Posts filed under ‘Infecciones respiratorias’

Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study.

European Respiratory Journal November 22, 2017 V.50 N.5   

Moore M1, Stuart B2, Little P2, Smith S3, Thompson MJ4, Knox K3, van den Bruel A3, Lown M2, Mant D3.

Author information

1 University of Southampton, Primary Care Medical Group, Aldermoor Health Centre, Southampton, UK mvm198@soton.ac.uk

2 University of Southampton, Primary Care Medical Group, Aldermoor Health Centre, Southampton, UK.

3 Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.

4 Dept of Family Medicine, University of Washington, Seattle, WA, USA.

Abstract

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009-13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5-4.8), crackles on auscultation (RR 1.8; 1.1-3.0), oxygen saturation <95% (RR 1.7; 1.0-3.1) and pulse >100·min-1 (RR 1.9; 1.1-3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3-23.1).In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5724402/pdf/ERJ-00434-2017.pdf

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January 16, 2018 at 11:01 am

lytA Quantitative PCR on Sputum and Nasopharyngeal Swab Samples for Detection of Pneumococcal Pneumonia among the Elderly

Journal of Clinical Microbiology January 2018 V.56 N.1

Annika Saukkoriipi, Arto A. Palmu, Thierry Pascal, Vincent Verlant, William P. Hausdorff and Jukka Jokinen

aDepartment of Public Health Solutions, National Institute for Health and Welfare, Oulu, Finland

bDepartment of Public Health Solutions, National Institute for Health and Welfare, Tampere, Finland

cGSK, Wavre, Belgium

dDepartment of Public Health Solutions, National Institute for Health and Welfare, Helsinki, Finland

Real-time quantitative PCR (qPCR) assay of sputum or nasopharyngeal specimens has shown promising results in the detection of pneumococcal community-acquired pneumonia (PncCAP). We applied qPCR for the autolysin gene (lytA) and compared sputum and nasopharyngeal swab (NPS) pneumococcal loads in elderly patients with community-acquired pneumonia (CAP), and specifically in patients with PncCAP, to those in patient groups with other respiratory diseases. We studied patients aged ≥65 years with radiologically confirmed CAP, clinical CAP not retrospectively radiologically confirmed, other acute respiratory infections, or stable chronic lung disease. Pneumococcal etiology of CAP was ascertained by using a combination of multiple diagnostic methods. We analyzed sputum and NPS specimens by lytA qPCR with 104 pneumococcal genome equivalents (GE)/ml as a cutoff for positivity. Among PncCAP patients, lytA qPCR detected pneumococci in 94% of the sputum samples and in large quantities (mean, 6.82 ± 1.02 log10 GE/ml) but less frequently in NPS (44%) and in smaller quantities (5.55 ± 0.92 log10 GE/ml). In all other patient groups, ≤10% of the sputum samples and <5% of the NPS samples were lytA qPCR positive; but when they were positive, the sputum pneumococcal loads were similar to those in the PncCAP patients, suggesting a pneumococcal etiology in these patients. This was supported by other pneumococcal assay results. Overall, sputum lytA qPCR positivity was more common in PncCAP patients than in the other patient groups, but the quantitative results were mainly similar. NPS lytA qPCR was less sensitive than sputum lytA qPCR in detecting PncCAP.

PDF

http://jcm.asm.org/content/56/1/e01231-17.full.pdf+html

January 5, 2018 at 8:20 am

Predictors of pneumonia in lower respiratory tract infections – 3C prospective cough complication cohort study.

European Respiratory Journal ERJ  November 2017 V.50 N.5

Michael Moore1, Beth Stuart 1, Paul Little1, Sue Smith2, Matthew J. Thompson3, Kyle Knox2, Anne van den Bruel2, Mark Lown1 and David Mant2

Affiliations:

1 University of Southampton, Primary Care Medical Group, Aldermoor Health Centre, Southampton, UK.

2 Nuffield Department of Primary Health Care Sciences, University of Oxford, Oxford, UK.

3 Dept of Family Medicine, University of Washington, Seattle, WA, USA.

Correspondence: Michael Moore, University of Southamptom K. E-mail: mvm198@soton.ac.uk

ABSTRACT

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care. A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13. Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review. The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis. The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2). Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270). Pulse oximetry may aid the diagnosis of pneumonia in this setting.

FULL TEXT

http://erj.ersjournals.com/content/50/5/1700434?etoc

PDF

http://erj.ersjournals.com/content/erj/50/5/1700434.full.pdf

December 7, 2017 at 8:34 am

Predictors of pneumonia in lower respiratory tract infections: 3C prospective cough complication cohort study

European Respiratory Journal  November 22, 2017        

Michael Moore, Beth Stuart, Paul Little, Sue Smith, Matthew J. Thompson, Kyle Knox, Anne van den Bruel, Mark Lown, David Mant

Abstract

The aim was to aid diagnosis of pneumonia in those presenting with lower respiratory tract symptoms in routine primary care.

A cohort of 28 883 adult patients with acute cough attributed to lower respiratory tract infections (LRTIs) was recruited from 5222 UK practices in 2009–13.

Symptoms, signs and treatment were recorded at presentation and subsequent events followed-up for 30 days by chart review.

The predictive value of patient characteristics, presenting symptoms and clinical findings for the diagnosis of pneumonia in the first 7 days was established.

Of the 720 out of 28 883 (2.5.%) radiographed within 1 week of the index consultation, 115 (16.0%; 0.40% of 28 883) were assigned a definite or probable pneumonia diagnosis.

The significant independent predictors of radiograph-confirmed pneumonia were temperature >37.8°C (RR 2.6; 95% CI 1.5–4.8), crackles on auscultation (RR 1.8; 1.1–3.0), oxygen saturation <95% (RR 1.7; 1.0–3.1) and pulse >100·min–1 (RR 1.9; 1.1–3.2).

Most patients with pneumonia (99/115, 86.1%) exhibited at least one of these four clinical signs; the positive predictive value of having at least one of these signs was 20.2% (95% CI 17.3–23.1).

In routine practice, radiograph-confirmed pneumonia as a short-term complication of LRTI is very uncommon (one in 270).

Pulse oximetry may aid the diagnosis of pneumonia in this setting.

FULL TEXT

http://erj.ersjournals.com/content/50/5/1700434

PDF

http://erj.ersjournals.com/content/erj/50/5/1700434.full.pdf

 

December 2, 2017 at 8:37 am

Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality

Clinical Infectious Diseases December 2017 V.65 N.11

EDITOR’S CHOICE

Julio A Ramirez; Timothy L Wiemken; Paula Peyrani; Forest W Arnold; Robert Kelley

Abstract

Background

Understanding the burden of community-acquired pneumonia (CAP) is critical to allocate resources for prevention, management, and research. The objectives of this study were to define incidence, epidemiology, and mortality of adult patients hospitalized with CAP in the city of Louisville, and to estimate burden of CAP in the US adult population.

Methods

This was a prospective population-based cohort study of adult residents in Louisville, Kentucky, from 1 June 2014 to 31 May 2016. Consecutive hospitalized patients with CAP were enrolled at all adult hospitals in Louisville. The annual population-based CAP incidence was calculated. Geospatial epidemiology was used to define ecological associations among CAP and income level, race, and age. Mortality was evaluated during hospitalization and at 30 days, 6 months, and 1 year after hospitalization.

Results

During the 2-year study, from a Louisville population of 587499 adults, 186384 hospitalizations occurred. A total of 7449 unique patients hospitalized with CAP were documented. The annual age-adjusted incidence was 649 patients hospitalized with CAP per 100000 adults (95% confidence interval, 628.2–669.8), corresponding to 1591825 annual adult CAP hospitalizations in the United States. Clusters of CAP cases were found in areas with low-income and black/African American populations. Mortality during hospitalization was 6.5%, corresponding to 102821 annual deaths in the United States. Mortality at 30 days, 6 months, and 1 year was 13.0%, 23.4%, and 30.6%, respectively.

Conclusions

The estimated US burden of CAP is substantial, with >1.5 million unique adults being hospitalized annually, 100000 deaths occurring during hospitalization, and approximately 1 of 3 patients hospitalized with CAP dying within 1 year.

PDF (CLIC en PDF)

https://academic.oup.com/cid/article/65/11/1806/4049508

November 29, 2017 at 8:20 am

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia: Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT).

Eur Respir J. September 10, 2017 V.50 N.3.

Torres A1,2, Niederman MS3,2, Chastre J4, Ewig S5, Fernandez-Vandellos P6, Hanberger H7, Kollef M8, Li Bassi G9, Luna CM10, Martin-Loeches I11, Paiva JA12, Read RC13, Rigau D14, Timsit JF15, Welte T16, Wunderink R17.

Author information

1 Dept of Pulmonology, Hospital Clínic de Barcelona, Universitat de Barcelona and IDIBAPS, CIBERES, Barcelona, Spain atorres@ub.edu

2 These two authors contributed equally to this work.

3 Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA.

4 Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.

5 CAPNETZ Stiftung and Thorax Centre in the Ruhr Area, Dept of Respiratory Medicine and Infectious Diseases, Evangelic Hospital in Herne and Augusta Hospital in Bochum, Bochum, Germany.

6 IDIBAPS, CIBERES, Barcelona, Spain.

7 Dept of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.

8 Pulmonary and Critical Care Division, Washington University School of Medicine, St Louis, MO, USA.

9 Dept of Pulmonology, Hospital Clínic de Barcelona, Universitat de Barcelona and IDIBAPS, CIBERES, Barcelona, Spain.

10 Hospital de Clínicas “José de San Martin”, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina.

11 Dept of Clinical Medicine, Wellcome Trust – HRB Clinical Research Facility, St James’s Hospital, Trinity College, Dublin, Ireland and CIBERES, Barcelona, Spain.

12 Emergency and Intensive Care Dept, Centro Hospitalar São João EPE and Dept of Medicine, University of Porto Medical School, Porto, Portugal.

13 Academic Unit of Clinical Experimental Sciences and NIHR Southampton Biomedical Research Unit, Faculty of Medicine, and Institute for Life Sciences, University of Southampton, Southampton, UK.

14 Iberoamerican Cochrane Centre, Barcelona, Spain.

15 IAME, INSERM UMR 1137, Medical and Infectious Diseases Intensive Care Unit, Paris Diderot University and Bichat Hospital, Paris, France.

16 Dept of Respiratory Medicine, Medizinische Hoschschule Hannover, Hannover and German Centre of Lung Research (DZL), Germany.

17 Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Abstract

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago.

Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms.

In addition, important differences between approaches in Europe and the USA have become apparent.

The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP.

Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives.

The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).

Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.

FULL TEXT

http://erj.ersjournals.com/content/50/3/1700582.long

PDF

http://erj.ersjournals.com/content/erj/50/3/1700582.full.pdf

November 22, 2017 at 12:00 pm

Fiebre de origen desconocido en pacientes HIV positivos

ANALES DE MEDICINA INTERNA (Madrid), 2001 V.18 N.4 P.181-186

BARBA, J. GÓMEZ-RODRIGO, J. MARCO, P. RONDÓN, G. EROLES,

LÓPEZ-VARAS, R. TORRES

Departamento de Medicina Interna y Enfermedades Infecciosas. Hospital Severo Ochoa.

Leganés. Madrid

RESUMEN

Objetivos

Describir la presentación clínica y la utilidad de los de tests diagnósticos habitualmente recomendados en el estudio de la fiebre de origen desconocido (FOD) en los pacientes VIH positivos.

Pacientes y métodos

Incluimos en el estudio a los 54 pacientes con infección por el VIH que ingresaron en nuestro Hospital por FOD durante un periodo de 23 meses. La FOD fue definida de acuerdo con los criterios modificados de Petersdorf´s.

Resultados

La causa de la fiebre se identificó en 48 casos (89%). La tuberculosis, la micobacteriosis atípica y la leishmaniasis pueden explicar el 68% de los casos. El aspirado de médula ósea, la punción aspiración o la biopsia de los ganglios linfáticos y los cultivos para micobacterias fueron las pruebas diagnósticas más rentables.

Conclusiones

La infección por micobacterias debe ser el primer diagnóstico de sospecha en los pacientes VIH positivos con FOD. Es posible precedir el diagnóstico de tuberculosis con una alta precisión (90,5%) con un modelo de regresión logística basado en datos clínicos y analíticos fácilmente obtenibles.

PDF

http://scielo.isciii.es/pdf/ami/v18n4/original2.pdf

November 21, 2017 at 8:41 am

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