PNEUMONIA

Selected abstracts:

1.         Blasi F, Aliberti S, Pappalettera M, Tarsia P. 100 years of respiratory medicine: pneumonia. Respir Med. 2007 May;101(5):875-81. 

Istituto di Tisiologia e Malattie dell'Apparato Respiratorio, University of Milan, Ospedale Maggiore Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, Via F. Sforza 35, Milan 20122, Italy. francesco.blasi@unimi.it

In this review, we aim to lead the readers through the historical highlights of pathophysiological concepts and treatment of pneumonia. Understanding the aetiology, the risk factors and the pathophysiology influenced our management approaches to pneumonia. Pneumonia is still associated with significant morbidity and mortality, presents in a variety of healthcare settings and imposes a considerable cost to healthcare services. Guidelines have been issued by international and national scientific societies in order to spread the scientific knowledge on this important disease and to improve its management.

2.         Feldman C. Prognostic scoring systems: which one is best? Curr Opin Infect Dis. 2007 Apr;20(2):165-9. Review. 

Division of Pulmonology, Department of Medicine, Johannesburg Hospital and University of the Witwatersrand, Johannesburg, South Africa. feldmanc@medicine.wits.ac.za

PURPOSE OF REVIEW: In the initial evaluation of patients with community-acquired pneumonia, a number of important assessments are made, including that of the severity of the illness. This assessment will determine the appropriate site of care, diagnostic work-up, and choice of empiric antibiotics. A number of severity assessment tools have been developed and some of the recent findings are reviewed. RECENT FINDINGS: A number of studies of the efficacy of the individual scoring systems, as well as comparator studies, have been undertaken. A significant number of patients with community-acquired pneumonia in Pneumonia Severity Index classes I and II are admitted to hospital and several of these patients suffer complications. Clinical and social factors other than those contained in the scoring systems need to be taken into consideration when deciding about hospitalization of patients with community-acquired pneumonia. A number of studies of the efficacy of the various scoring systems in predicting 'severe pneumonia' have been undertaken, as well as studies of their accuracy in the sub-set of patients with pneumococcal infections and in the elderly. SUMMARY: The various scoring systems have reasonable sensitivity and specificity and their own strengths and weaknesses, but should always be used in association with good clinical judgment.

3.         Kass SM, Williams PM, Reamy BV. Pleurisy. Am Fam Physician. 2007 May 1;75(9):1357-64. Review. 

Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA. smkass@us.med.navy.mil

Pleuritic chest pain is a common presenting symptom and has many causes, which range from life-threatening to benign, self-limited conditions. Pulmonary embolism is the most common potentially life-threatening cause, found in 5 to 20 percent of patients who present to the emergency department with pleuritic pain. Other clinically significant conditions that may cause pleuritic pain include pericarditis, pneumonia, myocardial infarction, and pneumothorax. Patients should be evaluated appropriately for these conditions before an alternative diagnosis is made. History, physical examination, and chest radiography are recommended for all patients with pleuritic chest pain. Electrocardiography is helpful, especially if there is clinical suspicion of myocardial infarction, pulmonary embolism, or pericarditis. When these other significant causes of pleuritic pain have been excluded, the diagnosis of pleurisy can be made. There are numerous causes of pleurisy, with viral pleurisy among the most common. Other etiologies may be evaluated through additional diagnostic testing in selected patients. Treatment of pleurisy typically consists of pain management with nonsteroidal anti-inflammatory drugs, as well as specific treatments targeted at the underlying cause.

4.         Klompas M. Does this patient have ventilator-associated pneumonia? JAMA. 2007 Apr 11;297(14):1583-93. Review. 

Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA. mklompas@partners.org

CONTEXT: Ventilator-associated pneumonia (VAP) is a common and serious nosocomial infection. Accurate, timely diagnosis enables affected patients to receive appropriate therapy and avoids mistreatment of patients having other conditions. OBJECTIVE: To review the published medical literature describing the precision and accuracy of clinical, radiographic, and laboratory data to diagnose bacterial VAP relative to a histological gold standard. DATA SOURCES: English-language articles identified by a structured search strategy using MEDLINE (January 1966-October 31, 2006) and Google Scholar. Additional articles were identified through the reference lists of studies and review papers identified by the search strategy. STUDY SELECTION: Included studies described clinical findings associated with VAP in 25 or more patients receiving mechanical ventilation who subsequently underwent pulmonary biopsy or autopsy. Fourteen studies describing clinical findings in 655 patients met inclusion criteria. DATA EXTRACTION: Data were abstracted onto a structured form, allowing calculation of the likelihood ratios (LRs) for each sign or combination of findings. DATA SYNTHESIS: The presence or absence of fever, abnormal white blood cell count, or purulent pulmonary secretions do not substantively alter the probability of VAP. However, the combination of a new radiographic infiltrate with at least 2 of fever, leukocytosis, or purulent sputum increases the likelihood of VAP (summary LR, 2.8; 95% confidence interval, 0.97-7.9). The absence of a new infiltrate on a plain chest radiograph lowers the likelihood of VAP (summary LR, 0.35; 95% confidence interval, 0.14-0.87). Fewer than 50% neutrophils on cell count analysis of lower pulmonary secretions makes VAP unlikely (LR range, 0.05-0.10). CONCLUSIONS: Routine bedside evaluation coupled with radiographic information provides suggestive but not definitive evidence that VAP is present or absent. Given the severity of VAP and the frequency of serious conditions that can mimic VAP, clinicians should be ready to consider additional tests that provide further evidence for VAP or that establish another diagnosis.

5.        Thomas CF Jr, Limper AH. Current insights into the biology and pathogenesis of Pneumocystis pneumonia. Nat Rev Microbiol. 2007 Apr;5(4):298-308. Review.

Thoracic Diseases Research Unit, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Rochester, Minnesota 55905, USA. thomas.charles@mayo.edu

The fungal infection Pneumocystis pneumonia is the most prevalent opportunistic infection in patients with AIDS. Although the analysis of this opportunistic fungal pathogen has been hindered by the inability to isolate it in pure culture, the use of molecular techniques and genomic analysis have brought insights into its complex cell biology. Analysis of the intricate relationship between Pneumocystis and the host lung during infection has revealed that the attachment of Pneumocystis to the alveolar epithelium promotes the transition of the organism from the trophic to the cyst form. It also revealed that Pneumocystis infection elicits the production of inflammatory mediators, culminating in lung injury and impaired gas exchange. Here we discuss these and other recent findings relating to the biology and pathogenesis of this intractable fungus.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

16498.   Atkinson M, Yanney M, Stephenson T, Smyth A. Effective treatment strategies for paediatric community-acquired pneumonia. Expert Opin Pharmacother. 2007 Jun;8(8):1091-101. Review.

16499.   Beers SL, Abramo TJ. Pleural effusions. Pediatr Emerg Care. 2007 May;23(5):330-4; quiz 335-8. Review.

16500.  Bhatt P, Halasa N. Increasing rates of infants hospitalized with pertussis. Tenn Med. 2007 May;100(5):37-9, 42. 

16501.  Boots RJ, Phillips GE, George N, Faoagali JL. Use of elastin fibres detected in non-directed low volume bronchial lavage in ventilated ICU patients. Anaesth Intensive Care. 2007 Apr;35(2):189-93. 

16502.  Calderon EJ, Rivero L, Respaldiza N, Morilla R, Montes-Cano MA, Friaza V, Munoz-Lobato F, Varela JM, Medrano FJ, Horra Cde L. Systemic inflammation in patients with chronic obstructive pulmonary disease who are colonized with Pneumocystis jiroveci. Clin Infect Dis. 2007 Jul 15;45(2):e17-9.

16503. Chan MC, Chang KM, Chao WC, Lin LY, Kuo BI, Hsu JY, Wu CL. Evaluation of a new inflammatory molecule (triggering receptor expressed on myeloid cells-1) in the diagnosis of pleural effusion. Respirology. 2007 May;12(3):333-8.

16504.   Dickinson KJ, Parry DJ, Sandoe JA, Gough MJ. Multiple peripheral pneumococcal mycotic aneurysms without aortic involvement: a unique case confirmed with the novel use of a molecular diagnostic technique. J Vasc Surg. 2007 Jun;45(6):1253-5.

16505.  Diederen BM, Peeters MF. Rapid diagnosis of pneumococcal pneumonia in adults using the Binax NOW Streptococcus pneumoniae urinary antigen test. Int J Infect Dis. 2007 May;11(3):284-5. 

16506.  Dolhnikoff M, Mauad T, Bethlem EP, Carvalho CR. Leptospiral pneumonias. Curr Opin Pulm Med. 2007 May;13(3):230-5. Review.

16507.   Falsey AR. Respiratory syncytial virus infection in adults. Semin Respir Crit Care Med. 2007 Apr;28(2):171-81. Review.

16508.   Fox BD, Shechtman I, Shitrit D, Bendayan D, Kramer MR. A "fat chance" it's malignant: lipoid pneumonia simulating lung cancer on PET scan. Thorax. 2007 May;62(5):464.  

16509.   Fujisawa T, Suda T, Matsuura S, Enomoto N, Takeshita K, Ohnishi K, Chida K. Peripheral T-cell lymphoma with diffuse pulmonary infiltration and an increase in serum KL-6 level. Respirology. 2007 May;12(3):452-4.

16510.   Hammond S, Chenever E, Durbin JE. Respiratory virus infection in infants and children. Pediatr Dev Pathol. 2007 May-Jun;10(3):172-80. Review. 

16511.   Haranaga S, Tateyama M, Higa F, Miyagi K, Akamine M, Azuma M, Yara S, Koide M, Fujita J. Intravenous ciprofloxacin versus erythromycin in the treatment of Legionella pneumonia. Intern Med. 2007;46(7):353-7.

16512.   Hartman TE, Jensen E, Tazelaar HD, Hanak V, Ryu JH. CT findings of granulomatous pneumonitis secondary to Mycobacterium avium-intracellulare inhalation: "hot tub lung". AJR Am J Roentgenol. 2007 Apr;188(4):1050-3.

16513.  Kiropoulos TS, Kostikas K, Oikonomidi S, Tsilioni I, Nikoulis D, Germenis A, Gourgoulianis KI. Acute phase markers for the differentiation of infectious and malignant pleural effusions. Respir Med. 2007 May;101(5):910-8.

16514.   Laskaj R, Slavica D, Cepelak I, Kuzman I. Gamma-glutamyltransferase activity and total antioxidant status in serum and platelets of patients with community-acquired pneumonia. Arch Med Res. 2007 May;38(4):424-31. 

16515.   Mitchell B. A background and critical analysis of the treatment of pneumocystis carinii pneumonia (PCP) in HIV/AIDS. Aust Nurs J. 2007 Apr;14(9):20-3. Review.

16516.   Mitka M. JCAHO tweaks emergency departments' pneumonia treatment standards. JAMA. 2007 Apr 25;297(16):1758-9.

16517.   Mueller-Mang C, Grosse C, Schmid K, Stiebellehner L, Bankier AA. What every radiologist should know about idiopathic interstitial pneumonias. Radiographics. 2007 May-Jun;27(3):595-615. Review.

16518.   O'Malley AS, Pham HH, Schrag D, Wu B, Bach PB. Potentially avoidable hospitalizations for COPD and pneumonia: the role of physician and practice characteristics. Med Care. 2007 Jun;45(6):562-70.

16519.   Resch B, Gusenleitner W, Mueller WD. Risk of concurrent bacterial infection in preterm infants hospitalized due to respiratory syncytial virus infection. Acta Paediatr. 2007 Apr;96(4):495-8.

16520.   Rizzi EB, Schinina V, Gentile FP, Bibbolino C. Reduced computed tomography radiation dose in HIV-related pneumonia: effect on diagnostic image quality. Clin Imaging. 2007 May-Jun;31(3):178-84. 

16521.   Rolla G, Guida G, Heffler E, Badiu I, Bommarito L, De Stefani A, Usai A, Cosseddu D, Nebiolo F, Bucca C. Diagnostic classification of persistent rhinitis and its relationship to exhaled nitric oxide and asthma: a clinical study of a consecutive series of patients. Chest. 2007 May;131(5):1345-52.

16522.   Scrimini S, Junemann A, Luna CM. Community acquired pneumonia in the tropics. Curr Opin Pulm Med. 2007 May;13(3):170-6. Review.

16523.   Shigemitsu H, Afshar K. Aspiration pneumonias: under-diagnosed and under-treated. Curr Opin Pulm Med. 2007 May;13(3):192-8. Review.

16524.   Tasaka S, Hasegawa N, Kobayashi S, Yamada W, Nishimura T, Takeuchi T, Ishizaka A.  Serum indicators for the diagnosis of pneumocystis pneumonia. Chest. 2007 Apr;131(4):1173-80.

16525.  Teixeira PJ, Seligman R, Hertz FT, Cruz DB, Fachel JM. Inadequate treatment of ventilator-associated pneumonia: risk factors and impact on outcomes. J Hosp Infect. 2007 Apr;65(4):361-7.

16526.   Vahid B, Esmaili A. Erlotinib-associated acute pneumonitis: report of two cases. Can Respir J. 2007 Apr;14(3):167-70.

16527.   Vijayan VK. How to diagnose and manage common parasitic pneumonias. Curr Opin Pulm Med. 2007 May;13(3):218-24. Review.

Pathogenesis:

16528.  Deffrasnes C, Hamelin ME, Boivin G. Human metapneumovirus. Semin Respir Crit Care Med. 2007 Apr;28(2):213-21. Review. 

16529.  Koh YY, Jung da E, Koh JY, Kim JY, Yoo Y, Kim CK. Bronchoalveolar cellularity and interleukin-8 levels in measles bronchiolitis obliterans. Chest. 2007 May;131(5):1454-60.

16530.  Mukae H, Ishimoto H, Yanagi S, Ishii H, Nakayama S, Ashitani J, Nakazato M, Kohno S.  Elevated BALF concentrations of alpha- and beta-defensins in patients with pulmonary alveolar proteinosis. Respir Med. 2007 Apr;101(4):715-21.

16531. Parra ER, Kairalla RA, de Carvalho CR, Capelozzi VL. Abnormal deposition of collagen/elastic vascular fibres and prognostic significance in idiopathic interstitial pneumonias. Thorax. 2007 May;62(5):428-37.

16532.  Yoshinouchi T, Naniwa T, Shimizu S, Ohtsuki Y, Fujita J, Sato S, Eimoto T, Ueda R.   Expression of chemokine receptors CXCR3 and CCR4 in lymphocytes of idiopathic nonspecific interstitial pneumonia. Respir Med. 2007 Jun;101(6):1258-64.

Vaccines:

16533.  Albrich WC, Baughman W, Schmotzer B, Farley MM. Changing characteristics of invasive pneumococcal disease in Metropolitan Atlanta, Georgia, after introduction of a 7-valent pneumococcal conjugate vaccine. Clin Infect Dis. 2007 Jun 15;44(12):1569-76. 

16534. Bennett N, Ellis J, Bonville C, Rosenberg H, Domachowske J. Immunization strategies for the prevention of pneumovirus infections. Expert Rev Vaccines. 2007 Apr;6(2):169-82. Review.

16535.  Elkayam O, Ablin J, Caspi D. Safety and efficacy of vaccination against streptococcus pneumonia in patients with rheumatic diseases. Autoimmun Rev. 2007 Apr;6(5):312-4. 

16536.  Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet. 2007 Apr 7;369(9568):1179-86. 

Chemotherapy, Immunotherapy, Management & Drugs:

16537.  Akca O. Endotracheal tube cuff leak: can optimum management of cuff pressure prevent pneumonia? Crit Care Med. 2007 Jun;35(6):1624-6.

16538.  Ampofo K, Byington C. Management of parapneumonic empyema. Pediatr Infect Dis J. 2007 May;26(5):445-6.

16539.  Chang CL, Sullivan GD, Karalus NC, Hancox RJ, McLachlan JD, Mills GD. Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome. Intern Med J. 2007 Apr;37(4):236-41.

16540.  Clark JE, Hammal D, Spencer D, Hampton F. Children with pneumonia: how do they present and how are they managed? Arch Dis Child. 2007 May;92(5):394-8.

16541.  Cobb E, Kimbrough RC, Nugent KM, Phy MP. Organizing pneumonia and pulmonary eosinophilic infiltration associated with daptomycin. Ann Pharmacother. 2007 Apr;41(4):696-701. 

16542.  Dowell SF. A new imperative for global pneumonia control: a commentary. Pediatr Infect Dis J. 2007 May;26(5):441-2.

16543.  Lynch JP 3rd, Walsh EE. Influenza: evolving strategies in treatment and prevention. Semin Respir Crit Care Med. 2007 Apr;28(2):144-58. Review. 

16544.  Niederman MS. Recent advances in community-acquired pneumonia: inpatient and outpatient. Chest. 2007 Apr;131(4):1205-15. Review.

16545.  Pieracci FM, Barie PS. Strategies in the prevention and management of ventilator-associated pneumonia. Am Surg. 2007 May;73(5):419-32. Review.

16546.  Takada K, Kishi J, Miyasaka N.  Step-up versus primary intensive approach to the treatment of interstitial pneumonia associated with dermatomyositis/polymyositis: a retrospective study. Mod Rheumatol. 2007;17(2):123-30.

16547.  Yepes D, Gil B. Anemia management program reduces transfusion volumes, incidence of ventilator-associated pneumonia, and cost in trauma patients. J Trauma. 2007 Apr;62(4):1065.