Pneumonia

The emphasis in this clinically focused text is on syndromesand patient care rather than on pathogens. Among the topicscovered are antimicrobial pharmacokinetics and pharmacodynamics;head and neck infections; upper respiratory tractinfections; bronchitis and pneumonia; endocarditis; pericarditisand myocarditis; peritonitis, liver abscess, and biliary tractinfections; viral hepatitis; CNS infections; skin and soft tissueinfections; animal and human bites; osteomyelitis and infectiousarthritis; foot infections in patients with diabetes; scarletfever and toxic shock syndromes; fever of unknown origin;bacterial, viral, and protozoal diarrhea; obstetric-gynecologicinfections; urinary tract infections; sexually transmitted diseases;infectious complications of HIV infection; tuberculosis;tropical diseases; zoonoses; bioterrorism; and fungal infections.Color and black-and-white photographs, photomicrographs,CT scans, radiographs, drawings, tables, and flowchartshighlight seminal points in the text.

A 53-year-old man complains ofdyspnea and a cough that has progressivelyworsened over the pastweek. He denies recent trauma.

A 60-year-old woman reportsthat she has felt intermittent“fullness” in her face for the past day.This sensation is present when sheis supine on the examination table.She denies shortness of breath, dysphagia,and chest discomfort. Thepatient has a 25 pack-year history ofcigarette smoking.

An 82-year-old man suddenly became extremely short of breath while helpinghis wife wash dishes. The dyspnea was not accompanied by pain, and it was notrelieved by sitting. He was taken to the emergency department after diaphoresisand cyanosis developed.

For 2 days, a 43-year-old woman has had a slightly tender rash on her trunk andextremities. Five days earlier, the patient was given levofloxacin for an upperrespiratory tract infection; because she is prone to yeast infections while takingantibiotics, fluconazole also was prescribed. Her only other medication is an oralcontraceptive, which she has been taking for several years.

A 34-year-old man has had Crohn disease for 12years. He presented initially with ileitis and has had 3surgeries for obstructive complications. Ileum resectionhas resulted in bile salt and fat malabsorption. Recently,the Crohn disease has spread to the large bowel. For thelast 2 years, he has also had seronegative spondyloarthropathy-another complication of Crohn disease.

KINGSTON, Ontario, Dec. 20 -- For critically ill patients on mechanical ventilation, bronchoalveolar lavage and endotracheal aspiration appear to be equally effective when diagnosing pneumonia, said researchers here.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

ROCKVILLE, Md. -- Two FDA advisory committees agreed today that the antibiotic Ketek (telithromycin) should be limited to second-line therapy for community-acquired pneumonia, and that the drug should have black box warning added to its label.

ROCKVILLE, Md. -- Two FDA advisory committees agreed today that the antibiotic Ketek (telithromycin) should be limited to second-line therapy for community-acquired pneumonia, and that the drug should have black box warning added to its label.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with unknown etiology and a grim prognosis.1,2 The median survival is about 3 years after diagnosis or 5 years from the onset of symptoms. Its pathologic findings are those of usual interstitial pneumonia.2 Surgical lung biopsy is needed for diagnosis when these findings are not present. Usual interstitial pneumonia is the histopathologic pattern that characterizes IPF (Figure).

The association between asthma and pneumococcal disease has been suspected by many clinicians; however, formal investigations confirming an increased risk of pneumococcal disease in patients with asthma are rare.

NEW ORLEANS -- The age of patients, how they ride to the emergency department, and how busy it is on arrival all factor in to whether those with pneumonia get antibiotics within the recommended four hours.

SAN FRANCISCO -- Children who receive Tamiflu (oseltamivir) within one day of influenza diagnosis are half as likely to develop pneumonia as a complication, researchers said here.

SAN FRANCISCO -- A short course of antibiotics is as effective as a longer course for mild-to-moderate community-acquired pneumonia, according to a meta-analysis presented here.

The authors report the incidental finding of a persistent left superior vena cava (PLSVC) during the routine placement of a left subclavian central line in an elderly man with acute renal failure.

A 19-day-old infant was brought to the emergency department (ED) after a day of fever, coughing, and difficulty in breathing. He had been born at full term via vaginal delivery. There was no history of prolonged rupture of membranes. The mother was group B streptococcus-positive and had been treated appropriately before the delivery. The infant received 48 hours of empiric antibiotic therapy after his birth; blood cultures were negative at the birth hospital. The infant had been doing well before the ED visit.

Staphylococcal pneumonia can be classified as either primary or secondary. In primary disease, the infection is caused by direct inoculation of the respiratory tract. Secondary disease occurs by hematogenous spread (eg, as in endocarditis).

Previous receipt of the pneumococcal vaccine is associated with improved survival, reduced risk of respiratory failure, and decreased length of stay among patients hospitalized with community-acquired pneumonia (CAP). This finding was reported by Fisman and associates, who evaluated data from 109 community and teaching hospitals.

An 8-year-old boy presented with a 6-week history of shortness of breath, cough, and myalgias, but no fever. His pediatrician had made the diagnosis of bronchiolitis, and the patient was treated with azithromycin and albuterol via a metered-dose inhaler. Because the patient did not improve, he was given a 10-day course of amoxicillin, followed by a course of clarithromycin after a chest radiograph revealed bilateral infiltrates, suggesting atypical pneumonia.

Abstract: Elderly persons with active tuberculosis may present with the classic features, such as cough, hemoptysis, and fever, but some patients present with less typical signs, such as hepatosplenomegaly, liver function abnormalities, and anemia. A high index of suspicion is required when a patient presents with cough or pneumonia unresponsive to conventional therapy. Acid-fast smear and mycobacterial culture of a sputum specimen are recommended for diagnosis. For an elderly patient who tests positive with purified protein derivative, 9 months of isoniazid prophylaxis is recommended. For patients who are intolerant of isoniazid or have been exposed to or infected by an isoniazid-resistant strain, rifampin single-agent preventive therapy may be an effective alternative. (J Respir Dis. 2006;27(7):307-315)

UTRECHT, The Netherlands - Oral swabbing with antiseptics may be an inexpensive and effective way to prevent bacterial pneumonia in patients on mechanical ventilators, according to a study here.

AMSTERDAM, The Netherlands ? A short course of antibiotics is just as effective as seven to 10 days for patients with uncomplicated community-acquired pneumonia who improve substantially, researchers here reported.

HAMILTON, Ontario ? A more intensive program of treating pneumonia in nursing home residents can keep many of them out the hospital, researchers here said.