Cases Of Community-acquired Pneumonia Research Articles

On the issue of the etiology of community-acquired pneumonia in children

According to global statistics, the number of cases of community-acquired pneumonia in children exceeds 150 million per year, and despite the introduction of vaccinations, this figure has not significantly decreased. Respiratory viruses, particularly respiratory syncytial virus, are recognized as the main cause of community-acquired pneumonia among preschool children during non-epidemic periods. Pneumococci also continue to play a significant role among bacterial pathogens. There is a significant increase in the prevalence of M. pneumoniae in the etiological structure of community-acquired pneumonia in recent years. Modern clinical guidelines for the use of antibiotics recommend taking into account patient age, vaccination status, and data on circulating pneumococcal strains when prescribing treatment. The COVID-19 pandemic and its subsequent relaxation of strict restrictions in the last two years have led to changes in the structure of infectious diseases, including the causes of lower respiratory tract infections.

"SWALLOWING AND ASPIRATION: HOW TO EVALUATE AND TREAT SWALLOWING DISORDERS ASSOCIATED WITH ASPIRATION PNEUMONIA IN OLDER PERSONS".

BACKGROUND Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. METHODOLOGY We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. RESULTS AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction and oral colonization by respiratory pathogens. Incidence is estimated at between 5%-15% of cases of CAP but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society (JRS), that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for healthcare professionals, new AI-based screening tools for OD combined with validated clinical methods such as the volume-viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. CONCLUSIONS The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection AP.

Impact of the COVID-19 Pandemic on Pediatric Bacterial Community-Acquired Pneumonia: A Multicenter Retrospective Study in Madrid (Spain).

This study conducted in Madrid (Spain) between 2018 and 2023 shows a significant decrease in the pediatric bacterial community-acquired pneumonia cases during the COVID-19 pandemic, followed by a notable postpandemic increase surpassing prepandemic incidence. Streptococcus pneumoniae remains predominant, with an increasing prevalence of serotype 3, while Streptococcus pyogenes was the second most common pathogen.

Risk factors of Community Acquired Pneumonia: A Cross-sectional study at Kushtia Medical College hospital

Community acquired pneumonia (CAP) a serious childhood clinical condition caused by bacteria, virus or fungi. It is promptly responsible for mortality and morbidity. The aim of the study is to evaluate the etiological factors of CAP patients. This study which was comparative cross-sectional, starting from at indoor and outdoor division of Paediatrics, Kushtia Medical College Hospital. In this study, 180 patients were enrolled. Among them, 90 respondents were suffering from CAP (case), on the other hand, 90 respondents were not suffering from pneumonia (control). It is found that, 46.1% respondents were less than 12 months. Among the respondents, 62.2% respondents were male. Out of 180 respondents, 33 case (18.3%) respondents were completely immunized. In case of control respondents, more patients were completely immunized comparing to pneumonic patients. Majority of the patients (65.6%) didn’t have positive history of previous hospitalization in due to any causes. In this clinical study, majority of cases underwent C/S procedure (37.2%) whereas, 44.4% cases had mature child-birth. To determine all the etiological factors causing CAP, it is a must to increase the clinical studies and raise social awareness against this public health life threatening problem.

Analysis of Pathogen Detection Data in 898 Pediatric Patients Hospitalized with Community-Acquired Pneumonia

Introduction: The prevalence of community-acquired pneumonia (CAP) in pediatric patients has seen significant changes following the lifting of COVID-19 restrictions. This study examines the epidemiology and pathogen detection in children hospitalized with CAP at Beijing New Century Children's Hospital throughout 2023. Objective: To analyze the pathogen detection rates and distribution characteristics among 898 pediatric CAP patients admitted during 2023, focusing on age-related and seasonal variations. Methods: This retrospective study included 898 pediatric patients diagnosed with CAP between January 1 and December 31, 2023. Respiratory pathogen detection was performed using a combination of antigen detection kits, nucleic acid testing, and bacterial culture. The data were analyzed for pathogen distribution across different age groups and seasons. Results: Of the 898 CAP cases, pathogens were detected in 703 cases (78.3%). Mycoplasma pneumoniae was the most frequently identified pathogen (44.1%), with detection rates increasing significantly with age, particularly in school-aged children. Viral pathogens were detected in 42.7% of cases, with Respiratory Syncytial Virus (32.4%) being the most prevalent. Bacterial pathogens were identified in 49.5% of cases, with Streptococcus pneumoniae (34.1%) and Haemophilus influenzae (33.0%) being the most common. Mixed infections were observed in 64.4% of cases, with a higher prevalence in older children and during the autumn and winter seasons. Conclusions: The study highlights significant age and seasonal variations in pathogen distribution among pediatric CAP patients. Mycoplasma pneumoniae was more common in older children and during autumn, while bacterial infections peaked in winter. The findings emphasize the need for age and season-specific strategies in managing pediatric CAP and suggest that comprehensive diagnostic approaches are crucial to accurately identify the causative pathogens.

Distinguishing types and severity of pediatric pneumonia using modified lung ultrasound score.

This study aimed to investigate the diagnostic utility of the modified lung ultrasound score (MLUS) in distinguishing between Mycoplasma pneumonia and viral pneumonia in children and evaluate their severity. A prospective collection of 137 suspected cases of community-acquired pneumonia in children admitted to the Quanzhou Maternity and Children's Hospital in Quanzhou City, Fujian Province, from January 2023 to December 2023 constituted the study cohort. All patients underwent lung ultrasound examinations, and MLUS scores were assigned based on ultrasound findings, including pleural lines, A-lines, B-lines, and lung consolidations. Based on the pathogenic results, the patients were categorized into the Mycoplasma pneumonia (74 cases) and viral pneumonia (63 cases) groups. The severity was classified as mild (110 cases) or severe (27 cases). The diagnostic value of MLUS for Mycoplasma pneumonia and viral pneumonia in children was analyzed. (1) MLUS scores were significantly different between the Mycoplasma pneumonia (15, 10-21) and viral pneumonia (8, 5-16) groups (P = 0.002). ROC curve analysis indicated that using a cut-off value of 11, MLUS exhibited a sensitivity of 70.3%, specificity of 58.7%, and an area under curve (AUC) of 0.653 for diagnosing Mycoplasma pneumonia. Furthermore, large-area lung consolidation on ultrasound images demonstrated good diagnostic performance for predicting Mycoplasma pneumonia, with an AUC of 0.763, a sensitivity of 71.6%, and a specificity of 81.0%. (2) MLUS scores were significantly different between the mild pneumonia (10.5, 5-17) and severe pneumonia (21, 16-29) groups (P < 0.001). ROC curve analysis using a cut-off value of 16 showed a sensitivity of 77.8%, specificity of 73.6%, and AUC of 0.818 for diagnosing severe pneumonia. Multivariate regression analysis revealed that both MLUS and white blood cell count were independent factors influencing the severity. The constructed nomogram model demonstrated robust stability with a sensitivity of 85.2%, a specificity of 74.5%, and an AUC of 0.858 for predicting severe childhood pneumonia. MLUS, coupled with ultrasound signs of large-area lung consolidation, had reference significance for the differential diagnosis of Mycoplasma pneumonia and viral pneumonia in children and can be a preliminary assessment of the severity of viral pneumonia or mycoplasma pneumonia in children.

Rare Culture positivity of Mycoplasma pneumoniae from a Community-acquired atypical pneumonia case

Rare Culture positivity of Mycoplasma pneumoniae from a Community-acquired atypical pneumonia case

Coinfection of viruses in children with community-acquired pneumonia

BackgroundVirus, particularly respiratory tract virus infection is likely to co-occur in children with community-acquired pneumonia (CAP). Study focusing on the association between common viruses coinfection and children with CAP is rare. We aimed to study the association between seven common viruses coinfection and clinical/laboratory indexes in children with CAP.MethodsSix hundred and eighty-four CAP cases from our hospital were enrolled retrospectively. Seven common viruses, including influenza A (FluA), influenza B (FluB), human parainfluenza virus (HPIV), Esptein-Barr virus (EBV), coxsackie virus (CoxsV), cytomegalovirus (CMV), and herpes simplex virus (HSV) were investigated for their associations with CAP. We analyzed the differences of hospitalization days, white blood cell (WBC), c-reactive protein (CRP), platelet (PLT), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), urine red blood cell (uRBC), blood urea nitrogen (BUN), serum creatinine (Scr), alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase isoenzyme (CKMB) among different viruses coinfection groups by using one-way ANOVA analysis. The differences of clinical/laboratory indexes between ordinary and severe pneumonia groups, as well as non-virus vs multi co-infection viruses groups, and single vs multi co-infection viruses groups by using independent samples T test. Receiver operating characteristic (ROC) curve analyses were applied to test the the predictive value of the clinical/laboratory parameters for the risk of viruses coinfections among CAP. Binary logistic analysis was performed to test the association between various indexes and viruses co-infection.ResultsEighty-four multiple viruses coinfections yielded different prognosis compared with that in 220 single virus coinfection. CMV coinfection was associated with longest hospitalization days, highest ALT, AST and CKMB level. HSV coinfection was associated with highest WBC count, CRP, ESR, and BUN. EBV coinfection was associated with highest PLT and PCT level. FluB coinfection was associated with highest Scr level. CoxsV coinfection was associated with highest uRBC, LDH and CK level. ROC curve analyses showed that CK had the largest area under the curve (AUC: 0.672, p < 10–4) for the risk of viruses coinfections risk in CAP. Significant association between PLT, uRBC, BUN, CK, and CKMB and virus coinfection risk in CAP was observed.ConclusionsMultiple viruses coinfections indicated different prognosis. Different viruses coinfection yielded varying degrees of effects on the cardiac, liver, kidney and inflamatory injury in CAP. The alterations of clinical/laboratory parameters, particularly CK may be associated with the risk of viruses coinfections in CAP.

The Role of Chest Ultrasound in the Diagnosis of Thoracic Tuberculosis

Abstract Introduction There is limited data on the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB). If the diagnostic accuracy of CUS for pulmonary TB (PTB) is similar to that for CUS in diagnosis of pneumonia, CUS could play an important role in diagnosis of PTB in areas without ready access to chest x-ray. Aim of the work This study aimed to describe the diagnostic features and utility of CUS in TTB. Comparing CUS findings in PTB versus community acquired pneumonia (CAP). Patients and methods Consecutive patients presenting with TTB and CAP to Abbasia Chest hospital between May 2019 to April 2020 were enrolled in this cohort study. CT of the chest, CUS, mediastinal ultrasound (US) and abdominal US to detect pericardial effusion were performed. CUS lesion pattern in thoracic TB, pulmonary TB and CAP cases were recorded. Results Sub-pleural nodules (97 patients, 95%), air-bronchograms (79 patients, 77,45%) and sub-pleural consolidations (SPC) (77 patients, 75.49%) were the most frequent features recorded by CUS in TB patients, CUS was able to report; pleural gap (28 patients, 27%), fragmented pleura (35 patients,34%), sub-pleural fluid collection (3 patients, 2.9%), and sub-pleural nodules (97patients, 95%) not detected by CT with P value &amp;lt; 0.05 for all. CUS was not only equal to CT in visualizing air-bronchogram (24 patients, 96%) and pleural effusion (4 patients,100%) in CAP, but also could detect fragmented pleura (12 patients, 48%) and SPC (8 patients, 32%) not detected by CT with P value &amp;lt; 0.05 for all. Conclusion CUS was more accurate than CT chest in diagnosis of TTB and CAP, it can report new patterns (pleural gap, fragmented pleura, sub-pleural fluid collection, SPN and SPC) not detected by CT.

A Systematic Review of Community-Acquired Pneumonia in Indian Adults.

This systematic review aimed to consolidate findings on the etiology of community-acquired pneumonia (CAP) among Indian adults. We adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) Guidelines 2020 and conducted a comprehensive search across databases including PubMed, Scopus-Elsevier, and hand-searched reference lists using key terms such as "Community-Acquired Pneumonia," "CAP," "Indian," and "adults." Articles published between January 2010 and January 2024 were included, with exclusions for studies involving pediatric populations, non-Indian patients, or those published before 2010. From an initial pool of 344 articles, duplicates were removed and titles and abstracts were screened, resulting in nine studies meeting the inclusion criteria. The analysis of pooled data comprising 1,643 Indian adult participants revealed the following pathogen distribution: Streptococcus pneumoniae was the most common organism, accounting for 33% of the cases. This was followed by Klebsiella pneumoniae at 23%, Staphylococcus aureus at 10%, Mycoplasma pneumoniae and Legionella pneumophila each at 7%, and Chlamydia pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa each at 4%. Notably, the review highlights a rising incidence of K. pneumoniae in CAP cases, which is a significant concern and should be considered when treating CAP patients in India. The findings emphasize the importance of comprehensive diagnostic testing, including advanced methods such as bronchoalveolar lavage, urinary antigen tests, serology for atypical pathogens, and enzyme-linked immunosorbent assays, to improve diagnostic yield and guide targeted antibiotic therapy. This review underscores the need for updated empirical treatment guidelines that account for dominant pathogens. Future research should focus on employing advanced diagnostic methods to enhance understanding of CAP etiology.

A novel risk-adjusted metric to compare hospitals on their antibiotic-prescribing at hospital discharge

Background: Approximately 40% of all antibiotics related to an acute-care hospital stay are prescribed at the time of hospital discharge. However, there is no metric to compare hospitals on their antibiotic-prescribing at this transition of care. In this study, we sought to build a risk-adjusted metric for comparing hospitals on their overall post-discharge antibiotic use. Methods: This was a retrospective study across all acute-care admissions within the Veterans Health Administration during 2018-2021. For patients discharged to home or self-care, data on antibiotics administered while inpatient and those prescribed at discharge were collected. To predict post-discharge antibiotic use (days of therapy, DOT), we built a zero-inflated negative binomial model with a random intercept for each VA medical center. Data were split into training and testing sets to measure model performance and absolute error. Covariates included patient demographics, medical specialty at discharge, comorbidities, discharge diagnoses of infection, and the length of inpatient antibiotic therapy. Outliers, defined as DOT ≥ 30, were excluded, and the predicted random intercept was used to determine hospital performance. To compare hospitals with a positive versus negative random intercept in our model (i.e. higher vs. lower than expected overall post-discharge use, respectively), we calculated mean total antibiotic duration (inpatient + post-discharge) for two uncomplicated infection types: community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). Results: 1,804,400 patients were discharged to home or self-care across 130 hospitals. The mean age was 67.8 (SD 12.9), and 93.7% were male. Antibiotics were prescribed to 41.5% while hospitalized and 19.5% at discharge. The median number of post-discharge DOT among those prescribed post-discharge antibiotics was 7 (IQR 4-12). The predictive model detected post-discharge antibiotic use with fidelity, including accurate identification of any post-discharge antibiotic exposure (area under the precision-recall curve=0.97 ) and reliable prediction of the number of post-discharge DOT in those who were exposed (mean absolute error = 1.65; Figure 1). At negative versus positive random intercept hospitals (Figure 2), antibiotic duration for CAP and SSTIs was 7.3 versus 8.1 days (p &lt; 0 .001) and 9.4 vs. 10.2 days (p &lt; 0 .001), respectively. Conclusion: A model using electronically available data was able to accurately predict antibiotic use prescribed at hospital discharge. Hospitals with lower than expected overall post-discharge antibiotic use also prescribed shorter courses of antibiotic therapy for uncomplicated cases of CAP and SSTI, which may reflect more robust processes at these sites to reduce antibiotic overuse at discharge.Disclosure: Michi Goto: Contracted Research – Merck

Improving Antibiotic Prescribing for Children with Community-acquired Pneumonia in Outpatient Settings

To assess whether a two-phase intervention was associated with improvements in antibiotic prescribing among nonhospitalized children with community-acquired pneumonia. In a large health care organization, a first intervention phase was implemented in September 2020 directed at antibiotic choice and duration for children 2months through 17years of age with pneumonia. Activities included clinician education and implementation of a pneumonia-specific order set in the electronic health record. In October 2021, a second phase comprised additional education and order set revisions. A narrow spectrum antibiotic (eg, amoxicillin) was recommended in most circumstances. Electronic health record data were used to identify pneumonia cases and antibiotics ordered. Using interrupted time series analyses, antibiotic choice and duration after phase one (September 2020-September 2021) and after phase two (October 2021-October 2022) were compared with a preintervention prepandemic period (January 2016-early March 2020). Overall, 3570 cases of community-acquired pneumonia were identified: 3246 cases preintervention, 98 post-phase one, and 226 post-phase two. The proportion receiving narrow spectrum monotherapy increased from 40.6% preintervention to 68.4% post-phase one to 69.0% post-phase two (P<.001). For children with an initial narrow spectrum antibiotic, duration decreased from preintervention (mean duration 9.9days, SD 0.5days) to post-phase one (mean 8.2, SD 1.9) to post-phase two (mean 6.8, SD 2.3) periods (P<.001). A two-phase intervention with educational sessions combined with clinical decision support was associated with sustained improvements in antibiotic choice and duration among children with community-acquired pneumonia.

Utility of pneumonia severity assessment tools for mortality prediction in healthcare-associated pneumonia: a systematic review and meta-analysis

Accurate prognostic tools for mortality in patients with healthcare-associated pneumonia (HCAP) are needed to provide appropriate medical care, but the efficacy for mortality prediction of tools like PSI, A-DROP, I-ROAD, and CURB-65, widely used for predicting mortality in community-acquired and hospital-acquired pneumonia cases, remains controversial. In this study, we conducted a systematic review and meta-analysis using PubMed, Cochrane Library (trials), and Ichushi web database (accessed on August 22, 2022). We identified articles evaluating either PSI, A-DROP, I-ROAD, or CURB-65 and the mortality outcome in patients with HCAP, and calculated the pooled sensitivities, specificities, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and the summary area under the curves (AUCs) for mortality prediction. Additionally, the differences in predicting prognosis among these four assessment tools were evaluated using overall AUCs pooled from AUC values reported in included studies. Eventually, 21 articles were included and these quality assessments were evaluated by QUADAS-2. Using a cut-off value of moderate in patients with HCAP, the range of pooled sensitivity, specificity, PLR, NLR, and DOR were found to be 0.91–0.97, 0.15–0.44, 1.14–1.66, 0.18–0.33, and 3.86–9.32, respectively. Upon using a cut-off value of severe in those patients, the range of pooled sensitivity, specificity, PLR, NLR, and DOR were 0.63–0.70, 0.54–0.66, 1.50–2.03, 0.47–0.58, and 2.66–4.32, respectively. Overall AUCs were 0.70 (0.68–0.72), 0.70 (0.63–0.76), 0.68 (0.64–0.73), and 0.67 (0.63–0.71), respectively, for PSI, A-DROP, I-ROAD, and CURB-65 (p = 0.66). In conclusion, these severity assessment tools do not have enough ability to predict mortality in HCAP patients. Furthermore, there are no significant differences in predictive performance among these four severity assessment tools.

Practical Insight into Understanding the Clinical Conundrum of Viral Community-acquired Pneumonia: A Review

Introduction Viruses are a frequent cause of community-acquired pneumonia (CAP). Even after a viral pathogen has been identified, clinicians still must consider the possibility of bacterial co-infection and determine if antibiotic therapy is needed. This question, whether bacterial co-infection is present, becomes critical when considering optimal therapeutic management for patients with viral CAP. Methods A review was conducted of the epidemiology of viral CAP, reported rates of bacterial co-infections, antibiotic prescribing, and diagnostic and clinical methods for assessing risk of bacterial co-infection. Results Reported co-infection rates are variable, but evidence suggests bacterial co-infections are not documented in the majority of cases of viral CAP. Conclusions Practical research is needed to determine when antibiotics can be withheld or discontinued in patients with viral CAP in order to prevent harm associated with unnecessary antibiotic use.

Fulminant septic shock due to community-acquired pneumonia caused by Legionella pneumophila SG1 Olda OLDA ST1. Case report

Legionellers’ desease accounts for 1–8 % of cases of severe community-acquired pneumonia (CAP). Legionella spp. Is the causative organism that can result in respiratory failure, multi-organ dysfunction, sepsis, and death. Therefore, rapid diagnosis and efficient treatment are crucial. We report the clinical and microbiology study of a patient with community-acquired pneumonia caused by Legionella pneumophila, with fatal outcome. After death, the strain causing the infection was identified as Legionella pneumophila serogroup 1, Olda OLDA phenotype and sequence-type 1. This is the first reported case of septic shock and death associated with an isolate of these characteristics.

The diagnostic value of lung ultrasound in children with community-acquired pneumonia

Objective: To investigate the diagnostic value of lung ultrasound in hospitalized children with community-acquired pneumonia (CAP). Methods: In the cross-sectional study, a total of 422 children with CAP who were hospitalized in the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, from February 2021 to August 2022 and completed lung ultrasound examination within 48 hours after admission were enrolled. The clinical characteristics, lung ultrasound and chest CT were collected. The patients were divided into two groups according to the signs of pneumonia indicated by chest CT, and the signs of lung ultrasound with diagnostic value were screened according to the signs of pneumonia indicated by chest CT by least absolute shrinkage and selection operator (Lasso) regression. According to severity of the disease, the children were divided into the severe group and the mild group, and the differences of lung ultrasound signs between the two groups were compared. Kruskal-Wallis test, Fisher's exact test was selected for comparison between groups. Random forest classifier wes used to evaluate the value of lung ultrasound in the diagnosis of CAP and prediction of severe pneumonia in children. The receiver operating characteristic curve was used to evaluate the prediction effect. Use DeLong test to compare the area under the curve. Results: Among the 422 cases of CAP, there were 258 males and 164 females, and the age of onset was 2.8 (1.3, 4.3) years. The confluent B-line, consolidation and pleural effusion detected by lung ultrasound were 309 cases (73.2%), 232 cases (55.0%) and 16 cases (3.8%), respectively, and the size of consolidation was 3.0 (0, 11.0) mm. One hundred and ten children (26.1%) with CAP completed chest CT. There were 90 cases with signs of pneumonia in chest CT and 20 cases without signs of pneumonia. Lasso was used for feature selection.Lung consolidation (OR=2.46), bilateral lung consolidation (OR=1.16) and confluent B-line (OR=1.34) were the main index. With random forest classifier, the accuracy of models using full variables and Lasso-selected variables were 0.79 (95%CI 0.70-0.86) and 0.79 (95%CI 0.70-0.86), the sensitivity were 0.81 and 0.81, and the specificity were 0.75 and 0.70, and the area under curve were 0.87 (95%CI 0.81-0.94, P<0.001) and 0.84 (95%CI 0.76-0.91, P<0.001), respectively. There were 97 cases in severe group and 325 cases in mild group. Compared with the mild group, the detection rate of consolidation, multiple consolidation, the size of consolidation and the size of consolidation was adjusted by body surface area (consolidation size/body surface area) in severe group were higher (66 cases (68.0%) vs. 166 cases (51.1%), 42 cases (43.3%) vs. 93 cases (28.6%), 8.0 (0, 17.0) vs. 1.0 (0, 9.0) mm, 12.5 (0, 24.6) vs. 2.1 (0, 17.6), χ2=8.59, 9.98, Z=14.40, 12.79, all P<0.05). Using lung ultrasound lung consolidation size and consolidation size/body surface area to predict the severe CAP, the optimal cut-off value were 6.7 mm and 10.2, the accuracy was 0.80 (95%CI 0.75-0.83) and 0.89 (95%CI 0.86-0.92), the sensitivity was 0.99 and 0.99, the specificity was 0.14 and 0.56, respectively, and the area under the curve was 0.66 (95%CI 0.60-0.72, P<0.001) and 0.76 (95%CI 0.70-0.83, P<0.001), respectively. The area under the curve of consolidation size/body surface area was higher than that of consolidation size (Z=5.50, P<0.001). Conclusions: Consolidation and confluent B-line, are important index for lung ultrasound diagnosis of CAP in children. The actual consolidation size adjusted by body surface area is superior to the size of consolidation in predicting severe CAP.

Innate Immune Response-Mediated Inflammation in Viral Pneumonia

Abstract Objective This study aims to investigate the intricate interactions between viral infections, specifically within the context of community-acquired pneumonia. We seek to shed light on the underestimation of viral pneumonia cases, utilizing advancements in molecular diagnostic testing. Methods The investigation involves a comprehensive review of existing literature to explore the prevalence and impact of various viruses causing pneumonia in both children and adults. Our focus spans parainfluenza virus, respiratory syncytial virus, human bocavirus, human metapneumovirus, and rhinoviruses in children and coronaviruses, rhinoviruses, and influenza viruses in adults. The study further delves into the host's innate immune response, emphasizing the roles of pattern recognition receptors (PRRs), type I interferons (IFNs), proinflammatory cytokines, and other immune cells during viral infections. Results The analysis reveals a substantial global burden of viral community-acquired pneumonia, estimating approximately 200 million cases annually in children and adults combined. This study underscores viruses' significant, previously underestimated role in causing pneumonia. Insights into specific viruses affecting different age groups and their prevalence in various geographical settings are provided. Conclusion In conclusion, this review emphasizes the necessity of recognizing the substantial contribution of viral infections to community-acquired pneumonia cases. The host's innate immune response, mediated by PRRs, type I IFNs, and other immune mediators, is pivotal in preventing viral invasion and replication. The study accentuates the importance of continued research into understanding the innate immune mechanisms involved in viral infections and the resulting inflammation.

Impact of Demographic Developments and PCV13 Vaccination on the Future Burden of Pneumococcal Diseases in Germany—An Integrated Probabilistic Differential Equation Approach

Streptococcus pneumonia is the primary cause of morbidity and mortality in infants and children globally. Invasive pneumococcal disease (IPD) incidence is affected by various risk factors such as age and comorbidities. Additionally, this bacterium is a major cause of community-acquired pneumonia (CAP), leading to higher rates of hospitalization, especially among older adults. Vaccination with pneumococcal conjugate vaccines (PCVs) has proven effective, but the demographic transition in Germany poses a challenge. This study introduces a novel stochastic approach by integrating a population forecast model into a transmission dynamic model to investigate the future burden of pneumococcal diseases in three age groups (0–4, 5–59, and 60 and older). Our simulations, presented through mean predictions and 75% prediction intervals, indicate that implementing PCV13 (13-valent pneumococcal conjugate vaccine) until the year 2050 results in reduced cases of IPD and CAP in all age groups compared to scenarios without infant vaccination. However, cases with non-vaccine serotypes may persist at higher levels compared to scenarios without infant vaccination. Consequently, there may be a need for improvement in the current national vaccine policy, such as implementing the use of higher-valent PCVs and strengthening adult vaccination uptake.

Comparative Efficacy of Levofloxacin Versus Amoxycillin/Clavulanic Acid Combined with Azithromycin in Treatment of Community-Acquired Pneumonia

Background: Community-acquired pneumonia (CAP) is an important cause of mortality and morbidity worldwide. Early initiation of antibiotics is highly recommended. In most CAP cases, multiple drug options are increasingly becoming available, but there is often a lack of evidence that allows for a direct comparison of the efficacy of one drug versus another. Aim: The main objective was to compare treatment outcomes using oral levofloxacin alone and combined azithromycin and amoxicillin/Clavulanic acid in outpatient treatment of Community-acquired pneumonia. Methods: This study was a prospective longitudinal design. Patients diagnosed with CAP were randomly assigned to first and second treatment groups. Community-acquired pneumonia was diagnosed according to America Thoracic Society criteria. The sample size of 78 was arrived at by Yamane Taro (1967) formula. Every patient diagnosed and treated in the outpatient department who gave written consent to participate was enrolled in the study and randomly assigned to one of the treatment groups. Minors below 18 years were excluded from the study. Data were analysed using SPSS for Windows version 26. An independent t-test compared the effectiveness of the two treatment groups. Changes in white blood cell count during the follow-up visits were done using a chi-square test. A p-value of &lt;0.05 was considered statistically significant. Results. The majority, 33(50%) of the patients, were aged between 21 and 29 years, and over sixty percent, 42(63.6%) of participants were females. Of all the participants, 66(100%) had a cough and chest pain, 57(86.4%) had crackles, and about ten percent, 6(9.1%) had difficulty breathing at the time of admission into the study. About 29(43.9%) of patients had a fever at baseline, and 14(21.2%) had a respiratory rate between 16 and 29 breaths per minute at baseline. A combination of azithromycin and amoxycillin/clavulanic acid was associated with statistically significant faster resolution of chest pains and cough (mean 1.7 and 3.14 days, respectively) compared to levofloxacin group (mean 2.21 and 3.71 days, respectively) in patients who had community-acquired pneumonia (p=0.009. There was no difference in fever resolution, time to crackles subsidence, resolution of difficulty in breathing, and change in white blood cell count in participants in the two treatment groups. Conclusions: Azithromycin combined with amoxycillin/clavulanic acid reduced chest pain in 1.70 days (SD=0.618) compared to levofloxacin alone (2.21 days, SD=1.204) (p=0.009). Azithromycin combined with amoxycillin/clavulanic acid reduced cough in 3.14 days (SD=0.789) versus levofloxacin alone (3.70 days, SD=0.588) (p=0.014). Hence, the azithromycin plus amoxycillin/clavulanic acid combination was found to be superior for managing CAP.

Effectiveness of Drip Infusion of Lascufloxacin, a Novel Fluoroquinolone Antibiotic, for Patients with Pneumonia Including Chronic Lung Disease Exacerbations and Lung Abscesses.

Lascufloxacin (LSFX), a novel fluoroquinolone antibacterial agent, has recently been used as a drip infusion for treating pneumonia, apparently with good effectiveness against various bacteria, including anaerobes, and good intrapulmonary penetration. The clinical effectiveness of LSFX was retrospectively investigated for the 55 patients admitted to our hospital with pneumonia, including chronic lung disease exacerbations and lung abscesses, from May 2021 to July 2023. The median age of the 55 patients was 76.1 (34.1-93.1) years, 45 (81.8%) were male, and 48 (87.5%) patients had underlying disease. Community-acquired pneumonia was seen in 47 (85.5%) patients, including 9 (16.4%) with lung abscess, and the other 8 (14.5%) had nursing and healthcare-associated pneumonia/hospital-acquired pneumonia. Moderate pneumonia was present in 33 (61.8%) of 55 patients, and LSFX was used as a second-line treatment for 28 (50.9%) patients in whom first-line antibiotics were ineffective. The median duration of intravenous LSFX administration was 9 (2.0-49) days. Streptococcus pneumoniae and methicillin-susceptible Staphylococcus aureus were isolated from 3 (7.1%) and 2 (4.8%) patients, respectively. Of the 55 patients, 45 (81.5%) improved clinically with intravenous LSFX administration; 20 (95.2%) of 21 community-acquired pneumonia cases, including 9 (100.0%) of 9 bacterial pneumonia cases, were improved by LSFX as first-line treatment, and 8 (88.9%) of 9 lung abscess patients also showed clinical improvement with LSFX as a second-line treatment. There were no severe adverse effects in any of the 55 patients. Based on these data, intravenous administration of LSFX seems effective for bacterial pneumonia, including chronic lung disease exacerbations and lung abscesses, and it appears to have broad antimicrobial activity and good tissue penetration into the lung.