Posts filed under ‘Infecciones respiratorias’

Antibiotic prescription strategies and adverse outcome for uncomplicated lower respiratory tract infections: Prospective cough complication cohort (3C) study.

BMJ May 22, 2017 V.357 P.j2148.   

Little P et al.


June 18, 2017 at 7:04 pm

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary.

Am J Respir Crit Care Med. 2017 Mar 1;195(5):557-582.

Vogelmeier CF1, Criner GJ2, Martinez FJ3, Anzueto A4,5, Barnes PJ6, Bourbeau J7, Celli BR8, Chen R9, Decramer M10, Fabbri LM11, Frith P12, Halpin DM13, López Varela MV14, Nishimura M15, Roche N16, Rodriguez-Roisin R17, Sin DD18, Singh D19, Stockley R20, Vestbo J19, Wedzicha JA6, Agustí A21.

Author information

1 1 University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany.

2 2 Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.

3 3 New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York.

4 4 University of Texas Health Science Center, San Antonio, Texas.

5 5 South Texas Veterans Health Care System, San Antonio, Texas.

6 6 National Heart and Lung Institute, Imperial College, London, United Kingdom.

7 7 McGill University Health Centre, McGill University, Montreal, Quebec, Canada.

8 8 Brigham and Women’s Hospital, Boston, Massachusetts.

9 9 State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

10 10 University of Leuven, Leuven, Belgium.

11 11 University of Modena and Reggio Emilia, Modena, Italy.

12 12 Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia.

13 13 Royal Devon and Exeter Hospital, Exeter, United Kingdom.

14 14 Universidad de la República, Hospital Maciel, Montevideo, Uruguay.

15 15 Hokkaido University School of Medicine, Sapporo, Japan.

16 16 Hôpital Cochin (Assistance Publique-Hôpitaux de Paris), University Paris Descartes, Paris, France.

17 17 Thorax Institute, Hospital Clinic Universitat de Barcelona, Barcelona, Spain.

18 18 St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada.

19 19 University of Manchester, Manchester, United Kingdom.

20 20 University Hospital, Birmingham, United Kingdom; and.

21 21 Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedade Respiratorias, Barcelona, Spain.


This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include:

(1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations;

(2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed;

(3) the concept of deescalation of therapy is introduced in the treatment assessment scheme;

(4) nonpharmacologic therapies are comprehensively presented; and

(5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.


June 18, 2017 at 4:18 pm

Two Cases of Legionnaires’ Disease in Newborns After Water Births — Arizona, 2016

Morbidity and Mortality Weekly Report June 9, 2017 / 66(22);590–591

Geoffrey Granseth, MPH1,2; Rachana Bhattarai, MS1; Tammy Sylvester, MSN3; Siru Prasai, MD3; Eugene Livar, MD1

1Arizona Department of Health Services; 2CDC/CSTE Applied Epidemiology Fellowship Program; 3Maricopa County Department of Public Health, Arizona.

Legionnaires’ disease is a severe, sometimes fatal disease characterized by fever, myalgia, cough, and clinical or radiographic pneumonia, caused by inhaling or aspirating small droplets of water containing Legionella bacteria.* In 2015, approximately 6,000 cases of Legionnaires’ disease were reported in the United States (1). Nearly 10% of cases are fatal (2). The number of reported cases of Legionnaires’ disease in Arizona has increased in recent years. Surveillance data from Arizona’s Medical Electronic Disease Surveillance Intelligence System (MEDSIS) identified 46 reported cases in 2011 and 93 in 2015 (3), representing more than a 100% increase. During 2011–2015, only one case was reported in an infant aged <1 month; however, during the first 4 months of 2016, two cases were reported in infants, both of whom were delivered at home in a birthing tub (water births)…..



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June 12, 2017 at 7:54 am

Association of C-Reactive Protein With Bacterial and Respiratory Syncytial Virus–Associated Pneumonia Among Children Aged <5 Years in the PERCH Study

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Melissa M. Higdon; Tham Le; Katherine L. O’Brien; David R. Murdoch; Christine Prosperi …


Lack of a gold standard for identifying bacterial and viral etiologies of pneumonia has limited evaluation of C-reactive protein (CRP) for identifying bacterial pneumonia. We evaluated the sensitivity and specificity of CRP for identifying bacterial vs respiratory syncytial virus (RSV) pneumonia in the Pneumonia Etiology Research for Child Health (PERCH) multicenter case-control study.


We measured serum CRP levels in cases with World Health Organization–defined severe or very severe pneumonia and a subset of community controls. We evaluated the sensitivity and specificity of elevated CRP for “confirmed” bacterial pneumonia (positive blood culture or positive lung aspirate or pleural fluid culture or polymerase chain reaction [PCR]) compared to “RSV pneumonia” (nasopharyngeal/oropharyngeal or induced sputum PCR-positive without confirmed/suspected bacterial pneumonia). Receiver operating characteristic (ROC) curves were constructed to assess the performance of elevated CRP in distinguishing these cases.


Among 601 human immunodeficiency virus (HIV)–negative tested controls, 3% had CRP ≥40 mg/L. Among 119 HIV-negative cases with confirmed bacterial pneumonia, 77% had CRP ≥40 mg/L compared with 17% of 556 RSV pneumonia cases. The ROC analysis produced an area under the curve of 0.87, indicating very good discrimination; a cut-point of 37.1 mg/L best discriminated confirmed bacterial pneumonia (sensitivity 77%) from RSV pneumonia (specificity 82%). CRP ≥100 mg/L substantially improved specificity over CRP ≥40 mg/L, though at a loss to sensitivity.


Elevated CRP was positively associated with confirmed bacterial pneumonia and negatively associated with RSV pneumonia in PERCH. CRP may be useful for distinguishing bacterial from RSV-associated pneumonia, although its role in discriminating against other respiratory viral-associated pneumonia needs further study.


June 3, 2017 at 2:37 pm

The Effect of Antibiotic Exposure and Specimen Volume on the Detection of Bacterial Pathogens in Children With Pneumonia

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Amanda J. Driscoll; Maria Deloria Knoll; Laura L. Hammitt; Henry C. Baggett; W. Abdullah Brooks …


Antibiotic exposure and specimen volume are known to affect pathogen detection by culture. Here we assess their effects on bacterial pathogen detection by both culture and polymerase chain reaction (PCR) in children.


PERCH (Pneumonia Etiology Research for Child Health) is a case-control study of pneumonia in children aged 1–59 months investigating pathogens in blood, nasopharyngeal/oropharyngeal (NP/OP) swabs, and induced sputum by culture and PCR. Antibiotic exposure was ascertained by serum bioassay, and for cases, by a record of antibiotic treatment prior to specimen collection. Inoculated blood culture bottles were weighed to estimate volume.


Antibiotic exposure ranged by specimen type from 43.5% to 81.7% in 4223 cases and was detected in 2.3% of 4863 controls. Antibiotics were associated with a 45% reduction in blood culture yield and approximately 20% reduction in yield from induced sputum culture. Reduction in yield of Streptococcus pneumoniae from NP culture was approximately 30% in cases and approximately 32% in controls. Several bacteria had significant but marginal reductions (by 5%–7%) in detection by PCR in NP/OP swabs from both cases and controls, with the exception of S. pneumoniae in exposed controls, which was detected 25% less frequently compared to nonexposed controls. Bacterial detection in induced sputum by PCR decreased 7% for exposed compared to nonexposed cases. For every additional 1 mL of blood culture specimen collected, microbial yield increased 0.51% (95% confidence interval, 0.47%–0.54%), from 2% when volume was ≤1 mL to approximately 6% for ≥3 mL.


Antibiotic exposure and blood culture volume affect detection of bacterial pathogens in children with pneumonia and should be accounted for in studies of etiology and in clinical management.


June 3, 2017 at 2:36 pm

Evaluation of Pneumococcal Load in Blood by Polymerase Chain Reaction for the Diagnosis of Pneumococcal Pneumonia in Young Children in the PERCH Study

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Maria Deloria Knoll; Susan C. Morpeth; J. Anthony G. Scott; Nora L. Watson; Daniel E. Park …


Detection of pneumococcus by lytA polymerase chain reaction (PCR) in blood had poor diagnostic accuracy for diagnosing pneumococcal pneumonia in children in 9 African and Asian sites. We assessed the value of blood lytA quantification in diagnosing pneumococcal pneumonia.


The Pneumonia Etiology Research for Child Health (PERCH) case-control study tested whole blood by PCR for pneumococcus in children aged 1–59 months hospitalized with signs of pneumonia and in age–frequency matched community controls. The distribution of load among PCR-positive participants was compared between microbiologically confirmed pneumococcal pneumonia (MCPP) cases, cases confirmed for nonpneumococcal pathogens, nonconfirmed cases, and controls. Receiver operating characteristic analyses determined the “optimal threshold” that distinguished MCPP cases from controls.


Load was available for 290 of 291 cases with pneumococcal PCR detected in blood and 273 of 273 controls. Load was higher in MCPP cases than controls (median, 4.0 × 103 vs 0.19 × 103 copies/mL), but overlapped substantially (range, 0.16–989.9 × 103 copies/mL and 0.01–551.9 × 103 copies/mL, respectively). The proportion with high load (≥2.2 log10 copies/mL) was 62.5% among MCPP cases, 4.3% among nonconfirmed cases, 9.3% among cases confirmed for a nonpneumococcal pathogen, and 3.1% among controls. Pneumococcal load in blood was not associated with respiratory tract illness in controls (P = .32). High blood pneumococcal load was associated with alveolar consolidation on chest radiograph in nonconfirmed cases, and with high (>6.9 log10 copies/mL) nasopharyngeal/oropharyngeal load and C-reactive protein ≥40 mg/L (both P < .01) in nonconfirmed cases but not controls.


Quantitative pneumococcal PCR in blood has limited diagnostic utility for identifying pneumococcal pneumonia in individual children, but may be informative in epidemiological studies.



June 3, 2017 at 2:35 pm

Detection of Pneumococcal DNA in Blood by Polymerase Chain Reaction for Diagnosing Pneumococcal Pneumonia in Young Children From Low- and Middle-Income Countries

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

Susan C. Morpeth; Maria Deloria Knoll; J. Anthony G. Scott; Daniel E. Park; Nora L. Watson …


We investigated the performance of polymerase chain reaction (PCR) on blood in the diagnosis of pneumococcal pneumonia among children from 7 low- and middle-income countries.


We tested blood by PCR for the pneumococcal autolysin gene in children aged 1–59 months in the Pneumonia Etiology Research for Child Health (PERCH) study. Children had World Health Organization–defined severe or very severe pneumonia or were age-frequency–matched community controls. Additionally, we tested blood from general pediatric admissions in Kilifi, Kenya, a PERCH site. The proportion PCR-positive was compared among cases with microbiologically confirmed pneumococcal pneumonia (MCPP), cases without a confirmed bacterial infection (nonconfirmed), cases confirmed for nonpneumococcal bacteria, and controls.


In PERCH, 7.3% (n = 291/3995) of cases and 5.5% (n = 273/4987) of controls were blood pneumococcal PCR-positive (P < .001), compared with 64.3% (n = 36/56) of MCPP cases and 6.3% (n = 243/3832) of nonconfirmed cases (P < .001). Blood pneumococcal PCR positivity was higher in children from the 5 African countries (5.5%–11.5% among cases and 5.3%–10.2% among controls) than from the 2 Asian countries (1.3% and 1.0% among cases and 0.8% and 0.8% among controls). Among Kilifi general pediatric admissions, 3.9% (n = 274/6968) were PCR-positive, including 61.7% (n = 37/60) of those with positive blood cultures for pneumococcus.


The utility of pneumococcal PCR on blood for diagnosing childhood pneumococcal pneumonia in the 7 low- and middle-income countries studied is limited by poor specificity and by poor sensitivity among MCPP cases.



June 3, 2017 at 2:34 pm

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