Cases Of Community-acquired Pneumonia Research Articles

Non-invasive pneumococcal pneumonia due to vaccine serotypes: A systematic review and meta-analysis.

SummaryBackgroundNon-invasive pneumococcal pneumonia causes significant morbidity and mortality in older adults. Understanding pneumococcal sero-epidemiology in adults ≥50 years is necessary to inform vaccination policies and the updating of pneumococcal vaccines.MethodsWe conducted a systematic review and random-effects meta-analysis to determine the proportion of community-acquired pneumonia (CAP) in people ≥50 years due to pneumococcus and the proportion caused by pneumococcal vaccine serotypes. We searched MEDLINE, EMBASE and PubMed from 1 January 1990 to 30 March 2021. Heterogeneity was explored by subgroup analysis according to a) patient group (stratified versus age) and depth of testing, b) detection/serotyping method, and c) continent. The protocol is registered with PROSPERO (CRD42020192002).FindingsTwenty-eight studies were included (34,216 patients). In the period 1–5 years after introduction of childhood PCV10/13 immunisation, 18% of CAP cases (95% CI 13–24%) were attributable to pneumococcus, with 49% (43–54%) of pneumococcal CAP due to PCV13 serotypes. The estimated proportion of pneumococcal CAP was highest in one study that used 24-valent serotype-specific urinary-antigen detection (ss-UAD)(30% [28–31%]), followed by studies based on diagnostic serology (28% [24–33%]), PCR (26% [15–37%]), ss-UAD14 (17% [13–22%]), and culture alone (14% [10–19%]). A higher estimate was observed in Europe (26% [21–30%] than North America (11% [9–12%](p<0·001). PCV13-serotype estimates were also influenced by serotyping methods.InterpretationNon-invasive pneumococcal CAP and vaccine-type pneumococcal CAP remains a burden in older adults despite widespread introduction of pneumococcal infant immunisation. Studies heavily reliant on ss-UADs restricted to vaccine-type serotypes may overestimate the proportion of potentially vaccine-preventable pneumococcal pneumonia. Sero-epidemiological data from low-income countries are lacking.

Diagnosis of Active Pulmonary Tuberculosis and Community Acquired Pneumonia Using Convolution Neural Network Based on Transfer Learning

A convolutional neural network (CNN) model for the diagnosis of active pulmonary tuberculosis (APTB) and community-acquired pneumonia (CAP) using chest radiographs (CRs) was constructed and verified based on transfer learning. CRs of 1247 APTB cases, 1488 CAP cases and 1247 normal cases were collected. All CRs were randomly divided into training set (1992 cases), validation set (1194 cases) and test set (796 cases) by stratified sampling in 5:3:2 radio. After normalization of CRs, the convolution base of pre-trained CNN (VGG16) model on ImageNet dataset was used to extract features, and the grid search was used to determine the optimal classifier module, which was added to the convolution base for transfer learning. After the training, the model with the highest accuracy of the validation set was selected as the optimal model to verify in the test set and calculate the accuracy of the model. The accuracy of validation set in the 63rd epochs was the highest, which was 0.9430, and the corresponding Categorical crossentropy was 0.1742. The accuracy of the training set was 0.9428, and the Categorical crossentropy was 0.1545. When the optimal model was applied to the test set, the accuracy was 0.9447, and the Categorical crossentropy was 0.1929. The transfer learning-based CNN model has good classification performance in the diagnosis of APTB, CAP and normal patients using CRs.

Respiratory virus monitoring in patients with community-acquired pneumonia during COVID-19 pandemic in Khabarovsk in 2020

Introduction. Emergence and spread of new coronavirus SARS-CoV-2 among population of the Khabarovsk krai influenced the growth of reported cases of community-acquired pneumonia in year 2020. Aim. To determine proportion of other respiratory viruses in development of viral pneumonia epidemic process in the Khabarovsk city in year 2020 during COVID-19 pandemic. Materials and methods. Sputum of 346 patients with community-acquired pneumonia that were hospitalized with suspected diagnosis of COVID-19 was analyzed during year 2020 in Khabarovsk city. Identification of viral agents was performed via real-time reverse-transcriptase polymerase chain reaction. Results. SARSCOV-2 RNA was identified in 183 (52.9%) out of 346 patients. Among other respiratory viruses parainfluenza virus type 3 and rhinoviruses were dominant mostly in SARS-CoV-2 negative examined people. It should be noted that etiology of pneumonia was identified only in 12.9% of all cases in this group (163 people). Co-infection with SARS-CoV-2 and other respiratory viruses such as parainfluenza virus type 3 virus, other coronaviruses and adenovirus was detected only in 2.2% of the cases. Conclusion. Low level of respiratory viruses detection in sputum can be caused by poor technique of sample collection in the hospital, disruption of storage and transportation conditions as well as development of secondary bacterial infection in certain patients. In order to evaluate influence of other respiratory viruses on the course of COVID-19 with underlying coinfection further investigation including analysis of patients’ clinical data is needed.

299. D-dimer as an ICU Admission Risk Predictor in COVID-19 Patients, A Prospective Study

BackgroundSince the onset of the 2019 coronavirus disease 2019 (COVID-19) pandemic, the rapid increase in community-acquired pneumonia (CAP) cases has led to an excessive rate of intensive care units (ICU) admissions, a rate varying between 5-18%, depending on the country. Consequently, the study of serum biomarkers, such as D-dimer, have been utilized to identify patient with severe disease. However, further data is needed to confirm the association between this serum concentration of D-dimer and the risk of ICU admission. Thus, the aim of this study was to determine if serum concentration of D-dimer predict the risk of ICU admission in patients with COVID-19 and CAP. MethodsA prospective observational study was carried out at the Clinica Universidad de La Sabana, Colombia. Patients older than 18 years old, hospitalized for COVID-19 or CAP were included. Then, patients were stratified into ICU and non-ICU patients. Plasma samples were collected within the first 24 hours of hospital admission to quantify D-dimer using the PATHFAST system. Concentrations were compared among groups and to assess the biomarker capacity to predict ICU admission risk, ROC curves were used. Finally, a DeLong test was applied to compare their differences. ResultsA total of 240 patients diagnosed with lower respiratory tract infection were included in the study. 88 patients were COVID-19 negative (CAP) and 152 were positive. Plasma concentrations of D-dimer (µg/ml) were significantly higher in COVID-19 patients admitted to the ICU when compared with non-ICU COVID-19 admitted patients (Median [IQR]; 1.54 [0.9-3.25] Vs. 1.13 [0.69-1.69], p=0.005). The area under curve (AUC) ROC to predict ICU admission was 0.62 among COVID-19 patients. DeLong’s test p value was 0.24. Serum D-dimer an ICU admission ConclusionD-dimer seems to be a promising tool to identify COVID-19 patients with disease. However, this predicting capacity was not observed in CAP patients. Further studies are needed to identify the mechanisms underling the elevation of D-dimer in COVID-19 patients. Disclosures All Authors: No reported disclosures

Epidemiology of Viruses Causing Pediatric Community Acquired Pneumonia in Shanghai During 2010-2020: What Happened Before and After the COVID-19 Outbreak?

IntroductionSince the global outbreak of COVID-19, there has been a significant reduction in pediatric outpatient and emergency visits for infectious diseases. The purpose of this study was to analyze the changes in respiratory viruses in children with community-acquired pneumonia (CAP) in Shanghai in the past 10 years, especially in the first year after COVID-19.MethodsWe conducted a retrospective, observational study; the results for eight common respiratory viruses (respiratory syncytial virus (RSV), influenza virus A and B, parainfluenza virus 1–3 (PIV), adenovirus (ADV) and human metapneumovirus) tested by direct fluorescent antibody assays in hospitalized CAP cases in Children’s Hospital of Fudan University during 2010–2020 were analyzed.ResultsOf the 5544 hospitalized CAP patients included in this study, 20.2% (1125/5544) were positive for the eight respiratory viruses. The top three pathogens were RSV, PIV3 and ADV, detected from 9.8% (543/5544), 5.3% (294/5544) and 2.0% (111/5544) of the samples, respectively. RSV had the highest positive rates among children < 2 years old. In 2020, the detection rate of all viruses showed a sharp decline from February to August compared with the previous 9 years. When the Shanghai community reopened in August 2020, the detection rate of eight viruses rebounded significantly in September.ConclusionsThese eight respiratory viruses, especially RSV and PIV, were important pathogens of CAP in Shanghai children in the past 10 years. The COVID-19 pandemic had a significant impact on the detection rates for eight respiratory viruses in children with CAP in Shanghai.

Особенности применения концепции открытых легких при респираторной терапии тяжелой внебольничной пневмонии

Важным этапом респираторной терапии является оценка рекрутабельности легких пациента и подбор оптимального уровня положительного давления конца выдоха (PEEP). Некорректные настройки параметров искусственной вентиляции легких (ИВЛ) могут существенно ухудшить результаты лечения. Нерекрутабельные легкие пациента требуют попыток привлечения более высокотехнологичных, адаптивно-интеллектуальных режимов ИВЛ. В данной статье нами был описан клинический случай респираторной терапии тяжелой внебольничной пневмонии. Терапия была осложнена нерекрутабельностью легких пациента и клиникой крайне тяжелой гипоксии. Высокие значения PEEP и использование альвеолярных рекрутментов негативно влияли на показатели оксигенации. В качестве альтернативы традиционным режимам нами был применен интеллектуальный режим вентиляции ASV, что улучшило показатели оксигенации. Положительный эффект наблюдался при проведении ИВЛ в prone-положении.

Pediatric Non-COVID-19 Community-Acquired Pneumonia in COVID-19 Pandemic.

IntroductionThe COVID-19 lockdown strategies were associated with a significant decrease in infectious diseases disseminated through airborne or fecal–oral transmissions. Social distancing and other lockdown strategies effectively slowed down the spread of common respiratory viral diseases and decreased the need for hospitalization among children. Thus, a decline in the incidence of respiratory viral diseases had been reported following the COVID-19 outbreak. However, the trend of non-COVID-19 pneumonia in children remains uncertain. This study aimed to assess the impact of the COVID-19 pandemic on the incidence of non-COVID-19 community-acquired pneumonia in children.Materials and MethodsWe conducted a retrospective analysis of all patients (age ≤18 years) presenting with pulmonary infection from January 2019 to December 2020 in a tertiary-level teaching hospital. We compared the number of pediatric patients admitted to our hospital with community-acquired pneumonia from January to December 2020 to those from the same period in 2019.ResultsA total of 65 patients were diagnosed with community-acquired pneumonia in 2019 and 18 in 2020. The number of patients with community-acquired pneumonia in 2020 was lower than that in 2019 by 47 cases in 2020. The most age distribution of pediatric patients with community-acquired pneumonia was 2–5 years in 2019, indicating the decreasing number of community-acquired pneumonia patients from 36 patients in 2019 to 3 in 2020.ConclusionThe number of pediatric with community-acquired pneumonia was lower than in the same period in 2019, which markedly decreased (−72.3%) in 2020. These interventions applied to control the COVID-19 pandemic were effective not only in substantial changes in the seasonal influenza activity but also in decreasing cases of pediatric community-acquired pneumonia.

Ключевые аспекты лечения тяжелой негоспитальной вирусно-бактериальной пневмонии

Актуальность. Высокая частота заболеваемости тяжелой пневмонией при инфицировании гриппом H5N1, A/H1N1, SARS, MERS и COVID-19 привлекает особое внимание и заставляет пересматривать и совершенствовать современные элементы комплексной интенсивной терапии. Цель: проанализировать основные элементы интенсивной терапии клинического случая тяжелой внебольничной вирусно-бактериальной пневмонии, подчеркнуть основные проблемы и предложить пути решения. Материалы и методы. Мы проанализировали клинический случай лечения тяжелой внебольничной вирусно-бактериальной пневмонии пациента, находившегося на лечении в ОАИТ КНП «Клиническая больница скорой медицинской помощи» г. Львова, и выделили основные ключевые аспекты интенсивной терапии: респираторную терапию, неинвазивную искусственную вентиляцию легких (ИВЛ), своевременность интубации, протективную ИВЛ и начало отлучения; cедацию, анальгезию и миорелаксацию; оценку волемического статуса, инфузионную терапию и энтеральное питание. Результаты. Общий срок проведения ИВЛ составил 26 дней. С 16-го дня начат процесс отлучения, который составлял 10 дней. Основные режимы ИВЛ, которые применялись, следующие: SIMV-PC (8 дней), BIPPV (7 дней), CPAP+PS (10 дней). Период применения дексмедетомидина составлял 12 дней. Использование NIV не обеспечило должного эффекта, о чем свидетельствует ухудшение состояния пациента после 24 часов данной респираторной поддержки. Волемический статус в критическом периоде (первые 48 часов после интубации) оценивался с помощью ультрасонографии функции сердца и состояния магистральных сосудов, что оказалось очень эффективно. Выводы. Пациенты с тяжелой внебольничной вирусной пневмонией требуют раннего начала ИВЛ и обязательного применения протективной стратегии. Именно респираторная терапия является основным и первоочередным звеном интенсивной терапии. Обеспечение адекватной и комфортной седации является одним из важных элементов комплекса интенсивной терапии, который решает проблему асинхронии. Ультразвуковое исследование позволяет провести неинвазивную оценку волемического статуса, риска отека легких и предусмотреть ответ пациента на инфузионную терапию. С этой целью следует проводить комплексный УЗИ-мониторинг нижней полой вены, легких и сердца у всех пациентов в критическом состоянии, которым планируется или уже налажена инфузионная терапия.

Therapeutic Response of Community Acquired Pneumonia in Geriatrics: A Case Series from Intensive Care Unit

Community acquired pneumonia (CAP) is a common major growing challenge to elderly populations. Several aging factors, including comorbidities, nutritional status and digestive dysfunctions have been associated with increasing CAP among older persons. Furthermore, Streptococcus pneumoniae remains the most predominant pathogen in geriatrics, although multiple drug resistance (MDR) species regularly occur, particularly in severe pneumonia. Broad-spectrum antibiotics or a combination of β-lactam and fluorokuinolones, or β-lactams and macrolides serve as a promising therapy mainly in critical CAP patients. This study describes two geriatric CAP cases representing two separate treatments with widely varied results. The combination of cefoperazone sulbactam-azithromycin did not generate suitable clinical response until 7 days. As a consequence, the macrolides were replaced with amikacin and continued for 3 days. Meanwhile, the cefoperazone sulbactam-levofloxacin samples significantly improved the clinical conditions under 9 days. The selection of antibiotics with sufficient lung penetration is important in providing the effective therapy. Conversely, azithromycin resistance potentially instigates ineffectiveness, but is also recommended due to its pleiotropic effects. The benefit of this case study shows that CAP treatment among older population requires a blend of antibiotics with either a fluorokuinolone or an aminoglycoside. In both instances, azitromisin is believed to demonstrate high resistance, therefore, it is incapable in functioning as a second antibiotic component.

Epidemiological features of community-acquired mycoplasma pneumonia

Aim. To analyse an epidemic process of community-acquired mycoplasma pneumonia in the Volga Federal District and the Nizhny Novgorod Region.Materials and Methods. We retrospectively analysed statistical reporting forms and electronic databases for 2012-2019 which included 443 cases of community-acquired mycoplasma pneumonia (349 foci and 4 outbreaks). In 2020, we assessed aetiology of community-acquired pneumonia in hospitalized patients of all ages who were diagnosed with a radiologically confirmed pneumonia (152 cases). In 2021, we carried out a microbiological study of pneumonia-causing pathogens in the nasopharynx among the healthy population (325 cases).Results. Average long-term incidence of community-acquired pneumonia in Nizhny Novgorod Region for 2012-2019 was 3.4 per 100,000 population (95% CI = 0.3-6.5, p &lt; 0.001), with a pronounced upward trend. In general, the aetiology of community-acquired pneumonia in the Nizhny Novgorod Region in 2019 was established at 25.81 ± 0.7% cases. M. pneumoniae accounted for 8.00 ± 0.43% cases (56.72 ± 2.53%) of all aetiologically defined communityacquired pneumonias. In children, the aetiology was determined in 93.1 ± 2.5% cases, of which M. pneumoniae accounted for 13.8 ± 3.5% cases (14.6 ± 3.74% of all community-acquired pneumonias).Conclusion. Mycoplasma pneumonia is responsible for a significant proportion of all community-acquired pneumonias in Nizhny Novgorod Region. Notably, there is a low detection rate of mycoplasma pneumonia in certain territories that might explain an uneven distribution of associated morbidity.

Incidence, Outcomes and Sex-Related Disparities in Pneumonia: A Matched-Pair Analysis with Data from Spanish Hospitals (2016-2019).

(1) Background: the purpose of this study is to analyze the incidence and in-hospital mortality (IHM) of community-acquired pneumonia (CAP) needing hospital admission and hospital-acquired pneumonia (HAP) in Spain (2016–2019). (2) Methods: using the Spanish Register of Specialized Care-Basic Minimum Database, we estimated the incidence of CAP and HAP. We matched each woman with a man with an identical age, according to comorbidities. (3) Results: we analyzed 518,838 cases of CAP and 38,705 cases of HAP, and 5192 ventilator-associated HAPs (13.4%). The incidence of CAP increased over time in both men (from 384.5 to 449.8 cases/105 population) and women (from 244.9 to 301.2 cases/105 population). Men showed a 47% higher adjusted incidence of CAP than women. The incidence of HAP increased over time in both men (from 302.3 to 342.2 cases/105 population) and women (from 139.2 to 167.6 cases/105 population). Men showed a 98% higher adjusted incidence of HAP than women. IHM was higher in men admitted for CAP than in women (12.9% vs. 12.2%; p < 0.001), but not in men who developed HAP (28.9% vs. 28.0%; p = 0.107). Men admitted for CAP (OR: 1.13; 95% CI: 1.10–1.15) and men who developed HAP (OR: 1.05; 95% CI: 1.01–1.10) had higher IHM than women. (4) Conclusions: men had higher incidence rates of CAP and HAP than women. Men admitted for CAP and men who developed HAP had higher IHM than women.

Molecular detection of Mycoplasma pneumoniae in Community acquired pneumonia

Community acquired pneumonia (CAP) remains a common and serious illness despite availability of potent anti-microbials and effective vaccine. Two types of CAP are commonly recognised - typical and atypical. Typical pneumonia is usually caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catharralis, whereas, atypical pneumonia can be caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneuomophila. Mycoplasma pneumoniae is found to be the most common cause of CAP among atypical pathogens and is called “Walking pneumonia”. It is a common atypical respiratory pathogen that produces diseases of varied severity ranging from mild upper respiratory tract infection to severe atypical pneumonia and is also responsible for producing a wide spectrum of non-pulmonary manifestations like neurological, hepatic, cardiac diseases, hemolytic anemia, polyarthritis and erythema multiforme which occur in as many as 25% of infected persons. As it lacks cell wall they are resistant to β lactam antibiotics, hence accurate and rapid diagnosis of M. pneumoniae infections is critical to initiate appropriate antibiotic treatment. Identification of M pneumoniae allows narrowing of initial empirical regimen which decreases antibiotic selection pressure and may lessen the risk of resistance. In view of this present study will be conducted in a tertiary care hospital for identification of M pneumoniae in cases of CAP by Polymerase chain reaction (PCR). 1. To detect proportion of Mycoplasma Pneumoniae among cases of CAP. 2. Detection of 16SrRNA Mycoplasma pneumoniae by PCR.Clinico-radiologically diagnosed 92 CAP patients were included in the study. Out of which 15 cases were caused by typical CAP pathogens like Streptococcus species, K.pneumoniae &amp; M.tuberculosis. Samples (Sputum Bronchoalveolar lavages) from 77 suspected cases of atypical pneumonia are inoculated on PPLO broth (Difco) followed by identification of genus specific 16S rRNA Mycoplasma pneumoniae using PCR. PCR was found to be positive in 9 (11.68%) out of 77 CAP patients. PCR was found to be positive in 9 (11.68%) out of 77 CAP patients. Detection of M.pneumoniae is essential for prompt diagnosis and start of empirical therapy, thereby reducing antibiotic selection pressure.

A Multicenter Study of Viral Aetiology of Community-Acquired Pneumonia in Hospitalized Children in Chinese Mainland.

Community-acquired pneumonia (CAP) is one of the leading causes of morbidity and mortality in children worldwide. In this study, we aimed to describe the aetiology of viral infection of pediatric CAP in Chinese mainland. During November 2014 to June 2016, the prospective study was conducted in 13 hospitals. The hospitalized children under 18 years old who met the criteria for CAP were enrolled. The throat swabs or nasopharyngeal aspirates (NPAs) were collected which were then screened 18 respiratory viruses using multiplex PCR assay. Viral pathogens were present in 56.6% (1539/2721) of the enrolled cases, with the detection rate of single virus in 39.8% of the cases and multiple viruses in 16.8% of the cases. The most frequently detected virus was respiratory syncytial virus (RSV) (15.2%, 414/2721). The highest detection rate of virus was in < 6-month-age group (70.7%, 292/413). RSV, human metapneumovirus (HMPV), human parainfluenza viruses (HPIVs) and influenza B virus (Flu B) showed the similar prevalence patterns both in north and south China, but HPIVs, Flu A, human bocavirus (HBoV), human adenovirus (HAdV) and human coronaviruses (HCoVs) showed the distinct circulating patterns in north and south China. Human enterovirus/human rhinovirus (HEV/HRV) (27.6%, 27/98), HBoV (18.4%, 18/98), RSV (16.3%, 16/98) and HMPV (14.3%, 14/98) were the most commonly detected viruses in severe pneumonia cases with single virus infection. In conclusion, viral pathogens are frequently detected in pediatric CAP cases and may therefore play a vital role in the aetiology of CAP. RSV was the most important virus in hospitalized children with CAP in Chinese mainland.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12250-021-00437-0.

High proportion of drug-resistant isolates in adult community-acquired pneumonia from Northeast India: A hospital-based study.

Background:Empirical antibiotic therapy is the mainstay of management of adult community-acquired pneumonia (CAP) globally. Knowledge of prevalent pathogen (bacterial) profile and drug susceptibility pattern is very essential for appropriate management of CAP cases, which again calls for regular update of pathogen profile in a given locality. This study was to identify the bacterial etiology of CAP cases and their antibiotic susceptibility pattern.Methods:This cross-sectional study was done on adult CAP patients from medicine, respiratory medicine, and intensive care unit area in our tertiary care hospital between May 1, 2015, and October 30, 2016. Subjects were enrolled continuously, and expectorated sputum, bronchoalveolar lavage fluid, and blood culture were performed. Urine antigen test was done for Streptococcus pneumoniae and Legionella pneumophila. Three types of ELISA (IgM, IgG, and IgA) were performed for atypical agents (Mycoplasma, Chlamydia, and Legionella) of CAP. Isolates obtained from culture of Sputum/BAL/Blood were further processed for antibiotic susceptibility testing - by disc diffusion as well as E-test method (latter for MIC i.e. minimum inhibitory concentration, determination).Results:About 574 subjects were included, and in 266 (46.3%) cases, bacterial pathogen could be detected. Klebsiella pneumoniae (33.6%) and S. pneumoniae (32.9%) were the predominant agents identified. Atypical agents (Mycoplasma, Legionella, and Chlamydia) were at 15.1%. A high proportion of pneumococci isolates were multidrug resistant (52.6%). Resistance to beta-lactams, macrolide, and other agents was on the higher side, but fluoroquinolones were found to be less resistant (15.8%–21.1%). Extended-spectrum beta-lactamase (among Klebsiella isolates) and methicillin-resistant Staphylococcus aureus were also detected.Conclusion:A moderate-to-high degree of drug-resistant in adult CAP was evident, which is detrimental in effective empirical management of such cases. Urgent implementation of antibiotic stewardship scheme is the need of the hour.

Иммунологический скрининг как этап формирования иммунокомпрометированной профессиональной когорты для вакцинации против пневмококковой инфекции

Background : The specificity of Streptococcus pneumoniae interaction with different epithelial cells has not been fully studied. Yet, it has been demonstrated that this type of streptococcus induced bacterial inflammation in 49 % of cases of various respiratory diseases. Previous studies indicate that inhalation exposure to occupational risk factors accounts for a higher average long-term incidence rate of community-acquired pneumonia among workers. The objective of our study was to substantiate approaches to developing criteria for establishing the immunocompromised status of workers exposed to chrysotile asbestos for subsequent vaccination against pneumococcal disease. Materials and methods : We analyzed data on 304 cases of community-acquired pneumonia registered in 2005–2016 among chrysotile miners and millers, obtained from the Information System of Epidemiological Surveillance maintained by the Center for Hygiene and Epidemiology in the Sverdlovsk Region. In addition, we screened 240 employees for prevaccination immunity using immunoassay tests. Results : We established a higher incidence of community-acquired pneumonia in miners and millers (217 cases or 71.4 %) compared to the control cohort consisting of auxiliary staff (87 cases or 28.6 %). We also noted that the longer length of employment was associated with an increased secretory IgA synthesis in both miners and millers and a significant decrease in the bactericidal action of neutrophils in miners. Conclusion : Chrysotile asbestos exposure leads to adaptive stress, strain of protective and compensatory mechanisms, poor resistance causing increased susceptibility to viral and bacterial diseases, and the development of secondary immunodeficiency in experienced workers of the main occupations, all contributing to higher incidence of community-acquired pneumonia.

Candida species in community-acquired pneumonia in patients with chronic aspiration

BackgroundWhen Candida species is found in a sputum culture, clinicians generally dismiss it as a contaminant. We sought to identify cases of community-acquired pneumonia (CAP) in which Candida might play a contributory etiologic role.MethodsIn a convenience sample of patients hospitalized for CAP, we screened for “high-quality sputum” by Gram stain (> 20 WBC/epithelial cell) and performed quantitative sputum cultures. Criteria for a potential etiologic role for Candida included the observation of large numbers of yeast forms on Gram stain, intracellular organisms and > 106 CFU/ml Candida in sputum. We gathered clinical information on cases that met these criteria for possible Candida infection.ResultsSputum from 6 of 154 consecutive CAP patients had large numbers of extra- and intracellular yeast forms on Gram stain, with > 106 CFU/ml Candida albicans, glabrata, or tropicalis on quantitative culture. In all 6 patients, the clinical diagnoses at admission included chronic aspiration. Greater than 105 CFU/ml of a recognized bacterial pathogen (Streptococcus pneumoniae, Staphylococcus aureus, or Pseudomonas) or > 106 CFU/ml of other ‘normal respiratory flora’ (Lactobacillus species) were present together with Candida spp. in every case. Blood cultures yielded Candida in 2 cases, and 1,3-beta-D glucan was > 500 ng/mL in 3 of 3 cases in which it was assayed. Since all patients were treated with anti-bacterial and anti-fungal drugs, no inference about etiology can be derived from therapeutic response.ConclusionsCandida spp. together with a recognized bacterial pathogen or normal respiratory flora may contribute to the cause of CAP in patients who chronically aspirate.

A Physician-Driven Quality Improvement Stewardship Intervention Using Lean Six Sigma Improves Patient Care for Community-Acquired Pneumonia.

The Infectious Diseases Society of America (IDSA) recommends a minimum of 5 days of antibiotic therapy in stable patients who have community-acquired pneumonia (CAP). However, excessive duration of therapy (DOT) is common. Define, measure, analyze, improve, and control (DMAIC) is a Lean Six Sigma methodology used in quality improvement efforts, including infection control; however, the utility of this approach for antimicrobial stewardship initiatives is unknown. To determine the impact of a prospective physician-driven stewardship intervention on excess antibiotic DOT and clinical outcomes of patients hospitalized with CAP. Our specific aim was to reduce excess DOT and to determine why some providers treat beyond the IDSA minimum DOT. A single-center, quasi-experimental quality improvement study evaluating rates of excess antimicrobial DOT before and after implementing a DMAIC-based antimicrobial stewardship intervention that included education, prospective audit, and feedback from a physician peer, and daily tracking of excess DOT on a Kaizen board. The baseline period included retrospective CAP cases that occurred between October 2018 and February 2019 (control group). The intervention period included CAP cases between October 2019 and February 2020 (intervention group). A total of 123 CAP patients were included (57 control and 66 intervention). Median antibiotic DOT per patient decreased (8 versus 5 days; p < 0.001), and the proportion of patients treated for the IDSA minimum increased (5.3% versus 56%; p < 0.001) after the intervention. No differences in mortality, readmission, length of stay, or incidence of Clostridioides difficile infection were observed between groups. Almost half of the caregivers surveyed were aware that as few as 5 days of antibiotic treatment could be appropriate. A physician-driven antimicrobial quality improvement initiative designed using DMAIC methodology led to reduced DOT and increased compliance with the IDSA treatment guidelines for hospitalized patients with CAP reduced without negatively affecting clinical outcomes.

Overview of Viral Pneumonia Associated With Influenza Virus, Respiratory Syncytial Virus, and Coronavirus, and Therapeutics Based on Natural Products of Medicinal Plants.

Viral pneumonia has been a serious threat to global health, especially now we have dramatic challenges such as the COVID-19 pandemic. Approximately six million cases of community-acquired pneumonia occur every year, and over 20% of which need hospital admission. Influenza virus, respiratory virus, and coronavirus are the noteworthy causative agents to be investigated based on recent clinical research. Currently, anaphylactic reaction and inflammation induced by antiviral immunity can be incriminated as causative factors for clinicopathological symptoms of viral pneumonia. In this article, we illustrate the structure and related infection mechanisms of these viruses and the current status of antiviral therapies. Owing to a set of antiviral regiments with unsatisfactory clinical effects resulting from side effects, genetic mutation, and growing incidence of resistance, much attention has been paid on medicinal plants as a natural source of antiviral agents. Previous research mainly referred to herbal medicines and plant extracts with curative effects on viral infection models of influenza virus, respiratory virus, and coronavirus. This review summarizes the results of antiviral activities of various medicinal plants and their isolated substances, exclusively focusing on natural products for the treatment of the three types of pathogens that elicit pneumonia. Furthermore, we have introduced several useful screening tools to develop antiviral lead compounds.

The Role of Plant-Based Protein Functional Food in Preventing Acute Respiratory Disease: A Case Study.

The Kaliningrad region is known for its specific climate, which can negatively affect the adaptive potential of the body. This manifests in an increased incidence of respiratory diseases and skin conditions. To prevent high morbidity, a plant protein product was included in the diet of first-year university students. This study aimed to assess the effectiveness of this food intervention in preventing the most common diseases among Kaliningrad students. Two groups of university students took part in the food trial. In the control group, catabolic processes prevailed in nutrient metabolism. Disadaptation manifested itself in the metabolism of proteins, vitamins, minerals, hematopoiesis and humoral immunity. Inflammation was indicated by α1- and α2-globulins, a weak immune response, and IgM and IgG. High oxidative stress and low antioxidative ability of blood serum were observed. The plant-based protein product (FP) helped preserve testosterone level and prevent an increase in catabolic reactions. Moreover, it had a positive effect on both red blood cell hematopoiesis (a smaller increase in the average volume of erythrocytes, the same average concentration and content of hemoglobin, an increased relative red cell distribution width (RDW) and white blood cell hematopoiesis (a beneficial effect for the immune system: lymphocytes, the relative content of neutrophils, monocytes, basophils and eosinophils). The stimulation of humoral immunity was evidenced by beta- and gamma-globulins, an active immune response, the level of IgM and IgG, antioxidant protection, reduction of peroxides and an increase in antioxidant activity of blood serum. The 34-week observation showed a 1.7-fold decrease in the incidence of respiratory illnesses and a 5.7-fold decrease in skin and subcutaneous tissue diseases. Acute respiratory infections were reduced 1.8-fold. There were no cases of community-acquired pneumonia in the treatment group, compared with 55.1‰ in the control group. The incidence of respiratory diseases was 3.3–10.6 times lower in the treatment group than in the control group in weeks 6–19. The findings testify to the prophylactic effect of functional food during social adaptation and acclimatization of students.

Immunity Testing as a Stage of Forming the Immunocompromised Occupational Cohort for Vaccination against Pneumococcal Disease

Background: The specificity of Streptococcus pneumoniae interaction with different epithelial cells has not been fully studied. Yet, it has been demonstrated that this type of streptococcus induced bacterial inflammation in 49 % of cases of various respiratory diseases. Previous studies indicate that inhalation exposure to occupational risk factors accounts for a higher average long-term incidence rate of community-acquired pneumonia among workers. The objective of our study was to substantiate approaches to developing criteria for establishing the immunocompromised status of workers exposed to chrysotile asbestos for subsequent vaccination against pneumococcal disease. Materials and methods: We analyzed data on 304 cases of community-acquired pneumonia registered in 2005–2016 among chrysotile miners and millers, obtained from the Information System of Epidemiological Surveillance maintained by the Center for Hygiene and Epidemiology in the Sverdlovsk Region. In addition, we screened 240 employees for prevaccination immunity using immunoassay tests. Results: We established a higher incidence of community-acquired pneumonia in miners and millers (217 cases or 71.4 %) compared to the control cohort consisting of auxiliary staff (87 cases or 28.6 %). We also noted that the longer length of employment was associated with an increased secretory IgA synthesis in both miners and millers and a significant decrease in the bactericidal action of neutrophils in miners. Conclusion: Chrysotile asbestos exposure leads to adaptive stress, strain of protective and compensatory mechanisms, poor resistance causing increased susceptibility to viral and bacterial diseases, and the development of secondary immunodeficiency in experienced workers of the main occupations, all contributing to higher incidence of community-acquired pneumonia.