Current opinion in infectious diseases
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Legionella pneumophila is increasingly recognized as a significant cause of sporadic and epidemic community-acquired and nosocomial-acquired pneumonia. This review focuses on the latest literature concerning the epidemiology, pathogenesis, clinical presentation, diagnosis, and treatment of Legionnaires' disease. ⋯ Legionnaires' disease is a significant health problem in many countries. Clinical manifestations are unreliable in diagnosing Legionnaires' disease. Therefore, diagnostic laboratory tests for Legionella, including the urinary antigen test, should be applied to all patients with pneumonia. Levofloxacin (or other fluoroquinolone) or azithromycin are the current drugs of choice for treatment of Legionnaires' disease. Effective preventive strategies are needed.
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Curr. Opin. Infect. Dis. · Apr 2010
ReviewCommon medications that increase the risk for developing community-acquired pneumonia.
Community-acquired pneumonia (CAP) is a common problem with significant morbidity, mortality and costs. Recent reports link several medications and the development of CAP and associated poor outcomes. Our aim was to review the most relevant data regarding the possible association of the use of inhaled corticosteroids for patients with chronic obstructive lung disease and the risk of development of CAP. In addition, we review the data regarding the use of gastric-acid suppressants including histamine-2 receptor antagonists and proton pump inhibitors and the increased incidence of CAP. ⋯ We explore the potential risks, pathogenesis and implications for the healthcare system of these potential associations with the use of ICS and proton pump inhibitors and increased risk of CAP.
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Two recent viral epidemics producing pneumonitis (severe acute respiratory syndrome and pandemic influenza A H1N1) have highlighted the potential for viral infections to cause respiratory failure with a significant risk of mortality. This review describes these epidemics and other causes of epidemic viral pneumonia. ⋯ The severe acute respiratory syndrome outbreak was too short to allow management protocols to be tested in a research environment. The current 2009 influenza A (H1N1) pandemic is fortunately not associated with as high a mortality rate as the avian influenza A (H5N1), another potential pandemic candidate virus. Prior pandemic planning as well as research planning has allowed a rapid response to this outbreak, with a significant amount of literature generated in a few months. Other common seasonal viruses, such as respiratory syncytial virus and parainfluenza, as well as previously poorly recognized viruses such as hantavirus, have the ability to cause significant respiratory morbidity and mortality.
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Curr. Opin. Infect. Dis. · Apr 2010
ReviewKaposi's sarcoma in sub-Saharan Africa: a current perspective.
The aim of this review is to summarize the most recent published literature on HIV/AIDS Kaposi's sarcoma in sub-Saharan Africa (SSA). We attempted to update readers on the epidemiology of Kaposi's sarcoma herpesvirus infection and HIV Kaposi's sarcoma in SSA, as well as clinical features, therapy and immune reconstitution inflammatory syndrome associated with HIV Kaposi's sarcoma. ⋯ Kaposi's sarcoma is a public health concern in SSA. More studies appropriate to therapy for Kaposi's sarcoma in resource-poor environments like SSA are imperative. We are hopeful that with the increased availability of highly active antiretroviral therapy, the incidence of HIV Kaposi's sarcoma will decrease and management will improve, as it has in the West.
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Curr. Opin. Infect. Dis. · Apr 2010
ReviewDo guidelines change outcomes in ventilator-associated pneumonia?
The purpose of the study is to summarize effects of implementation of current and past guidelines for management and treatment of ventilator-associated pneumonia (VAP) on outcome of intensive care patients, with particular focus on etiology of VAP, pathogens prediction, appropriate empiric antibiotic therapy and mortality. ⋯ Guidelines implementation can improve outcomes. To achieve this goal, guidelines should be adapted to local microbiology, accurately predict VAP pathogens and help physicians to administer the most appropriate empirical antimicrobial therapy.