Archive for February 25, 2017

Severe Community-Acquired Pneumonia Caused by Human Adenovirus in Immunocompetent Adults: A Multicenter Case Series.

PLoS One. 2016 Mar 11;11(3):e0151199.

Tan D1, Zhu H1, Fu Y1, Tong F2, Yao D2, Walline J3, Xu J1, Yu X1.

Author information

1Department of Emergency, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing, China.

2Department of Emergency, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei province, China.

3Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, United States of America.

Abstract

BACKGROUND:

Severe community-acquired pneumonia (CAP) caused by human adenovirus (HAdV), especially HAdV type 55 (HAdV-55) in immunocompetent adults has raised increasing concerns. Clinical knowledge of severe CAP and acute respiratory distress syndrome induced by HAdV-55 is still limited, though the pathogen has been fully characterized by whole-genome sequencing.

METHODS:

We conducted a multicentre retrospective review of all consecutive patients with severe CAP caused by HAdV in immunocompetent adults admitted to the Emergency Department Intensive Care Unit of two hospitals in Northern China between February 2012 and April 2014. Clinical, laboratory, radiological characteristics, treatments and outcomes of these patients were collected and analyzed.

RESULTS:

A total of 15 consecutive severe CAP patients with laboratory-confirmed adenovirus infections were included. The median age was 30 years and all cases were identified during the winter and spring seasons. HAdV-55 was the most frequently (11/15) detected HAdV type. Persistent high fever, cough and rapid progression of dyspnea were typically reported in these patients. Significantly increased pneumonia severity index (PSI), respiratory rate, and lower PaO2/FiO2, hypersensitive CRP were reported in non-survivors compared to survivors (P = 0.013, 0.022, 0.019 and 0.026, respectively). The rapid development of bilateral consolidations within 10 days after illness onset were the most common radiographic finding, usually accompanied by adjacent ground glass opacities and pleural effusions. Total mortality was 26.7% in this study. Corticosteroids were prescribed to 14 patients in this report, but the utilization rate between survivors and non-survivors was not significant.

CONCLUSIONS:

HAdV and the HAdV-55 sub-type play an important role among viral pneumonia pathogens in hospitalized immunocompetent adults in Northern China. HAdV should be tested in severe CAP patients with negative bacterial cultures and a lack of response to antibiotic treatment, even if radiologic imaging and clinical presentation initially suggest bacterial pneumonia

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788423/pdf/pone.0151199.pdf

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February 25, 2017 at 1:27 pm

Streptococcus pyogenes Pneumonia in Adults: Clinical Presentation and Molecular Characterization of Isolates 2006-2015.

PLoS One. 2016 Mar 30;11(3):e0152640.

Tamayo E1, Montes M1,2, Vicente D1,2, Pérez-Trallero E1,2,3.

Author information

1Biomedical Research Center Network for Respiratory Diseases (CIBERES), San Sebastián, Spain.

2Microbiology Department, Hospital Universitario Donostia-Instituto Biodonostia, San Sebastián, Spain.

3Medicine Faculty, University of the Basque Country, UPV/EHU, San Sebastián, Spain.

Abstract

INTRODUCTION:

In the preantibiotic era Streptococcus pyogenes was a common cause of severe pneumonia but currently, except for postinfluenza complications, it is not considered a common cause of community-acquired pneumonia in adults.

AIM AND MATERIAL AND METHODS:

This study aimed to identify current clinical episodes of S. pyogenes pneumonia, its relationship with influenza virus circulation and the genotypes of the involved isolates during a decade in a Southern European region (Gipuzkoa, northern Spain). Molecular analysis of isolates included emm, multilocus-sequence typing, and superantigen profile determination.

RESULTS:

Forty episodes were detected (annual incidence 1.1 x 100,000 inhabitants, range 0.29-2.29). Thirty-seven episodes were community-acquired, 21 involved an invasive infection and 10 developed STSS. The associated mortality rate was 20%, with half of the patients dying within 24 hours after admission. Influenza coinfection was confirmed in four patients and suspected in another. The 52.5% of episodes occurred outside the influenza seasonal epidemic. The 67.5% of affected persons were elderly individuals and adults with severe comorbidities, although 13 patients had no comorbidities, 2 of them had a fatal outcome. Eleven clones were identified, the most prevalent being emm1/ST28 (43.6%) causing the most severe cases.

CONCLUSIONS:

  1. pyogenes pneumonia had a continuous presence frequently unrelated to influenza infection, being rapidly fatal even in previously healthy individuals.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814053/pdf/pone.0152640.pdf

February 25, 2017 at 1:26 pm

Severe adenovirus community-acquired pneumonia in immunocompetent adults: chest radiographic and CT findings.

J Thorac Dis. 2016 May;8(5):848-54.

Tan D1, Fu Y1, Xu J1, Wang Z1, Cao J1, Walline J1, Zhu H1, Yu X1.

Author information

11 Department of Emergency, 2 Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical sciences, Beijing 100730, China ; 3 Division of Emergency Medicine, Department of Surgery, Saint Louis University Hospital, Saint Louis, Missouri, USA.

Abstract

BACKGROUND:

Severe adenovirus pneumonia and its associated imaging features are well-described in immunocompromised patients but are rare and poorly understood in immunocompetent adults. We sought to describe the radiographic and CT findings of severe adenovirus community-acquired pneumonia (CAP) in eight immunocompetent adults.

METHODS:

We reviewed systematically chest imaging manifestations of laboratory-confirmed severe adenovirus pneumonia in eight immunocompetent adults from April 2012 to April 2014.

RESULTS:

All patients showed abnormal results on initial chest radiograph and CT, with the exception of one normal initial chest radiograph. The abnormalities of the initial chest radiographs were unilateral (n=4) or bilateral (n=3), including consolidation (n=4), dense patchy opacity (n=3), ground glass opacity (GGO) (n=1), and pleural effusion (n=1). The initial CT findings consisted of unilateral (n=5) and bilateral (n=3) abnormalities, including consolidation (n=8), GGO (n=2), pleural effusion (n=3) and small nodules (n=1). Focal consolidation was the predominant finding in six patients whose initial CT scans were examined within one week after illness onset. Follow-up radiologic findings showed rapid development of bilateral consolidation within ten days after illness onset, usually accompanied by adjacent ground-glass opacity and pleural effusion. The parenchymal abnormalities began to absorb around two weeks after illness onset, with no appearances of fibrosis.

CONCLUSIONS:

Severe adenovirus CAP in immunocompetent adults mainly appears as focal consolidation followed by rapid progression to bilateral consolidation, usually accompanied by adjacent GGO and pleural effusion, which may resemble bacterial pneumonia. Adenovirus should be considered in severe pneumonia cases with negative cultures and failure to respond to antibiotics.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4842832/pdf/jtd-08-05-848.pdf

February 25, 2017 at 1:25 pm

Clinical Features of Severe or Fatal Mycoplasma pneumoniae Pneumonia.

Front Microbiol. 2016 Jun 1;7:800.

Izumikawa K1.

Author information

1Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences Nagasaki, Japan.

Abstract

Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia in children and young adults.

The incidence of fulminant M. pneumoniae pneumonia (MPP) is relatively rare despite the high prevalence of M. pneumoniae infection.

This literature review highlights the clinical features of fulminant MPP by examining the most recent data in epidemiology, clinical presentation, pathogenesis, and treatment.

Fulminant MPP accounts for 0.5-2% of all MPP cases and primarily affects young adults with no underlying disease.

Key clinical findings include a cough, fever, and dyspnea along with diffuse abnormal findings in radiological examinations.

Levels of inflammatory markers such as white blood cells and C-reactive protein are elevated, as well as levels of lactate dehydrogenase, IL-18, aspartate transaminase, and alanine transaminase.

The exact pathogenesis of fulminant MPP remains unclear, but theories include a delayed hypersensitivity reaction to M. pneumoniae and the contribution of delayed antibiotic administration to disease progression.

Treatment options involve pairing the appropriate anti-mycoplasma agent with a corticosteroid that will downregulate the hypersensitivity response, and mortality rates are quite low in this treatment group. Further research is necessary to determine the exact pathogenesis of severe and fulminant types of MPP.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888638/pdf/fmicb-07-00800.pdf

February 25, 2017 at 1:24 pm

Predictive factors of true bacteremia and the clinical utility of blood cultures as a prognostic tool in patients with community-onset pneumonia.

Medicine (Baltimore). 2016 Oct;95(41):e5058.

Lee JH1, Kim YH.

Author information

1aDepartment of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju bDepartment of Pulmonary and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Korea.

Abstract

Although blood cultures (BCs) are an important component of diagnostic practice for antibiotic management in patients with pneumonia, several studies have questioned whether they should be performed.

The objective of this study was to evaluate the predictive factors of bacteremia and the role of BCs in patients with community-onset pneumonia (community-acquired pneumonia and healthcare-associated pneumonia).

This study was retrospectively conducted in patients with community-onset pneumonia who were hospitalized at Jeju National University Hospital between January 2012 and December 2014.

A true bacteremia (TB) group and a contaminants or negative bacteremia (CNB) group were classified according to the bacterial growth on the BC media and were investigated for the clinical relevance of the BCs.We enrolled 785 patients; the TB group and the CNB group contained 36 patients (4.5%) and 749 (95.4%) patients, respectively.

Only 10 patients (1.2%) required a change in antibiotic therapy based on the BC results (3 patients with an escalation, 7 with a de-escalation).

There was no significant difference between the community-acquired pneumonia and the healthcare-associated pneumonia groups with regard to the rate of antibiotic change due to the BC results (1.1% vs 1.4%; P = 0.751).

Chronic liver disease (odds ratio [OR] 2.973, 95% confidence interval [CI] 1.099-8.037), a confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB-65) score of 4 to 5 points (OR 3.484, 95% CI 1.304-9.307), and Pneumonia Severity Index (PSI) class V (OR 2.405, 95% CI 1.007-5.743) were independently associated with TB.

In patients with PSI class V and a CURB-65 score of 4 to 5 points, the TB group tended to show a higher inhospital mortality rate than the CNB group (50.0% vs 29.4%; P = 0.060, 60.0% vs 42.5%; P = 0.480).

The areas under the curve for PSI score and CURB-65 score for predicting TB revealed an increased tendency compared with that of C-reactive protein (0.72, 95% CI 0.630-0.809; and 0.72, 95% CI 0.622-0.819 vs 0.629, 95% CI 0.522-0.735, respectively).

It seemed reasonable to selectively conduct BC in patients hospitalized with severe community-onset pneumonia based upon its low overall positive rate, its effects on antimicrobial modification, and the associations of TB with the severity indices of pneumonia.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072946/pdf/medi-95-e5058.pdf

February 25, 2017 at 1:22 pm

Viral-bacterial coinfection affects the presentation and alters the prognosis of severe community-acquired pneumonia.

Crit Care. 2016 Oct 25;20(1):375.

Voiriot G1,2, Visseaux B3, Cohen J4, Nguyen LB5, Neuville M4, Morbieu C5, Burdet C5, Radjou A4, Lescure FX5, Smonig R4, Armand-Lefèvre L6, Mourvillier B4, Yazdanpanah Y5,7, Soubirou JF4, Ruckly S8, Houhou-Fidouh N3, Timsit JF4,7.

Author information

1Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France. guillaume.voiriot@aphp.fr

2Hôpital Bichat Claude Bernard, 46 rue Henri Huchard, Paris, 75018, France. guillaume.voiriot@aphp.fr

3Service de Virologie, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

4Service de Réanimation Médicale et Infectieuse, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

5Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

6Service de Microbiologie, Hôpital Bichat Claude Bernard, Hôpital Bichat Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France.

7Université Paris Diderot-Paris VII, Paris, France.

8Université de Grenoble 1, Center U823 Epidemioloy of Cancers and Severe Diseases, La Tronche, France.

Abstract

BACKGROUND:

Multiplex polymerase chain reaction (mPCR) enables recovery of viruses from airways of patients with community-acquired pneumonia (CAP), although their clinical impact remains uncertain.

METHODS:

Among consecutive adult patients who had undergone a mPCR within 72 hours following their admission to one intensive care unit (ICU), we retrospectively included those with a final diagnosis of CAP. Four etiology groups were clustered: bacterial, viral, mixed (viral-bacterial) and no etiology. A composite criterion of complicated course (hospital death or mechanical ventilation > 7 days) was used. A subgroup analysis compared patients with bacterial and viral-bacterial CAP matched on the bacterial pathogens.

RESULTS:

Among 174 patients (132 men [76 %], age 63 [53-75] years, SAPSII 38 [27;55], median PSI score 106 [78;130]), bacterial, viral, mixed and no etiology groups gathered 46 (26 %), 53 (31 %), 45 (26 %) and 30 (17 %) patients, respectively. Virus-infected patients displayed a high creatine kinase serum level, a low platelet count, and a trend toward more frequent alveolar-interstitial infiltrates. A complicated course was more frequent in the mixed group (31/45, 69 %), as compared to bacterial (18/46, 39 %), viral (15/53, 28 %) and no etiology (12/30, 40 %) groups (p < 0.01). In multivariate analysis, the mixed (viral-bacterial) infection was independently associated with complicated course (reference: bacterial pneumonia; OR, 3.58; CI 95 %, 1.16-11; p = 0.03). The subgroup analysis of bacteria-matched patients confirmed these findings.

CONCLUSIONS:

Viral-bacterial coinfection during severe CAP in adults is associated with an impaired presentation and a complicated course.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112669/pdf/13054_2016_Article_1517.pdf

February 25, 2017 at 1:20 pm

Severe community-acquired adenovirus pneumonia treated with oral ribavirin: a case report.

BMC Res Notes. 2017 Jan 18;10(1):47.

Yoon BW1, Song YG1, Lee SH2,3.

Author information

1Department of Internal Medicine, Hanil General Hospital, Seoul, Republic of Korea.

2Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea. humanmd04@hanmail.net

3Department of Pulmonary and Critical Care Medicine, Kyung Hee University School of Medicine, Kyungheedae-ro 23, Dongdaemun-gu, Seoul, 02447, Republic of Korea. humanmd04@hanmail.net

Abstract

BACKGROUND:

Adenovirus is a common pathogen of acute upper respiratory infection in children and is generally self-limiting. Severe adenovirus infections have been reported in immunocompromised hosts especially bone marrow transplantation recipients due to hematologic malignancy. Severe adenovirus pneumonia in immunocompetent hosts has rarely been reported and optimal treatment has not been established. We report a case of community-acquired severe adenovirus pneumonia which was successfully treated with early administration of oral ribavirin.

CASE PRESENTATION:

A 39 year-old, previously healthy Korean male was admitted with symptoms of cough, myalgia, febrile sensation. Laboratory findings revealed that he had hypoxemia, thrombocytopenia and elevated transaminase. Chest imaging showed a consolidation with pleural effusion, which was rapidly progressed. All microbiological tests were negative except multiplex real-time reverse transcriptase polymerase chain reaction using respiratory specimen, which was positive for human adenovirus. Under the diagnosis of severe adenovirus pneumonia, we started oral ribavirin, which results in complete recovery without any complications.

CONCLUSIONS:

This case demonstrates that oral ribavirin, instead of other expensive antiviral treatment, could be a good therapeutic option for the severe adenovirus pneumonia at least occurred in immunocompetent hosts.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241922/pdf/13104_2016_Article_2370.pdf

February 25, 2017 at 1:19 pm


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