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Ito A, Ishida T, Tachibana H, Nakanishi Y, Kawataki M, Yamazaki A, Washio Y. Identification rate of Legionella species in non-purulent sputum culture is comparable to that in purulent sputum culture in Legionella pneumonia. J Clin Microbiol 2024; 62:e0166523. [PMID: 38501659 PMCID: PMC11005338 DOI: 10.1128/jcm.01665-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/28/2024] [Indexed: 03/20/2024] Open
Abstract
Many Legionella pneumonia patients do not produce sputum, and it is unknown whether purulent sputum is required for the identification of Legionella species. This study aimed to evaluate the identification rate of Legionella species based on sputum quality and the factors predictive of Legionella infection. This study included Legionella pneumonia patients at Kurashiki Central Hospital from November 2000 to December 2022. Sputum quality, based on gram staining, was classified as the following: Geckler 1/2, 3/6 and 4/5. Geckler 4/5 was defined as purulent sputum. The sputa of 104 of 124 Legionella pneumonia patients were cultured. Fifty-four patients (51.9%) were identified with Legionella species, most of which were Legionella pneumophila serogroup 1 (81.5%). The identification rates of Legionella species according to sputum quality were 57.1% (16/28) in Geckler 1/2 sputum, 50.0% (34/68) in Geckler 3/6 sputum, and 50.0% (4/8) in Geckler 4/5 sputum, which were not significantly different (P = 0.86). On multivariate analysis, pre-culture treatment with anti-Legionella antimicrobials (odds ratio [OR] 0.26, 95% confidence interval [CI] 0.06-0.91), Pneumonia Severity Index class ≥IV (OR 2.57 [95% CI 1.02-6.71]), and intensive care unit admission (OR 3.08, 95% CI 1.06-10.09) correlated with the ability to identify Legionella species, but sputum quality did not (OR 0.88, 95% CI 0.17-4.41). The identification rate of Legionella species in non-purulent sputum was similar to that in purulent sputum. For the diagnosis of Legionella pneumonia, sputum should be collected before administering anti-Legionella antibiotics and cultured regardless of sputum quality.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiromasa Tachibana
- Department of Respiratory Medicine, National Hospital Organization, Minami Kyoto Hospital, Kyoto, Japan
| | - Yosuke Nakanishi
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
| | - Masanori Kawataki
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akio Yamazaki
- Department of Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Yasuyoshi Washio
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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2
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Lüthi-Corridori G, Roth AI, Boesing M, Jaun F, Tarr PE, Leuppi-Taegtmeyer AB, Leuppi JD. Diagnosis and Therapy of Community-Acquired Pneumonia in the Emergency Department: A Retrospective Observational Study and Medical Audit. J Clin Med 2024; 13:574. [PMID: 38276080 PMCID: PMC10816545 DOI: 10.3390/jcm13020574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Despite advances in therapy, community-acquired pneumonia (CAP) is still associated with significant morbidity and mortality. Several studies conducted in different countries have reported suboptimal adherence to the guidelines. However, there are currently no available data on adherence to CAP guidelines specifically in Switzerland. OBJECTIVES The aim of this study was to audit the quality of diagnosis and therapy of CAP at a Swiss general hospital. METHODS A retrospective, observational, single-center cohort study was conducted, including patients older than 18 years diagnosed with CAP and admitted to a medical ward throughout 2019 without prior antibiotic therapy prescribed by their general practitioner (GP). The baseline characteristics of the patients were analyzed, and the diagnostic workup and treatment were compared to the Swiss guidelines for CAP. RESULTS A total of 254 patients diagnosed with CAP were included in this study (median age 78 years, 51.6% males). Atypical pneumonia was diagnosed in 4% of patients, while an organism was identified in 33% of cases, with Streptococcus pneumoniae being the most frequently detected pathogen (57%). A chest image was taken in almost all patients. Documentation of respiratory rate was missing in 23% of cases. Procalcitonin was measured in 23.2% of cases. Pneumococcal and legionella urinary antigen testing was performed on approximately 90% of all patients and blood cultures were drawn in approximately 80% of patients. In 39% of cases, arterial blood gas analysis was performed. Guideline adherence for the administration of empiric antibiotics was documented/recorded in 75% of cases. Twelve different antibiotic regimens were administered, and they were mostly amoxicillin/clavulanate with or without macrolides, as suggested by the guidelines. In particular, the use of ceftriaxone was higher (19.7%) compared to the Swiss guidelines. The average length of antibiotic therapy was longer (8.2 days) compared to the guidelines (5-7 days). Oral steroid therapy was administered to 29.1% of patients, including to 75% of those diagnosed with COPD. CONCLUSION Overall, guideline adherence was moderately low, especially with regards to the assessment of respiratory rate, performance of arterial blood gas analysis, and sputum collection. Regarding antibiotic therapy, the use of ceftriaxone and the length of antibiotic therapy should be reduced. Further research is needed to identify the reasons for guideline non-adherence, and to find effective measures for the improvement of guideline adherence.
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Affiliation(s)
- Giorgia Lüthi-Corridori
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Andrea I. Roth
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Maria Boesing
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Fabienne Jaun
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
| | - Philip E. Tarr
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
- University Center for Internal Medicine, Infectious Diseases and Hospital Epidemiology Service, Cantonal Hospital Baselland, 4101 Bruderholz, Switzerland
| | - Anne B. Leuppi-Taegtmeyer
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
- Department of Patient Safety, Medical Directorate, University Hospital Basel, 4031 Basel, Switzerland
| | - Jörg D. Leuppi
- University Institute of Internal Medicine (UIIM), Cantonal Hospital Baselland, 4410 Liestal, Switzerland; (G.L.-C.); (A.I.R.); (M.B.); (F.J.); (A.B.L.-T.)
- Faculty of Medicine, University of Basel, 4056 Basel, Switzerland;
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3
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Tubiana S, Epelboin L, Casalino E, Naccache JM, Feydy A, Khalil A, Hausfater P, Duval X, Claessens YE. Effect of diagnosis level of certainty on adherence to antibiotics' guidelines in ED patients with pneumonia: a post-hoc analysis of an interventional trial. Eur J Emerg Med 2023; 30:102-109. [PMID: 35758267 DOI: 10.1097/mej.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND IMPORTANCE Clinical diagnosis of community-acquired pneumonia (CAP) is difficult to establish with certainty. Adherence to antibiotic guidelines independently affects the prognosis of CAP patients. OBJECTIVE We aimed to determine whether guidelines' adherence was related to CAP diagnosis level of certainty and could be reinforced accordingly to diagnosis improvement. DESIGN Secondary analysis of a prospective, multicenter study, which evaluated the impact of early thoracic CT scan on diagnosis and therapeutic plan in patients with clinically suspected CAP visiting emergency departments. SETTING AND PARTICIPANTS In total 319 patients with clinically suspected CAP were enrolled in four emergency departments, Paris, France, between Nov 2011 and Jan 2013. OUTCOME MEASURES AND ANALYSIS We evaluated guidelines' adherence before and after CT scan and its relationship with CAP diagnosis level of certainty. Antibiotics were categorized as adherent according to 2010 French guidelines. CAP diagnosis level of certainty was prospectively classified by the emergency physicians based on a Likert scale as excluded, possible, probable or definite before and immediately after the CT scan. These classifications and therapeutic plans were also completed by an independent adjudication committee. Determinants of adherence were assessed using Poisson regression with robust variance. MAIN RESULTS Adherence to guidelines increased from 34.2% before CT scan to 51.3% after CT scan [difference 17.1% (95% CI, 9.5-24.7)], meanwhile CAP diagnosis with high level of certainty (definite and excluded CAP) increased from 46.1 to 79.6% [difference 33.5% (95% CI, 26.5-40.5)]. Diagnosis level of certainty before CT scan was the strongest determinant of adherence in multivariate analysis (RR, 2.63; 95% CI, 1.89-3.67). CONCLUSION Antibiotic guidelines' adherence was poor and positively related to CAP diagnosis level of certainty. The results suggest that improvements in CAP diagnosis may increase adherence to antibiotic guidelines. Clinical trial registered with www.clinicaltrials.gov (NCT01574066).
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Affiliation(s)
- Sarah Tubiana
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité
- Inserm Clinical Investigation Center 1425, Hôpital Bichat
| | - Loïc Epelboin
- Infectious and Tropical Diseases Department, Hôpital Pitié-Salpétriêre
| | | | | | | | | | - Pierre Hausfater
- Department of Emergency Medicine, Hôpital Pitié-Salpétriêre, Assistance Publique Hôpitaux de Paris
- Sorbonne Universités, UPMC University Paris 06, Paris, France
| | - Xavier Duval
- IAME, Inserm UMR 1137, University Paris Diderot, Sorbonne Paris Cité
- Inserm Clinical Investigation Center 1425, Hôpital Bichat
| | - Yann-Erick Claessens
- Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Monaco. Principality of Monaco
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Gao CA, Pickens CI, Morales-Nebreda L, Wunderink RG. Clinical Features of COVID-19 and Differentiation from Other Causes of CAP. Semin Respir Crit Care Med 2023; 44:8-20. [PMID: 36646082 DOI: 10.1055/s-0042-1759889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, one of the most common reasons for infection-related death worldwide. Causes of CAP include numerous viral, bacterial, and fungal pathogens, though frequently no specific organism is found. Beginning in 2019, the COVID-19 pandemic has caused incredible morbidity and mortality. COVID-19 has many features typical of CAP such as fever, respiratory distress, and cough, and can be difficult to distinguish from other types of CAP. Here, we highlight unique clinical features of COVID-19 pneumonia such as olfactory and gustatory dysfunction, lymphopenia, and distinct imaging appearance.
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Affiliation(s)
- Catherine A Gao
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Chiagozie I Pickens
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Luisa Morales-Nebreda
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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5
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Gadsby NJ, Musher DM. The Microbial Etiology of Community-Acquired Pneumonia in Adults: from Classical Bacteriology to Host Transcriptional Signatures. Clin Microbiol Rev 2022; 35:e0001522. [PMID: 36165783 PMCID: PMC9769922 DOI: 10.1128/cmr.00015-22] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
All modern advances notwithstanding, pneumonia remains a common infection with substantial morbidity and mortality. Understanding of the etiology of pneumonia continues to evolve as new techniques enable identification of already known organisms and as new organisms emerge. We now review the etiology of pneumonia (at present often called "community-acquired pneumonia") beginning with classic bacteriologic techniques, which identified Streptococcus pneumoniae as the overwhelmingly common cause, to more modern bacteriologic studies, which emphasize Haemophilus influenzae, Staphylococcus aureus, Moraxella catarrhalis, Enterobacteriaceae, Pseudomonas, and normal respiratory flora. Urine antigen detection is useful in identifying Legionella and pneumococcus. The low yield of bacteria in recent studies is due to the failure to obtain valid sputum samples before antibiotics are administered. The use of high-quality sputum specimens enables identification of recognized ("typical") bacterial pathogens as well as a role for commensal bacteria ("normal respiratory flora"). Nucleic acid amplification technology for viruses has revolutionized diagnosis, showing the importance of viral pneumonia leading to hospitalization with or without coinfecting bacterial organisms. Quantitative PCR study of sputum is in its early stages of application, but regular detection of high counts of bacterial DNA from organisms that are not seen on Gram stain or grown in quantitative culture presents a therapeutic dilemma. This finding may reflect the host microbiome of the respiratory tract, in which case treatment may not need to be given for them. Finally, host transcriptional signatures might enable clinicians to distinguish between viral and bacterial pneumonia, an important practical consideration.
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Affiliation(s)
- Naomi J. Gadsby
- Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Daniel M. Musher
- Michael E. DeBakey Veterans Administration Medical Center, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
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Beentjes D, Shears RK, French N, Neill DR, Kadioglu A. Mechanistic Insights into the Impact of Air Pollution on Pneumococcal Pathogenesis and Transmission. Am J Respir Crit Care Med 2022; 206:1070-1080. [PMID: 35649181 PMCID: PMC9704843 DOI: 10.1164/rccm.202112-2668tr] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Streptococcus pneumoniae (the pneumococcus) is the leading cause of pneumonia and bacterial meningitis. A number of recent studies indicate an association between the incidence of pneumococcal disease and exposure to air pollution. Although the epidemiological evidence is substantial, the underlying mechanisms by which the various components of air pollution (particulate matter and gases such as NO2 and SO2) can increase susceptibility to pneumococcal infection are less well understood. In this review, we summarize the various effects air pollution components have on pneumococcal pathogenesis and transmission; exposure to air pollution can enhance host susceptibility to pneumococcal colonization by impairing the mucociliary activity of the airway mucosa, reducing the function and production of key antimicrobial peptides, and upregulating an important pneumococcal adherence factor on respiratory epithelial cells. Air pollutant exposure can also impair the phagocytic killing ability of macrophages, permitting increased replication of S. pneumoniae. In addition, particulate matter has been shown to activate various extra- and intracellular receptors of airway epithelial cells, which may lead to increased proinflammatory cytokine production. This increases recruitment of innate immune cells, including macrophages and neutrophils. The inflammatory response that ensues may result in significant tissue damage, thereby increasing susceptibility to invasive disease, because it allows S. pneumoniae access to the underlying tissues and blood. This review provides an in-depth understanding of the interaction between air pollution and the pneumococcus, which has the potential to aid the development of novel treatments or alternative strategies to prevent disease, especially in areas with high concentrations of air pollution.
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Affiliation(s)
- Daan Beentjes
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca K Shears
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Neil French
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Daniel R Neill
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Aras Kadioglu
- Department of Clinical Immunology, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
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7
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Global Perspective of Legionella Infection in Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031907. [PMID: 35162928 PMCID: PMC8835084 DOI: 10.3390/ijerph19031907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 12/11/2021] [Accepted: 01/20/2022] [Indexed: 01/27/2023]
Abstract
Legionnaires’ disease (LD) (Legionella) is a common cause of community-acquired pneumonia (CAP) in those requiring hospitalization. Geographical variation in the importance of Legionella species as an aetiologic agent of CAP is poorly understood. We performed a systematic review and meta-analysis of population-based observational studies that reported the proportion of Legionella infection in patients with CAP (1 January 1990 to 31 May 2020). Using five electronic databases, articles were identified, appraised and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of the included studies was assessed using the Newcastle–Ottawa Scale. Univariate and multivariate meta-regression analyses were conducted using study design, WHO region, study quality and healthcare setting as the explanatory variables. We reviewed 2778 studies, of which 219 were included in the meta-analysis. The mean incidence of CAP was 46.7/100,000 population (95% CI: 46.6–46.8). The mean proportion of Legionella as the causative agent for CAP was 4.6% (95% CI: 4.4 to 4.7). Consequently, the mean Legionella incidence rate was 2.8/100,000 population (95% CI: 2.7–2.9). There was significant heterogeneity across all studies I2 = 99.27% (p < 0.0001). After outliers were removed, there was a decrease in the heterogeneity (I2 = 43.53%). Legionella contribution to CAP has a global distribution. Although the rates appear highest in high income countries in temperate regions, there are insufficient studies from low- and middle-income countries to draw conclusions about the rates in these regions. Nevertheless, this study provides an estimate of the mean incidence of Legionella infection in CAP, which could be used to estimate the regional and global burden of LD to support efforts to reduce the impact of this infection as well as to fill important knowledge gaps.
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Clinical Redesign: An Innovative Approach to Leading Change at an Academic Healthcare System. J Healthc Manag 2022; 67:13-24. [PMID: 34982746 DOI: 10.1097/jhm-d-20-00299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
SUMMARY
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9
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Narendrakumar L, Ray A. Respiratory tract microbiome and pneumonia. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2022; 192:97-124. [DOI: 10.1016/bs.pmbts.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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An Elderly COVID-19 Patient with Community-Acquired Legionella and Mycoplasma Coinfections: A Rare Case Report. Healthcare (Basel) 2021; 9:healthcare9111598. [PMID: 34828643 PMCID: PMC8625241 DOI: 10.3390/healthcare9111598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 01/08/2023] Open
Abstract
The combination of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection and other respiratory pathogens is a real challenge for health care systems in terms of diagnosis, treatment, and management. Most of the reported bacterial coinfections among SARS-CoV-2 patients are hospital-acquired infections that occurred after several days of hospitalization. Little is known about the incidence of community-acquired atypical bacterial coinfections with SARS-CoV-2. In this work, we report on a rare case of an elderly SARS-CoV-2 patient with underdiagnosed bacterial coinfections who received care in the medical ward for 23 days then was discharged home. Retrospective serological investigation revealed positivity for Legionella pneumophila and Mycoplasma pneumoniae, indicating double community-acquired atypical bacterial coinfections that were in agreement with clinical manifestations that patients showed at his admission to the hospital. Screening for possible community-acquired respiratory co-pathogens among elderly SARS-CoV-2 patients is critical for effective treatment and management.
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Carlicchi E, Gemma P, Poerio A, Caminati A, Vanzulli A, Zompatori M. Chest-CT mimics of COVID-19 pneumonia-a review article. Emerg Radiol 2021; 28:507-518. [PMID: 33646498 PMCID: PMC7917172 DOI: 10.1007/s10140-021-01919-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 02/15/2021] [Indexed: 01/02/2023]
Abstract
Coronavirus disease 2019 (COVID-19) emerged in early December 2019 in China, as an acute lower respiratory tract infection and spread rapidly worldwide being declared a pandemic in March 2020. Chest-computed tomography (CT) has been utilized in different clinical settings of COVID-19 patients; however, COVID-19 imaging appearance is highly variable and nonspecific. Indeed, many pulmonary infections and non-infectious diseases can show similar CT findings and mimic COVID-19 pneumonia. In this review, we discuss clinical conditions that share a similar imaging appearance with COVID-19 pneumonia, in order to identify imaging and clinical characteristics useful in the differential diagnosis.
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Affiliation(s)
- Eleonora Carlicchi
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy.
| | - Pietro Gemma
- Post-graduate School in Radiodiagnostic, Università degli Studi di Milano, Milan, Italy
| | - Antonio Poerio
- Radiology Unit, Santa Maria della Scaletta Hospital, Imola, Italy
| | - Antonella Caminati
- Respiratory Medicine and Semi-Intensive Therapy Unit, Respiratory Physiopathology and Pulmonary Haemodynamics Services, San Giuseppe Hospital Multimedica, Milan, Italy
| | - Angelo Vanzulli
- Radiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy
- Oncology and Hemato-Oncology Unit, Università degli Studi di Milano, via Festa del Perdono 7, 20122, Milan, Italy
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Ramos-Sevillano E, Ercoli G, Guerra-Assunção JA, Felgner P, Ramiro de Assis R, Nakajima R, Goldblatt D, Tetteh KKA, Heyderman RS, Gordon SB, Ferreria DM, Brown JS. Protective Effect of Nasal Colonisation with ∆cps/piaA and ∆cps/proABCStreptococcus pneumoniae Strains against Recolonisation and Invasive Infection. Vaccines (Basel) 2021; 9:vaccines9030261. [PMID: 33804077 PMCID: PMC8000150 DOI: 10.3390/vaccines9030261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Nasopharyngeal administration of live virulence-attenuated Streptococcus pneumoniae strains is a potential novel preventative strategy. One target for creating reduced virulence S. pneumoniae strains is the capsule, but loss of the capsule reduces the duration of S. pneumoniae colonisation in mice which could impair protective efficacy against subsequent infection. OBJECTIVES To assess protective efficacy of nasopharyngeal administration of unencapsulated S. pneumoniae strains in murine infection models. METHODS Strains containing cps locus deletions combined with the S. pneumoniae virulence factors psaA (reduces colonisation) or proABC (no effect on colonisation) were constructed and their virulence phenotypes and ability to prevent recolonisation or invasive infection assessed using mouse infection models. Serological responses to colonisation were compared between strains using ELISAs, immunoblots and 254 S. pneumoniae protein antigen array. MEASUREMENTS AND MAIN RESULTS The ∆cps/piaA and ∆cps/proABC strains were strongly attenuated in virulence in both invasive infection models and had a reduced ability to colonise the nasopharynx. ELISAs, immunoblots and protein arrays showed colonisation with either strain stimulated weaker serological responses than the wild type strain. Mice previously colonised with these strains were protected against septicaemic pneumonia but, unlike mice colonised with the wild type strain, not against S. pneumoniae recolonisation. CONCLUSIONS Colonisation with the ∆cps/piaA and ∆cps/proABC strains prevented subsequent septicaemia, but in contrast, to published data for encapsulated double mutant strains they did not prevent recolonisation with S. pneumoniae. These data suggest targeting the cps locus is a less effective option for creating live attenuated strains that prevent S. pneumoniae infections.
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Affiliation(s)
- Elisa Ramos-Sevillano
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, Rayne Institute, London WC1E 6JF, UK;
- Correspondence: (E.R.-S.); (J.S.B.); Tel.: +44-20-7679-6008 (J.S.B.); Fax: +44-20-7679-6973 (J.S.B.)
| | - Giuseppe Ercoli
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, Rayne Institute, London WC1E 6JF, UK;
| | | | - Philip Felgner
- Vaccine Research and Development Center, Department of Physiology and Biophysics, University of California Irvine, Irvine, CA 92697-4560, USA; (P.F.); (R.R.d.A.); (R.N.)
| | - Rafael Ramiro de Assis
- Vaccine Research and Development Center, Department of Physiology and Biophysics, University of California Irvine, Irvine, CA 92697-4560, USA; (P.F.); (R.R.d.A.); (R.N.)
| | - Rie Nakajima
- Vaccine Research and Development Center, Department of Physiology and Biophysics, University of California Irvine, Irvine, CA 92697-4560, USA; (P.F.); (R.R.d.A.); (R.N.)
| | - David Goldblatt
- Immunobiology Section, UCL Great Ormond Street Institute of Child Health, NIHR Biomedical Research Centre, London WC1N 1EH, UK;
| | - Kevin Kweku Adjei Tetteh
- Faculty of Infectious and Tropical Diseases, London School of Tropical Medicine and Hygiene, London WC1E 7HT, UK;
| | - Robert Simon Heyderman
- Research Department of Infection, Division of Infection and Immunity, University College London, Rayne Institute, London WC1E 6JF, UK;
| | - Stephen Brian Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre 30096, Malawi;
| | - Daniela Mulari Ferreria
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK;
| | - Jeremy Stuart Brown
- Centre for Inflammation and Tissue Repair, UCL Respiratory, Division of Medicine, University College London, Rayne Institute, London WC1E 6JF, UK;
- Correspondence: (E.R.-S.); (J.S.B.); Tel.: +44-20-7679-6008 (J.S.B.); Fax: +44-20-7679-6973 (J.S.B.)
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Vinaykumar N, Maruti PJ. Clinical profile of acute lower respiratory tract infections in children aged 2-60 months: An observational study. J Family Med Prim Care 2021; 9:5152-5157. [PMID: 33409180 PMCID: PMC7773121 DOI: 10.4103/jfmpc.jfmpc_624_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 11/14/2022] Open
Abstract
Background: Assessment of risk factors and clinical profile for acute lower respiratory tract infections (ALRIs) with severe and very severe pneumonia in children <5 years age is obligatory. Objective: To study the clinical profile, risk factors, and clinical outcomes associated with ALRIs in children aged 2–60 months. Methodology: In total, 130 children of either gender, diagnosed with ALRIs, admitted in a tertiary care hospital were enrolled. Demographic data and clinical history was collected. Clinical profile data such as respiratory and heart rate, oxygen supplementation, ventilator use, and lab investigation such as erythrocyte sedimentation rate, hemoglobin, total leucocyte count, differential leucocytes count, and blood culture were analyzed and noted. Results: The study findings demonstrated male gender predominance for ALRIs with 1.3:1 male to female ratio. Around 16% of them had pneumonia, 61% had severe pneumonia, and 23% had very severe pneumonia. The birth weight of child, maternal and paternal literacy, socioeconomic status, overcrowding at home, immunization status of children, type of kitchen and fuel used for cooking, malnutrition, anemia, and need for oxygen supplementation were found to be associated with the occurrence of ALRIs (P < 0.05). Most of the presented symptoms were cough (100%), breathlessness (96.92%), and fever (92.31%). Bronchiolitis (63%), bronchopneumonia (27%), and lobar pneumonia (25%) were the major clinical outcomes. Conclusion: The study identified various sociodemographic, environmental, and nutritional risk factors for ALRIs along with the clinical profile, which can be managed by effective peripheral health personnel's training and persuasive community health education.
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Affiliation(s)
- Nandimalla Vinaykumar
- Department of Pediatrics, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
| | - Pawar Jalinder Maruti
- Department of Pediatrics, Krishna Institute of Medical Sciences, Karad, Maharashtra, India
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14
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Yokoi T, Kuwabara K, Ono K, Kito Y, Kato K, Kato K, Hirose M, Kondo R, Horiguchi T. Evaluation of the pneumococcal urinary antigen test (PUT): a retrospective study. FUJITA MEDICAL JOURNAL 2021; 7:23-28. [PMID: 35111540 PMCID: PMC8749485 DOI: 10.20407/fmj.2019-028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/09/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To determine the usefulness of the pneumococcal urinary antigen test (PUT) and to describe the characteristics of pneumococcal pneumonia. METHODS In this retrospective study, we examined the effects of prior antibiotic treatment, pneumonia onset period, and sputum quality on the results of PUT. Clinical information was collected via medical records from all adult patients who were hospitalized at the Fujita Health University Bantane Hospital with "pneumonia" as a new diagnosis from April 2015 to March 2018. RESULTS A total of 482 patients with pneumonia were included, of whom 103 had pneumococcal pneumonia. The frequency of PUT positivity did not differ significantly in patients with a pneumonia onset period of ≥3 days compared with those with a period of ≤2 days (P=0.514). Patients with a history of prior antimicrobial therapy had a significantly lower rate of positive sputum culture vs those with no such history (P=0.005); however, PUT positivity in the two groups did not differ significantly (P=0.367). CONCLUSIONS Our results showed that urinary antigen testing for pneumococcal pneumonia is useful for diagnosis regardless of prior antibiotic treatment and time since symptom onset.
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Affiliation(s)
- Tatsuyoshi Yokoi
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Kazunobu Kuwabara
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Kiyotaka Ono
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Yusuke Kito
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Kenichi Kato
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Keisuke Kato
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Masahiro Hirose
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Rieko Kondo
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
| | - Takahiko Horiguchi
- Department of Respiratory Medicine II, Fujita Health University, School of
Medicine, Nagoya, Aichi Japan
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15
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Costa MI, Cipriano A, Santos FV, Valdoleiros SR, Furtado I, Machado A, Abreu M, Bastos HN. Clinical profile and microbiological aetiology diagnosis in adult patients hospitalized with community-acquired pneumonia. Pulmonology 2020; 28:358-367. [PMID: 33358259 DOI: 10.1016/j.pulmoe.2020.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022] Open
Abstract
Early introduction of appropriate antibiotherapy is one of the major prognostic-modifying factors in community acquired pneumonia (CAP). Despite established guidelines for empirical therapy, several factors may influence etiology and, consequently, antibiotic choices. The aims of this study were to analyze the etiology of CAP in adults admitted to a northern Portugal University Hospital and evaluate the yield of the different methods used to reach an etiological diagnosis, as well as analyze of the impact of patient demographic and clinical features on CAP etiology. We retrospectively analyzed 1901 cases of CAP with hospitalization. The diagnostic performance increased significantly when blood and sputum cultures were combined with urinary antigen tests. The most frequent etiological agent was Streptococcus pneumoniae (45.7%), except in August, when it was overtaken by gram-negative bacilli (GNB) and Legionella pneumophila infections. Viral infections were almost exclusive to winter and spring. A negative microbiological result was associated with increasing age, non-smoking and lack of both blood/sputum cultures. Younger age was a predictor for S. pneumoniae, Influenza and L. pneumophila infections. Active smoking without any previously known respiratory disease was a risk factor for legionellosis. COPD was associated with Haemophilus influenzae cases, while dementia was typical in GNB and S. aureus patients. Diabetes mellitus (DM) and heart disease were negative predictors of S. pneumoniae and H. influenzae, respectively. P. aeruginosa was an independent risk factor for mortality (OR 13.02, 95% CI 2.94-57.7). This study highlights the importance of a comprehensive microbiological diagnostic workup and provides clues to predicting the most probable CAP causative agents, based on a patient's clinical profile. These may be taken into account when establishing first line antibiotherapy.
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Affiliation(s)
- M I Costa
- Department of Pulmonology of Porto Hospital Center, Porto, Portugal.
| | - A Cipriano
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - F V Santos
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - S R Valdoleiros
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - I Furtado
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal
| | - A Machado
- Department of Internal Medicine of Porto Hospital Center, Porto, Portugal
| | - M Abreu
- Department of Infectious Diseases of Porto Hospital Center, Porto, Portugal; Instituto de Ciências Biomédicas Abel Salazar, Univesity of Porto, Portugal
| | - H N Bastos
- Department of Pulmonology of São João Hospital Center, Porto, Portugal; Faculty of Medicine of University of Porto, Porto, Portugal; IBMC/i3S - Instituto de Biologia Molecular e Celular/Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
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16
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Zhu JS, Ge P, Jiang C, Zhang Y, Li X, Zhao Z, Zhang L, Duong TQ. Deep-learning artificial intelligence analysis of clinical variables predicts mortality in COVID-19 patients. J Am Coll Emerg Physicians Open 2020; 1:1364-1373. [PMID: 32838390 PMCID: PMC7405082 DOI: 10.1002/emp2.12205] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 01/01/2023] Open
Abstract
Objective The large number of clinical variables associated with coronavirus disease 2019 (COVID-19) infection makes it challenging for frontline physicians to effectively triage COVID-19 patients during the pandemic. This study aimed to develop an efficient deep-learning artificial intelligence algorithm to identify top clinical variable predictors and derive a risk stratification score system to help clinicians triage COVID-19 patients. Methods This retrospective study consisted of 181 hospitalized patients with confirmed COVID-19 infection from January 29, 2020 to March 21, 2020 from a major hospital in Wuhan, China. The primary outcome was mortality. Demographics, comorbidities, vital signs, symptoms, and laboratory tests were collected at initial presentation, totaling 78 clinical variables. A deep-learning algorithm and a risk stratification score system were developed to predict mortality. Data were split into 85% training and 15% testing. Prediction performance was compared with those using COVID-19 severity score, CURB-65 score, and pneumonia severity index (PSI). Results Of the 181 COVID-19 patients, 39 expired and 142 survived. Five top predictors of mortality were D-dimer, O2 Index, neutrophil:lymphocyte ratio, C-reactive protein, and lactate dehydrogenase. The top 5 predictors and the resultant risk score yielded, respectively, an area under curve (AUC) of 0.968 (95% CI = 0.87-1.0) and 0.954 (95% CI = 0.80-0.99) for the testing dataset. Our models outperformed COVID-19 severity score (AUC = 0.756), CURB-65 score (AUC = 0.671), and PSI (AUC = 0.838). The mortality rates for our risk stratification scores (0-5) were 0%, 0%, 6.7%, 18.2%, 67.7%, and 83.3%, respectively. Conclusions Deep-learning prediction model and the resultant risk stratification score may prove useful in clinical decisionmaking under time-sensitive and resource-constrained environment.
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Affiliation(s)
- Jocelyn S Zhu
- Departments of Radiology, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Peilin Ge
- Departments of Radiology, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Chunguo Jiang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Yong Zhang
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Xiaoran Li
- Departments of Radiology, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Zirun Zhao
- Departments of Radiology, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Liming Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina
| | - Tim Q. Duong
- Departments of Radiology, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
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Sellarès-Nadal J, Burgos J, Falcó V, Almirante B. Investigational and Experimental Drugs for Community-Acquired Pneumonia: the Current Evidence. J Exp Pharmacol 2020; 12:529-538. [PMID: 33239925 PMCID: PMC7682597 DOI: 10.2147/jep.s259286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/10/2020] [Indexed: 12/23/2022] Open
Abstract
Community-acquired pneumonia (CAP) is a common infection with a constantly evolving etiological spectrum. This changing etiology conditions the adequate selection of optimal therapeutic regimens, both in empirical and definitive treatments. In recent years, new antimicrobials have been approved by regulatory authorities for use in CAP, although it is necessary to continue incorporating new antimicrobial agents that improve the activity profile in relation to the appearance of bacterial resistance in certain pathogens, such as pneumococcus, Staphylococcus aureus or Pseudomonas aeruginosa. Delafloxacin, omadacycline and lefamulin are the most recently approved antibiotics for CAP. These three antibiotics have shown non-inferiority to their comparators for the treatment of CAP with an excellent safety profile. However, in the 2019 ATS/IDSA guidelines, it has been considered that more information is needed to incorporate these new drugs into community-based treatment. New antimicrobials, such as solithromycin and nemonoxacin, are currently being studied in Phase III clinical trials. Both drugs have shown non-inferiority against the comparators and an acceptable safety profile; however, they have not yet been approved by the regulatory authorities. Several drugs are being tested in Phase I and II clinical trials. These include zabofloxacin, aravofloxacin, nafithromycin, TP-271, gepotidacin, radezolid, delpazolid, and CAL02. The preliminary results of these clinical trials allow us to assure that most of these drugs may play a role in the future treatment of CAP.
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Affiliation(s)
- Juilia Sellarès-Nadal
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquin Burgos
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Vicenç Falcó
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
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18
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Ito A, Yamamoto Y, Ishii Y, Okazaki A, Ishiura Y, Kawagishi Y, Takiguchi Y, Kishi K, Taguchi Y, Shinzato T, Okochi Y, Hayashi R, Nakamori Y, Kichikawa Y, Murata K, Takeda H, Higa F, Miyara T, Saito K, Ishikawa T, Ishida T, Tateda K. Evaluation of a novel urinary antigen test kit for diagnosing Legionella pneumonia. Int J Infect Dis 2020; 103:42-47. [PMID: 33176204 DOI: 10.1016/j.ijid.2020.10.106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the diagnostic utility of a novel test kit that could theoretically detect all serogroups of Legionella pneumophila for diagnosing Legionella pneumonia, in comparison with existing kits. METHODS This study was conducted in 16 hospitals in Japan from April 2016 to December 2018. Three urinary antigen test kits were used: the novel kit (LAC-116), BinaxNOW Legionella (Binax), and Q-line Kyokutou Legionella (Q-line). In addition, sputum culture and nucleic acid detection tests and serum antibody tests were performed where possible. The diagnostic accuracy and correlations of the novel kit with the two existing kits were analyzed. RESULTS In total, 56 patients were diagnosed with Legionella pneumonia. The sensitivities of LAC-116, Binax, and Q-line were 79%, 84%, and 71%, respectively. The overall match rate between LAC-116 and Binax was 96.8% and between LAC-116 and Q-line was 96.4%. One patient had L. pneumophila serogroup 2, and only LAC-116 showed a positive result, whereas Binax and Q-line did not. CONCLUSIONS The novel Legionella urinary antigen test kit was useful for diagnosing Legionella pneumonia. In addition, it could detect Legionella pneumonia caused by non-L. pneumophila serogroup 1.
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Affiliation(s)
- Akihiro Ito
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Yoshihiro Yamamoto
- Department of Clinical Infectious Diseases, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.
| | - Yoshikazu Ishii
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan.
| | - Akihito Okazaki
- Department of Respiratory Medicine, Koseiren Takaoka Hospital, 5-10 Eirakumachi, Takaoka, Toyama 933-8555, Japan.
| | - Yoshihisa Ishiura
- First Department of Internal Medicine, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Yukio Kawagishi
- Department of Internal Medicine, Kurobe City Hospital, 1108-1 Mikkaichi, Kurobe, Toyama 938-8502, Japan.
| | - Yasuo Takiguchi
- Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, 1273-2 Aoba-chou, Chuo-ku, Chiba, Chiba 260-0852, Japan.
| | - Kazuma Kishi
- Department of Respiratory Medicine, Toho University Omori Medical Center, 6-11-1 Omori-nishi, Ota-ku, Tokyo 143-8541, Japan.
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, 200 Mishima-cho, Tenri, Nara 632-8552, Japan.
| | - Takashi Shinzato
- Department of Infectious Diseases and Internal Medicine, Nakagami General Hospital, 610 Noborikawa, Okinawa, Okinawa 904-2195, Japan.
| | - Yasumi Okochi
- Department of Respiratory Medicine, Japan Community Health Care Organization, Tokyo Yamate Medical Center, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0073, Japan.
| | - Ryuji Hayashi
- Clinical Oncology, Toyama University Hospital, 2630 Sugitani, Toyama, Toyama 930-0194, Japan.
| | - Yoshitaka Nakamori
- Division of Respiratory Medicine, Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
| | - Yoshiko Kichikawa
- Division of Respiratory Medicine, Mishuku Hospital, 5-33-12 Kamimeguro, Meguro-ku, Tokyo 153-0051, Japan.
| | - Kengo Murata
- Department of Respiratory Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo 183-8524, Japan.
| | - Hiroaki Takeda
- Department of Respiratory Medicine, Yamagata Saisei Hospital, 79-1 Okimachi, Yamagata, Yamagata 990-8545, Japan.
| | - Futoshi Higa
- Department of Internal Medicine, National Hospital Organization Okinawa Hospital, 3-20-14 Ganeko, Ginowan, Okinawa 901-2214, Japan.
| | - Takayuki Miyara
- Department of Infection Prevention and Control, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
| | - Keisuke Saito
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan.
| | - Takeo Ishikawa
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University Daisan Hospital, 4-11-1 Izumihoncho, Komae, Tokyo 201-8601, Japan.
| | - Tadashi Ishida
- Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan.
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo 143-8540, Japan.
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Morrow G, Roberts A, Newton J, Rees J, Walkley M, Flavell L. Impact of a community-acquired pneumonia care bundle in North East England from 2014 to 2017-A quality improvement project. CLINICAL RESPIRATORY JOURNAL 2020; 15:74-83. [PMID: 32931088 DOI: 10.1111/crj.13271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 12/23/2019] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore the impact of implementation of Community-Acquired Pneumonia (CAP) quality care bundle. SETTING Eight acute hospitals in the North East of England and North Cumbria. PARTICIPANTS ICD-10 coded CAP aged >18 were identified. A total of 16 201 CAP patients were discharged 2016/2017 (15 707; 2015/2016 and 10 733; 2014/2015). OUTCOME MEASURES Secondary User Service (SUS) data were collected monthly from April 2014 to 2017. Data were pseudonymised and data flows governed by Data Sharing Agreements. CAP measures were based on British Thoracic Society guidance and agreed following clinician consultation. CAP admissions and individual organisational compliance with and impact of, CAP quality bundle measures was explored. RESULTS Average length of stay (LOS) was 10.4 days (median 6) 25% >13 days. Crude in-hospital mortality rate was 17.6%, significantly lower (95% CI) than 19.1% in 2015/2016 and 19.3% in 2014/2015. Emergency readmissions within 28 days were 19.7% (19.2%; 2015/2016, 17.9%; 2014/2015). A total of 39.5% of patients received all appropriate care measures. Compliance has improved over time, although not for all hospitals. Most quality measures have higher mortality for those passing measures compared to those failing (P < .05 95% CI). Giving oxygen, had a significantly higher emergency readmission rate, 3.3% higher (95% CI 1.1% to 5.5%). Appropriate antibiotics and recording CURB-65 scores reduced the emergency readmission rates (-2.7% (95% CI -4.5% to -0.8%) -2.6% (95% CI -3.8% to -1.4%), respectively, (P = ns)). CONCLUSION CAP accounts for significant bed days, mortality and readmissions. Although mortality was lower, LOS and readmission rates were not, despite improvements in compliance after implementation of the care bundle. Care bundle use remained sub-optimal.
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Affiliation(s)
- Gerry Morrow
- North East Quality Observatory Service, Newcastle upon Tyne, UK
| | - Anthony Roberts
- South Tees Hospitals NHS Foundation Hospital, The James Cook University Hospital, Middlesbrough, UK
| | - Julia Newton
- Academic Health Science Network North East and North Cumbria, Newcastle upon Tyne, UK
| | - Jon Rees
- School of Psychology, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Michael Walkley
- South Tees Hospitals NHS Foundation Hospital, The James Cook University Hospital, Middlesbrough, UK
| | - Linda Flavell
- Clarity Informatics Limited, Newcastle upon Tyne, UK
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Species Identification and Antibiotic Resistance Prediction by Analysis of Whole-Genome Sequence Data by Use of ARESdb: an Analysis of Isolates from the Unyvero Lower Respiratory Tract Infection Trial. J Clin Microbiol 2020; 58:JCM.00273-20. [PMID: 32295890 PMCID: PMC7315026 DOI: 10.1128/jcm.00273-20] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/04/2020] [Indexed: 12/12/2022] Open
Abstract
Whole-genome sequencing (WGS) is now routinely performed in clinical microbiology laboratories to assess isolate relatedness. With appropriately developed analytics, the same data can be used for prediction of antimicrobial susceptibility. We assessed WGS data for identification using open-source tools and antibiotic susceptibility testing (AST) prediction using ARESdb compared to matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification and broth microdilution phenotypic susceptibility testing on clinical isolates from a multicenter clinical trial of the FDA-cleared Unyvero lower respiratory tract infection (LRTI) application (Curetis). Whole-genome sequencing (WGS) is now routinely performed in clinical microbiology laboratories to assess isolate relatedness. With appropriately developed analytics, the same data can be used for prediction of antimicrobial susceptibility. We assessed WGS data for identification using open-source tools and antibiotic susceptibility testing (AST) prediction using ARESdb compared to matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification and broth microdilution phenotypic susceptibility testing on clinical isolates from a multicenter clinical trial of the FDA-cleared Unyvero lower respiratory tract infection (LRTI) application (Curetis). For the trial, more than 2,000 patient samples were collected from intensive care units across nine hospitals and tested for LRTI. The isolate subset used in this study included 620 clinical isolates originating from 455 LRTI culture-positive patient samples. Isolates were sequenced using the Illumina Nextera XT protocol and FASTQ files with raw reads uploaded to the ARESdb cloud platform (ares-genetics.cloud; released for research use in 2020). The platform combines Ares Genetics’ proprietary database ARESdb with state-of-the-art bioinformatics tools and curated public data. For identification, WGS showed 99 and 93% concordance with MALDI-TOF MS at the genus and species levels, respectively. WGS-predicted susceptibility showed 89% categorical agreement with phenotypic susceptibility across a total of 129 species-compound pairs analyzed, with categorical agreement exceeding 90% in 78 species-compound pairs and reaching 100% in 32. Results of this study add to the growing body of literature showing that, with improvement of analytics, WGS data could be used to predict antimicrobial susceptibility.
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Anai S, Ibusuki R, Takao T, Okushima K, Sakurai Y, Hisasue J, Furukawa T, Shiraishi N, Takaki Y, Hara N. Splenic volume in pneumococcal pneumonia patients is associated with disease severity and mortality. J Infect Chemother 2020; 26:977-985. [PMID: 32376162 DOI: 10.1016/j.jiac.2020.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 11/17/2022]
Abstract
Splenectomy is a risk factor for serious pneumococcal disease like overwhelming post-splenectomy infection (OPSI). In healthy individuals with small spleen, fulminant pneumococcal infection similar to OPSI has been reported. Furthermore, it is reported that small spleen was associated with severe pneumococcal infection patients treated in an intensive care unit. However, the association between the small spleen and pneumococcal pneumonia was not investigated enough. We retrospectively analyzed patients with pneumococcal pneumonia who underwent computed tomography examination with measurement of the splenic volume at Harasanshin Hospital between 2004 and 2019. Data on their background characteristics, laboratory findings, and clinical courses were collected. 413 patients were included in the final analysis. The splenic volume was significantly lower in the moderate (P < 0.001), severe (P < 0.00005), and extremely severe (P < 0.001) pneumonia groups compared with the mild pneumonia group. Furthermore, the splenic volume was significantly lower in patients died within 30 days of pneumonia treatment (median of 73.49 versus 110.77 cm3, P < 0.005) or during hospitalization (median of 71.69 versus 111.01 cm3, P < 0.0005). Splenic volume <40 cm3 was significantly associated with mortality within 30 days and total hospital mortality as a risk factor in univariate analysis. Splenic volume <40 cm3 was an independent risk factor for mortality within 30 days (odds ratio: 5.0, 95% confidence interval: 1.2-21.1, P < 0.05) and total hospital mortality (odds ratio: 7.4, 95% confidence interval: 1.8-30.6, P < 0.01) in multivariate logistic regression analysis. These results suggest that small spleen is a risk factor for severity and mortality of pneumococcal pneumonia.
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Affiliation(s)
- Satoshi Anai
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan.
| | - Ritsu Ibusuki
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Tomoaki Takao
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Kazuhiro Okushima
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Yuko Sakurai
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Junko Hisasue
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Tatsuya Furukawa
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Naotaka Shiraishi
- Division of Clinical Radiology, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Yoichi Takaki
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
| | - Naohiko Hara
- Division of Respiratory Medicine, Harasanshin Hospital, 1-8 Taihaku-cho, Hakata-ku, Fukuoka, 812-0033, Japan
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Barbagelata E, Cillóniz C, Dominedò C, Torres A, Nicolini A, Solidoro P. Gender differences in community-acquired pneumonia. Minerva Med 2020; 111:153-165. [PMID: 32166931 DOI: 10.23736/s0026-4806.20.06448-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Community-acquired pneumonia (CAP) is the most common type of lower respiratory tract infection and a major cause of morbidity and mortality in adults worldwide. Sex and gender play an active role in the incidence and outcomes of major infectious diseases, including CAP. EVIDENCE ACQUISITION We searched the following electronic databases from January 2001 to December 2018: MEDLINE, EMBASE, CINHAIL, CENTRAL (Cochrane Central register of Controlled Trials), DARE (Database of Abstracts of Reviews of Effectiveness), Cochrane Database of Systematic Reviews and ACP Journal Club database. EVIDENCE SYNTHESIS Several studies have reported higher male susceptibility to pulmonary infections and higher risk of death due to sepsis. Biological differences (e.g. hormonal cycles and cellular immune-mediated responses) together with cultural, behavioral and socio-economic differences are important determinants of the course and outcome of CAP. However, gender-related bias in the provision of care and use of hospital resources has been reported among women, resulting in delayed hospital admission and consequently necessary care. CONCLUSIONS CAP is more severe in males than in females, leading to higher mortality in males, especially in older age. To identify gender differences in CAP can guide patient's prognostication and management.
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Affiliation(s)
- Elena Barbagelata
- Department of Internal Medicine, General Hospital, Sestri Levante, Genoa, Italy
| | - Catia Cillóniz
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute - IDIBAP S, Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), University of Barcelona, Barcelona, Spain
| | - Antonello Nicolini
- Unit of Respiratory Diseases, General Hospital, Sestri Levante, Genoa, Italy -
| | - Paolo Solidoro
- Unit of Pneumology U, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Eletu SD, Sheppard CL, Rose S, Smith K, Andrews N, Lim WS, Litt DJ, Fry NK. Re-validation and update of an extended-specificity multiplex assay for detection of Streptococcus pneumoniae capsular serotype/serogroup-specific antigen and cell-wall polysaccharide in urine specimens. Access Microbiol 2020; 2:acmi000094. [PMID: 32974571 PMCID: PMC7470314 DOI: 10.1099/acmi.0.000094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/08/2020] [Indexed: 12/27/2022] Open
Abstract
National surveillance of pneumococcal disease at the serotype level is essential to assess the effectiveness of vaccination programmes. We previously developed a highly sensitive extended-specificity multiplex immunoassay for detection of Streptococcus pneumoniae serotype-specific antigen in urine in the absence of isolates. The assay uses human mAbs that detect the 24 pneumococcal serotype/groups targeted by the pneumococcal conjugate vaccines (PCVs) and pneumococcal polysaccharide vaccine (PPV-23) plus some cross-reactive types and the pneumococcal cell-wall polysaccharide. However, the previous assay had some limitations, namely the reduced specificity of the serotype 7F, 20 and 22F assays, for which non-specific binding in urine samples was observed. Here we report on the further development and re-validation of a new version of the assay (version 2.1), which offers improved sensitivity towards serotypes 7F, 18C and 19F and increased specificity for serotypes 7F, 20 and 22F by replacement of some of the antibody clones with new clones. Using a panel of urine specimens from patients diagnosed with community-acquired pneumonia or pneumococcal disease, the overall clinical sensitivity of this version of the assay based on isolation of S. pneumoniae from a normally sterile site is 94.3 % and the clinical specificity is 93.6 %, in comparison with clinical sensitivity and specificity values of 96.2 % and 89.9 % in the previous assay.
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Affiliation(s)
- Seyi D Eletu
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, Colindale Avenue, London, NW9 5EQ, UK
| | - Carmen L Sheppard
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, Colindale Avenue, London, NW9 5EQ, UK
| | - Samuel Rose
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, Colindale Avenue, London, NW9 5EQ, UK
| | - Kenneth Smith
- Oklahoma Medical Research Foundation, 825 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England - National Infection Service, Colindale Avenue, London, NW9 5EQ, UK
| | - Wei Shen Lim
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - David J Litt
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, Colindale Avenue, London, NW9 5EQ, UK
| | - Norman K Fry
- Vaccine Preventable Bacteria Section, Public Health England - National Infection Service, Colindale Avenue, London, NW9 5EQ, UK.,Immunisation and Countermeasures Division, Public Health England - National Infection Service, Colindale Avenue, London, NW9 5EQ, UK
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Monitoring of community-acquired pneumonia hospitalisations before the introduction of pneumococcal conjugate vaccine into Polish National Immunisation Programme (2009-2016): A nationwide retrospective database analysis. Vaccine 2019; 38:194-201. [PMID: 31653527 DOI: 10.1016/j.vaccine.2019.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Community-acquired pneumonia (CAP) is a common infection with significant morbidity and mortality. In January 2017, Poland introduced pneumococcal conjugate vaccine (PCV) into their national immunisation programme to protect children against invasive pneumococcal disease. This study was designed to investigate pneumonia-related hospitalisation rates and trends from 2009 to 2016 prior to the introduction of nationally funded PCV vaccination. METHODS Using national public statistic data available from the National Institute of Public Health - National Institute of Hygiene, annual hospitalisation rates for pneumonia were analysed, categorised by aetiology and age (<2, 2-3, 4-5, 6-19, 20-59, 60+ years). Trends over time were assessed, as well as in-hospital mortality. RESULTS The overall hospitalisation rate due to pneumonia varied between 325.9 and 372.2/100,000 population. Higher rates of hospitalisation were seen in older adults and children ≤5 years. Trends were observed when analysing hospitalisations by pneumonia aetiology within age groups: between 2009 and 2016, Streptococcus pneumoniae hospitalisations significantly increased for children aged <2, 2-3, and 4-5 years, from 5.3 to 12.4, 5.2 to 8.2, and 1.9 to 4.6/100,000 population respectively. Whereas hospitalisations due to Haemophilus influenzae pneumonia decreased significantly from 7.8 to 1.8 and 4.8 to 1.9/100,000 children aged <2 and 2-3 years respectively. The numbers of in-hospital deaths increased from 5578 in 2009 to 8149 in 2016, with >85% of deaths in the 60+ age group. CONCLUSIONS This is the first national study of pneumonia hospitalisations in Poland, providing the baseline data from which to investigate the impact of the change in vaccination policy on pneumonia hospitalisations in Poland.
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Ghia CJ, Dhar R, Koul PA, Rambhad G, Fletcher MA. Streptococcus pneumoniae as a Cause of Community-Acquired Pneumonia in Indian Adolescents and Adults: A Systematic Review and Meta-Analysis. Clin Med Insights Circ Respir Pulm Med 2019; 13:1179548419862790. [PMID: 31391784 PMCID: PMC6669839 DOI: 10.1177/1179548419862790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is one of the primary cause of community-acquired pneumonia (CAP) worldwide. However, scant data are available on the prevalence of etiological organisms for CAP in adolescent and adult Indian population. OBJECTIVE We performed a systematic review and meta-analysis to determine the contribution of S. pneumoniae in the causation of CAP in Indian patients aged 12 years or above. METHODOLOGY We performed a systematic search of both indexed and non-indexed publications using PubMed, databases of National Institute of Science Communication and Information Resources (NISCAIR), Annotated Bibliography of Indian Medicine (ABIM), Google Scholar, and hand search including cross-references using key terms 'community acquired pneumonia AND India'. All studies, published between January 1990 and January 2017, that evaluated Indian patients aged above 12 years with a confirmed diagnosis of CAP were eligible for inclusion. Our search retrieved a total of 182 studies, of which only 17 and 12 qualified for inclusion in the systematic review of all etiological organisms, and meta-analysis of S. pneumonia, respectively. RESULTS A total of 1435 patients met the inclusion criteria. The pooled proportion of patients with S. pneumoniae infection was 19% (95% confidence interval [CI]: 12%-26%; I2 = 94.5% where I2 represents heterogeneity, P < .01). Other major etiological agents are Mycoplasma pneumoniae (15.5% [1.1%-35.5%]), Klebsiella pneumoniae (10.5% [1.6%-24.0%]), and Legionella pneumophila (7.3% [2.5%-23.8%]). CONCLUSIONS Analysis found approximately a one-fifth proportion of adult Indian patients of CAP with S. pneumoniae infection, suggesting it as a leading organism for causing CAP compared with other etiological organisms.
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Affiliation(s)
- Canna J. Ghia
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
| | - Raja Dhar
- Consultant Pulmonologist, Department of Pulmonology, Fortis Hospital, Kolkata, India
| | - Parvaiz A Koul
- Department of Internal and Pulmonary Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Gautam Rambhad
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
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Abstract
PURPOSE OF REVIEW The first guidelines on community-acquired pneumonia (CAP) were published in 1993, but since then many of the challenges regarding the outpatient management of CAP persist. These include the difficulty in establishing the initial clinical diagnosis, its risk stratification, which will dictate the place of treatment, the empirical choice of antibiotics, the relative scarcity of novel antibiotics and the importance of knowing local microbiological susceptibility patterns. RECENT FINDINGS New molecular biology methods have changed the etiologic perspective of CAP, especially the contribution of virus. Lung ultrasound and biomarkers might aid diagnosis and severity stratification in the outpatient setting. Antibiotic resistance is a growing problem that reinforces the importance of novel antibiotics. And finally, prevention and the use of anti-pneumococcal vaccine are instrumental in reducing the burden of disease. SUMMARY Most of CAP cases are managed in the community; however, most research comes from hospitalized severe patients. New and awaited advances might contribute to aid diagnosis, cause and assessment of patients with CAP in the community. This knowledge might prove decisive in the execution of stewardship programmes that maintain current antibiotics, safeguard future ones and reinforce prevention.
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Mojtahedi SY, Rahbarimanesh A, Noorbakhsh S, Shokri H, Jamali-Moghadam-Siyahkali S, Izadi A. Urinary antigene and PCR can both be used to detect Legionella pneumophila in children's hospital-acquired pneumonia. Eur J Transl Myol 2019; 29:8120. [PMID: 31354920 PMCID: PMC6615363 DOI: 10.4081/ejtm.2019.8120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022] Open
Abstract
Legionella pneumophila is the causative agent of more than 95% cases of severe Legionella pneumonia. Nosocomial pneumonias in different hospital wards is an important medical and pharmaceutical concern. This study aimed to detect Legionella with two methods: polymerase chain reaction (PCR) and detection of urine antigenic test (UAT) in patients suffering from nosocomial pneumonia admitted to pediatric intensive care unit (PICU) of children hospitals. This study was conducted in PICU wards of Rasool Akram and Bahrami children hospitals, Tehran, Iran during 2013-2014. In patients diagnosed with hospital-acquired pneumonia, intratracheal secretion samples for PCR and urine sample for UAT were taken. Simultaneously, PCR and urinary antigen test were conducted using commercial kits. The results of urinary antigen test and PCR were analyzed by SPSS v.19 for statistical comparison. In this study, 96 patients aging 2.77 years on average with two age peaks of less than 1 year and 7-8 year were enrolled. More than half of the patients were under 1 year old. The most common underlying diseases were seizure, Acute Lymphoblastic Lymphoma, Down syndrome and metabolic syndromes. The positivity rate of Legionella urinary antigen test was 16.7% and positivity rate of PCR test was 19.8%. There were no significant associations between the results obtained by both assays with age, gender or underlying diseases. In conclusion, PCR is a better detection method for Legionella infection than urinary antigen test, but the difference between the two methods was not significant.
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Affiliation(s)
- Sayed-Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Rahbarimanesh
- Department of Pediatric Infectious Disease, Bahrami Hospital, Tehran University of Medical sciences, Tehran, Iran
| | - Samileh Noorbakhsh
- Research Center of Pediatric Infectious Disease, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Shokri
- Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Anahita Izadi
- Department of Pediatric Infectious disease, Tehran University of Medical science, Tehran, Iran
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Miyashita N, Horita N, Higa F, Aoki Y, Kikuchi T, Seki M, Tateda K, Maki N, Uchino K, Ogasawara K, Kiyota H, Watanabe A. Validation of a diagnostic score model for the prediction of Legionella pneumophila pneumonia. J Infect Chemother 2019; 25:407-412. [PMID: 30935766 DOI: 10.1016/j.jiac.2019.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) due to Legionella has a high mortality rate in patients who do not receive adequate antibiotic therapy. In a previous study, we developed a simple Legionella Score to distinguish patients with Legionella and non-Legionella pneumonia based on clinical information at diagnosis. In the present study, we validated this Legionella Score for the presumptive diagnosis of Legionella CAP. METHODS This validation cohort included 109 patients with Legionella CAP and 683 patients with non-Legionella CAP. The Legionella Score includes six parameters by assigning one point for each of the following items: being male, absence of cough, dyspnea, C-reactive protein (CRP) ≥ 18 mg/dL, lactate dehydrogenase (LDH) ≥ 260 U/L, and sodium < 134 mmol/L. RESULTS When the Legionella CAP and non-Legionella CAP were compared by univariate analysis, most of the evaluated symptoms and laboratory test results differed substantially. The six parameters that were used for the Legionella Score also indicated clear differences between the Legionella and non-Legionella CAP. All Legionella patients had a score of 2 points or higher. The median Legionella Scores were 4 in the Legionella CAP cases and 2 in the non-Legionella CAP cases. A receiver operating characteristics curve showed that the area under the curve was 0.93. The proposed best cutoff, total score ≥3, had sensitivity of 93% and specificity of 75%. CONCLUSION Our Legionella Score was shown to have good diagnostic ability with a positive likelihood of 3.7 and a negative likelihood of 0.10.
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Affiliation(s)
- Naoyuki Miyashita
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan.
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan
| | - Futoshi Higa
- National Hospital Organization Okinawa National Hospital, Japan
| | - Yosuke Aoki
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Masafumi Seki
- Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan
| | - Nobuko Maki
- Taisho Toyama Pharmaceutical Co., Ltd, Japan
| | | | - Kazuhiko Ogasawara
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan
| | - Hiroshi Kiyota
- Department of Urology, The Jikei University Katsushika Medical Center, Japan
| | - Akira Watanabe
- Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Japan
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The Pneumococcal Surface Proteins PspA and PspC Sequester Host C4-Binding Protein To Inactivate Complement C4b on the Bacterial Surface. Infect Immun 2018; 87:IAI.00742-18. [PMID: 30323030 DOI: 10.1128/iai.00742-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/15/2022] Open
Abstract
Complement is a critical component of antimicrobial immunity. Various complement regulatory proteins prevent host cells from being attacked. Many pathogens have acquired the ability to sequester complement regulators from host plasma to evade complement attack. We describe here how Streptococcus pneumoniae adopts a strategy to prevent the formation of the C3 convertase C4bC2a by the rapid conversion of surface bound C4b and iC4b into C4dg, which remains bound to the bacterial surface but no longer forms a convertase complex. Noncapsular virulence factors on the pneumococcus are thought to facilitate this process by sequestering C4b-binding protein (C4BP) from host plasma. When S. pneumoniae D39 was opsonized with human serum, the larger C4 activation products C4b and iC4b were undetectable, but the bacteria were liberally decorated with C4dg and C4BP. With targeted deletions of either PspA or PspC, C4BP deposition was markedly reduced, and there was a corresponding reduction in C4dg and an increase in the deposition of C4b and iC4b. The effect was greatest when PspA and PspC were both knocked out. Infection experiments in mice indicated that the deletion of PspA and/or PspC resulted in the loss of bacterial pathogenicity. Recombinant PspA and PspC both bound serum C4BP, and both led to increased C4b and reduced C4dg deposition on S. pneumoniae D39. We conclude that PspA and PspC help the pneumococcus to evade complement attack by binding C4BP and so inactivating C4b.
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Razanajatovo NH, Guillebaud J, Harimanana A, Rajatonirina S, Ratsima EH, Andrianirina ZZ, Rakotoariniaina H, Andriatahina T, Orelle A, Ratovoson R, Irinantenaina J, Rakotonanahary DA, Ramparany L, Randrianirina F, Richard V, Heraud JM. Epidemiology of severe acute respiratory infections from hospital-based surveillance in Madagascar, November 2010 to July 2013. PLoS One 2018; 13:e0205124. [PMID: 30462659 PMCID: PMC6248916 DOI: 10.1371/journal.pone.0205124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/19/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Few comprehensive data exist regarding the epidemiology of severe acute respiratory infections (SARI) in low income countries. This study aimed at identifying etiologies and describing clinical features of SARI-associated hospitalization in Madagascar. METHODS It is a prospective surveillance of SARI in 2 hospitals for 3 years. Nasopharyngeal swabs, sputum, and blood were collected from SARI patients enrolled and tested for viruses and bacteria. Epidemiological and clinical information were obtained from case report forms. RESULTS Overall, 876 patients were enrolled in the study, of which 83.1% (728/876) were tested positive for at least one pathogen. Viral and bacterial infections occurred in 76.1% (667/876) and 35.8% (314/876) of tested samples, respectively. Among all detected viruses, respiratory syncytial virus (RSV) was the most common (37.7%; 348/924) followed by influenza virus A (FLUA, 18.4%; 170/924), rhinovirus (RV, 13.5%; 125/924), and adenovirus (ADV, 8.3%; 77/924). Among bacteria, Streptococcus pneumoniae (S. pneumoniae, 50.3%, 189/370) was the most detected followed by Haemophilus influenzae type b (Hib, 21.4%; 79/370), and Klebsiella (4.6%; 17/370). Other Streptococcus species were found in 8.1% (30/370) of samples. Compared to patients aged less than 5 years, older age groups were significantly less infected with RSV. On the other hand, patients aged more than 64 years (OR = 3.66) were at higher risk to be infected with FLUA, while those aged 15-29 years (OR = 3.22) and 30-64 years (OR = 2.39) were more likely to be infected with FLUB (influenza virus B). CONCLUSION The frequency of influenza viruses detected among SARI patients aged 65 years and more highlights the need for health authorities to develop strategies to reduce morbidity amongst at-risk population through vaccine recommendation. Amongst young children, the demonstrated burden of RSV should guide clinicians for a better case management of children. These findings reveal the need to develop point-of-care tests to avoid overuse of antibiotics and to promote vaccine that could reduce drastically the RSV hospitalizations.
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Affiliation(s)
| | - Julia Guillebaud
- National Influenza Centre, Virology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | - Aina Harimanana
- Epidemiology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | | | | | | | | | | | - Arnaud Orelle
- National Influenza Centre, Virology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | - Rila Ratovoson
- Epidemiology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | | | | | - Lovasoa Ramparany
- Center for Biological Analysis, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | | | - Vincent Richard
- Epidemiology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
| | - Jean-Michel Heraud
- National Influenza Centre, Virology Unit, Pasteur Institute of Madagascar, Antananarivo, Madagascar
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Cui J, Yan W, Xie H, Xu S, Wang Q, Zhang W, Ni A. A retrospective seroepidemiologic survey of Chlamydia pneumoniae infection in patients in Beijing between 2008 and 2017. PLoS One 2018; 13:e0206995. [PMID: 30403740 PMCID: PMC6221324 DOI: 10.1371/journal.pone.0206995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/23/2018] [Indexed: 11/18/2022] Open
Abstract
Background Chlamydia pneumoniae (C. pneumoniae) is an obligate intracellular bacterium and a human pathogen that causes respiratory infectious diseases. More than 50% of the adult population worldwide was once infected with C. pneumoniae, but investigations into this topic are insufficient in mainland China. Methods Anti-C. pneumoniae IgG and IgM antibodies were detected using micro-immunofluorescence test in serum samples of patients visiting Peking Union Medical College Hospital between 2008 and 2017 for routine medical purposes, and the aim of this retrospective study was to analyze the test results. Results Among 12,050 serum specimens tested for anti-C. pneumoniae IgG and IgM antibodies, the overall prevalence of anti-C. pneumoniae IgG antibodies was 86.6%, 87.2% for men and 86.0% for women. Adult men (>20 years) were found to have a significantly higher prevalence of anti-C. pneumoniae IgG than women (χ2 = 30.32, P = 0.000). 3 to 5 years old patients were observed to have the lowest prevalence of anti-C. pneumoniae IgG, 42.8%, then increased with age, reaching the highest level of 98.6% in patients over 70 years of age. In the 10,434 specimens with C. pneumoniae IgG antibodies, the total geometric mean titer (GMT) for C. pneumoniae IgG was 45.71. Although GMTs were found to be significantly higher among all men than among all women (t = 5.916, P = 0.000), sex difference actually began in patients over 40 years of age and increased in the elderly. In the total 12,050 specimens, 1.2% had anti-C. pneumoniae IgM, 3.3% had anti-C. pneumoniae IgG with titers equal to or greater than 1:512; 0.39% had ≥4-fold increasing titers of antibodies in acute and convalescent phase paired samples, and 4.4% were finally confirmed to have acute antibodies against C. pneumoniae. 6 to 10 years old patients were found to have the highest rate of both IgM antibodies (3.9%) and acute antibodies (6.2%) against C. pneumoniae. Acute antibodies against C. pneumoniae were found to be more frequent in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD, 14.0%, χ2 = 20.43, P = 0.000), patients with pneumonia (7.8%, χ2 = 51.87, P = 0.000) and patients with acute respiratory tract infection (12.3%, χ2 = 60.91, P = 0.000) than among all patients (4.4%). Both anti-C. pneumoniae IgG and IgM antibodies should be tested for acute antibodies against C. pneumoniae as testing for either alone will underestimate by a maximum of two-thirds the incidence of acute antibodies against C. pneumoniae. Conclusions More than 86% of Chinese patients on an average were once infected with C. pneumoniae. Adult men had both a higher prevalence and higher levels of antibodies than women. 6 to10 year old patients were found to have the most frequent acute infection of C. pneumoniae. C. pneumoniae is associated with AECOPD, pneumonia and acute respiratory tract infection. Anti-C. pneumoniae IgG and IgM should be tested simultaneously to avoid underestimation of acute antibodies against C. pneumoniae.
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Affiliation(s)
- Jingtao Cui
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjuan Yan
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongjie Xie
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoxia Xu
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiaofeng Wang
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihong Zhang
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Anping Ni
- Department of Clinical Laboratories, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- * E-mail:
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Slow S, Epton M, Storer M, Thiessen R, Lim S, Wong J, Chin P, Tovaranonte P, Pearson J, Chambers ST, Murdoch DR. Effect of adjunctive single high-dose vitamin D 3 on outcome of community-acquired pneumonia in hospitalised adults: The VIDCAPS randomised controlled trial. Sci Rep 2018; 8:13829. [PMID: 30218062 PMCID: PMC6138743 DOI: 10.1038/s41598-018-32162-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 08/29/2018] [Indexed: 02/01/2023] Open
Abstract
Low vitamin D status is associated with increased risk of pneumonia, greater disease severity and poorer outcome. However, no trials have examined the effect of adjunctive vitamin D therapy on outcomes in adults with community-acquired pneumonia (CAP). We conducted a randomised, double-blind, placebo-controlled trial examining the effects of adjunctive vitamin D in adults hospitalised with CAP. Participants were randomised to either a single oral dose of 200,000 IU vitamin D3 or placebo. The primary outcome was the complete resolution of chest radiograph infiltrate at 6 weeks post-study treatment. Secondary outcomes included length of hospital stay, intensive care admission and return to normal activity. Only participants who completed the study or died within the 6 week period were included in the analysis (n = 60 vitamin D, n = 57 placebo). Adjunctive vitamin D did not have any effect on the primary outcome (OR 0.78, 95% CI 0.31 to 1.86, p = 0.548). However, there was evidence it increased the complete resolution of pneumonia in participants with baseline vitamin D levels <25 nmol/L (OR 17.0, 95% CI 1.40-549.45, P = 0.043), but this did not reach statistical significance using exact methods (OR 13.0, 95%CI 0.7-960.4, P = 0.083). There were no significant effects for any secondary outcome.
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Affiliation(s)
- Sandy Slow
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
| | - Michael Epton
- Canterbury Respiratory Research Group, Canterbury District Health Board, Christchurch, New Zealand
| | - Malina Storer
- Canterbury Respiratory Research Group, Canterbury District Health Board, Christchurch, New Zealand
| | - Rennae Thiessen
- Radiology Department, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Steven Lim
- Radiology Department, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - James Wong
- Department of General Medicine, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.,Waimairi Road Medical Centre, Christchurch, New Zealand
| | - Paul Chin
- Department of General Medicine, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.,Clinical Pharmacology, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Pleayo Tovaranonte
- Department of General Medicine, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand.,Rolleston Central Health, Rolleston, Canterbury, New Zealand
| | - John Pearson
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Stephen T Chambers
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
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Kim HY, Kim SK, Seo HS, Jeong S, Ahn KB, Yun CH, Han SH. Th17 activation by dendritic cells stimulated with gamma-irradiated Streptococcus pneumoniae. Mol Immunol 2018; 101:344-352. [PMID: 30036800 DOI: 10.1016/j.molimm.2018.07.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/22/2018] [Accepted: 07/15/2018] [Indexed: 12/11/2022]
Abstract
Dendritic cells (DCs) play an important role in antigen presentation, which is an essential step for the induction of antigen-specific adaptive immunity. Inactivated bacterial whole cell vaccines have been widely used to prevent many bacterial infections because they elicit good immunogenicity due to the presence of various antigens and are relatively inexpensive and easy to manufacture. Recently, gamma-irradiated whole cells of nonencapsulated Streptococcus pneumoniae were developed as a broad-spectrum and serotype-independent multivalent vaccine. In the present study, we generated gamma-irradiated S. pneumoniae (r-SP) and investigated its capacity to stimulate mouse bone marrow-derived DCs (BM-DCs) in comparison with heat-inactivated and formalin-inactivated S. pneumoniae (h-SP and f-SP, respectively). r-SP showed an attenuated binding and internalization level to BM-DCs when compared to h-SP or f-SP. r-SP weakly induced the expression of CD80, CD83, CD86, MHC class I, and PD-L2 compared with h-SP or f-SP. Furthermore, r-SP less potently induced IL-6, TNF-α, and IL-23 expression than h-SP or f-SP but more potently induced IL-1β expression than h-SP or f-SP in BM-DCs. Since Th17-mediated immune responses are known to be important for the protection against pneumococcal infections, r-SP-primed DCs were co-cultured with splenocytes or splenic CD4+ T cells. Interestingly, r-SP-sensitized BM-DCs markedly induced IL-17A+ CD4+ T cells whereas h-SP- or f-SP-sensitized BM-DCs weakly induced them. Collectively, these results suggest that r-SP could be an effective pneumococcal vaccine candidate eliciting Th17-mediated immune responses by stimulation of DCs.
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Affiliation(s)
- Hyun Young Kim
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea
| | - Sun Kyung Kim
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea
| | - Ho Seong Seo
- Research Division for Biotechnology, Korea Atomic Energy Research Institute, Jeongeup 56212, Republic of Korea
| | - Soyoung Jeong
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea
| | - Ki Bum Ahn
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea; Research Division for Biotechnology, Korea Atomic Energy Research Institute, Jeongeup 56212, Republic of Korea
| | - Cheol-Heui Yun
- Department of Agricultural Biotechnology and Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul 08826, Republic of Korea
| | - Seung Hyun Han
- Department of Oral Microbiology and Immunology, DRI, and BK21 Plus Program, School of Dentistry, Seoul National University, Seoul 08826, Republic of Korea.
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35
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Kim B, Kim J, Jo YH, Lee JH, Hwang JE, Park MJ, Lee S. Prognostic value of pneumococcal urinary antigen test in community-acquired pneumonia. PLoS One 2018; 13:e0200620. [PMID: 30028834 PMCID: PMC6054390 DOI: 10.1371/journal.pone.0200620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/29/2018] [Indexed: 12/18/2022] Open
Abstract
Background The pneumococcal urinary antigen test (UAT) has been known to improve sensitivity and specificity for the diagnosis of pneumococcal pneumonia. Associations of UAT results with prognosis in community acquired pneumonia (CAP) are not known. We hypothesized that positive UAT is associated with a good prognosis, and incorporation of UAT into CRB65 would improve its prognostic performance. Methods In this registry-based retrospective study, we analyzed CAP patients over a 10-year period beginning in April 2008. Patients who had UAT results were included in multivariable extended Cox-regression analyses to determine the association between UAT positivity and 30-day mortality. UAT results were incorporated for patients with a CRB65 score of 1 by subtracting 1 from the scoring system if the test was positive. The performance of the modified scoring systems was assessed with area under the receiver operating characteristic (AUROC) curves. Results Among 5145 CAP patients, total 2280 patients had UAT results and were included in analyses. A positive UAT result was associated with a good prognosis after a week of hospitalization (aHR, 0.14; p = 0.007). After modification of CRB65 using UAT results, positive and negative predictive values for 30-day mortality were increased from 7.7 to 8.3 (p<0.001) and 98.9 to 99.1 (p = 0.010). The AUROC increased from 0.73 to 0.75 (p<0.001). Conclusions Positive results on UAT could be considered as a good prognostic factor in CAP. UAT could be used as a useful tool in deciding whether to refer patients to the hospital, especially in moderate CAP with a CRB score of 1.
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Affiliation(s)
- Byunghyun Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
- * E-mail:
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Ji Eun Hwang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Min Ji Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Sihyung Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
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Musher DM, Abers MS, Bartlett JG. Evolving Understanding of the Causes of Pneumonia in Adults, With Special Attention to the Role of Pneumococcus. Clin Infect Dis 2018; 65:1736-1744. [PMID: 29028977 PMCID: PMC7108120 DOI: 10.1093/cid/cix549] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 09/05/2017] [Indexed: 01/18/2023] Open
Abstract
Before 1945, Streptococcus pneumoniae caused more than 90% of cases of pneumonia in adults. After 1950, the proportion of pneumonia caused by pneumococcus began to decline. Pneumococcus has continued to decline; at present, this organism is identified in fewer than fewer10%-15% of cases. This proportion is higher in Europe, a finding likely related to differences in vaccination practices and smoking. Gram-negative bacilli, Staphylococcus aureus, Chlamydia, Mycoplasma, and Legionella are each identified in 2%-5% of patients with pneumonia who require hospitalization. Viruses are found in 25% of patients, up to one-third of these have bacterial coinfection. Recent studies fail to identify a causative organism in more than 50% of cases, which remains the most important challenge to understanding lower respiratory infection. Our findings have important implications for antibiotic stewardship and should be considered as new policies for empiric pneumonia management are developed.
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Affiliation(s)
- Daniel M Musher
- Departments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine.,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Michael S Abers
- Massachusetts General Hospital.,Harvard Medical School, Boston, Massachusetts
| | - John G Bartlett
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S. Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia. Infect Chemother 2018; 50:160-198. [PMID: 29968985 PMCID: PMC6031596 DOI: 10.3947/ic.2018.50.2.160] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 01/07/2023] Open
Abstract
Community-acquired pneumonia is common and important infectious disease in adults. This work represents an update to 2009 treatment guideline for community-acquired pneumonia in Korea. The present clinical practice guideline provides revised recommendations on the appropriate diagnosis, treatment, and prevention of community-acquired pneumonia in adults aged 19 years or older, taking into account the current situation regarding community-acquired pneumonia in Korea. This guideline may help reduce the difference in the level of treatment between medical institutions and medical staff, and enable efficient treatment. It may also reduce antibiotic resistance by preventing antibiotic misuse against acute lower respiratory tract infection in Korea.
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Affiliation(s)
- Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonology, The Institute of Chest Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungmin Kiem
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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38
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Development of a prediction tool for patients presenting with acute cough in primary care: a prognostic study spanning six European countries. Br J Gen Pract 2018; 68:e342-e350. [PMID: 29632005 DOI: 10.3399/bjgp18x695789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/02/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Accurate prediction of the course of an acute cough episode could curb antibiotic overprescribing, but is still a major challenge in primary care. AIM The authors set out to develop a new prediction rule for poor outcome (re-consultation with new or worsened symptoms, or hospital admission) in adults presenting to primary care with acute cough. DESIGN AND SETTING Data were collected from 2604 adults presenting to primary care with acute cough or symptoms suggestive of lower respiratory tract infection (LRTI) within the Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe (GRACE; www.grace-lrti.org) Network of Excellence. METHOD Important signs and symptoms for the new prediction rule were found by combining random forest and logistic regression modelling. Performance to predict poor outcome in acute cough patients was compared with that of existing prediction rules, using the models' area under the receiver operator characteristic curve (AUC), and any improvement obtained by including additional test results (C-reactive protein [CRP], blood urea nitrogen [BUN], chest radiography, or aetiology) was evaluated using the same methodology. RESULTS The new prediction rule, included the baseline Risk of poor outcome, Interference with daily activities, number of years stopped Smoking (> or <45 years), severity of Sputum, presence of Crackles, and diastolic blood pressure (> or <85 mmHg) (RISSC85). Though performance of RISSC85 was moderate (sensitivity 62%, specificity 59%, positive predictive value 27%, negative predictive value 86%, AUC 0.63, 95% confidence interval [CI] = 0.61 to 0.67), it outperformed all existing prediction rules used today (highest AUC 0.53, 95% CI = 0.51 to 0.56), and could not be significantly improved by including additional test results (highest AUC 0.64, 95% CI = 0.62 to 0.68). CONCLUSION The new prediction rule outperforms all existing alternatives in predicting poor outcome in adult patients presenting to primary care with acute cough and could not be improved by including additional test results.
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39
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Contemporary Situation of Community-acquired Pneumonia in China: A Systematic Review. J Transl Int Med 2018; 6:26-31. [PMID: 29607301 DOI: 10.2478/jtim-2018-0006] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The prevalence and microbial pattern reported for Community-acquired pneumonia (CAP) differ considerably and contemporary situation remains changing over time. We therefore searched both international and domestic databases for relevant references and pooled incidence of CAP and etiological distribution were estimated separately between children and adults groups. The results showed that CAP remained a major public health issue in China, with a relatively higher incidence than that reported in Western countries. Although pathogens were not detected in nearly half of patients, Mycoplasma pneumoniae remained to be the most frequently detected agent across age groups, the detection yield of which was lower than that reported from other countries. Notably, the incidence of influenza virus A in adults was almost four times higher than that in children while the prevalence of respiratory syncytial virus was much less common in adults than that in children. Despite some limitations, the value of this review, approaching to systematically review grey published data, is to sketch out the contemporary epidemiological and etiological situation of CAP in our country, which could be useful to help policymakers and clinicians make informed choices and to inspire future studies and surveillance.
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40
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Bjarnason A, Westin J, Lindh M, Andersson LM, Kristinsson KG, Löve A, Baldursson O, Gottfredsson M. Incidence, Etiology, and Outcomes of Community-Acquired Pneumonia: A Population-Based Study. Open Forum Infect Dis 2018; 5:ofy010. [PMID: 29479548 PMCID: PMC5804852 DOI: 10.1093/ofid/ofy010] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 12/17/2022] Open
Abstract
Background The microbial etiology of community-acquired pneumonia (CAP) is often unclear in clinical practice, and previous studies have produced variable results. Population-based studies examining etiology and incidence are lacking. This study examined the incidence and etiology of CAP requiring hospitalization in a population-based cohort as well as risk factors and outcomes for specific etiologies. Methods Consecutive admissions due to CAP in Reykjavik, Iceland were studied. Etiologic testing was performed with cultures, urine-antigen detection, and polymerase chain reaction analysis of airway samples. Outcomes were length of stay, intensive care unit admission, assisted ventilation, and mortality. Results The inclusion rate was 95%. The incidence of CAP requiring hospitalization was 20.6 cases per 10000 adults/year. A potential pathogen was detected in 52% (164 of 310) of admissions and in 74% (43 of 58) with complete sample sets. Streptococcuspneumoniae was the most common pathogen (61 of 310, 20%; incidence: 4.1/10000). Viruses were identified in 15% (47 of 310; incidence: 3.1/10000), Mycoplasmapneumoniae were identified in 12% (36 of 310; incidence: 2.4/10000), and multiple pathogens were identified in 10% (30 of 310; incidence: 2.0/10000). Recent antimicrobial therapy was associated with increased detection of M pneumoniae (P < .001), whereas a lack of recent antimicrobial therapy was associated with increased detection of S pneumoniae (P = .02). Symptoms and outcomes were similar irrespective of microbial etiology. Conclusions Pneumococci, M pneumoniae, and viruses are the most common pathogens associated with CAP requiring hospital admission, and they all have a similar incidence that increases with age. Symptoms do not correlate with specific agents, and outcomes are similar irrespective of pathogens identified.
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Affiliation(s)
- Agnar Bjarnason
- Faculty of Medicine, University of Iceland, Reykjavik.,Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Westin
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases/Clinical Virology, University of Gothenburg, Sweden
| | - Magnus Lindh
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases/Clinical Virology, University of Gothenburg, Sweden
| | - Lars-Magnus Andersson
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Infectious Diseases/Clinical Virology, University of Gothenburg, Sweden
| | - Karl G Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik.,Departments of Medicine, Microbiology and Virology, Landspitali University Hospital, Reykjavik, Icel
| | - Arthur Löve
- Faculty of Medicine, University of Iceland, Reykjavik.,Departments of Medicine, Microbiology and Virology, Landspitali University Hospital, Reykjavik, Icel
| | - Olafur Baldursson
- Departments of Medicine, Microbiology and Virology, Landspitali University Hospital, Reykjavik, Icel
| | - Magnus Gottfredsson
- Faculty of Medicine, University of Iceland, Reykjavik.,Departments of Medicine, Microbiology and Virology, Landspitali University Hospital, Reykjavik, Icel
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Development of an Extended-Specificity Multiplex Immunoassay for Detection of Streptococcus pneumoniae Serotype-Specific Antigen in Urine by Use of Human Monoclonal Antibodies. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2017; 24:CVI.00262-17. [PMID: 28978509 DOI: 10.1128/cvi.00262-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 09/30/2017] [Indexed: 11/20/2022]
Abstract
Current pneumococcal vaccines cover the 10 to 23 most common serotypes of the 92 presently described. However, with the increased usage of pneumococcal-serotype-based vaccines, the risk of serotype replacement and an increase in disease caused by nonvaccine serotypes remains. Serotype surveillance of pneumococcal infections relies heavily on culture techniques, which are known to be insensitive, particularly in cases of noninvasive disease. Pneumococcal-serotype-specific urine assays offer an alternative method of serotyping for both invasive and noninvasive disease. However, the assays described previously cover mainly conjugate vaccine serotypes, give little information about circulating nonvaccine serotypes, and are currently available only in one or two specialist laboratories. Our laboratory has developed a Luminex-based extended-range antigen capture assay to detect pneumococcal-serotype-specific antigens in urine samples. The assay targets 24 distinct serotypes/serogroups plus the cell wall polysaccharide (CWP) and some cross-reactive serotypes. We report that the assay is capable of detecting all the targeted serotypes and the CWP at 0.1 ng/ml, while some serotypes are detected at concentrations as low as 0.3 pg/ml. The analytical serotype specificity was determined to be 98.4% using a panel of polysaccharide-negative urine specimens spiked with nonpneumococcal bacterial antigens. We also report clinical sensitivities of 96.2% and specificities of 89.9% established using a panel of urine specimens from patients diagnosed with community-acquired pneumonia or pneumococcal disease. This assay can be extended for testing other clinical samples and has the potential to greatly improve serotype-specific surveillance in the many cases of pneumococcal disease in which a culture is never obtained.
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42
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Biteker FS, Biteker M, Başaran Ö, Doğan V, Özlek B, Yıldırım B, Özlek E, Çelik O. A small pericardial effusion is a marker of complicated hospitalization in patients with community-acquired pneumonia. J Crit Care 2017; 44:294-299. [PMID: 29247912 DOI: 10.1016/j.jcrc.2017.11.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Although often asymptomatic, presence of small pericardial effusion (SPE) is shown to be associated with adverse events and increased mortality in various conditions. This study aimed to evaluate the frequency and prognostic importance of SPE in a cohort of patients hospitalized for community-acquired pneumonia (CAP). METHODS We prospectively followed 154 consecutive adult patients hospitalized with CAP. The severity of CAP was evaluated with the pneumonia severity index (PSI) and the CURB-65 (confusion, urea, respiratory rate, arterial blood pressure and age) score. All patients underwent transthoracic echocardiography within the first 48h of admission. Patients were followed-up until hospital discharge or death. The outcomes of interest were length of stay in hospital and complicated hospitalization (CH) which is defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. RESULTS A total 34 episodes of CHs occurred in 21 (13.6%) patients. Older patients and those with more co-morbid conditions such as diabetes, coronary artery diseases, cerebrovascular diseases, and chronic obstructive pulmonary diseases tended to have a higher rate of CH. Patients with CH had higher N-terminal pro-brain natriuretic peptide, troponin and creatinine levels on admission compared to patients without CH. Patients with CH had also higher CURB-65 and PSI scores and had longer durations of stay compared to patients with uncomplicated course. SPE was noted in 24 (15.6%) of the patients in our study cohort. Incidence of CH was greater for patients with a SPE (26 CHs occurred in 14 of the 24 patients) compared to those without an effusion (8 CHs occurred in 7 of the 130 patients, p<0.001). Logistic multivariate analysis revealed that the presence of SPE was an independent predictor of CH (OR: 3.26; 95% CI: 2.19-8.71; p=0.008). CONCLUSION This study is the first to demonstrate that the presence of SPE is associated with increased adverse events in patients with CAP.
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Affiliation(s)
- Funda Sungur Biteker
- Yatağan State Hospital, Department of Infectious Diseases and Clinical Microbiology, Turkey
| | - Murat Biteker
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - Özcan Başaran
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - Volkan Doğan
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - Bülent Özlek
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey.
| | - Birdal Yıldırım
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine, Turkey
| | - Eda Özlek
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - Oğuzhan Çelik
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
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Athlin S, Lidman C, Lundqvist A, Naucler P, Nilsson AC, Spindler C, Strålin K, Hedlund J. Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 2017. Infect Dis (Lond) 2017; 50:247-272. [PMID: 29119848 DOI: 10.1080/23744235.2017.1399316] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.
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Affiliation(s)
- Simon Athlin
- a Department of Infectious Diseases , Örebro University Hospital , Örebro , Sweden.,b Faculty of Medicin and Health , Örebro University , Örebro , Sweden
| | - Christer Lidman
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anders Lundqvist
- e Department of Infectious Diseases , Södra Älvsborgs Hospital , Borås , Sweden
| | - Pontus Naucler
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Anna C Nilsson
- f Infectious Disease Research Unit, Department of Translational Medicine , Lund University , Malmö , Sweden
| | - Carl Spindler
- d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Kristoffer Strålin
- b Faculty of Medicin and Health , Örebro University , Örebro , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden.,g Unit of Infectious Diseases, Department of Medicine Huddinge , Karolinska Institutet , Stockholm , Sweden
| | - Jonas Hedlund
- c Unit of Infectious Diseases, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.,d Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
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44
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Yin JK, Jayasinghe SH, Charles PG, King C, Chiu CK, Menzies RI, McIntyre PB. Determining the contribution of
Streptococcus pneumoniae
to community‐acquired pneumonia in Australia. Med J Aust 2017; 207:396-400. [DOI: 10.5694/mja16.01102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
- J Kevin Yin
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Sanjay H Jayasinghe
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
- University of Sydney, Sydney, NSW
| | | | - Catherine King
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | - Clayton K Chiu
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
| | | | - Peter B McIntyre
- National Centre for Immunisation Research and Surveillance, Kids Research Institute, Children's Hospital at Westmead, Sydney, NSW
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45
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Chlamydia psittaci (psittacosis) as a cause of community-acquired pneumonia: a systematic review and meta-analysis. Epidemiol Infect 2017; 145:3096-3105. [PMID: 28946931 DOI: 10.1017/s0950268817002060] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Psittacosis is a zoonotic infectious disease caused by the transmission of the bacterium Chlamydia psittaci from birds to humans. Infections in humans mainly present as community-acquired pneumonia (CAP). However, most cases of CAP are treated without diagnostic testing, and the importance of C. psittaci infection as a cause of CAP is therefore unclear. In this meta-analysis of published CAP-aetiological studies, we estimate the proportion of CAP caused by C. psittaci infection. The databases MEDLINE and Embase were systematically searched for relevant studies published from 1986 onwards. Only studies that consisted of 100 patients or more were included. In total, 57 studies were selected for the meta-analysis. C. psittaci was the causative pathogen in 1·03% (95% CI 0·79-1·30) of all CAP cases from the included studies combined, with a range between studies from 0 to 6·7%. For burden of disease estimates, it is a reasonable assumption that 1% of incident cases of CAP are caused by psittacosis.
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Wong D, Yap E. Pleural infection in a New Zealand centre: high incidence in Pacific people and RAPID score as a prognostic tool. Intern Med J 2017; 46:703-9. [PMID: 27040467 DOI: 10.1111/imj.13087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Whilst there is an increase in incidence of pleural infection worldwide, there is a paucity of New Zealand data. AIMS This study looked at the epidemiology of pleural infection in a single New Zealand institution and evaluated the RAPID score as a prognostic tool. METHODS A retrospective review was performed on patients with pleural infection over a 3-year period. Pleural infection was defined as having clinical evidence of infection and fulfilling one of the following: (i) positive pleural fluid Gram stain or culture, (ii) frank pus, (iii) pH <7.2 or (iv) radiological evidence of complex effusion. RESULTS There were 108 patients; 76% were male, and mean age was 54 years. Two thirds of patients came from the most deprived areas. The dominant ethnic group was Pacific people (42%), which was twice as high as the Pacific population in the area (19%), P < 0.0001. After adjusting for deprivation, Pacific people were still over-represented, P = 0.0002. There were 14 deaths (13%), and these were associated with increasing age (P = 0.001) and urea (P = 0.007) but not ethnicity or socioeconomic deprivation. The RAPID score found that those in the high-risk (P = 0.026) and moderate-risk (P = 0.036) groups had significantly higher mortality compared with the low-risk group. CONCLUSION The over-representation of Pacific people with pleural infection is not fully explained by socioeconomic deprivation, highlighting other factors at play, such as genetic susceptibility. The RAPID score was of clinical utility in predicting mortality in our population.
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Affiliation(s)
- D Wong
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - E Yap
- Department of Respiratory Medicine, Middlemore Hospital, Auckland, New Zealand
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Abstract
Legionella pneumophila and influenza types A and B viruses can cause either community-acquired pneumonia with respiratory failure, or Legionella infection could attribute to influenza infection with potentially fatal prognosis. Copathogenesis between pandemic influenza and bacteria is characterized by complex interactions between coinfecting pathogens and the host. Understanding the underlying reason of the emersion of the secondary bacterial infection during an influenza infection is challenging. The dual infection has an impact on viral control and may delay viral clearance. Effective vaccines and antiviral therapy are crucial to increase resistance toward influenza, decrease the prevalence of influenza, and possibly interrupt the potential secondary bacterial infections.
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Affiliation(s)
- Eleni E Magira
- 1st Department of Critical Care Medicine, Evangelismos General Hospital, National and Kapodistrian University of Athens, 45-47 Ispilandou Street, Athens 10675, Greece.
| | - Sryros Zakynthinos
- 1st Department of Critical Care and Pulmonary Services, Center of Sleep Disorders, Evangelismos General Hospital, National and Kapodistrian University of Athens, 45-47 Ipsilantou Street, Athens 10676, Greece
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Alimi Y, Lim WS, Lansbury L, Leonardi-Bee J, Nguyen-Van-Tam JS. Systematic review of respiratory viral pathogens identified in adults with community-acquired pneumonia in Europe. J Clin Virol 2017; 95:26-35. [PMID: 28837859 PMCID: PMC7185624 DOI: 10.1016/j.jcv.2017.07.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/07/2017] [Accepted: 07/31/2017] [Indexed: 12/30/2022]
Abstract
Respiratory viruses are potentially implicated in one quarter to one-third of adult cases of community-acquired pneumonia. In such cases influenza is the most frequently detected viral pathogen. Failure to test for respiratory viruses in hospitalised patients may lead to missed opportunities for early therapeutic intervention.
Community-acquired pneumonia (CAP) is an important respiratory disease and the fifth leading cause of mortality in Europe. The development of molecular diagnostic tests has highlighted the contributions of respiratory viruses to the aetiology of CAP, suggesting the incidence of viral pneumonia may have been previously underestimated. We performed a systematic review and meta-analysis to describe the overall identification of respiratory viruses in adult patients with CAP in Europe, following PRISMA guidelines (PROSPERO; CRD42016037233). We searched EMBASE, MEDLINE, CINAHL, WHOLIS, COCHRANE library and grey literature sources for relevant studies, and screened these against protocol eligibility criteria. Two researchers performed data extraction and risk of bias assessments, independently, using a piloted form. Results were synthesised narratively, and random effects meta-analyses performed to calculate pooled estimates of effect; heterogeneity was quantified using I2. Twenty-eight studies met inclusion criteria of which 21 were included in the primary meta-analysis. The pooled proportion of patients with identified respiratory viruses was 22.0% (95% CI: 18.0%–27.0%), rising to 29.0% (25.0%–34.0%) in studies where polymerase chain reaction (PCR) diagnostics were performed. Influenza virus was the most frequently detected virus in 9% (7%–12%) of adults with CAP. Respiratory viruses make a substantial contribution to the aetiology of CAP in adult patients in Europe; one or more respiratory viruses are detected in about one quarter of all cases.
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Affiliation(s)
- Y Alimi
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - W S Lim
- University Hospitals NHS Trust, Nottingham, UK
| | - L Lansbury
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - J Leonardi-Bee
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK
| | - J S Nguyen-Van-Tam
- Health Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham School of Medicine, Nottingham, UK.
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Duarte JC, Cordeiro CR, Ferreira AJ. Role of flexible bronchoscopy in non-resolving community-acquired pneumonia - A retrospective analysis. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:168-169. [PMID: 28412145 DOI: 10.1016/j.rppnen.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- J C Duarte
- Pulmonology Unit, Hospitais da Universidade de Coimbra - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, Coimbra, Portugal.
| | - C R Cordeiro
- Pulmonology Unit, Hospitais da Universidade de Coimbra - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - A J Ferreira
- Pulmonology Unit, Hospitais da Universidade de Coimbra - Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; University of Coimbra, Faculty of Medicine, Coimbra, Portugal
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50
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Angrup A, Chaudhry R, Sharma S, Valavane A, Passi K, Padmaja K, Javed S, Dey AB, Dhawan B, Kabra SK. Application of real-time quantitative polymerase chain reaction assay to detect Legionella pneumophila in patients of community-acquired pneumonia in a tertiary care hospital. Indian J Med Microbiol 2017; 34:539-543. [PMID: 27934840 DOI: 10.4103/0255-0857.195353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Legionella pneumophila is one of the important pathogen responsible for community -acquired pneumonia attributing for 1-5% of cases. Since early and accurate therapy reduces mortality, rapid and reliable diagnostic methods are needed. A total of 134 samples of blood, urine and respiratory tract fluids were collected. Blood was tested for IgG, IgM and IgA antibodies using commercially available kits. A total of 8 (6%) samples were found to be positive for L. pneumophila by quantitative reverse transcription polymerase chain reaction (qRT-PCR), compared to conventional PCR where 6 (4.4%) samples were positive. Serology was positive in a total of 32 (23%) cases though only 3 (2.2%) of the PCR-positive cases were positive by serology as well. These results suggest that real-time PCR can detect Legionella infection early in the course of the disease before serological response develops.
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Affiliation(s)
- A Angrup
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - R Chaudhry
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - S Sharma
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - A Valavane
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - K Passi
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - K Padmaja
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - S Javed
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - A B Dey
- Department of Microbiology, All Institute of Medical Sciences, New Delhi, India
| | - B Dhawan
- Department of Medicine, All Institute of Medical Sciences, New Delhi, India
| | - S K Kabra
- Department of Pediatrics, All Institute of Medical Sciences, New Delhi, India
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