Current opinion in infectious diseases
-
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.
-
Curr. Opin. Infect. Dis. · Apr 2010
ReviewDefining and predicting severe community-acquired pneumonia.
Community-acquired pneumonia is a significant clinical and public health problem. Defining and predicting severe pneumonia is difficult but important. ⋯ Definitions of pneumonia severity depend on the relevant clinical or public health question. A health services reference definition seems most useful in most settings. The Infectious Disease Society of America/American Thoracic Society 2007 guidelines and SMART-COP are two recent promising methods for predicting severe pneumonia at the time of presentation. The traditional pneumonia severity index and Confusion Uremia Respiratory rate Blood pressure (CURB)-65 models are less useful. Accurate assessment of severity has important implications for triage, outcome, and defining populations for research applications. Novel biomarkers, while somewhat promising, do not yet have a validated role in pneumonia severity assessment.
-
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.
-
Curr. Opin. Infect. Dis. · Apr 2010
ReviewManagement of methicillin-resistant Staphylococcus aureus pneumonia.
Staphylococcus aureus, and particularly methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly important etiology of pneumonia, both in healthcare and community settings. Associated with highest morbidity, mortality and costs in public health, it represents a major challenge for the management of this group of patients. ⋯ Overall, MRSA is an important cause of pneumonia; optimal management strategies for improving morbidity and mortality are still under development.
-
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.