Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Jun 2012
ReviewGlobal changes in the epidemiology of community-acquired pneumonia.
Lower respiratory tract infections are the most common infectious cause of death in the world and the third most common cause of death globally (all causes). This article reviews the epidemiology of community-acquired pneumonia from a global perspective. Major areas of epidemiological work include (1) disease surveillance to define the burden of disease and to document outbreaks, (2) identification of risk factors for a disease to optimize prevention strategies, and (3) comparisons of treatment effects to improve clinical outcomes for patients with the disease.
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Semin Respir Crit Care Med · Jun 2012
ReviewAssessing severity of patients with community-acquired pneumonia.
Despite all advances in its management, community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality requiring a great consumption of health, social, and economic resources. An early and adequate severity assessment is of paramount importance to provide optimized care to these patients. In the last 2 decades, this issue has been the subject of extensive research. ⋯ Biomarkers should be seen as a complement rather than superseding clinical judgment or validated clinical scores. The search for a gold standard is not over, and new tools, like bacterial DNA load, are in the pipeline. Until then, CAP severity assessment should be based in three key points: a pneumonia-specific score, biomarkers, and clinical judgment.
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Semin Respir Crit Care Med · Jun 2012
ReviewClinical stability versus clinical failure in patients with community-acquired pneumonia.
Once antibiotics have been started in patients with community-acquired pneumonia (CAP), the evaluation of clinical outcomes represents one of the essential steps in patient care. Among CAP patients who improve, recognition of clinical stability should be based on both subjective and objective parameters that are locally available in the everyday clinical practice. ⋯ It is crucial to understand the etiology of failure so as to develop different measures at both international and local levels to prevent adverse outcomes. Finally, several efforts should be made to define incidence, timing, and risk factors for nonresolving pneumonia that, to date, remains one of the most indeterminate clinical outcomes in patients with CAP.
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Semin Respir Crit Care Med · Jun 2012
ReviewThe role of atypical pathogens in community-acquired pneumonia.
The term atypical pneumonia was first used in 1938, and by the 1970s it was widely used to refer to pneumonia due to Mycoplasma pneumoniae, Legionella pneumophila (or other Legionella species), and Chlamydophila pneumoniae. However, in the purest sense all pneumonias other than the classic bacterial pneumonias are atypical. Currently many favor abolition of the term atypical pneumonia. ⋯ We emphasize viral pneumonia because with the increasing availability of multiplex polymerase chain reaction we can identify the agent(s) responsible for viral pneumonia. By using a sensitive assay for procalcitonin one can distinguish between viral and bacterial pneumonia. This allows pneumonia to be categorized as bacterial or viral at the time of admission to hospital or at discharge from the emergency department and soon thereafter further classified as to the etiology, which should be stated as definite or probable.
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Semin Respir Crit Care Med · Jun 2012
ReviewCommunity-acquired pneumonia: genomics, epigenomics, transcriptomics, proteomics, and metabolomics.
Community-acquired pneumonia remains a significant health problem with very little progress having been made over the past 2 to 3 decades. Recent technological advances have opened up whole new avenues of exploration in the fields of genomics, epigenomics, transcriptomics, proteomics, and metabolomics. ⋯ This review discusses recent studies in pneumonia using these new approaches as well as relevant research in sepsis and other diseases. Current and potential future uses of these platforms are discussed, and both key findings and key barriers to further progress are highlighted.