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Clinical Utility of Procalcitonin for Differentiating between Cryptogenic Organizing Pneumonia and Community-Acquired Pneumonia  [PDF]
Satoshi Takeda, Nobuhiko Nagata, Hiroyuki Miyazaki, Takanori Akagi, Taishi Harada, Masaru Kodama, Shinichiro Ushijima, Takashi Aoyama, Kentaro Wakamatsu, Masaki Fujita, Kentaro Watanabe
International Journal of Clinical Medicine (IJCM) , 2015, DOI: 10.4236/ijcm.2015.66048
Abstract:
Background: Differentiating cryptogenic organizing pneumonia (COP) from community-acquired pneumonia (CAP) can be difficult in some cases. Objective: To clarify the clinical utility of procalcitonin (PCT) levels for differentiating between COP and CAP. Methods: Blood PCT levels, leukocyte count, C-reactive protein concentration, number of segments involved on computed tomography (CT) images, and pneumonia severity assessment scale were retrospectively investigated from clinical charts and chest CT images of COP and CAP patients who were admitted to our hospital from 2012 to 2014. The clinical characteristics of COP patients were compared to those of CAP patients for whom causative organisms were not detected. Results: There were 16 COP and 94 CAP patients for whom causative organisms were not detected. Blood PCT levels of all COP patients were less than 0.16 ng/dL, and significantly lower than those of CAP patients (p = 0.0004), while the number of involved segments was significantly higher than that of CAP patients (p = 0.0001). Blood PCT levels and the number of involved segments remained independently significant for differentiating between COP and CAP by multivariate analysis. Receiver operating characteristics curve analysis revealed that 7 was the best cut-off number for involved segments to differentiate between COP and CAP patients with low PCT levels (sensitivity 85.7%, specificity 94.7%). Conclusion: A combination of PCT levels and number of involved segments on CT images is useful for differentiation between COP and CAP.
Prevalence of Herpes and Respiratory Viruses in Induced Sputum among Hospitalized Children with Non Typical Bacterial Community-Acquired Pneumonia  [PDF]
Weimin Zhou, Feng Lin, Lingfang Teng, Hua Li, Jianyi Hou, Rui Tong, Changhua Zheng, Yongliang Lou, Wenjie Tan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0079477
Abstract: Objective Few comprehensive studies have searched for viruses in infants and young children with community-acquired pneumonia (CAP) in China. The aim of this study was to investigate the roles of human herpes viruses (HHVs) and other respiratory viruses in CAP not caused by typical bacterial infection and to determine their prevalence and clinical significance. Methods Induced sputum (IS) samples were collected from 354 hospitalised patients (infants, n = 205; children, n = 149) with respiratory illness (CAP or non-CAP) admitted to Wenling Hospital of China. We tested for HHVs and respiratory viruses using PCR-based assays. The epidemiological profiles were also analysed. Results High rate of virus detection (more than 98%) and co-infection (more than 80%) were found among IS samples from 354 hospitalised infants and children with respiratory illness in this study. Of 273 CAP samples tested, CMV (91.6%), HHV-6 (50.9%), RSV (37.4%), EBV (35.5%), HBoV (28.2%), HHV-7 (18.3%) and rhinovirus (17.2%) were the most commonly detected viruses. Of 81 non- CAP samples tested, CMV (63%), RSV (49.4%), HHV-6 (42%), EBV (24.7%), HHV-7 (13.6%) and HBoV (8.6%) were the dominant viruses detected. The prevalence of several viral agents (rhinovirus, bocavirus, adenovirus and CMV) among IS samples of CAP were significantly higher than that of non-CAP control group. We also found the prevalence of RSV coinfection with HHVs was also higher among CAP group than that of non-CAP control. Conclusions With sensitive molecular detection techniques and IS samples, high rates of viral identification were achieved in infants and young children with respiratory illness in a rural area of China. The clinical significance of rhinovirus, bocavirus, adenovirus and HHV (especially CMV) infections should receive greater attention in future treatment and prevention studies of CAP in infants and children.
A cross-sectional study of isolates from sputum samples from bacterial pneumonia patients in Trinidad
Nagalingam, Nabeetha A.;Adesiyun, Abiodun A.;Swanston, William H.;Bartholomew, Maria;
Brazilian Journal of Infectious Diseases , 2005, DOI: 10.1590/S1413-86702005000300006
Abstract: we determined the frequency of streptococcus pneumoniae, haemophilus influenzae, staphylococcus aureus, and gram-negative enteric bacteria (gneb) in pneumonia patients, determined the antibiograms of these pathogens, and investigated the relationship between pneumonia and selected risk factors. sputum and demographic data were collected from 124 pneumonia patients. sputum was cultured for s. aureus, gneb, h. influenzae and s. pneumoniae. the disc diffusion method was used to determine resistance to eight antimicrobial agents. among the 124 sputum samples, eight (6.5%) were positive for s. aureus, 15 (12.1%) for gneb, two (1.6%) for s. pneumoniae and one (0.8%) for h. influenzae. hospitals, gender, ethnicity, co-morbidities and symptoms did not significantly (p > 0.05; c2) affect the prevalence of these bacteria. gneb infection was most prevalent (47%) in patients over 70 years old. gentamicin and levofloxacin were the most effective against these bacteria.
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.
Community-acquired pneumonia due to Legionella pneumophila, the utility of PCR, and a review of the antibiotics used
Paul Zarogoulidis, Ioanna Alexandropoulou, Gioulia Romanidou, et al
International Journal of General Medicine , 2011, DOI: http://dx.doi.org/10.2147/IJGM.S15654
Abstract: mmunity-acquired pneumonia due to Legionella pneumophila, the utility of PCR, and a review of the antibiotics used Case report (6123) Total Article Views Authors: Paul Zarogoulidis, Ioanna Alexandropoulou, Gioulia Romanidou, et al Published Date January 2011 Volume 2011:4 Pages 15 - 19 DOI: http://dx.doi.org/10.2147/IJGM.S15654 Paul Zarogoulidis1,2, Ioanna Alexandropoulou1,2, Gioulia Romanidou3, Theocharis G Konstasntinidis1,2, Eirini Terzi3, S Saridou1, Athanasios Stefanis1, Kostas Zarogoulidis1,2, TC Constantinidis1,2 1Regional Laboratory of Public Health, East Macedonia-Thrace, Komotini, Greece; 2Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Komotini, Greece; 3Department of Internal Medicine, General Municipal Hospital (“Sismanoglio” of Komotini), Komotini, Greece Introduction: There are at least 40 types of Legionella bacteria, half of which are capable of producing disease in humans. The Legionella pneumophila bacterium, the root cause of Legionnaires’ disease, causes 90% of legionellosis cases. Case presentation: We describe the case of a 60-year-old woman with a history of diabetes mellitus and arterial hypertension who was admitted to our hospital with fever and symptoms of respiratory infection, diarrhea, and acute renal failure. We used real-time polymerase chain reaction (PCR) to detect L. pneumophila DNA in peripheral blood and serum samples and urine antigen from a patient with pneumonia. Legionella DNA was detected in all two sample species when first collected. Conclusion: Since Legionella is a cause of 2% to 15% of all community-acquired pneumonias that require hospitalization, legionellosis should be taken into account in an atypical pulmonary infection and not be forgotten. Moreover, real-time PCR should be considered a useful diagnostic method.
Bordetella bronchiseptica pneumonia in a man with acquired immunodeficiency syndrome: a case report
Michal Galeziok, Ingram Roberts, Jo-Anne Passalacqua
Journal of Medical Case Reports , 2009, DOI: 10.1186/1752-1947-3-76
Abstract: A 42-year-old African-American man with human immunodeficiency virus presented with pulmonary symptoms that mimicked Pneumocystis jiroveci pneumonia. A sputum culture grew Bordetella brochiseptica, a common respiratory commensal of wild and domestic animals, rarely implicated in human infections.Bordetella bronchiseptica should be added to the differential list of pathogens which can affect people with human immunodeficiency virus and pulmonary symptoms. Sputum culture, as well as history of animal exposure, in these patients is advised.Bordetella bronchiseptica is a common pathogen in the respiratory tract of many wild and domestic animals, but it is rarely found in humans [1]. This pathogen is believed to be transmitted from dogs with tracheobronchitis [2]. Bordetella bronchiseptica is considered an etiologic agent of upper respiratory tract infections, pneumonitis, endocarditis, peritonitis, meningitis, sepsis and recurrent bacteraemia in people with immunological abnormalities [3]. In human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS) patients, Bordetella bronchiseptica can cause an interstitial pneumonia which can resemble pneumocystis pneumonia.A 42-year-old African-American man with HIV/AIDS, not taking any medications including HAART and pneumocystis jiroveci prophylaxis since January 2007, presented in August 2007 with complaints of progressing shortness of breath, right-sided pleuritic chest pain, non-productive cough, and low-grade fever for last several weeks. He was diagnosed with HIV initially in 1999, during hospitalization for community-acquired pneumonia. The patient also had a history of facial herpes simplex virus type 2 (HSV-2) which has been recurrent and a history of pneumocystis pneumonia in June 2005. Previous laboratory studies from November 2006 revealed a CD4+ lymphocyte count of 20 and viral load HIV RNA of 65,833 copies/ml. He was a social drinker and had never used illicit drugs or tobacco products. HIV wa
Community-acquired pneumonia due to Legionella pneumophila, the utility of PCR, and a review of the antibiotics used  [cached]
Paul Zarogoulidis,Ioanna Alexandropoulou,Gioulia Romanidou,et al
International Journal of General Medicine , 2011,
Abstract: Paul Zarogoulidis1,2, Ioanna Alexandropoulou1,2, Gioulia Romanidou3, Theocharis G Konstasntinidis1,2, Eirini Terzi3, S Saridou1, Athanasios Stefanis1, Kostas Zarogoulidis1,2, TC Constantinidis1,21Regional Laboratory of Public Health, East Macedonia-Thrace, Komotini, Greece; 2Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace, Komotini, Greece; 3Department of Internal Medicine, General Municipal Hospital (“Sismanoglio” of Komotini), Komotini, GreeceIntroduction: There are at least 40 types of Legionella bacteria, half of which are capable of producing disease in humans. The Legionella pneumophila bacterium, the root cause of Legionnaires’ disease, causes 90% of legionellosis cases.Case presentation: We describe the case of a 60-year-old woman with a history of diabetes mellitus and arterial hypertension who was admitted to our hospital with fever and symptoms of respiratory infection, diarrhea, and acute renal failure. We used real-time polymerase chain reaction (PCR) to detect L. pneumophila DNA in peripheral blood and serum samples and urine antigen from a patient with pneumonia. Legionella DNA was detected in all two sample species when first collected.Conclusion: Since Legionella is a cause of 2% to 15% of all community-acquired pneumonias that require hospitalization, legionellosis should be taken into account in an atypical pulmonary infection and not be forgotten. Moreover, real-time PCR should be considered a useful diagnostic method.Keywords: Legionnaires’ disease, Lionella pneumophila
RNA viruses in community-acquired childhood pneumonia in semi-urban Nepal; a cross-sectional study
Maria Mathisen, Tor A Strand, Biswa N Sharma, Ram K Chandyo, Palle Valentiner-Branth, Sudha Basnet, Ramesh K Adhikari, Dag Hvidsten, Prakash S Shrestha, Halvor Sommerfelt
BMC Medicine , 2009, DOI: 10.1186/1741-7015-7-35
Abstract: From July 2004 to June 2007, we examined nasopharyngeal aspirates (NPA) from 2,230 cases of pneumonia (World Health Organization criteria) in children 2 to 35 months old recruited in a randomized trial of zinc supplementation at a field clinic in Bhaktapur, Nepal. The specimens were examined for respiratory syncytial virus (RSV), influenza virus type A (InfA) and B (InfB), parainfluenza virus types 1, 2 and 3 (PIV1, PIV2, and PIV3), and human metapneumovirus (hMPV) using a multiplex reverse transcriptase polymerase chain reaction (PCR) assay.We identified 919 virus isolates in 887 (40.0%) of the 2,219 NPA specimens with a valid PCR result, of which 334 (15.1%) yielded RSV, 164 (7.4%) InfA, 129 (5.8%) PIV3, 98 (4.4%) PIV1, 93 (4.2%) hMPV, 84 (3.8%) InfB, and 17 (0.8%) PIV2. CAP occurred in an epidemic pattern with substantial temporal variation during the three years of study. The largest peaks of pneumonia occurrence coincided with peaks of RSV infection, which occurred in epidemics during the rainy season and in winter. The monthly number of RSV infections was positively correlated with relative humidity (rs = 0.40, P = 0.01), but not with temperature or rainfall. An hMPV epidemic occurred during one of the three winter seasons and the monthly number of hMPV cases was also associated with relative humidity (rs = 0.55, P = 0.0005).Respiratory RNA viruses were detected from NPA in 40% of CAP cases in our study. The most commonly isolated viruses were RSV, InfA, and PIV3. RSV infections contributed substantially to the observed CAP epidemics. The occurrence of viral CAP in this community seemed to reflect more or less overlapping micro-epidemics with several respiratory viruses, highlighting the challenges of developing and implementing effective public health control measures.Viruses are important causes of lower respiratory tract infection (LRTI) in developing countries [1-3]. The most common cause of viral LRTI is RNA viruses: respiratory syncytial virus (RSV), hum
Role of Serum Procalcitonin Level in Differentiating between Pulmonary Tuberculosis and Community-Acquired Pneumonia  [PDF]
Mohammad Shameem, Mazhar Alam, Shagufta Moin, Rakesh Bhargava, Zuber Ahmad, Jamal Akhtar
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.515121
Abstract:

Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP) are common causes of consolidation patch in chest radiograph. Sputum Z-N staining is positive in 30% to 60% cases only and sputum examination has poor yield in CAP. This study aimed to assess the value of serum Procalcitonin (PCT) levels in patients with Pulmonary Tuberculosis (PTB) and Community-Acquired Pneumonia (CAP). Patients with new opacity in chest radiograph were included in the study. Serum sample were taken at admission and stored. Patient’s diagnosis were confirmed and categorized into pulmonary TB group (32) and community-acquired pneumonia group (23). Their mean PCT level was compared with mean PCT level of 25 controls. Serum procalcitonin levels were found to be significantly elevated in patients of community-acquired pneumonia as compared to patients of pulmonary tuberculosis. In presence of consolidation in x-ray chest, increased level of serum procalcitonin might be used to differentiate pulmonary tuberculosis from community-acquired pneumonia. High level of serum procalcitonin was associated with high mortality rate in community-acquired pneumonia patients.

Severe community-acquired adenovirus pneumonia in an immunocompetent 44-year-old woman: a case report and review of the literature
Tristan W Clark, Daniel H Fleet, Martin J Wiselka
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-259
Abstract: A 44-year-old immunocompetent Caucasian woman was admitted to our hospital with an acute febrile respiratory illness associated with a rash. Her blood tests were non-specifically abnormal, and tests for bacterial pathogens were negative. Her condition rapidly deteriorated while she was in our hospital and required mechanical ventilation and inotropic support. A multiplex real-time RT-PCR assay performed on respiratory specimens to detect respiratory viruses was negative for influenza but positive for adenovirus DNA. The patient recovered on supportive treatment, and antibiotics were stopped after 5 days.Community-acquired adenovirus pneumonia in immunocompetent adult civilians presents as a non-specific acute febrile respiratory illness followed by the abrupt onset of respiratory failure, often requiring mechanical ventilation. Its laboratory and radiological features are typical of viral infections but also are non-specific. Novel multiplex real-time RT-PCR testing for respiratory viruses enabled us to rapidly make the diagnosis in this case. The new technology could be used more widely in patients with acute respiratory illness and has potential utility for rationalization of the use of antibiotics and improving infection control measures.Adenoviruses are double-stranded DNA viruses belonging to the family Adenoviridae. There are over 50 known serotypes of adenovirus, which are categorized into six subgenera (A to F). Adenoviruses are a common cause of acute febrile and respiratory infections in children and are generally self-limiting [1]. Severe infections, including pneumonia, can occur in neonates [2] and in adults with compromised immunity, such as those with hematopoietic stem cell transplants and in patients with human immunodeficiency virus (HIV) infection [3]. Outbreaks of acute respiratory illness, including pneumonia, caused by adenovirus serotypes 3, 4, 7, 14 and 21 are common among military recruits, and fatal outcomes have occasionally been reported
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