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus Nishihara, Japan
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8
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Saraya T, Kurai D, Nakagaki K, Sasaki Y, Niwa S, Tsukagoshi H, Nunokawa H, Ohkuma K, Tsujimoto N, Hirao S, Wada H, Ishii H, Nakata K, Kimura H, Kozawa K, Takizawa H, Goto H. Novel aspects on the pathogenesis of Mycoplasma pneumoniae pneumonia and therapeutic implications. Front Microbiol 2014; 5:410. [PMID: 25157244 PMCID: PMC4127663 DOI: 10.3389/fmicb.2014.00410] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/20/2014] [Indexed: 01/30/2023] Open
Abstract
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.
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Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Daisuke Kurai
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Kazuhide Nakagaki
- Department of Virology and Immunology, College of Veterinary Medicine, Nippon Veterinary and Animal Science University Mitaka, Japan
| | - Yoshiko Sasaki
- Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan
| | - Shoichi Niwa
- Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan
| | - Hiroyuki Tsukagoshi
- Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan
| | - Hiroki Nunokawa
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Kosuke Ohkuma
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Naoki Tsujimoto
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Susumu Hirao
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Hiroo Wada
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Koh Nakata
- Bioscience Medical Research Center, Niigata University Medical and Dental Hospital Niigata, Japan
| | - Hirokazu Kimura
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases Tokyo, Japan
| | - Kunihisa Kozawa
- Gunma Prefectural Institute of Public Health and Environmental Sciences Maebashi, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
| | - Hajime Goto
- Department of Respiratory Medicine, Kyorin University School of Medicine Mitaka, Japan
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