Pub Date : 2015-12-01DOI: 10.15172/pneu.2015.6/656
I. Koppen, A. A. Bosch, E. Sanders, M. V. van Houten, D. Bogaert
Recent studies investigating the relationship between the microbiota and disease are demonstrating novel concepts that could significantly alter the way we treat disease and promote health in the future. It is suggested that the microbiota acquired during childhood may shape the microbial community and affect immunological responses for later life, and could therefore be important in the susceptibility towards disease. Several diseases, including asthma, pneumonia, and otitis media, are associated with changes in composition and diversity of the respiratory microbiota. This review summarises current literature, focusing on the composition and development of the respiratory microbiota in children and its relationship with respiratory diseases.
{"title":"The respiratory microbiota during health and disease: a paediatric perspective","authors":"I. Koppen, A. A. Bosch, E. Sanders, M. V. van Houten, D. Bogaert","doi":"10.15172/pneu.2015.6/656","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/656","url":null,"abstract":"Recent studies investigating the relationship between the microbiota and disease are demonstrating novel concepts that could significantly alter the way we treat disease and promote health in the future. It is suggested that the microbiota acquired during childhood may shape the microbial community and affect immunological responses for later life, and could therefore be important in the susceptibility towards disease. Several diseases, including asthma, pneumonia, and otitis media, are associated with changes in composition and diversity of the respiratory microbiota. This review summarises current literature, focusing on the composition and development of the respiratory microbiota in children and its relationship with respiratory diseases.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"90 - 100"},"PeriodicalIF":6.8,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/656","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-11-12DOI: 10.15172/pneu.2015.6/529
B. Sobott, D. Peake, James F. P. Black, R. Rassool
The World Health Organization recommends oxygen therapy for children with severe pneumonia, but this essential medicine is unavailable in many health centres in limited-resource settings. To address this need, an appropriate means of oxygen provision will need to be low-cost and robust, require little maintenance and not compete for fuel with other vital functions, and be environmentally sustainable. This report presents the preliminary results of the Fully Renewable Energy Oxygen (FREO2) system, confirming the viability of a novel means of producing medical grade oxygen without any electricity. The approach relies on exploiting the reduction in pressure of water flowing through a raised siphon to create a source of vacuum. This is used to power a customised vacuum-pressure-swing-adsorption system and produce medical grade oxygen. The FREO2 system has been designed to meet the criteria for successful oxygen delivery in small health facilities. It is ideally suited for deployment in tropical or mountainous regions with proximity to flowing water. Importantly, the oxygen generating capacity of FREO2 rises with the increased demand commonly observed during the rainy season in such climates.
{"title":"FREO2: An electricity free oxygen concentrator","authors":"B. Sobott, D. Peake, James F. P. Black, R. Rassool","doi":"10.15172/pneu.2015.6/529","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/529","url":null,"abstract":"The World Health Organization recommends oxygen therapy for children with severe pneumonia, but this essential medicine is unavailable in many health centres in limited-resource settings. To address this need, an appropriate means of oxygen provision will need to be low-cost and robust, require little maintenance and not compete for fuel with other vital functions, and be environmentally sustainable. This report presents the preliminary results of the Fully Renewable Energy Oxygen (FREO2) system, confirming the viability of a novel means of producing medical grade oxygen without any electricity. The approach relies on exploiting the reduction in pressure of water flowing through a raised siphon to create a source of vacuum. This is used to power a customised vacuum-pressure-swing-adsorption system and produce medical grade oxygen. The FREO2 system has been designed to meet the criteria for successful oxygen delivery in small health facilities. It is ideally suited for deployment in tropical or mountainous regions with proximity to flowing water. Importantly, the oxygen generating capacity of FREO2 rises with the increased demand commonly observed during the rainy season in such climates.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"115 - 119"},"PeriodicalIF":6.8,"publicationDate":"2015-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/529","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Cox, A. B. Brueggemann, T. Mitchell, Jeremy S. Brown
{"title":"Progress towards understanding the pathology of the pneumococcus","authors":"A. Cox, A. B. Brueggemann, T. Mitchell, Jeremy S. Brown","doi":"10.1007/BF03371466","DOIUrl":"https://doi.org/10.1007/BF03371466","url":null,"abstract":"","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"7 1","pages":"1-2"},"PeriodicalIF":6.8,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF03371466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"51683532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-11DOI: 10.15172/pneu.2015.6/682
T. Wiemken, V. Jala, R. Kelley, P. Peyrani, William A. Mattingly, F. Arnold, Patricio W. Cabral, R. Cavallazzi, B. Haribabu, J. Ramirez
The composition of the upper respiratory tract microbiome may play an important role in the development of lower respiratory tract infections. Here, we characterised the microbiome of the nasopharynx and oropharynx of hospitalised patients with community-acquired pneumonia (CAP) with unknown aetiology in an attempt to obtain insight into the aetiology of CAP. A random sample of 10 patients hospitalised with CAP previously enrolled in a separate clinical trial (ClinicalTrials.gov registry, Study ID: NCT01248715) in which a complete microbiological workup was not able to define an aetiology were analysed in this pilot study. This larger trial (n = 1,221) enrolled patients from 9 adult hospitals in Louisville, Kentucky, USA. Nasopharyngeal and oropharyngeal swabs were obtained for metagenomic analysis. Polymerase chain reaction (PCR) for Streptococcus pneumoniae was performed in all patients. One patient had a distinct nasophararyngeal microbiome consisting largely of Haemophilus influenzae. This was the only patient with a negative PCR for S. pneumoniae in both nasophararyngeal and oropharyngeal specimens. Overall, substantial differences were found between nasophararyngeal and oropharyngeal microbiomes. The upper respiratory tract microbiome of only one patient suggested H. influenzae as a probable aetiology of CAP. Although this was a pilot study of only 10 patients, the presence of S. pneumoniae in the upper respiratory tract of the other 9 patients warrants further investigation.
{"title":"The upper respiratory tract microbiome of hospitalised patients with community-acquired pneumonia of unknown aetiology: a pilot study","authors":"T. Wiemken, V. Jala, R. Kelley, P. Peyrani, William A. Mattingly, F. Arnold, Patricio W. Cabral, R. Cavallazzi, B. Haribabu, J. Ramirez","doi":"10.15172/pneu.2015.6/682","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/682","url":null,"abstract":"The composition of the upper respiratory tract microbiome may play an important role in the development of lower respiratory tract infections. Here, we characterised the microbiome of the nasopharynx and oropharynx of hospitalised patients with community-acquired pneumonia (CAP) with unknown aetiology in an attempt to obtain insight into the aetiology of CAP. A random sample of 10 patients hospitalised with CAP previously enrolled in a separate clinical trial (ClinicalTrials.gov registry, Study ID: NCT01248715) in which a complete microbiological workup was not able to define an aetiology were analysed in this pilot study. This larger trial (n = 1,221) enrolled patients from 9 adult hospitals in Louisville, Kentucky, USA. Nasopharyngeal and oropharyngeal swabs were obtained for metagenomic analysis. Polymerase chain reaction (PCR) for Streptococcus pneumoniae was performed in all patients. One patient had a distinct nasophararyngeal microbiome consisting largely of Haemophilus influenzae. This was the only patient with a negative PCR for S. pneumoniae in both nasophararyngeal and oropharyngeal specimens. Overall, substantial differences were found between nasophararyngeal and oropharyngeal microbiomes. The upper respiratory tract microbiome of only one patient suggested H. influenzae as a probable aetiology of CAP. Although this was a pilot study of only 10 patients, the presence of S. pneumoniae in the upper respiratory tract of the other 9 patients warrants further investigation.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"83 - 89"},"PeriodicalIF":6.8,"publicationDate":"2015-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/682","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-04DOI: 10.15172/pneu.2015.6/645
R. José, Ali O. Mohammed, J. Goldring, R. Chambers, Jeremy S. Brown, B. Agarwal
Patients with community-acquired pneumonia (CAP) and an underlying diagnosis of cancer have worse outcomes. However, the characteristics of cancer patients with CAP admitted to intensive care units (ICUs) are not well established. In a retrospective observational study, patients admitted to a London university hospital ICU between January 2006 and October 2011 with a primary diagnosis of CAP were included. Demographic, clinical, laboratory, and outcome data were collected from the ICU and hospital pathology databases. The analysis included 96 patients with CAP, 19 of whom had an existing diagnosis of cancer. Patients with cancer had a longer median time interval between hospital and ICU admission (1 vs 2 days, p = 0.049). On admission to ICU, there were no differences in white cell count, C-reactive protein, clotting, renal function, liver function, heart rate, temperature, systolic blood pressure or oxygenation index between patients with or without cancer. However, patients with cancer had significantly lower haemoglobin levels (median 8.6 vs 10.0 g/dl, p = 0.010) and lowest diastolic blood pressure (median 40 vs 50 mmHg, p = 0.026), and higher sodium levels (median 142 vs 139 mmol/l), p = 0.020), APACHE II (median 25 vs 20, p = 0.009), SAPS II (median 51 vs 43, p = 0.039) and SOFA (median 12 vs 9, p = 0.018) scores. There were no statistically significant differences in the proportion of patients receiving mechanical ventilation or renal support, the duration of mechanical ventilation or ICU or hospital length of stay. Patients with cancer were more likely to receive vasopressors (89.5% vs 63.6%, p = 0.030) and had increased ICU (68.4% vs 31.2%, p = 0.004) and hospital (78.9% vs 33.8%, p = 0.001) mortality. The limitations of this study are its relatively small sample size and those associated with the retrospective study design. In conclusion, cancer patients with CAP had an increased risk of death that was associated with increased illness severity and prevalence of septic shock at the time of ICU admission, suggesting there may be a delay in recognition for the need for intensive care support in these patients.
社区获得性肺炎(CAP)和潜在癌症诊断的患者预后更差。然而，重症监护病房(icu)的CAP癌症患者的特征尚未得到很好的确定。在一项回顾性观察性研究中，纳入了2006年1月至2011年10月期间伦敦大学医院ICU收治的初步诊断为CAP的患者。人口统计学、临床、实验室和结局数据收集自ICU和医院病理数据库。该分析包括96名CAP患者，其中19人已有癌症诊断。癌症患者住院至ICU住院的中位时间间隔较长(1天vs 2天，p = 0.049)。入ICU时，有无肿瘤患者白细胞计数、c反应蛋白、凝血、肾功能、肝功能、心率、体温、收缩压、氧合指数均无差异。然而，癌症患者的血红蛋白水平显著降低(中位数8.6 vs 10.0 g/dl, p = 0.010)，舒张压最低(中位数40 vs 50 mmHg, p = 0.026)，钠水平较高(中位数142 vs 139 mmol/l)， APACHE II(中位数25 vs 20, p = 0.009)， SAPS II(中位数51 vs 43, p = 0.039)和SOFA(中位数12 vs 9, p = 0.018)评分。两组患者接受机械通气或肾支持的比例、机械通气持续时间、ICU或住院时间差异均无统计学意义。癌症患者更容易接受血管加压药物治疗(89.5%比63.6%，p = 0.030)， ICU(68.4%比31.2%，p = 0.004)和医院(78.9%比33.8%，p = 0.001)死亡率增加。本研究的局限性在于样本量相对较小，且与回顾性研究设计有关。综上所述，CAP癌症患者的死亡风险增加，这与ICU入院时疾病严重程度和感染性休克患病率的增加有关，表明这些患者对重症监护支持需求的认识可能存在延迟。
{"title":"Cancer patients with community-acquired pneumonia treated in intensive care have poorer outcomes associated with increased illness severity and septic shock at admission to intensive care: a retrospective cohort study","authors":"R. José, Ali O. Mohammed, J. Goldring, R. Chambers, Jeremy S. Brown, B. Agarwal","doi":"10.15172/pneu.2015.6/645","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/645","url":null,"abstract":"Patients with community-acquired pneumonia (CAP) and an underlying diagnosis of cancer have worse outcomes. However, the characteristics of cancer patients with CAP admitted to intensive care units (ICUs) are not well established. In a retrospective observational study, patients admitted to a London university hospital ICU between January 2006 and October 2011 with a primary diagnosis of CAP were included. Demographic, clinical, laboratory, and outcome data were collected from the ICU and hospital pathology databases. The analysis included 96 patients with CAP, 19 of whom had an existing diagnosis of cancer. Patients with cancer had a longer median time interval between hospital and ICU admission (1 vs 2 days, p = 0.049). On admission to ICU, there were no differences in white cell count, C-reactive protein, clotting, renal function, liver function, heart rate, temperature, systolic blood pressure or oxygenation index between patients with or without cancer. However, patients with cancer had significantly lower haemoglobin levels (median 8.6 vs 10.0 g/dl, p = 0.010) and lowest diastolic blood pressure (median 40 vs 50 mmHg, p = 0.026), and higher sodium levels (median 142 vs 139 mmol/l), p = 0.020), APACHE II (median 25 vs 20, p = 0.009), SAPS II (median 51 vs 43, p = 0.039) and SOFA (median 12 vs 9, p = 0.018) scores. There were no statistically significant differences in the proportion of patients receiving mechanical ventilation or renal support, the duration of mechanical ventilation or ICU or hospital length of stay. Patients with cancer were more likely to receive vasopressors (89.5% vs 63.6%, p = 0.030) and had increased ICU (68.4% vs 31.2%, p = 0.004) and hospital (78.9% vs 33.8%, p = 0.001) mortality. The limitations of this study are its relatively small sample size and those associated with the retrospective study design. In conclusion, cancer patients with CAP had an increased risk of death that was associated with increased illness severity and prevalence of septic shock at the time of ICU admission, suggesting there may be a delay in recognition for the need for intensive care support in these patients.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"77 - 82"},"PeriodicalIF":6.8,"publicationDate":"2015-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/645","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-09-01DOI: 10.15172/pneu.2015.6/648
K. Meyer, J. Bierach, J. Kanne, J. Torrealba, N. D. de Oliveira
Acute fibrinous and organising pneumonia (AFOP) is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561). We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.
{"title":"Acute fibrinous and organising pneumonia following lung transplantation is associated with severe allograft dysfunction and poor outcome: a case series","authors":"K. Meyer, J. Bierach, J. Kanne, J. Torrealba, N. D. de Oliveira","doi":"10.15172/pneu.2015.6/648","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/648","url":null,"abstract":"Acute fibrinous and organising pneumonia (AFOP) is a histopathologic variant of acute lung injury that has been associated with infection and inflammatory disorders and has been reported as a complication of lung transplantation. A retrospective chart review was performed for all patients transplanted at the University of Wisconsin Hospital and Clinics from January 1995 to December 2013 (n = 561). We identified 6 recipients whose clinical course was complicated by AFOP. All recipients were found to have AFOP on lung biopsy or at post-mortem examination, and 5 of the 6 patients suffered progressive allograft dysfunction that led to fatal outcome. Only 1 of the 6 patients stabilised with augmented immunosuppression and had subsequent improvement and stabilisation of allograft function. We could not clearly identify any specific cause of AFOP, such as drug toxicity or infection. Lung transplantation can be complicated by lung injury with an AFOP pattern on histopathologic examination of lung biopsy specimens. The presence of an AFOP pattern was associated with irreversible decline in lung function that was refractory to therapeutic interventions in 5 of our 6 cases and was associated with severe allograft dysfunction and death in these 5 individuals. AFOP should be considered as a potential diagnosis when lung transplant recipients develop progressive decline in lung function that is consistent with a clinical diagnosis of chronic lung allograft dysfunction.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"67 - 76"},"PeriodicalIF":6.8,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/648","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-25DOI: 10.15172/pneu.2015.6/559
Feroze A. Ganaie, V. Govindan, Ravi Kumar
Rapid diagnosis of Streptococcus pneumoniae can play a significant role in decreasing morbidity and mortality of infection. The accurate diagnosis of pneumococcal disease is hampered by the difficulties in growing the isolates from clinical specimens and also by misidentification. Molecular methods have gained popularity as they offer improvement in the detection of causative pathogens with speed and ease. The present study aims at validating and standardising the use of 4 oligonucleotide primer-probe sets (pneumolysin [ply], autolysin [lytA], pneumococcal surface adhesion A [psaA] and Spn9802 [DNA fragment]) in a single-reaction mixture for the detection and discrimination of S. pneumoniae. Here, we validate a quantitative multiplex real-time PCR (qmPCR) assay with a panel consisting of 43 S. pneumoniae and 29 non-pneumococcal isolates, 20 culture positive, 26 culture negative and 30 spiked serum samples. A standard curve was obtained using S. pneumoniae ATCC 49619 strain and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene was used as an endogenous internal control. The experiment showed high sensitivity with lower limit of detection equivalent to 4 genome copies/µl. The efficiency of the reaction was 100% for ply, lytA, Spn9802 and 97% for psaA. The test showed sensitivity and specificity of 100% with culture isolates and serum specimens. This study demonstrates that qmPCR analysis of sera using 4 oligonucleotide primers appears to be an appropriate method for the genotypic identification of S. pneumoniae infection.
{"title":"Standardisation and evaluation of a quantitative multiplex real-time PCR assay for the rapid identification of Streptococcus pneumoniae","authors":"Feroze A. Ganaie, V. Govindan, Ravi Kumar","doi":"10.15172/pneu.2015.6/559","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/559","url":null,"abstract":"Rapid diagnosis of Streptococcus pneumoniae can play a significant role in decreasing morbidity and mortality of infection. The accurate diagnosis of pneumococcal disease is hampered by the difficulties in growing the isolates from clinical specimens and also by misidentification. Molecular methods have gained popularity as they offer improvement in the detection of causative pathogens with speed and ease. The present study aims at validating and standardising the use of 4 oligonucleotide primer-probe sets (pneumolysin [ply], autolysin [lytA], pneumococcal surface adhesion A [psaA] and Spn9802 [DNA fragment]) in a single-reaction mixture for the detection and discrimination of S. pneumoniae. Here, we validate a quantitative multiplex real-time PCR (qmPCR) assay with a panel consisting of 43 S. pneumoniae and 29 non-pneumococcal isolates, 20 culture positive, 26 culture negative and 30 spiked serum samples. A standard curve was obtained using S. pneumoniae ATCC 49619 strain and glyceraldehyde 3-phosphate dehydrogenase (GAPDH) gene was used as an endogenous internal control. The experiment showed high sensitivity with lower limit of detection equivalent to 4 genome copies/µl. The efficiency of the reaction was 100% for ply, lytA, Spn9802 and 97% for psaA. The test showed sensitivity and specificity of 100% with culture isolates and serum specimens. This study demonstrates that qmPCR analysis of sera using 4 oligonucleotide primers appears to be an appropriate method for the genotypic identification of S. pneumoniae infection.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"57 - 66"},"PeriodicalIF":6.8,"publicationDate":"2015-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-21DOI: 10.15172/pneu.2015.6/636
A. Chang, H. Smith-Vaughan, T. Sloots, P. Valery, D. Whiley, J. Beissbarth, P. Torzillo
Indigenous Australian children have high (up to 90%) rates of nasopharyngeal microbial colonisation and of hospitalisation for pneumonia. In Indigenous children hospitalised with pneumonia in Central Australia, we describe the nasopharyngeal detection of viruses and bacteria and assessed whether their presence related to signs of pneumonia (tachypnoea and/or chest in-drawing) on hospital admission and during subsequent days. Nasopharyngeal swabs (NPS) and data were prospectively collected from 145 children (median age = 23.5 months, interquartile range [IQR] 8.7–50) hospitalised with pneumonia at Alice Springs Hospital, Australia, between April 2001 and July 2002. The cohort was enrolled in a randomised controlled study using zinc and/or vitamin A supplementation. NPS were taken within 24 hours of hospitalisation and kept frozen at-80°C until analysed in 2014. Polymerase chain reaction (PCR) was used to detect Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and 16 respiratory viruses. Uni- and multi-variate analyses were used to examine the relationships. One or more organisms were present in 137 (94.5%) NPS; 133 (91.7%) detected ≥ 1 bacterium, 34 (37.2%) for ≥ 1 virus and 50 (34.5%) were positive for both viruses and bacteria. C. pneumoniae (n = 3) and M. pneumoniae (n = 2) were rare. In multi-variate analyses, age < 12 months (odds ratio [OR] 6.6 [95% confidence interval {CI} 1.7–25.4]) and fever (OR 4.1 [95% CI 1.7–10.4]) were associated with tachypnoea and chest in-drawing. However the presence of bacteria and/or virus type was not associated with tachypnoea and/or chest in-drawing on admission or during recovery. In children with high nasopharyngeal microbial colonisation rates, the utility of NPS in determining the diagnosis of clinical pneumonia or duration of tachypnoea or in-drawing is likely limited. Larger cohort and case-control studies are required to confirm our findings.
{"title":"Upper airway viruses and bacteria detection in clinical pneumonia in a population with high nasal colonisation do not relate to clinical signs","authors":"A. Chang, H. Smith-Vaughan, T. Sloots, P. Valery, D. Whiley, J. Beissbarth, P. Torzillo","doi":"10.15172/pneu.2015.6/636","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/636","url":null,"abstract":"Indigenous Australian children have high (up to 90%) rates of nasopharyngeal microbial colonisation and of hospitalisation for pneumonia. In Indigenous children hospitalised with pneumonia in Central Australia, we describe the nasopharyngeal detection of viruses and bacteria and assessed whether their presence related to signs of pneumonia (tachypnoea and/or chest in-drawing) on hospital admission and during subsequent days. Nasopharyngeal swabs (NPS) and data were prospectively collected from 145 children (median age = 23.5 months, interquartile range [IQR] 8.7–50) hospitalised with pneumonia at Alice Springs Hospital, Australia, between April 2001 and July 2002. The cohort was enrolled in a randomised controlled study using zinc and/or vitamin A supplementation. NPS were taken within 24 hours of hospitalisation and kept frozen at-80°C until analysed in 2014. Polymerase chain reaction (PCR) was used to detect Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, Chlamydophila pneumoniae, Mycoplasma pneumoniae, and 16 respiratory viruses. Uni- and multi-variate analyses were used to examine the relationships. One or more organisms were present in 137 (94.5%) NPS; 133 (91.7%) detected ≥ 1 bacterium, 34 (37.2%) for ≥ 1 virus and 50 (34.5%) were positive for both viruses and bacteria. C. pneumoniae (n = 3) and M. pneumoniae (n = 2) were rare. In multi-variate analyses, age < 12 months (odds ratio [OR] 6.6 [95% confidence interval {CI} 1.7–25.4]) and fever (OR 4.1 [95% CI 1.7–10.4]) were associated with tachypnoea and chest in-drawing. However the presence of bacteria and/or virus type was not associated with tachypnoea and/or chest in-drawing on admission or during recovery. In children with high nasopharyngeal microbial colonisation rates, the utility of NPS in determining the diagnosis of clinical pneumonia or duration of tachypnoea or in-drawing is likely limited. Larger cohort and case-control studies are required to confirm our findings.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"48 - 56"},"PeriodicalIF":6.8,"publicationDate":"2015-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/636","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2015-08-18DOI: 10.15172/pneu.2015.6/690
Simone M C Spoorenberg, Stefan M T Vestjens, W. Albrich, G. Rijkers
Corticosteroid therapy as adjunctive treatment in community-acquired pneumonia (CAP) is a promising but controversial subject. The potentially beneficial effect of corticosteroids is based on the ability of steroids to dampen an excessive inflammatory response that often occurs in patients with CAP. This excessive inflammatory response can cause damage to the lungs and other organs, and is associated with poor outcome.
{"title":"Corticosteroids for all adult patients with community-acquired pneumonia?","authors":"Simone M C Spoorenberg, Stefan M T Vestjens, W. Albrich, G. Rijkers","doi":"10.15172/pneu.2015.6/690","DOIUrl":"https://doi.org/10.15172/pneu.2015.6/690","url":null,"abstract":"Corticosteroid therapy as adjunctive treatment in community-acquired pneumonia (CAP) is a promising but controversial subject. The potentially beneficial effect of corticosteroids is based on the ability of steroids to dampen an excessive inflammatory response that often occurs in patients with CAP. This excessive inflammatory response can cause damage to the lungs and other organs, and is associated with poor outcome.","PeriodicalId":45120,"journal":{"name":"Pneumonia","volume":"6 1","pages":"44 - 47"},"PeriodicalIF":6.8,"publicationDate":"2015-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.15172/pneu.2015.6/690","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67245680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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