Pneumonia

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.

LYNCHBURG, Va. -- Televalgelism pioneer Jerry Falwell, the founder of Moral Majority and a stalwart of the Christian right wing of the GOP, died today after collapsing in his office here. Falwell was 73 and had suffered in recent years from congestive heart failure and pneumonia.

SEATTLE -- Gastric acid suppression with proton pump inhibitors appears to hold no excess risk of pneumonia in hospitalized older adults, researchers reported here.

NASHVILLE, Tenn. -- Evidence continues to mount that the use of the new pneumococcal conjugate vaccine is dramatically reducing the rate of pneumonia in young children - and even in adults who have never been vaccinated.

A 57-year-old woman presents with swelling of the hands that began several weeks earlier and is now worsening. She denies joint pain, and she has no history of trauma or significant vascular disease. She has had pneumonia several times; each episode was successfully treated with antibiotics. She has smoked 2 packs of cigarettes a day for the past 20 years

The Pneumonia Severity Index (PSI), which categorizes patients into 5 groups according to risk of short-term mortality, is used at some centers to determine which patients with community-acquired pneumonia can be safely treated as outpatients. Is this a reasonable practice? Yes, according to a multicenter study conducted in France, which found that use of the PSI in emergency departments (EDs) is associated with a greater likelihood of low-risk patients being treated as outpatients, without compromising patient safety.

ORLANDO -- Swabbing the oral cavity with chlorhexidine (Peridex) reduces the risk of ventilator-associated pneumonia in some intubated intensive care patients, a Richmond, Va., researcher said here.

SPRINGFIELD, Mass. -- Offering hospitals a relatively small financial incentive improved their quality of care for acute myocardial infarction, heart failure, and pneumonia, researchers here reported.

The authors report a case of adult-onset acute lymphoblastic leukemia (ALL) presenting with a right upper lobe infiltrate associated with acute fibrinous and organizing pneumonia (AFOP), which resolved spontaneously during the course of chemotherapy.

The authors report a case of idiopathic eosinophilic pneumonia in a man with sclerosing cholangitis and ulcerative colitis associated with features of sarcoidosis.

On a warm August day, a 79-year-old man is hospitalized because of progressive lethargy over the past week. Previously, he was alert and able to converse. He has no chest pain, dyspnea, or cough. His history includes hypertension of unknown duration, chronic obstructive pulmonary disease, and a recent hospitalization for pneumonia.

Quinolones are commonlyused to treat a widevariety of infectious diseases,such as community-acquired pneumoniaand urinary tract infections. Somequinolones are also given as prophylaxisfor spontaneous bacterial peritonitis.These popular antimicrobial agents areassociated with several clinically significantdrug interactions, which can beclassified into 2 major categories1-3:

A 62-year-old woman was found on thefloor of her bathroom at home with herwheelchair partially on top of her.She was unresponsive except to painfulstimulus.

A 62-year-old woman presents with severe, sharp pain in her right mid chestthat worsens when she breathes. The pain began the previous night, shortlyafter she had been awakened by a shaking chill, followed by the sensationof fever. She also has a relatively nonproductive cough of recent onset.

The FDA has approved Ketek (telithromycin) fromAventis Pharmaceuticals to treat acute exacerbationof chronic bronchitis, acute bacterial sinusitis, and mild tomoderate community-acquired pneumonia. This is thefirst agent in a new class of antibiotics known as ketolides.Ketek has already been released in European, Latin American,and Asian markets.

A 48-year-old African Americanwoman with HIV infection who hadbeen hospitalized several days earlierfor presumed Pneumocystis cariniipneumonia (PCP) is readmittedbecause of worsening dyspnea and atemperature of 38.8oC (102oF).She also complains of painful swellingand erythema on her right arm.Her symptoms have worseneddespite treatment with trimethoprimsulfamethoxazole.