Pneumonia

The 13-valent pneumococcal conjugate vaccine reduced nearly by half vaccine-type community acquired pneumonia in adults aged 65 years and older.

Risk of MI, stroke, and fatal coronary heart disease remained elevated among some patients hospitalized for pneumonia up to 10 years after the index event.

Several related health concerns-including asthma, pericarditis, and pneumonia-are treatable within the primary care office.

This week: 3 questions on GI disorders, 1 Pneumonia, and the link between the brain and pain. Can you answer all 5 questions?

Respiratory symptoms are a major reason why outpatients seek medical care, and primary care physicians who treat children frequently see pneumonia. This week’s photo essay tests your knowledge of respiratory problems in kids.

Proton pump inhibitors have been associated with magnesium deficiency, pneumonia, and Clostridium difficile infection.

However, such therapy does not alter mortality, according to a systematic review and meta-analysis.

A 56-year-old was seen in the ED after 4 days of hemoptysis and intermittent left chest pain. He also complained of exertional dyspnea and arthralgias. He had been treated for “pneumonia” twice during the past month. Histories were unremarkable.

A 61-year-old man with arthritis and an 80-pack-year smoking history presented with fever, dyspnea, and productive cough of a week’s duration that did not respond to outpatient treatment with levofloxacin.

Health care–associated pneumonia (HCAP) is a relatively new term used to describe pneumonia that develops in patients who have recently been exposed to nosocomial and drug-resistant pathogens as a result of hospitalization or residence in a nursing home, for example. A recent study found that about 25% of patients hospitalized with pneumonia had HCAP, and that the mortality rate was higher in those with HCAP than in those with community-acquired pneumonia (CAP).

For 3 days, a 45-year-old woman with HIV infection who was noncompliant with her antiretroviral medications had cough, yellowish sputum, fever, and dyspnea. She denied hemoptysis, weight loss, or recent hospitalization. She had a long history of heavy smoking and alcohol and intravenous drug abuse.

New guidelines for community-acquired pneumonia (CAP) issued jointly by the Infectious Diseases Society of America and the American Thoracic Society emphasize the need for communities to adapt the recommendations to local conditions.

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged?

SAN DIEGO -- Rushing the decision to treat suspected pneumonia with antibiotics may lead to unnecessary treatment in a majority of cases, according to a small study reported here.

SAN DIEGO -- A potentially deadly form of community-acquired pneumonia linked to adenovirus type 14 has emerged in the Pacific northwest, according to a report presented here.

EDMONTON, Alberta -- Pneumococcal vaccine dose not prevent community-acquired pneumonia but can significantly reduce deaths or ICU admissions from it, researchers here reported.

Congestive heart failure and cirrhosis are the most common causes of transudative pleural effusions, while pneumonia and malignancy are responsible for the majority of exudative effusions. Plain chest films are valuable in confirming the presence of an effusion, providing clues to the cause, and directing the method of pleural fluid sampling. Thoracentesis is safe and simple, and it is diagnostic in about 75% of cases. Pleural biopsy is indicated for unexplained exudative effusions, most of which are found to result from malignancy or tuberculosis. Medical thoracoscopy, if available, is the procedure of choice for patients with these effusions. Thoracoscopy permits visually directed pleural biopsies and allows for therapeutic intervention at the time of diagnosis, obviating the need for subsequent invasive procedures.

abstract: While the risk factors for aspiration pneumonia are similar to those for aspiration pneumonitis, the 2 syndromes have different presentations. Aspiration pneumonia tends to occur in older patients or in those with neurological diseases, and the aspiration is not usually witnessed. Aspiration pneumonitis is more likely to occur in patients undergoing anesthesia or in those with acute drug and alcohol overdoses, and the aspiration is often witnessed. The workup may include bedside assessment of the cough and gag reflexes, chest radiography, videofluoroscopic imaging, or fiberoptic endoscopy. Empiric antibiotic therapy should be avoided in most patients with pneumonitis; however, antibiotics may be indicated for those at high risk for bacterial colonization of oropharyngeal and gastric contents who have fever, increasing sputum production, or new infiltrates or for those who fail to improve within 48 hours. (J Respir Dis. 2007;28(9):370-385)

The patient described here was treated for pneumonia, but a chest wall mass and CT changes suggested that more was going on.

PITTSBURGH -- Fatal sepsis in hospitalized pneumonia patients is most likely to occur in the presence of high levels of certain proinflammatory and anti-inflammatory cytokines, investigators here found.

GENEVA, Switzerland -- The risk of late-onset ventilator-associated pneumonia in ICU patients rises as the nurse-to-patient ratio declines, reported investigators here.

MONTREAL -- Chronic obstructive pulmonary disease patients who inhaled corticosteroids had a 70% increase in the risk of pneumonia hospitalization over those not given the drugs, researchers here reported.

abstract: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease of unknown etiology that leads to progressive fibrosis and respiratory failure. Patients with IPF typically present in their sixth to seventh decade of life with the insidious onset of progressive dyspnea and cough. Lung histopathology reveals the distinct lesion of usual interstitial pneumonia (UIP), and other causes of UIP, such as collagen-vascular disease, drug exposure, or occupational exposures, must be excluded. A confident clinical diagnosis of IPF can often be made without resorting to surgical lung biopsy if certain clinical features are present and a typical pattern is identified on high-resolution CT (HRCT) scanning of the thorax. Changes on HRCT scans that are typical for UIP include a predilection for peripheral and basilar lung zones with patchy involvement and sparing of more central areas, especially in upper lung zones. (J Respir Dis. 2007;28(7):283-292)

Given the dramatic advances in antimicrobials since penicillin was introduced, why has the mortality rate associated with community-acquired pneumonia (CAP) remained essentially unchanged? Inadequate application of practice guidelines may be the chief reason, according to a committee from the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS).1

A 53-year-old woman presented to the emergency department complaining of substernal chest pain that awoke her from sleep. The chest pain was associated with left shoulder numbness, radiating to her back, and was partially alleviated with sublingual nitroglycerin. During this episode, the patient had a cough productive of yellow phlegm and one instance of cough productive of 1 tbs of bright red blood.

INDIANAPOLIS -- Community Acquired Pneumonia (CAP) is the sixth leading cause of death in the U.S., yet health care professionals don't always offer immunization to their most vulnerable patients.

HOUSTON -- Myocardial infarction and other acute cardiac events closely track pneumococcal pneumonia, which suggests a need for multiple admitting diagnoses.

abstract: The use of fiberoptic bronchoscopy (FOB) in HIV- infected patients has sharply declined since the availability of highly active antiretroviral therapy and the resulting decrease in the incidence of opportunistic infections. Nevertheless, FOB continues to be an important diagnostic tool in this patient population. For example, FOB is useful in evaluating for Pneumocystis jiroveci (formerly carinii) pneumonia (PCP) in patients with CD4+ cell counts of less than 200/µL who have diffuse pulmonary infiltrates and in whom sputum induction has not been performed or is nondiagnostic. It is also useful for evaluating patients who have not responded adequately to empiric therapy for bacterial pneumonia or PCP. Other applications include the visual diagnosis of endobronchial Kaposi sarcoma or the assessment of suspected lung cancer. (J Respir Dis. 2007;28(6): 244-252)

abstract: Inflammatory bowel disease (IBD) can have a variety of extraintestinal manifestations, including pulmonary disease. Bronchial involvement is the most common, but other manifestations include upper airway disease; parenchymal involvement, such as bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial lung disease; and serositis, including pleural effusions and pericarditis. Patients with BOOP may present with fever, dyspnea, cough, and pleuritic chest pain. Chest radiographs show bilateral patchy airspace opacities or a diffuse process; CT scans often demonstrate the opacities to be pleural-based. Corticosteroids appear to be effective in the management of certain pulmonary manifestations of IBD, such as BOOP and pulmonary infiltrates with eosinophilia. (J Respir Dis. 2007;28(6):227-234)

LOUISVILLE, Ky. -- Hospitalized patients with community-acquired pneumonia should get drugs that cover both typical and atypical pathogens, international researchers have recommended.