Clinical Features Of Pneumonia Research Articles

Diagnostic Accuracy of Lung Ultrasound in Diagnosis of Pneumonia in Children using Chest X-RAY as Gold Standard

Objective: To determine the diagnostic accuracy of lung ultrasound (LUS) in the diagnosis of pneumonia in children using chest x-ray as the gold standard. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Sialkot Pakistan, from Feb to Aug 2021 Methodology: All patients underwent clinical examination, chest radiograph (anterior-posterior view), lung ultrasound and blood sample analysis in the first 24 hours after admission. A pre-specified hospital radiologist carried out a lung ultrasound. The examination was performed with the patient sitting upright or supine. The presence of pneumonia on x-ray and USG were recorded. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasound in the diagnosis of pneumonia by taking chest x-ray as the gold standard was calculated in all the study participants. Results: In this study, 262 patients with clinical features of pneumonia were enrolled. The mean age of the study participants was 3.27±2.344 years. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy and frequency of lung ultrasonography (US) vs chest radiography (CR) in diagnosing pneumonia was 95.28%, 87.5%, 99.59%, 36.84%, 95.04% and 96.95% respectively. Conclusion: Lung ultrasound emerged as a sensitive diagnostic tool to diagnose pneumonia in children. Sensitivity, specificity, positive predictive value, and negative predictive value all favoured the use of this modality to diagnose pneumonia in paediatric patients.

Pneumonia Clinical Features in Under-Five Children Treated in Atma Jaya Hospital in 2017-2020

Pneumonia is the leading cause of infection-related death among children and still remains a global health problem, especially for children under five. This study aimed to identify the clinical features of pneumonia in under-five chilren treated at Atma Jaya Hospital during the period of 2017-2020. This was a cross-sectional retrospective descriptive study on all under-five patients diagnosed with pneumonia treated in Atma Jaya Hospital. Data were collected from November 2021-January 2022 from the medical records of these children (n=148) and analyzed using the univariate analysis. Results showed that most subjects of this study were boys (60.8%), in the age group of 1-4 years old (62.2%), with fever as the most common pnemonia clinical symptom (93.9%). Physical examinations revealed that the average pulse of the subjects were 131.2 beats/minute and the average temperature was 37.1°C. Other signs and symptoms identified during physical examinations were tachypnea (20,3%), retractions (56.1%), crackles (82.4%), and wheezing (22,3%). The laboratory findings presented a mean hemoglobin of 11.0 g/dL, a mean hematocrit of 32.5%, and a mean CRP of 13.2 mg/dL, while most subjects had normal leukocyte (58.1%) and platelet counts (52.0%). The most common chest X-ray finding of pneumonia in these children was infiltrate (92.6%) and the average length of stay was 4 days. Most under-five children experiencing pneumonia recovered after treatment (97.3%).

Acute management of pneumonia in adult patients.

Acute management of pneumonia in adult patients.

28-Year-Old Man With Joint Pain

28-Year-Old Man With Joint Pain

An Overview on Atypical Pneumonia Clinical Features and Management Approach

Atypical pneumonia has evolved in recent decades to signify lower respiratory tract diseases caused by certain respiratory pathogens. These pathogens are distinguished clinically and radiologically from typical bacterial community-acquired pneumonia (CAP). The spectrum of such infections includes zoonotic and non-zoonotic transmissions, with the latter being more common. The tendency of extrapulmonary involvement, which is true for each kind of atypical CAP, distinguishes clinically from classic

Clinical Features and Risk Factors for Mortality in Hospitalized Older Adults with Pneumonia.

Background Pneumonia is a common disease among the aging population in Japan. Hence, it is important to elucidate the risks related to pneumonia mortality. Since Streptococcus pneumoniae is the most commonly observed pathogen, pneumococcal vaccination is recommended to older adults. Therefore, this study aimed to clarify the clinical features of pneumonia, including the status of pneumococcal vaccination, in hospitalized older adult patients in Japan. Methods This single-centered retrospective study was conducted by reviewing the medical records of all patients with acute pneumonia at Fujisawa City Hospital in Japan from April 2018 to March 2019. Patients were divided into two groups based on their history of pneumococcal vaccination. The primary endpoint was in-hospital mortality, while the secondary endpoint was risk factors associated with mortality. Results We included 93 patients with pneumonia in this retrospective study. Although the mortality rate was higher in the vaccinated group (15.8%) than in the unvaccinated group (9.1%), vaccination status was not identified as a significant risk factor for mortality after multivariable logistic regression (odds ratio: 2.71; 95% confidence interval: 0.667–11.02; p=0.16). In addition, the A-DROP score was identified as an independent risk factor (odds ratio: 2.64; 95% confidence interval: 1.22–5.72; p=0.008). Conclusions Our study suggested that the A-DROP score is a risk factor of mortality for pneumonia in older adults. In addition, pneumococcal vaccination history was related to increased mortality; however, the influence of the vaccination remains unclear because of the small sample size.

A CRACK LUNG WITH CRACK COCAINE

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Crack lung is an acute pulmonary syndrome with a spectrum of clinical and histopathologic findings occurring within 48 hours of smoking crack cocaine.1 Patients may present with clinical features of pneumonia. As such, it is important to differentiate the two clinical entities as the management approach differs. Here we present a case of acute pulmonary cocaine toxicity mimicking possible pneumonia. CASE PRESENTATION: A 40 year old man with a history of depression was brought in by paramedics after being found unconscious.He was given naloxone en route with improved consciousness but was tachypneic and hypoxic, requiring oxygen. On arrival to the Emergency Department, he admitted to having smoked crack cocaine which was impure.He reported having hemoptysis and rhinorrhea but denied any chest pain, fever or any gastrointestinal symptoms.There was no personal or family history of lung or autoimmune disease. On presentation he was afebrile, tachycardic, tachypneic and persistently hypoxic requiring high flow nasal cannula (HFNC). Pertinent findings were diminished breath sounds with diffuse rales, with an otherwise unremarkable exam. Laboratory results were notable for cocaine on urine toxicology, leukocytosis with neutrophilia, elevated procalcitonin with normal CRP, BNP, serial troponins, lactic acid, COVID-19 test and HIV. Initial CXR showed bilateral extensive nodular interstitial lung pattern. He was admitted for acute hypoxic respiratory failure (AHRF) secondary to crack lung syndrome with superimposed pneumonia on HFNC and started on empiric antibiotics as well as methylprednisolone. Unfortunately, he remained persistently tachypneic and required non-invasive ventilation (NIV) and transfer to the intensive care unit. On day 2, his respiratory status markedly improved and he was weaned from NIV to room air. Final blood cultures and mycoplasma antibody were negative and the rest of his hospital stay was uneventful. DISCUSSION: In 2018, approximately 5.5 million persons aged ≥ 12 years reported cocaine use within the past year of which 757,000 used crack cocaine.2,3 With likely underreported usage, the deleterious pulmonary complications related to cocaine use including pulmonary edema, alveolar hemorrhage, eosinophilic pneumonia, pneumothorax, thromboembolic disease and AHRF,4 are clinically relevant. However, the diagnosis of cocaine-induced pulmonary diseases remains challenging for clinicians given that the clinical features and chest images are non specific and can mimic several other processes e.g. pneumonia.5 This distinction is important as mortality for pneumonia requiring ICU admission approaches 30%,6 while acute eosinophilic pneumonia portends an excellent prognosis with rapid clinical recovery. CONCLUSIONS: This case highlights that "Crack Lung" should be considered as a differential diagnosis in patients with AHRF and diffuse bilateral pulmonary infiltrates. REFERENCE #1: Forrester, J. M., Steele, A. W., Waldron, J. A., & Parsons, P. E. (1990). Crack lung: an acute pulmonary syndrome with a spectrum of clinical and histopathologic findings. The American review of respiratory disease, 142(2), 462–467. https://doi.org/10.1164/ajrccm/142.2.462 REFERENCE #2: National Institute on Drug Abuse.(2020) What is the scope of cocaine use in the United States? Available from:https://www.drugabuse.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states REFERENCE #3: 3.Center for Disease Control and Prevention. (2019). Annual surveillance report of drug-related risks and outcome. Available from:https://www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillance-report.pdf DISCLOSURES: No relevant relationships by Sahai Donaldson, source=Web Response No relevant relationships by Lorenzo Leys, source=Web Response No relevant relationships by Alicia Thomas, source=Web Response No relevant relationships by Felix Wireko, source=Web Response

DiGeorge syndrome presenting with seizure in neonatal period: a case report

DiGeorge syndrome is caused by a micro-deletion of chromosome 22q11.2 that disrupts development of the third and fourth pharyngeal pouches during early embryogenesis. Other structures forming at the same period are also frequently affected. So, the phenotypic spectrum shows a wide variability. In this case report, we describe a 1-month and 24-day old male child who presented with history of recurrent afebrile seizure and noisy breathing since early neonatal period. He had history of repeated chest infections. On examination, patient had stridor, facial dysmorphism, pectus excavatum and clinical features of pneumonia. Investigations revealed hypocalcaemia, hypoparathyroidism, consolidation on X-ray chest and cellular immunodeficiency. Echocardiography findings were normal. Fluorescent in situ hybridization (FISH) was performed which confirmed the diagnosis 22q11.2 deletion.
 Birdem Med J 2021; 11(2): 128-132

Vitamin D status in children with community acquired pneumonia and its association with severity: a hospital-based study.

International and observational epidemiological studies provide evidence that vitamin D deficiency may confer increased risk of influenza and respiratory tract infection. This study was undertaken to evaluate the prevalence of vitamin D deficiency in pneumonia in children, and to assess its relationship with the severity. Study group included children aged between 2 months to 5 years of age admitted as inpatients who presented with clinical features of pneumonia as per WHO Classification. Detailed clinical assessment and physical examination was done at the time of admission and patients were enrolled and relevant findings were noted in prestructured proforma. Vitamin D levels <30 nmol/L (<12 ng/mL) were defined as deficient, 30-50 nmol/L (12-20 ng/mL) as insufficient, and >125 nmol/L (>50 ng/mL) as sufficient. Outcomes of the patients admitted were recorded in terms of duration of hospitalization, Intensive Care Unit (ICU) stay, oxygen requirement, antibiotic need and duration, need for upgradation of antibiotics, nebulization need with drugs used, ventilator need and other parameters. Statistical analysis was performed using statistical package for social sciences software (SPSS Inc., Chicago, IL, USA). A P value of <0.05 was considered statistically significant. Out of 101 patients, 100% presented with fever, cough and fast breathing, 42.6% with grunting, 41 (40.5%) with noisy breathing, 5.7% with bluish discoloration, and 4.3% with apnea. Forty-one (40.5%) patients had crepitation, 53 (52.4%) patients had rhonchi, while 7 (6%) presented with bronchial breathing. Chest radiography features at admission helped to differentiate between presumed viral and presumed bacterial infection. Vitamin D deficient patients had significantly longer duration of hospital stay as compared to vitamin D sufficient group (P<0.001). The need for upgradation of antibiotics between the three groups were found to be significant (P<0.001). This showed that vitamin D deficiency is directly proportional to the need of upgradation of antibiotics. Bacterial pneumonia presents mostly as alveolar infiltrates and/or pleural effusion while viral pneumonia presents as interstitial infiltrates and/or hyperinflation. Cases with presumed bacterial pneumonia (based on X-ray, 38 out of 48, 79.1%) were more often vitamin D deficient as compared to case with presumed viral pneumonia (32 out of 52, 61.5%, P=0.05). Vitamin D is widely prevalent in Indian children with pneumonia. Vitamin D deficient patients needed a longer duration of hospitalization, more upgradation of antibiotics, and PICU admissions; moreover, it had more CPAP requirement, longer duration of PICU stay and longer duration of CPAP requirements as compared to vitamin D sufficient group.

Clinical features of pneumonia in severely malnourished children with diarrhoea compared to those without diarrhoea.

Introduction: Pneumonia and diarrhoea are amongst the most common causes for hospital admission for children in low- and middle-income countries such as Bangladesh. Undernourished children often have more severe infections and a higher morbidity and mortality. Objective: The objective of this study was to determine the clinical features and outcomes of pneumonia in severely malnourished children with and without diarrhoea. Methodology: A retrospective chart analysis was carried out on children under 5 years of age who were admitted in intensive care unit of the Dhaka hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). A total of 245 severe acute malnourished children with pneumonia and diarrhoea (PD group) were compared with 89 children with pneumonia only (PO group). Results: A significantly higher number of children from the PD group had some/severe dehydration (16.3% vs. 1.1%; p < 0.005) when compared with children from the PO group. The PD group showed less cough (83.3% vs. 100%; p < 0.001), lower chest wall indrawing (40.4% vs. 60.7%; p = 0.001), and crackles (62.4% vs. 87.6%; p < 0.001) compared to the PO group at the time of admission. Conclusion: Early diagnosis and treatment of some/severe dehydration in addition to WHO recommended other routine treatment of diarrhoea, pneumonia and severe acute malnutrition in children may help to reduce childhood morbidity and mortality especially in low- and middle-income countries.

Socio-demographic and clinical pattern of childhood pneumonia in a tertiary hospital in Sokoto, Nigeria

Context: Pneumonia is the world’s leading infectious killer of children, particularly under- fives. Practical, achievable and affordable key interventions have been identified to reduce morbidity and mortality from Pneumonia. Despite these measures, it still remains a disease that has significant impact on child’s survival.Objectives: To determine the sociodemographic and clinical features of Pneumonia in hospitalized children at Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria.Materials and methods: A retrospective review of records of children admitted for Pneumonia over a 30-month period and relevant information eg. age, gender, symptoms and signs were documented.Results: Of the189 children reviewed, 114(60.3%) were below 1 year of age, males were 108(57.1%) with a M:F ratio of 1.3:1. One hundred and twenty three (65.0%) belonged to the low socio-economic class (SEC) and only 95(50.3%) were fully immunized. Cough and fever were the commonest presenting symptoms while crepitations, chest in drawing and tachypnoea were the commonest signs. Majority 178(94.2%) had Bronchopneumonia while 11(5.8%) had Lobar Pneumonia. 151(79.9%) were discharged, 1(0.5%) absconded and 37(19.6%) died. Cough and fever were seen in more children that died, however it was not significant. Similarly, more children that had crepitations, tachypnoea, chest indrawing and hypoxaemia died, only chest in drawing was significantly associated with mortality (p=0.020).Conclusion: Pneumonia is still a common cause of mortality, socio-demographic and clinical features remain similar to other reports. Despite the availability of preventive measures and treatment guidelines, mortality remains high. We recommend and advocate for equitable access to quality primary health care in order to prevent, diagnose and treat pneumonia.

Clinical characteristics analysis of patients with pneumonia infected by Chlamydia psittaci

To explore the clinical characteristics of pneumonia infected by Chlamydophila psittaci (C. psittaci). A retrospective analysis was performed on 3 cases of C. psittaci pneumonia admitted to People's Hospital of Tongling City from July 2019 to January 2020. The patients' contact history, clinical manifestations, laboratory examination, imaging characteristics and evolution, etiology, treatment process and outcome were analyzed, so as to provide experience for the diagnosis and prevention of C. psittaci pneumonia. The 3 patients had been infected through pet or zoonotic exposures. All symptoms included high fever (body temperature > 39 centigrade), cough, sputum, chest tightness and dyspnea. The disease progressed rapidly, with severe acute respiratory distress syndrome (ARDS) and shock as the main manifestations, but the damages to the heart, liver and kidney were mild. Laboratory tests showed that C-reactive protein (CRP, all > 200 mg/L) and neutrophil proportion (Neut%, > 0.90) were significantly increased, while white blood cell count (WBC) and procalcitonin (PCT) were not significantly increased. Chest computed tomography (CT) showed inflammatory infiltration with interstitial changes, either unilateral or bilateral. Chest X-ray showed large areas of inflammatory infiltrations, fan-shaped or wedge-shaped to the edge of pleura. After 7 days of treatment, the bedside computed X-ray (CR) showed absorption of infiltration. After 11-13 days, the CT reexamination indicated lung infection was basically absorbed. Metagenomic next-generation sequencing (mNGS) confirmed the presence of C. psittaci in patients' sputum. It was sensitive to quinolones and tetracyclines. The patients' body temperature dropped to normal after 2-3 days of antibiotics, and all patients were extubated and transferred to normal ward 10 days later. The total course of illness was 20-30 days. The patients with C. psittaci pneumonia are critically ill, and clinical manifestations of moderate to severe ARDS and shock are common. Early diagnosis depends on mNGS, and reasonable treatment is important for prognosis.

THE EVANESCENT LUNG

SESSION TITLE: Medical Student/Resident Obstructive Lung Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Vanishing lung syndrome (VLS), also known as giant bullous emphysema, is a chronic progressive condition predominantly seen in upper lobes of lungs, occupying at least one-third of the hemithorax and can compress normal lung parenchyma. It is commonly seen in young males with a history of chronic smoking. Other risk factors include α-1-antitrypsin deficiency and marijuana (1). Complications include tension pneumothorax. Bullectomy is usually the treatment of choice. Herein, we describe a rare case where an elderly male with symptoms of pneumonia was found to have an incidental finding of VLS on computed tomography pulmonary angiogram (CTPA). CASE PRESENTATION: A 76-year-old African American male with a medical history of prostate cancer status post-radiotherapy and hypertension came in with a 2-day history of sudden onset shortness of breath, cough with yellowish-brownish sputum and subjective fevers. He had a 60 pack-year smoking history. Vitals were remarkable for a body mass index of 15, heart rate of 125/min, respiratory rate of 22/min, and fever of 100.8 but there was no hypoxia. On comprehensive physical examination, he had stage 3 nail clubbing. Pulmonary examination revealed hyper resonant percussion in the right upper zone and decreased air entry. Laboratory investigation was unremarkable except for leukocytosis of 15.8 X 103 /mm3. A chest radiograph demonstrated acute infiltrates in the right lung inferior to the right hilum. There was a large bleb within the right hemithorax occupying most of the right hemithorax. Left hemithorax exhibited chronic emphysematous changes with peripheral blebs. Since the patient had a history of malignancy and was tachycardic on admission. CTPA was done which revealed very large right pulmonary bleb and air space opacities suggestive of acute bronchopneumonia or bronchitis. Ceftriaxone and azithromycin were started after which the patient clinically improved in one day. Investigating the imaging findings, α-1 antitrypsin levels were normal. HIV testing was negative. Cardiothoracic surgery was consulted and a decision was taken to do bullectomy but the patient refused the procedure as he was asymptomatic. DISCUSSION: VLS is a rare condition usually seen in young males with chronic smoking history or marijuana abuse. A common presentation is tension pneumothorax as a result of the rupture of the bulla. What makes this case unique is that our patient was an asymptomatic elderly male without any prior diagnosis of the same. He presented with clinical features of pneumonia and was incidentally found to have VLS at this age(2). CONCLUSIONS: VLS becomes evident as it progresses and can lead to tension pneumothorax. Patients should be referred for pulmonary function tests for diagnosis of chronic obstructive pulmonary disease and cardiothoracic surgery for bullectomy which is the treatment of choice and improves the function of the lung significantly (3). Reference #1: 1. Barry Ladizinski, M.D., and Christopher Sankey, M.D.; Vanishing Lung Syndrome N Engl J Med 2014; 370:e14, DOI: 10.1056/NEJMicm1305898 Reference #2: 2. Amarjit Singh Vij, Robert James, Akashdeep Singh, Amrinder Singh Dhaliwal, Ajay Chhabra, Kamaljeet Kaur Vij; A Rare Case of Vanishing Lung Syndrome; J Assoc Physicians India. 2014 Dec;62(12):51-3. PMID: 26259424 Reference #3: 3. Nidhi Sood, Nikhil Sood; A Rare Case of Vanishing Lung Syndrome; Case Rep Pulmonol. 2011; 2011: 957463. doi: 10.1155/2011/957463. PMID: 22937434 DISCLOSURES: No relevant relationships by Ankit Agrawal, source=Web Response No relevant relationships by Sanya Chandna, source=Web Response No relevant relationships by Monarch Shah, source=Web Response

Lessons learned from early compassionate use of convalescent plasma on critically ill patients with Covid-19.

BackgroundThe management of critically ill patients with coronavirus disease 2019 (COVID‐19), caused by a new human virus severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), is challenging. Recently, there have been several reports with inconsistent results after treatment with convalescent plasma (CP) on critically ill patients with COVID‐19, which was produced with a neutralizing antibody titer and tested in a P3 or P4 laboratory. However, due to the limitation of the conditions on mass production of plasma, most producers hardly had the capability to isolate the neutralizing antibody. Here, we report the clinical courses of three critically ill patients with COVID‐19 receiving CP treatments by total immunoglobulin G (IgG) titer collection.MethodsThree patients with COVID‐19 in this study were laboratory confirmed to be positive for SARS‐CoV‐2, with radiographic and clinical features of pneumonia. CP was collected by total IgG titer of 160 (range, 200‐225 mL), and patients were transfused between 20 and 30 days after disease onset at the critical illness stage as a trial in addition to standard care. The clinical courses of these patients, including laboratory results and pulmonary functional and image studies after receiving convalescent plasma infusions, were reviewed.ResultsNo therapeutic effect of CP was observed in any of the patients; instead, all three patients deteriorated and required extracorporeal membrane oxygenation treatment. A potential cytokine storm 4 hours after infusion of CP in Patient 2 was observed. No more patients were put on the trial of CP transfusion.ConclusionsWe recommend extreme caution in using CP in critically ill patients more than 2 weeks after the onset of COVID‐19 pneumonia.

Clinical, Paraclinical Characteristics and Pathogens of Pneumonia in Children at the Pediatric Deparment, Bach Mai Hospital

This study describes the clinical, paraclinical characteristics and pathogens of pneumonia in 195 children with pneumonia at the Pediatric Department, Bach Mai Hospital from January to June 2019. According to the study results, most of the cases were aged under five (93.3%) with pneumonia clinical features of tachypnea, 99%; cough, 97.4%; crackling sound, 81.6%; respiratory failure, 80.5%; leukocytosis, 55.9%; and high CRP level in serum, 54.9%. There were 90 cases positive with incubated bacteria with the prevalence of three nasopharyngeal carriages: S.pneumoniae was 48.7%; H.influenzae, 27.8%; and M.catarrhalis, 18.3%. All the bacteria were susceptible to almost all the antibiotics used in treatment, such as Amoxicillin/acid clavunamic, cefotaxim and ceftriason. The study concludes that clinical and paraclinical characteristics in children with pneumonia were fairly various and bacterial pathogens of pediatric pneumonia were similar and susceptible to basic antibiotics.&#x0D; Keywords&#x0D; Pneumonia, Steptococcus pneumoniae, Haemophilus influenzae, antibiotic-resistant.&#x0D; References&#x0D; [1] T.K.P. Nguyen, T.H.Tran, C.L. Roberts et al, Child pneumonia – focus on the Western Pacific Region, Paediatr Respir Rev 21 (2017) 102-110.[2] P.M.M. Yan Jin, Jose Irineu, Rigotti et al, Cause-specific child mortality performance and contributions to all-cause child mortality, and number of child lives saved during the Millennium Development Goals era: a country-level analysis, Glob Health Action 11(1) (2018) 1-20.[3] L. Liu, S. Oza, D. Hogan et al, Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals, Lancet Child Adolesc Health 16 (2016) 31593-31598.[4] WHO, World Health Statistics, 2015.[5] Bonita F. Stanton and Richard E. Behrman (2016), Overview of Pediatrics, Robert M. Kliegman Nelson Text Book of Pediatrics, 20th Edition, (Elsevier), Philadelphia, 20-39.[6] L.N. Tra, Biologycal constant of Vietnamese in 90th decade, 20th century. Medical Publishing house, Hanoi ( 2004).[7] WHO, Anemia. Global Database on Anaemia, (2015) 4-9.[8] Thomas Bénet, Sánchez Picot, Mélina Messaoudi et al, Microorganisms Associated With Pneumonia in Children &lt;5 Years of Age in Developing and Emerging Countries: The GABRIEL Pneumonia Multicenter, Prospective, Case-Control Study, Clin Infect Dis 65(4) (2018) 604–612.[9] S.E. Katz and D.J. Williams, Pediatric Community-Acquired Pneumonia in the United States Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future, Infect Dis Clin North Am 32(1) (2018) 47–63.[10] Yi-Yi Yu, Luo Ren, Yu Deng et al, Epidemiological characteristics of nasopharyngeal Streptococcus pneumoniae strains among children with pneumonia in Chongqing, China, Sci Rep (9) (2019) 1-8.[11] Mohamed M Rashad, Sahar M Fayed and Aly Mona K El-Hag, Iron-deficiency anemia as a risk factor for pneumonia in children, Benha Medical Journal 32(2) (2015) 96-100.[12] Sopio Chochua, Valérie D'Acremont, Christiane Hanke et al, Increased Nasopharyngeal Density and Concurrent Carriage of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis Are Associated with Pneumonia in Febrile Children, PLoS One 11(12) (2016) 1-12.[13] Le Thi Hong Hanh, Đao Minh Tuan, Nguyen Duy Bo et al, Pneumonia at the Respiratory Department and Allergy Immunology Department of National Children Hospital in 2015, Vietnam Medical Journal 447 (2016) 70-75.[14] Ministry of Health, Guinline diagnosis and treatment pneumonia in children, 2015.[15] A. Zafar, R. Hasan, S. Nizamuddin,, Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002–15, J Antimicrob Chemother 71(1) (2016) 103-109.

Pneumonia in children admitted to the national referral hospital in Bhutan: A prospective cohort study

ObjectivesThe study aim was to describe the etiological profile and clinical characteristics of pneumonia among children hospitalized in Thimphu, Bhutan. MethodsThis prospective study enrolled children aged 2–59 months admitted to the Jigme Dorji Wangchuck National Referral Hospital with World Health Organization (WHO)-defined clinical pneumonia. Demographic and clinico-radiological data were collected through questionnaires, physical examination, and chest radiography. Blood samples and nasopharyngeal washing were collected for microbiological analysis including culture and molecular methods. ResultsFrom July 2017 to June 2018, 189 children were enrolled, of which 53.4% were infants. Pneumonia-related admissions were less frequent over the winter. Chest radiographies were obtained in 149 children; endpoints included pneumonia in 39 cases (26.2%), other infiltrates in 31 (20.8%), and were normal in 79 children (53.0%). Non-contaminated bacterial growth was detected in 8/152 (5.3%) blood cultures, with only two cases of Streptococcus pneumoniae. Viral detection in upper respiratory secretions was common, with at least one virus detected in 103/115 (89.6%). The three most-commonly isolated viruses were respiratory syncytial virus (52/115; 45.2%), rhinovirus (42/115; 36.5%), and human parainfluenza virus (19/115; 16.5%). A third of patients with viral infections showed mixed infections. Case fatality rate was 3.2% (6/189). ConclusionRespiratory viral infections predominated among this cohort of WHO-defined clinical pneumonia cases, whereas bacterial aetiologies were uncommon, highlighting the epidemiologic transition that Bhutan seems to have reached.

Effect of Gastrointestinal Symptoms in Patients With COVID-19

Because of accumulating evidence pointing to continuous person-to-person transmission of coronavirus disease 2019 (COVID-19) in hospital and family settings,1,2 the World Health Organization has recently declared COVID-19 a public health emergency of international concern. Fever and respiratory symptoms tend to be initial and major, whereas gastrointestinal (GI) symptoms were also observed in a significant portion of patients.3 Positive findings of reverse transcription polymerase chain reaction further showed that COVID-19 may spread by fecal-oral transmission.

Characteristics of Hospitalized Rhinovirus-Associated Community-Acquired Pneumonia in Children, Finland, 2003-2014.

Background: Rhinovirus (RV) is the most common cause of respiratory tract infections in children but, still, the clinical characteristics of RV-associated pneumonia have not been sufficiently investigated.Methods: We identified children and adolescents younger than 18 years of age treated for community-acquired pneumonia as inpatients at the Turku University Hospital from 2003 to 2014 and analyzed for RV by PCR of a respiratory tract specimen. We collected the data from medical records and compared RV-positive children with RV-negative children.Results: Of the study population of 313 children with pneumonia who were studied for RV, it was detected in 82 (26%). RV-positive children were younger (median age 2.6 years, interquartile range [IQR] 1.1–4.6 vs. 3.5 years, IQR 1.7–8.3, p = 0.002) and they had more often a history of preterm birth (16% vs. 5%, adjusted odds ratio 2.89, 95% confidence interval 1.21–6.92, p = 0.017) than RV-negative children. RV-positive children had a higher median white blood cell count than RV-negative children at presentation with pneumonia. The signs, symptoms, and severity of pneumonia were mostly similar in RV-positive and RV-negative children.Conclusions: RV was frequently detected in young children hospitalized with community-acquired pneumonia. We identified premature birth as a factor associated with RV-positive pneumonia. The clinical features of pneumonia did not clearly differ between RV-positive and RV-negative children. Further studies are needed to clarify the clinical significance of detection of RV in children with pneumonia.

Relationship Between the Quorum Network (Sensing/Quenching) and Clinical Features of Pneumonia and Bacteraemia Caused by A. baumannii.

Acinetobacter baumannii (Ab) is one of the most important pathogens associated with nosocomial infections, especially pneumonia. Interest in the Quorum network, i.e., Quorum Sensing (QS)/Quorum Quenching (QQ), in this pathogen has grown in recent years. The Quorum network plays an important role in regulating diverse virulence factors such as surface motility and bacterial competition through the type VI secretion system (T6SS), which is associated with bacterial invasiveness. In the present study, we investigated 30 clinical strains of A. baumannii isolated in the “II Spanish Study of A. baumannii GEIH-REIPI 2000-2010” (Genbank Umbrella Bioproject PRJNA422585), a multicentre study describing the relationship between the Quorum network in A. baumannii and the development of pneumonia and associated bacteraemia. Expression of the aidA gene (encoding the AidA protein, QQ enzyme) was lower (P < 0.001) in strains of A. baumannii isolated from patients with bacteraemic pneumonia than in strains isolated from patients with non-bacteraemic pneumonia. Moreover, aidA expression in the first type of strain was not regulated in the presence of environmental stress factors such as the 3-oxo-C12-HSL molecule (substrate of AidA protein, QQ activation) or H2O2 (inhibitor of AidA protein, QS activation). However, in the A. baumannii strains isolated from patients with non-bacteraemic pneumonia, aidA gene expression was regulated by stressors such as 3-oxo-C12-HSL and H2O2. In an in vivo Galleria mellonella model of A. baumannii infection, the A. baumannii ATCC 17978 strain was associated with higher mortality (100% at 24 h) than the mutant, abaI-deficient, strain (carrying a synthetase enzyme of Acyl homoserine lactone molecules) (70% at 24 h). These data suggest that the QS (abaR and abaI genes)/QQ (aidA gene) network affects the development of secondary bacteraemia in pneumonia patients and also the virulence of A. baumannii.

Pathogenic spectrum, clinical features and drug resistance of pneumonia caused by nontuberculous mycobacteria in acquined immunodeficiency syndrome patients

Objective To explore the pathogen spectrum, drug resistance rate and clinical characteristics of pneumonia caused by non-tuberculous mycobacteria (NTM) in acquined immuno-deficiency syndrome (AIDS) patients. Methods The clinical data of 31 hospitalized AIDS patients with bronchoalceolar lavage flind (BALF) culture confirmed NTM pulmonary disease in Guangzhou No. 8 People′s Hospital from January, 2008 to February, 2015 were retrospectively analyzed, including pathogen spectrum, drug resistance rate and clinical characteristics. The clinical characteristics and drug resistance were compared between Mycobacterium avmm-intracellulare complex (MAC) pneumonia and the non-MAC pneumonia, and t test and chi-square test were used. Results Of the 31 AIDS patients, 28 were male and 3 were female, with the mean age of 40.9 years old. The 31 NTM strains were consisted of 14 MAC strains and 17 non-MAC strains (including 4 M. kansasii strains, 3 M. lentiflavumstrains, 2 M. szulgai strains, 2 M. yongonense strains etc). There was no significant difference between two groups in sex ratio, mean age, clinical manifestations, laboratory tests and treatment outcome (all P>0.05). The major clinical manifestations included fever, productive cough, weight loss, anemia and low CD4+ count (<50/μL). Most patients showed thoracic lymphadenectasis and patchy shadows in lungs, and few patients had millet shadows and pericardial effusion. Compared with non-MAC strains, MAC strains had higher drug resistant rate of moxifloxacin (10/14 vs 4/17), levofloxacin (14/14 vs 8/17), and clarithromycin (11/14 vs 7/17). More extensively drug resistance strains were seen in non-MAC strains compared with MAC strains (11/14 vs 7/17). Conclusions MAC is the most common pathogen of NTM pulmonary disease in AIDS patients. The clinical features of pneumonia caused by MAC and non-MAC are similar, but drug resistance of MAC strains are more severe. Key words: Acquired immuno deficiency syndrome; Nontuberculous mycobacteria; Pneumonia; Mycobacterium avium complex; Drug resistance