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Sputum Bacteriology And In-Vitro Antibiotic Susceptibility In Hospitalized Patients With Community Acquired Pneumonia In A State Tertiary - Referral Hospital – A Retrospective Study  [PDF]
Yow-Wen Chin,Li-Cher Loh,Thim-Fatt Wong,Abdul Razak Muttalif
International e-Journal of Science, Medicine & Education , 2007,
Abstract: Introduction: To review the sputum bacteriology and itsin-vitro antibiotic susceptibility in patients hospitalizedwith community-acquired pneumonia (CAP) in a statetertiary-referral Hospital (Penang hospital, Malaysia) inorder to determine the most appropriate empiricantibiotics.Methods: From September 2006 to May 2007,68 immunocompetent adult patients [mean age: 52years (range 16-89); 69% male] admitted to respiratorywards for CAP with positive sputum isolates within 48hours of admission were retrospectively identified andreviewed.Results: 62 isolates were Gram(-) bacilli (91%) &6 were Gram(+) cocci (9%). The two commonestpathogens isolated were Pseudomonas aeruginosa(n=20) and Klebsiella pneumoniae (n=19)together constituted 57% of all positive isolates.Among the Pseudomonas isolates, 84.2% were fullysensitive to cefoperazone and cefoperazon/sulbactam;95% to ceftazidime, cefepime, piperacillin/tazobactam,ciprofloxacin and amikacin, and 100% to gentamycin,netilmycin, imipenem and meropenem. Among theKlebsiella isolates, 5.3% were fully sensitive toampicillin; 84.2% to amoxicillin, ampicllin/sulbactam,cefuroxime and ceftriazone; 89.5% to piperacillin/tazobactam; 93.3% to cefoperazon/sulbactam and 100%sensitive to ceftazidime, cefepime, ciprofloxacin,all aminoglycosides and carbopenems.Conclusion: In view of the high prevalence ofrespiratory Pseudomonas aeruginosa, ampicillin/sulbactam, currently the most prescribed antibiotic totreat CAP in our respiratory wards, may not be the mostappropriate empiric choice. Higher generationcephalosporins with or without beta-lactamaseinhibitors, ciprofloxacin or carbapenem may be themore appropriate choices. The lack of information onpatients’ premorbidities such as recent hospitalizationand prior antibiotic exposure, limits the interpretationof our findings and may have biased our results towardshigher rates of Gram negative organisms.
Bacteriological and clinical profile of Community acquired pneumonia in hospitalized patients  [cached]
Shah Bashir,Singh Gurmeet,Naik Muzafar,Dhobi Ghulam
Lung India , 2010,
Abstract: The aim of our study was to obtain comprehensive insight into the bacteriological and clinical profile of community-acquired pneumonia requiring hospitalization. The patient population consisted of 100 patients admitted with the diagnosis of community-acquired pneumonia (CAP), as defined by British Thoracic society, from December 1998 to Dec 2000, at the Sher- i-Kashmir institute of Medical Sciences Soura, Srinagar, India. Gram negative organisms were the commonest cause (19/29), followed by gram positive (10/29). In 71 cases no etiological cause was obtained. Pseudomonas aeruginosa was the commonest pathogen (10/29), followed by Staphylococcus aureus (7/29), Escherichia coli (6/29), Klebsiella spp. (3/29), Streptococcus pyogenes (1/29), Streptococcus pneumoniae (1/29) and Acinetobacter spp. (1/29). Sputum was the most common etiological source of organism isolation (26) followed by blood (6), pleural fluid (3), and pus culture (1). Maximum number of patients presented with cough (99%), fever (95%), tachycardia (92%), pleuritic chest pain (75%), sputum production (65%) and leucocytosis (43%). The commonest predisposing factors were smoking (65%), COPD (57%), structural lung disease (21%), diabetes mellitus (13%), and decreased level of consciousness following seizure (eight per cent) and chronic alcoholism (one per cent). Fourteen patients, of whom, nine were males and five females, died. Staphylococcus aureus was the causative organism in four, Pseudomonas in two, Klebsiella in one, and no organism was isolated in seven cases. The factors predicting mortality at admission were - age over 62 years, history of COPD or smoking, hypotension, altered sensorium, respiratory failure, leucocytosis, and s0 taphylococcus pneumonia and undetermined etiology. The overall rate of identification of microbial etiology of community-acquired pneumonia was 29%, which is very low, and if serological tests for legionella, mycoplasma and viruses are performed the diagnostic yield would definitely be better. This emphasizes the need for further studies (including the serological tests for Legionella, mycoplasma and viruses) to identify the microbial etiology of CAP.
Respiratory viruses from hospitalized children with severe pneumonia in the Philippines  [cached]
Suzuki Akira,Lupisan Socorro,Furuse Yuki,Fuji Naoko
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-267
Abstract: Background Pneumonia remains a leading cause of child death in developing countries. The viruses in severe pneumonia remain poorly defined. Methods The study was conducted at the Eastern Visayas Regional Medical Center in Tacloban City, Philippines from May 2008 to May 2009. Patients aged 8 days to 13 years old who were admitted to the Department of Pediatrics with severe pneumonia were enrolled for the study. Upon admission, polymerase chain reaction was performed using nasopharyngeal swabs and blood cultures to detect respiratory viruses and bacteria, respectively. Result Among the 819 patients enrolled, at least one virus was detected in 501 cases (61.2%). In addition, 423 cases were positive for a single virus while bacteria were detected in the blood culture sample of 31 cases. The most commonly detected viruses were human rhinoviruses (n = 189), including types A (n = 103), B (n = 17), and C (n = 69), and respiratory syncytial virus (RSV) (n = 165). Novel viruses such as human metapneumovirus, human coronavirus NL63, human bocavirus, and human polyomaviruses WU and KI were also detected. There were 70 deaths, and one or more viruses were detected in 35 (50%) of these cases. Positivity only for influenza A virus (OR = 4.3, 95% CI = 1.3-14.6) was significantly associated with fatal outcome. From the blood culture, Burkholderia cepacia group (n = 9), Streptococcus pneumoniae (n = 4), Staphylococcus aureus (n = 4), Haemophilus influenzae (n = 1), and Salmonella C1 (n = 1) were also isolated. Conclusion Viruses were commonly detected in children with severe pneumonia in the Philippines. Hence, viral etiologies should be considered while developing better effective strategies to reduce child pneumonia-related deaths in developing countries.
Neumonía neumocócica adquirida en la comunidad en adultos hospitalizados Community acquired pneumococcal pneumonia in hospitalized adult patients  [cached]
Alejandro Díaz F,Catalina Torres M,Luis José Flores S,Patricia García C
Revista médica de Chile , 2003,
Abstract: Background: S pneumoniae is the most common cause of community-acquired pneumonia. Aim: To evaluate the clinical characteristics, antibiotic resistance, management and prognostic factors in pneumococcal pneumonia. Methods: Prospective evaluation in 46 adults (age ± sd: 68±17 years) hospitalized with pneumococcal pneumonia confirmed by sputum, blood or pleural fluid cultures. Clinical and radiographic variables, risk factors for antibiotic resistance, and hospital mortality rate were recorded. Results: Heart disease (39%), COPD/asthma (25%), and diabetes mellitus (18%) were the most frequent underlying diseases. None of the patients had previously received pneumococcal vaccine. Only 17% of the patients had the classic triad of chills, fever and productive cough. At admission, interestingly, 17% presented with congestive heart failure. Resistance of pneumococci to penicillin, cefotaxime or erythromycin was 15%, 6% and 11%, respectively. Antibiotic use prior to admission was significantly associated with antibiotic resistance (OR=6; CI 95% = 1.1-32; p <0.05). Fifty per cent of the patients were admitted to intermediate or intensive care units, 15% were mechanically ventilated, 20% developed septic shock, 20% developed acute renal failure and 13% died in the hospital. Clinical factors significantly associated with higher mortality were systolic hypotension (£90 mmHg), ICU admission and BUN >30 mg per dL. Conclusions: Our data suggest that pneumococcal pneumonia is still a severe infection with high mortality; hence, efforts should be made at prevention using pneumococcal immunization (Rev Méd Chile 2003; 131: 505-14).
Herpes Simplex Virus 2 ICP0? Mutant Viruses Are Avirulent and Immunogenic: Implications for a Genital Herpes Vaccine  [PDF]
William P. Halford,Ringo Püschel,Brandon Rakowski
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0012251
Abstract: Herpes simplex virus 1 (HSV-1) ICP0? mutants are interferon-sensitive, avirulent, and elicit protective immunity against HSV-1 (Virol J, 2006, 3:44). If an ICP0? mutant of herpes simplex virus 2 (HSV-2) exhibited similar properties, such a virus might be used to vaccinate against genital herpes. The current study was initiated to explore this possibility. Several HSV-2 ICP0? mutant viruses were constructed and evaluated in terms of three parameters: i. interferon-sensitivity; ii. virulence in mice; and iii. capacity to elicit protective immunity against HSV-2. One ICP0? mutant virus in particular, HSV-2 0ΔNLS, achieved an optimal balance between avirulence and immunogenicity. HSV-2 0ΔNLS was interferon-sensitive in cultured cells. HSV-2 0ΔNLS replicated to low levels in the eyes of inoculated mice, but was rapidly repressed by an innate, Stat 1-dependent host immune response. HSV-2 0ΔNLS failed to spread from sites of inoculation, and hence produced only inapparent infections. Mice inoculated with HSV-2 0ΔNLS consistently mounted an HSV-specific IgG antibody response, and were consistently protected against lethal challenge with wild-type HSV-2. Based on their avirulence and immunogenicity, we propose that HSV-2 ICP0? mutant viruses merit consideration for their potential to prevent the spread of HSV-2 and genital herpes.
Frequency and relevance of concomitant diseases in elderly patients hospitalized for community acquired pneumonia  [PDF]
?uri? Mirna,Pova?an ?or?e,Se?en Nevena,Perin Branislav
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0912619d
Abstract: Introduction. Patients' age and concomitant diseases are relevant for the development and treatment outcome of pneumonia. Objective. To establish the frequency and relevance of concomitant diseases in patients over 65 years of age hospitalized for community acquired pneumonia. Methods. The research included 550 patients hospitalized at the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica due to community acquired pneumonia. Data on concomitant diseases and mortality rate was correlated with the patients' age limit of 65 years, and then statistically analyzed and presented in tables. Results. There were 446 (81.45%) patients under and 102 (18.55%) over the age of 65 years. Dyspnea, impaired consciousness, cyanosis, tachycardia and arterial hypertension were significantly more common in patients over 65 years of age, who also had a higher prognostic score. Mortality was significantly higher (21.6% vs. 6.0%) in the patients aged over 65 years (p<0.001). Concomitant diseases were significantly more common (p<0.001) among the patients over 65 years (94.1%vs.69.2%), and the majority of the elderly patients had two or three comorbidities. The following comorbidities were significantly more common among the patients aged over 65 years: chronic obstructive disease, bronchiectasis, compensated and decompensated cardiomyopathy, cardiac arrhythmia, arterial hypertension and diabetes mellitus. The higher number of concomitant diseases was associated with a significantly elevated hospital mortality (p<0.001). A statistically significant mortality rate difference was found in both age groups regarding the comorbidity of chronic obstructive disease and decompensated cardiomyopathy. Conclusion. The patients aged over 65 years hospitalized due to community acquired pneumonia had a statistically significantly higher prognostic score, mortality rate and concomitant diseases than the patients below 65 yeas of age. Most subjects of the older group of patients had two or three comorbidities. Concomitant diseases resulted in a statistically significant hospital mortality elevation. When comborbitities involved chronic obstructive pulmonary disease and decompensated cardiomyopathy, a statistically significant mortality difference was registered in both age groups.
Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana
Theophilus B Kwofie, Yaw A Anane, Bernard Nkrumah, Augustina Annan, Samuel B Nguah, Michael Owusu
Virology Journal , 2012, DOI: 10.1186/1743-422x-9-78
Abstract: Nasopharyngeal samples and blood cultures were collected from children less than 5 years who have been hospitalized for acute lower respiratory tract infection. Viruses and bacteria were identified using Reverse Transcriptase Real-Time Polymerase Chain Reaction and conventional biochemical techniques.Out of 128 patients recruited, 33(25.88%%, 95%CI: 18.5% to 34.2%) were positive for one or more viruses. Respiratory Syncytial Virus (RSV) was detected in 18(14.1%, 95%CI: 8.5% to 21.3%) patients followed by Adenoviruses (AdV) in 13(10.2%, 95%CI: 5.5% to 16.7%), Parainfluenza (PIV type: 1, 2, 3) in 4(3.1%, 95%CI: 0.9% to 7.8%) and influenza B viruses in 1(0.8%, 95%CI: 0.0 to 4.3). Concomitant viral and bacterial co-infection occurred in two patients. There were no detectable significant differences in the clinical signs, symptoms and severity for the various pathogens isolated. A total of 61.1% (22/36) of positive viruses were detected during the rainy season and Respiratory Syncytial Virus was the most predominant.The study has demonstrated an important burden of respiratory viruses as major causes of childhood acute respiratory infection in a tertiary health institution in Ghana. The data addresses a need for more studies on viral associated respiratory tract infection.Acute respiratory infections (ARI) are one of the major causes of morbidity and mortality in young children throughout the world especially in developing countries [1,2]. Data from WHO estimated the burden of ARI at 94,037,000 disability-adjusted life years (DALYs) and 3.9 million deaths in 2001 [3]. Similar report from a meta-analysis study demonstrates that throughout the world 1.9 million (95% CI 1.6-2.2 million) children died from ARI in 2000, 70% of them in Africa and Southeast Asia [2]. A further systematic analysis also estimated 1.575 million (uncertainty range: 1.046 million - 1.874 million) deaths of children worldwide in 2008 as due to ARI [4].Majority of acute lower respiratory tract infecti
Refining criteria for diagnosis of cutaneous infections caused by herpes viruses through correlation of morphology with molecular pathology
B?er Almut,Herder Nina,Bl?dorn-Schlicht Norbert,Steinkraus Volker
Indian Journal of Dermatology, Venereology and Leprology , 2006,
Abstract: BACKGROUND: Infections of the skin by herpes viruses do not always present themselves in typical fashion. Early diagnosis, however, is crucial for appropriate treatment. Polymerase chain reaction (PCR) allows diagnosis and differential diagnosis of herpes virus infections, but the method is not yet available in large parts of the world, where diagnosis is made based on morphology alone. AIM: To refine criteria for the diagnosis of herpes virus infections of the skin by way of correlation of clinical and histopathologic findings with results of PCR studies. METHODS: We studied 75 clinically diagnosed patients of "zoster," "varicella," and "herpes simplex", to correlate clinical and histopathological findings with results of PCR studies on paraffin embedded biopsy specimens. RESULTS: Clinical suspicion of infection by herpes viruses was confirmed by histopathology in 37% of the cases and by PCR studies in 65% of the cases. Zoster was frequently misdiagnosed as infection with herpes simplex viruses (30%). When diagnostic signs of herpes virus infection were encountered histopathologically, PCR confirmed the diagnosis in 94%. By way of correlation with results of PCR studies, initial lesions of herpes virus infections could be identified to have a distinctive histopathological pattern. Herpetic folliculitis appeared to be a rather common finding in zoster, it occurring in 28% of the cases. CONCLUSION: We conclude that correlation of clinical and histopathological features with results of PCR studies on one and the same paraffin embedded specimen permits identification of characteristic morphologic patterns and helps to refine criteria for diagnosis both clinically and histopathologically.
Presentation, complications and management outcome of community acquired pneumonia in hospitalized children in Maiduguri, Nigeria
MG Mustapha, GM Ashir, MA Alhaji, AI Rabasa, BA Ibrahim, Z Mustapha
Nigerian Journal of Paediatrics , 2013,
Abstract: Background: Pneumonia remains a leading cause of U-5 morbidity and mortality in developing countries like Nigeria. This study was conducted to determine the clinical presentation, complications and factors contributing to mortality in the hospitalized children with community acquired pneumonia (CAP) in Maiduguri, Nigeria. Methods: Children younger than 14 years admitted into the Emergency Paediatric Unit of the University of Maiduguri Teaching Hospital (UMTH), Maiduguri, in 2011 with the diagnosis of community acquired pneumonia were followed up until discharge or death. Chest radiographs were read by radiologists. Results: Eighty nine children aged two months to 14 years were studied. The commonest clinical features were fever, cough, tachypnoea and dyspnoea. Radiographic evidence of pneumonia was found in 84 (94.4%) of cases. Dehydration and congestive cardiac failure (CCF) were the commonest complications encountered. Eight (9.0%) children died, seven of whom had complications of pneumonia. The rate of occurrence of complications, radiographic pattern of pneumonia and outcome of treatment did not significantly differ statistically in the different age groups; p = 0.135, 0.622 and 0.167 respectively. Conclusion: While dehydration and CCF were found to be commonest complications, mortality was commoner among the male infants hospitalized for pneumonia.
Exploring the Prevalence of Ten Polyomaviruses and Two Herpes Viruses in Breast Cancer  [PDF]
Annika Antonsson, Seweryn Bialasiewicz, Rebecca J. Rockett, Kevin Jacob, Ian C. Bennett, Theo P. Sloots
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0039842
Abstract: Several different viruses have been proposed to play a role in breast carcinogenesis. The aim of this study was to investigate the prevalence of a subset of viruses in breast cancer tissue. We investigated the prevalence of 12 DNA viruses: EBV and CMV from the Herpesviridae family and SV40, BKV, JCV, MCV, WUV, KIV, LPV, HPyV6, HPyV7, and TSV from the Polyomaviridae family in 54 fresh frozen breast tumour specimens. Relevant clinical data and basic lifestyle data were available for all patients. The tissue samples were DNA extracted and real-time PCR assays were used for viral detection. The highest prevalence, 10% (5/54), was found for EBV. MCV, HPyV6, and HPyV7 were detected in single patient samples (2% each), while WUV, KIV, JCV, BKV, LPV, SV40, TSV and CMV were not detected in the 54 breast cancer specimens analysed here. Further investigations are needed to elucidate the potential role of viruses, and particularly EBV, in breast carcinogenesis.
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