Diagnosis Of Bacterial Pneumonia Research Articles

582. Comparing Broad-range PCR Testing and The Biofire® FilmArray® Pneumonia (PN) Panel in the Diagnosis of Bacterial Pneumonia

Abstract Background Given the low sensitivity of conventional microbial isolation methods for identifying respiratory pathogens in bacterial pneumonia, target-specific syndromic multiplex real-time PCR panels have been used in conjunction with culture methods to improve diagnostic yield. Additionally, broad-range polymerase chain reaction (BR-PCR) targeting bacterial 16s rRNA conserved region has shown higher sensitivity with certain specimen types, so we sought to evaluate the clinical performance of BR-PCR performed on bronchoalveolar lavage (BAL) specimens in comparison to The Biofire® FilmArray® Pneumonia (PN) Panel (BioFire Diagnostics, Salt Lake City, UT, USA). Methods A retrospective chart review was performed on all BAL specimens that had both a PN panel test and BR-PCR performed from January 2020 to May 2022 at all Indiana University affiliated hospitals. The PN panel test was performed in-house as per laboratory protocol, while BR-PCR was performed in a reference laboratory. Outcomes assessed included turn-around times (TAT), sensitivity and specificity of BR-PCR and clinical impact, if any. Results A total of 68 BAL specimens from 53 patients were identified (83% of patients were immunocompromised). Percent positivity for the PN panel was 19% and that of BR-PCR was 18%. With the PN panel used as the gold standard, the sensitivity and specificity of BR-PCR was 85% and 98%, respectively. Only one respiratory organism was detected by BR-PCR but not by the PN panel, and it was not considered pathogenic or to have a significant clinical impact. The median TAT for the PN panel was 2.1 hours (1.8, 3.2) versus 7.8 days (6.9, 10.4) for BR-PCR. Conclusion In our cohort of patients, BR-PCR testing was not superior to the Biofire® FilmArray® Pneumonia (PN) Panel when used to detect certain bacterial etiologies of pneumonia. Additionally, faster TAT for the panel test has the potential to enhance antimicrobial stewardship practices by enabling better antibiotic utilization. Adjunctive BR-PCR testing may be useful for clinical care when conventional testing is negative and patients are at risk for a variety of potential pathogens, including fungi. Disclosures All Authors: No reported disclosures

The utility of procalcitonin for diagnosing bacteremia and bacterial pneumonia in hospitalized oncology patients.

Procalcitonin (PCT) is an inflammatory marker elevated in bacteremia and bacterial pneumonia. We aimed to assess the real-world diagnostic accuracy of PCT in hospitalized patients with malignancy. A retrospective cohort of 715 patients with cancer who had PCT measured during 750 admissions was analyzed. Diagnosis of bacteremia was determined using blood culture data. Diagnosis of bacterial pneumonia was based on radiographic infiltrate and/or sputum culture. PCT's performance was assessed using receiver operating characteristic (ROC) curves, sensitivity, and specificity. Patients had bacteremia, bacterial pneumonia, or both during 210 admissions (28%). PCT elevation above 0.5ng/mL was significantly associated with diagnosed infection in the overall population (p < 0.0001) and in subgroups with solid tumor malignancies (p < 0.0001) and hematologic malignancies (p = 0.008). PCT was associated with infectious status in patients with any metastases, but not those with primary lung cancer, lung metastases, neuroendocrine tumors, febrile neutropenia, or history of bone marrow transplant (BMT). The area under the ROC curve for PCT in the overall population was 0.655. An ideal cutoff of 0.21ng/mL led to a sensitivity of 60% and specificity of 59%. At cutoffs of 0.5ng/mL and 0.05ng/mL, PCT's sensitivity was 39% and 94%, while specificity was 79% and 17%, respectively. In this large cohort of hospitalized oncology patients, PCT elevation was associated with diagnosed bacteremia and/or bacterial pneumonia. However, specificity was limited, and PCT elevation was not associated with diagnosed infection in some subpopulations. While PCT may have some diagnostic utility for hospitalized oncology patients, values must be interpreted cautiously and considering clinical context.

Evaluation of prognostic factors in febrile neutropenic patients with hematological malignancies

Objectives: Hematological malignancies presenting with febrile neutropenia constitute an important health issue all over the globe. In this study, we aimed to elucidate the prognostic factors of febrile neutropenic patients with hematological malignancies and to investigate the causes of mortality. &#x0D; Method: This research had a retrospective nature. A total of 174 febrile neutropenia patients ≥ 18 years of age hospitalized have been enrolled in the study. Patients enrolled in the analysis were determined according to the American Society for Infectious Diseases 2010 Febrile Neutropenia Diagnosis and Treatment Guidelines. Accordingly, neutropenia was defined as an expected decrease in the absolute neutrophil count (ANS) to &lt; 500 cells/mm³ or &lt; 500 cells/mm³ over the next 48 hours and body temperature over ≥ 38°C. &#x0D; Results: A total of 174 patients have been included in the analysis and 32 (18.5%) died while 142 (81.5%) did not develop mortality. When the statistically significant results are evaluated according to multivariate analysis; Age, Crp, MASCC, acute renal failure, and hypotension were similar in both groups. On the other hand, when univariate statistically highly significant results are evaluated according to multivariate analysis; the Presence of urinary catheter, diagnosis of bacterial pneumonia, and ANS not increasing after 1 week were found to be statistically significant in the mortality group.&#x0D; Conclusion: The results of the study showed that in febrile neutropenic patients, mortality was increased by 6.7 times by a diagnosis of bacterial pneumonia, 245.6 times by the absence of ANS elevation, and 13.9 times by urinary catheterization.

Integrated Basic Heart and Lung Ultrasound Examination for the Differentiation between Bacterial Pneumonia and Lung Neoplasm in Dogs-A New Diagnostic Algorithm.

Simple SummaryDyspnea is a highly alarming sign both for dog owners and veterinarians. Although its recognition is usually easy due to prominent suffering of an animal, finding its cause is challenging because many diseases of the heart, lungs, and airways may manifest themselves this way. Echocardiography and lung ultrasound allow for relatively quick and accurate identification of heart diseases. Dyspneic dogs without a heart and upper airway disease are usually suspected of either bacterial pneumonia or lung neoplasm. Although prognosis in these two conditions is diametrically different, differentiation between them is challenging. Chest radiography is performed in a lateral position, which is barely tolerated by a dyspneic dog, and intensive chest movements often make X-ray scans inconclusive. Computed tomography, although much more accurate, requires general anesthesia, which is difficult and potentially life-threating in a dyspneic dog. Therefore, lung ultrasound, which can be performed quickly in a conscious dog, standing or in sternal position, seems to be the method of choice. We develop and evaluate a diagnostic algorithm based on detection of three well-defined abnormalities in the lung ultrasound. The algorithm allows one to distinguish between bacterial pneumonia and lung neoplasm in a dyspneic dog with high probability of a conclusive result (91%) and high accuracy (>95%).The diagnostics of two of the most prevalent lung diseases in dogs, bacterial pneumonia (BP) and lung neoplasm (LN), are challenging as their clinical signs are identical and may also occur in extrapulmonary diseases. This study aims to identify ultrasonographic criteria and develop a lung ultrasound (LUS)-based diagnostic algorithm which could help distinguish between these two conditions. The study is carried out in 66 dyspneic dogs in which a heart disease was excluded using echocardiography. Based on imaging and laboratory diagnostic tests, as well as follow-up, the dogs are classified into LN (35 dogs) and BP (31 dogs) groups. LUS is performed at admission and the presence of seven lung abnormalities (pleural thickening, B-lines, subpleural consolidations, hepatization with or without aeration, nodule sign and mass classified together as a tumor, and free pleural fluid) and classification and regression trees are used to develop an LUS-based diagnostic algorithm. Distribution of all LUS abnormalities except for aerations differs significantly between groups; however, their individual differentiating potential is rather low. Therefore, we combine them in an algorithm which allows for definitive classification of 60 dogs (91%) (32 with LN and 28 with BP) with correct diagnosis of LN and BP in 31 dogs and 27 dogs, respectively.

Clinical value of blood related indexes in the diagnosis of bacterial infectious pneumonia in children

BackgroundThis study sought to explore the value of hematological indexes [i.e., the neutrophil count/lymphocyte count ratio (NLR), the platelet count/lymphocyte count ratio (PLR), and red cell distribution width (RDW) index] in the diagnosis of bacterial infectious pneumonia in children.MethodsFifty cases of mycoplasma infectious pneumonia, 50 cases of bacterial infectious pneumonia and 50 healthy children were enrolled in this study. The differences between the NLR, PLR, and RDW index values in each group were compared using the Mann-Whitney test. The correlation coefficients of the NLR, PLR, and RDW index with the interleukin-6 (IL-6) and procalcitonin (PCT) were analyzed using the Spearman’s rank test. The specificity and sensitivity of the NLR, PLR, and RDW index in the diagnosis of bacterial pneumonia in children were evaluated by receiver operating characteristic (ROC) curves.ResultsThe NLR value of the children with bacterial infectious pneumonia was significantly higher than that of the children with mycoplasma infectious pneumonia (P<0.05) and healthy children (P<0.05), while the PLR value of the children with bacterial infectious pneumonia was significantly lower than that of the children with mycoplasma infectious pneumonia (P<0.05) and healthy children (P<0.05). There was no significant difference in the RDW index values of the healthy control children and the children with mycoplasma infectious pneumonia and bacterial infectious pneumonia (P>0.05). There was a positive correlation between NLR and serum IL-6 (R=0.203; P=0.041), and a negative correlation between PLR and serum PCT (R=–0.291; P=0.037). In addition, there was no significant correlation between the RDW index and serum IL-6, and the RDW index and serum PCT in children with bacterial infectious pneumonia. When the 3 indicators were each used to differentiate between healthy children and children with bacterial pneumonia, the area under the PLR curve was the largest for the ROC curve [0.898, 95% confidence interval (CI): 0.815–0.953]. In the differential diagnosis of mycoplasma pneumonia and bacterial pneumonia, the area under the PLR curve was also the largest (0.803, 95% CI: 0.577–0.780).ConclusionsThe PLR has clinical value in the diagnosis of bacterial infectious pneumonia in children.

Automatic Sequence-Based Network for Lung Diseases Detection in Chest CT.

ObjectiveTo develop an accurate and rapid computed tomography (CT)-based interpretable AI system for the diagnosis of lung diseases.BackgroundMost existing AI systems only focus on viral pneumonia (e.g., COVID-19), specifically, ignoring other similar lung diseases: e.g., bacterial pneumonia (BP), which should also be detected during CT screening. In this paper, we propose a unified sequence-based pneumonia classification network, called SLP-Net, which utilizes consecutiveness information for the differential diagnosis of viral pneumonia (VP), BP, and normal control cases from chest CT volumes.MethodsConsidering consecutive images of a CT volume as a time sequence input, compared with previous 2D slice-based or 3D volume-based methods, our SLP-Net can effectively use the spatial information and does not need a large amount of training data to avoid overfitting. Specifically, sequential convolutional neural networks (CNNs) with multi-scale receptive fields are first utilized to extract a set of higher-level representations, which are then fed into a convolutional long short-term memory (ConvLSTM) module to construct axial dimensional feature maps. A novel adaptive-weighted cross-entropy loss (ACE) is introduced to optimize the output of the SLP-Net with a view to ensuring that as many valid features from the previous images as possible are encoded into the later CT image. In addition, we employ sequence attention maps for auxiliary classification to enhance the confidence level of the results and produce a case-level prediction.ResultsFor evaluation, we constructed a dataset of 258 chest CT volumes with 153 VP, 42 BP, and 63 normal control cases, for a total of 43,421 slices. We implemented a comprehensive comparison between our SLP-Net and several state-of-the-art methods across the dataset. Our proposed method obtained significant performance without a large amount of data, outperformed other slice-based and volume-based approaches. The superior evaluation performance achieved in the classification experiments demonstrated the ability of our model in the differential diagnosis of VP, BP and normal cases.

Synbiotic or Zinc supplementation in the treatment of children with bacterial pneumonia, a double-blinded randomized clinical trial

Background: There is disagreement about the use of zinc and synbiotics in improving the effectiveness of antibiotics in the treatment of bacterial pneumonia in children or reducing the side effects of this treatment. The aim of this study was to evaluate the interventional effects of synbiotics and zinc sulfate on reducing clinical symptoms and the average duration of treatment in children suffering from bacterial pneumonia.Material and Methods: This study was a randomized clinical trial with a parallel-group in which 1 month to 18 years children who were hospitalized to Sabzevar Heshmatieh Hospital with fever, cough, and respiratory distress with a diagnosis of bacterial pneumonia were assigned to the antibiotic only, antibiotics/synbiotics and antibiotics/zinc groups, randomely. Clinical symptoms include fever, faster respiration rate per minute (Tachypnea), retraction (subcostal, intercostal, suprasternal, and nasal flaring), crackles, wheezing, cough, and gastrointestinal side effects (diarrhea) were recorded on arrival and daily until discharge and compared at a significance level of 0.05.Results: Overall, there was no significant difference between patients' clinical symptoms (fever, respiration rate per minute, subcostal, intercostal and suprasternal retraction, and nasal flaring), crackles‎, wheezing, cough, and gastrointestinal side effects (diarrhea) between the groups.Conclusion: The results of this study could not show the clinical benefit of prescribing zinc or synbiotics in combination with standard antibiotic therapy in the treatment of children and infants and reducing the side effects of this treatment.

Utility of PCT, CRP, CD64, N/L and N% in Diagnosis of Bacterial Pneumonia in Adults: Based on the Data of 199 Bacterial Pneumonia

In the background of inefficient indicators for early diagnosis of pneumonia in adults, Objective Explore the utility of PCT, CRP, CD64 and Routine Blood Parameter in diagnosis of bacterial pneumonia in adults. Methods From January 1, 2019 to December 31, 2019, 191 adult bacterial pneumonia patients diagnosed and treated in the affiliated Hospital of Inner Mongolia University for Nationalities and 99 healthy people were selected as study subjects. A total of 191 adult bacterial pneumonia patients were treated as the case group, and 99 healthy physical examination patients were treated as the control group. PCT, CRP, CD64 and blood routine test parameters were compared between them. Correlation analysis and multiple linear regression analysis were used to explore the differential factors of adult bacterial pneumonia, and ROC curve was used to analyze the effectiveness of each indicator in the differential diagnosis of adult bacterial pneumonia. Results PCT (4.95±2.462), CRP (33.53±9.342), CD64 (9.26±4.023), N/L (9.54±3.878) and N% (1.16±0.632) in the case group were significantly higher than (0.22±0.059), (3.29±1.712), (1.91±0.600), (2.66±0.665) and (0.66±0.158), those of the control group. There were no statistically significant differences in other indicators. Adult bacterial pneumonia was significantly correlated with PCT, CRP, CD64, N/L and N%, but not with WBC. PCT, CRP, CD64, N/L and N% were correlated with each other, and the correlation was statistically significant. The results of multiple linear regression model showed that PCT, CRP, CD64, N/L and N% indexes were used for the differential diagnosis of adult bacterial pneumonia are trustworthy. The AUC (95%CI) of PCT, CRP, CD64, N/L, and N% were 0.916 (0.877, 0.954), 0.995 (0.000, 1.000), 0.980 (0.962, 0.997), 0.949 (0.921, 0.976), and 0.865 (0.822, 0.908), respectively. We conclude that PCT, CRP, CD64, N/L and N% indexes are comprehensive indexes for the differential diagnosis of adult bacterial pneumonia, which have certain significance and reference value in the early identification and diagnosis of adult bacterial pneumonia.

Imunocromatografic Tests Improving Point-of-Care Management of Respiratory Virus Infection in Children

Background: Respiratory syncytial virus (RSV) and influenza virus (flu) contribute substantially to the overall burden of severe respiratory tract infection in children. However, the molecular etiological diagnostic methods of viral infection are still insufficiently accessible in public hospitals. Rapid immunochromatographic tests can add important information at the point of care, including antiviral or antibiotic indication, viral , and effective precaution measures to prevent outbreaks. The aim of this study was to evaluate this impact for pediatric patients under 5 years of age in our hospital. Methods: We conducted a retrospective, observational study of clinical outcomes of children under 5 years requiring hospitalization from 2013 to 2018 for viral respiratory disease, and who had positive RSV and/or flu immunochromatographic rapid test results. Results: In total, we identified 221 cases: RSV, 193; flu, 6; codetections, 19. (Table 1). The mortality rate was 1.8% (2 cases), and 88% of our patients were &lt;1 year of age. Variables significantly associated with orotracheal intubation, the most intensive intervention, were younger age in months, comorbidities, RSV and flu codetection, and bacterial pneumonia diagnosis during hospitalization. Conclusions: In the multivariate analysis, RSV and flu codetection was associated with the least favorable clinical prognoses. Rapid test diagnosis may provide important information at the point of care, and molecular panels are not yet widely accessible in public hospitals. Hence, we believe that immunochromatographic rapid tests represent a valuable and feasible diagnostic alternative facilitating timely evaluation and treatment implementation.Funding: NoneDisclosures: None

Viral and Bacterial Pneumonia Diagnosis via Deep Learning Techniques and Model Explainability

Pneumonia is one of the most serious diseases for infants and young children, people older than age 65, and people with health problems or weakened immune systems. From nu-merous studies, scientists have found that a variety of organisms, including bacteria, viruses, and fungi, can be the cause of the disease. Coronavirus pandemic (COVID-2019) which comes from a type of pneumonia has been causing hundreds of thousands of deaths and is still progressing. Machine learning approaches are applied to develop models for medicine but they still work as a black-box are difficult to interpret output generated by machine learning models. In this study, we propose a method for image-based diagnosis for Pneumonia leveraging deep learning techniques and interpretability of explanation models such as Local Interpretable Model-agnostic Explanations and Saliency maps. We experiment on a variety of sizes and Convolutional neural network architecture to evaluate the efficiency of the proposed method on the set of Chest x-ray images. The work is expected to provide an approach to distinguish between healthy individuals and patients who are affected by Pneumonia as well as differentiate between viral Pneumonia and bacteria Pneumonia by providing signals supporting image-based disease diagnosis approaches.

Detection of high serum levels of \u03b2-D-Glucan in disseminated nocardial infection: a case report

Backgroundβ-D-glucan (BDG) is a helpful diagnostic marker for many invasive fungal infections, but not for nocardiosis. Here, we reported the first case of nocardial infection with high serum level of BDG.Case presentationA 73-year-old man was hospitalized because of fever, headache, and appetite loss after 10 months of steroid and immunosuppressive therapy for cryptogenic organizing pneumonia. With a diagnosis of bacterial pneumonia, treatment with ampicillin/sulbactam was initiated. There was improvement on chest radiograph, but fever persisted. Further work-up revealed multiple brain abscesses on cranial magnetic resonance imaging (MRI). Serum galactomannan and BDG were elevated at 0.6 index and 94.7 pg/ml, respectively. Voriconazole was initiated for presumed aspergillus brain abscess. However, fever persisted and consciousness level deteriorated. Drainage of brain abscess was performed; based on the Gram stain and Kinyoun acid-fast stain, disseminated nocardiosis was diagnosed. Voriconazole was then shifter to trimethoprim/sulfamethoxazole. The presence of Nocardia farcinica was confirmed by the 16S rRNA gene sequence. Treatment course was continued; BDG level normalized after 1 month and cranial MRI showed almost complete improvement after 2 months.ConclusionBDG assay is widely used to diagnose invasive fungal infection; therefore, clinicians should be aware that Nocardia species may show cross-reactivity with BDG assay on serum.

The value of peripheral blood neutrophil CD64 expression in early differential diagnosis of etiology in children with community-acquired pneumonia

Objective To evaluate the application value of peripheral blood neutrophil CD64 expression in early differential diagnosis of etiology in children with community-acquired pneumonia. Methods From June 2014 to June 2015 in our hospital, total of 99 cases of different pathogen infection were divided into three groups, bacterial pneumonia group(n=41), non-bacterial pneumonia group(n=38), healthy children group(n=20); and the non-bacterial pneumonia group was divided into two subgroups, viral pneumonia group(n=22) and mycoplasma pneumoniae pneumonia group(n=16). Flow cytometry was used to test the median fluorescence intensity(MFI) of peripheral blood neutrophil CD64.The levels of peripheral blood CRP, WBC and neutrophil percentage were detected. Results The levels of CD64 expression, CRP and WBC in bacterial pneumonia group were statistically higher than those of non-bacterial pneumonia group and healthy children group respectively(both P<0.01). The optimal cutoff value of CD64 was 6 519 MFI when using ROC curve, and the sensitivity and specificity of the diagnosis of bacterial pneumonia were 87.8% and 89.7% respectively.The levels of CD64 expression in bacterial pneumonia group were significantly higher than those in viral pneumonia group, mycoplasma pneumoniae pneumonia group and healthy children group(all P<0.01). Conclusion The expression of peripheral blood neutrophil CD64 increases in children with community-acquired pneumonia of bacteria infection.It can be used to guide early diagnosis of children with bacterial pneumonia and the using of antibiotics. Key words: CD64; Child; Community-acquired pneumonia; C-reactive protein

Uncomplicated pneumonia in healthy Canadian children and youth: Practice points for management.

Although immunization has decreased the incidence of bacterial pneumonia in vaccinated children, pneumonia remains common in healthy children. Symptoms of bacterial pneumonia frequently overlap those present with viral infections or reactive airway disease. Optimally, the diagnosis of bacterial pneumonia should be supported by a chest radiograph before starting antimicrobials. Factors such as age, vital signs and other measures of illness severity are critical when deciding whether to admit a patient to hospital. Because Streptococcus pneumoniae continues to be the most common cause of bacterial pneumonia in children, prescribing amoxicillin or ampicillin for seven to 10 days remains the mainstay of empirical therapy for nonsevere pneumonia. If improvement does not occur, consideration should be given to searching for complications (empyema or lung abscess). Routine chest radiographs at the end of therapy are not recommended unless clinically indicated.

Buccal Bifurcation Cyst: A Case Report

Buccal bifurcation cyst is an unusual inflammatory odontogenic cyst arising from the lateral periodontium of a vital tooth. A 6-year-old female admitted to the hospital with a diagnosis of bacterial pneumonia. During hospitalization, she presented with a painful intraoral swelling on the buccal gingiva of the first mandibular molar, with drainage of purulent secretion. The tooth was vital and presented a periodontal pocket at the buccal surface. Radiography and computed tomography showed a well-defined radiolucent area at the bifurcation of the tooth, with cortical expansion. Based on the clinical and radiological images, the diagnosis was buccal bifurcation cyst. Surgical enucleation was planned for after hospital discharge. However, 2 months later, there was radiographic evidence that the lesion had regressed. Therefore, the surgery was canceled. The patient has been under follow-up for 10 months, and the affected area shows bone repair.

Risk factors for slowly resolving pneumonia in the intensive care unit

Slowly resolving pneumonia (SRP) poses early challenges for identification and medical expense for clinicians in intensive care units (ICUs); to date, the literature has been very limited in this regard. This was a retrospective and cohort-based study in the ICU of a university-affiliated hospital in Shanghai. Medical records of pneumonia patients in the ICU between April 2008 and February 2011were reviewed retrospectively to evaluate the risk factors for SRP. In all, 106 pneumonia patients in the ICU were identified as immune-competent with a diagnosis of bacterial pneumonia. There were 62 (58.49%) patients who showed SRP and their radiographic infiltrations were completely resolved between 5 weeks and 8 weeks. Multivariate logistic regression analysis demonstrated that initial treatment with an inappropriate antibiotic, multilobar infiltration, and a high CURB-65 score were independent risk factors for SRP, with odds ratio (OR) values of 8.338 [95% confidence interval (CI) 2.117-32.848], 11.184 (95% CI 2.526-49.514), and 2.329 (95% CI 1.172-4.626), respectively. The length of the ICU stay in the SRP group was twice as long as that of the normally resolving pneumonia (NRP) group (62.27±73.73 vs. 32.25±23, p=0.002). The 28-day and 60-day mortality rates in the SRP group were 17.74% and 25.81%, respectively. In addition, the 60-day mortality rate was significantly higher in the SRP group than the NRP group (25.81% vs. 6.82%, respectively; p=0.012). Moreover, SRP was an independent risk factor for 60-day mortality (OR 5.687, 95% CI 1.334-24.240). Treatment with an inappropriate antibiotic, multilobar infiltration, and a high CURB-65 score were independent risk factors for SRP.

Oseltamivir Treatment for Influenza in Hospitalized Children Without Underlying Diseases

To determine whether the treatment with oseltamivir improves the outcome of children with confirmed influenza infection and no other underlying disease. Multicentric, retrospective study performed in 10 hospitals of Madrid between September 2010 and June 2012. All children admitted to the hospitals with confirmed influenza infections were eligible. Children with risk factors for serious disease and nosocomial influenza infections were excluded. Asthma was not considered an exclusion factor. The study compared patients treated and untreated with oseltamivir. Fever duration, oxygen support, antibiotics administration, length of hospital stay, intensive care admission and bacterial complications were analyzed. To compare variables, χ(2) test, Fisher exact test, ANOVA or Mann-Whitney U test were used. Two hundred eighty-seven children were included and 93 of them were treated with oseltamivir (32%). There were no significant differences between treated and untreated patients in days of fever after admission (1.7 ± 2; 2.1 ± 2.9, P > 0.05), length of stay (5.2 ± 3.6; 5.5 ± 3.4, P > 0.05), days of hypoxia (1.6 ± 2.3; 2.1 ± 2.9, P > 0.05), diagnosis of bacterial pneumonia (10%; 17%, P > 0.05), intensive care admission (6.5%; 1.5%,P > 0.05) or antibiotic prescription (44%; 51%, P > 0.05). There were no differences when the population was stratified by age (below or over 1 year) or by the presence or absence of asthma. There were no proven benefits of treatment with oseltamivir in hospitalized pediatric patients without the underlying diseases or risk factors for developing a serious illness, including those with asthma.

Impact of clinical history on chest radiograph interpretation

The inclusion of clinical information may have unrecognized influence in the interpretation of diagnostic testing. The objective of the study was to determine the impact of clinical history on chest radiograph interpretation in the diagnosis of pneumonia. Prospective case-based study. Radiologists interpreted 110 radiographs of children evaluated for suspicion of pneumonia. Clinical information was withheld during the first interpretation. After 6 months the radiographs were reviewed with clinical information. Radiologists reported on pneumonia indicators described by the World Health Organization (ie, any infiltrate, alveolar infiltrate, interstitial infiltrate, air bronchograms, hilar adenopathy, pleural effusion). Children's Hospital of Philadelphia and Boston Children's Hospital. Six board-certified radiologists. Inter- and inter-rater reliability were assessed using the kappa statistic. The addition of clinical history did not have a substantial impact on the inter-rater reliability in the identification of any infiltrate, alveolar infiltrate, interstitial infiltrate, pleural effusion, or hilar adenopathy. Inter-rater reliability in the identification of air bronchograms improved from fair (k = 0.32) to moderate (k = 0.53). Intra-rater reliability for the identification of alveolar infiltrate remained substantial to almost perfect for all 6 raters with and without clinical information. One rater had a decrease in inter-rater reliability from almost perfect (k = 1.0) to fair (k = 0.21) in the identification of interstitial infiltrate with the addition of clinical history. Alveolar infiltrate and pleural effusion are findings with high intra- and inter-rater reliability in the diagnosis of bacterial pneumonia. The addition of clinical information did not have a substantial impact on the reliability of these findings.

HIV-associated lung cancer

HIV-associated lung cancer

A Case of Pneumonia with Septic Shock Due toNocardia farciniain Liver Transplant Patient

Nocardia farcinia, an aerobic, gram-positive bacilli actinomycetes of the genus Nocardia, is an uncommon pathogen found in humans. The most common Nocardia infection sites are the lung, central nervous system, and skin. Even though hematogenous dissemination can occur, isolation of the organism from blood cultures is very rare. We report a case of Nocardia infection that was isolated on blood cultures. A 59-year-old male with a medical history that includes a liver transplantation 6-years prior due to hepatocellular carcinoma secondary to chronic hepatitis B, developed pneumonia and was transferred to Severance Hospital. At the time of admission, the patient`s initial exam showed hypothermia, tachypnea, and hypotension. His chest radiograph showed severe pneumonia and a large abscess on left upper lobe. Under the presumptive diagnosis of bacterial pneumonia or other opportunistic infection, we started broad spectrum antibiotics. However, he developed Nocardia sepsis, rapidly deteriorated, and subsequently died.

HERPES SIMPLEX ESOPHAGITIS IN THE ELDERLY

Herpes simplex esophagitis (HSE) occurs mostly in immunocompromised patients and rarely in immunocompetent patients. We encountered an elderly patient, a biologically immunocompromised patient with HSE who had characteristic endoscopic features and responded to acyclovir therapy. An 82-year-old woman presented with high-grade fever and epigastric discomfort for several days. A diagnosis of bacterial pneumonia was made based on imaging studies and cultures. Despite antibiotic treatment, epigastric discomfort persisted. Endoscopy revealed multiple exudative and circumscribed shallow ulcers with slightly raised edges in the mid-distal esophagus. Esophageal biopsy specimens showed multinucleated giant cells with Cowdry type A intranuclear inclusion bodies in epithelial cells, which were positive for herpes simplex virus-type 1 DNA by polymerase chain reaction. Because a diagnosis of HSE was made, she was treated with acyclovir, resulting in esophageal mucosal healing. In elderly patients with esophageal symptoms, HSE should be considered.