Pneumonia In Young Patients Research Articles

Can the Omicron variant of COVID-19 cause pneumonia in young patients without risk factors?

The Omicron variant (B.1.1.529) of coronavirus disease 2019 (COVID‐19) has rapidly spread worldwide since December 2021. In daily medical practice, pneumonia does not often appear as a complication of the Omicron variant. We present a case of COVID‐19 pneumonia by the Omicron variant in young patients without obvious risk factors.

Infecciones por estafilococos

Staphylococci encompass a multitude of species with different pathological capacities in human beings, with Staphylococcus aureus (SA) standing out as the most virulent species. SA is capable of producing a multitude of clinical syndromes, both mediated by the toxin and by tissue invasion and destruction. Of note for their frequency and severity are skin and soft tissue infections, bone and joint infections, bacteremia, endocarditis, prosthetic device infections, and pneumonia (including hemorrhagic pneumonia in young patients). It can have various mechanisms of resistance, of which resistance to beta-lactams (methicillin-resistant SA, MRSA) mediated by the production of PBP2a (mecA gene) is of note for its therapeutic importance. Treatment of methicillin-sensitive SA is based on cloxacillin or cefazolin whereas treatment options for MRSA are vancomycin, daptomycin, or linezolid. Coagulase-negative staphylococci are less virulent, although they tend to be resistant to methicillin. They only cause infections in patients with predisposing conditions (immunosuppressed, prosthetic material, venous access, etc.), with the exception of Staphylococcus lugdunensis, which can cause infections similar to SA and which also tend to be sensitive to penicillin.

Assessment of the clinical course of community acquired pneumonia in young patients, taking into account the CMV-persistence and its severity

Today, the question of establishing the features of clinical course of community acquired pneumonia (CAP) due to the presence or absence of CMVI-infection persistence in the human body, the study of the type and nature of the effects of concomitant persistent CMVI on the symptoms of CAP, the effectiveness of treatment, was one of the unexplored. This issue is particularly relevant for young people, as it does not only damage the condition of patients but also directly and indirectly affects the economic component of the disease, increasing direct and indirect losses for the able-bodied patient and the state as a whole.

Assessment of the clinical course of community acquired pneumonia in young patients, taking into account the CMV-persistence and its severity

Assessment of the clinical course of community acquired pneumonia in young patients, taking into account the CMV-persistence and its severity

Teška pneumonija izazvana antipsihotičnim lekovima - šta ne odgovara, pacijent ili lek?

Introduction: Antipsychotic drugs are generally categorized as typical antipsychotics (sometimes referred to as first-generation or conventional antipsychotics, or neuroleptics) and atypical antipsychotics; both are approved for the treatment of acute and chronic psychoses (i.e, schizophrenia), mania, agitation, and other psychiatric disorders. In 2005 the US Food and Drug Administration issued a warning about the increased risk of all-cause mortality associated with atypical antipsychotic use in elderly patients with dementia. Community acquired pneumonia (CAP) was one of the most frequently reported causes of death. The same warning was extended to typical antipsychotics in 2008 with extension to people with or without dementia. Case report: We present a 65-year-old Caucasian woman who was admitted to hospital due to massive pneumonia. She was suffered forschisophrenia 15-years and at moment of admission she was in remission. She had continuously high fever up to 40 degrees. All collected cultures (blood, sputum, urine, smear of aspirating catheter) were negative. She was treated with various antibiotics without improvement. After changing antipsychotic drugs, she showed slow improvement until total recovery after 3 months. Discussion and conclusion: Antipsychotic-associated CAP seems to be a clinically relevant issue in frail elderly patients, as consistently documented in several epidemiologic investigations. No clear evidence exists for an increased risk of pneumonia in younger patients treated with antipsychotics. In elderly populations, the increase in risk is dose-dependent, and is more pronounced in the early phases of treatment. Future studies should better define the mechanism underlying antipsychotic-induced pneumonia and identify subgroups of antipsychotic users at higher risk of developing pneumonia.

Chronic interstitial pneumonia in young patients undergoing lung transplantation or autopsy: clinico-radiologic-pathologic observations from a single institution.

To retrospectively evaluate high-resolution computed tomography (HRCT) findings and clinical diagnoses of chronic interstitial pneumonia (IP) with a poor prognosis in young patients (≤50years). HRCT images of 8 men and 7 women (mean age 34.8years) obtained before lung transplantation or autopsy were reviewed. After reviewing whole lung specimens and pathologic diagnoses, all patients were clinically diagnosed according to the 2010 idiopathic pulmonary fibrosis/usual interstitial pneumonia (IPF/UIP) consensus statement. HRCT images revealed intralobular reticular opacity, air cysts, ground glass opacity, traction bronchiectasis, and interlobular septal thickening. Intralobular reticular opacity was the most extensive finding. Abnormal findings existed predominantly in both the peripheral and lower lung zones in only 1 patient. Classifications of HRCT patterns were "UIP" (n=2), "inconsistent with UIP" (n=11), and "indeterminate UIP" (n=2). Multidisciplinary diagnoses were "IPF/UIP" (n=1), "possible IPF/UIP" (n=1), "IP with connective tissue disease" (n=7), "fibrotic nonspecific IP" (n=1), and "unclassified IP" (n=5). The most extensive HRCT finding was intralobular reticular opacity. Most HRCT images differed from typical IPF/UIP, and IPF/UIP was uncommon in young patients with chronic IP with a poor prognosis.

Clinical characteristics of severe community-acquired pneumonia among younger patients: an analysis of 18 years at a community hospital.

Unlike elderly patients with community-acquired pneumonia whose outcomes are markedly affected by their background characteristics, it appears that the severity of the infection itself contributes to outcomes in younger patients with community-acquired pneumonia. In order to identify clinical characteristics of severe community-acquired pneumonia in younger patients under 60 years old, among such cases prospectively collected at our hospital over a period of 18 years, those meeting the criteria for severe community-acquired pneumonia, as defined in the Infectious Diseases Society of America/American Thoracic Society Guidelines for community-acquired pneumonia, were retrospectively examined and compared to elderly patients with severe community-acquired pneumonia. Younger patients with severe pneumonia accounted for 12.9% of younger hospitalized patients. Although the incidence of severe pneumonia in younger patients was lower than that in elderly patients, its severity may be underestimated by severity assessment based on the conventional guidelines. Thus, attention is required. While Streptococcus pneumoniae and Legionella species were important causative pathogens, atypical pathogens and viruses were also frequently detected. There were only 11 deaths over a period of 18 years. Based on multivariate analysis, the risk factors for aggravation of community-acquired pneumonia among younger patients were age 50 years or older, diabetes mellitus, chronic liver disease, and Legionella pneumonia. Although the mortality rate from community-acquired pneumonia is extremely low in previously healthy younger patients, outcomes might be poor for patients with underlying diseases and those with rapid progression. Multimodal treatments including respiratory management may be appropriate.

An analysis of diagnostic values of prognostic tools for communityacquired pneumonia in young patients in a closed community

Aim. One of the key issues of management of a patient with communityacquired pneumonia (CAP) is an adequate initial assessment of severity. This is especially important during CAP epidemic outbreaks among young patients in closed communities. Currently, several scales are used allowing a rational choice of a place of therapy on the basis of risk of poor outcome. These scales have advantages and disadvantages but they have not been studied in CAP patients in closed communities. Methods. A comparative analysis of diagnostic values of CRB65 and SMRTCO scales in 274 young patients in closed communities was performed. Procalcitonin (PCT) and Creactive protein (CRP) were measured. Discriminative values of the scales were estimated with the ROCanalysis. Results. CRB65 and SMRTCO scores were significantly related to PCT level. The correlation between SMRTCO score and PCT was closer compared to correlation between CRB65 score and PCT. Conclusion . The results have shown obvious perspectives in improvement SMRTCO score by adding PCT that could increase its sensitivity.

“Community-acquired pneumonia in younger patients is an entity on its own.” Benjamin Klapdor, Santiago Ewig, Mathias W. Pletz, Gernot Rohde, Hartwig Schütte, Tom Schaberg and Tobias Welte for the CAPNETZ study group.Eur Respir J2012; 39: 1156–1161.

“Community-acquired pneumonia in younger patients is an entity on its own.” Benjamin Klapdor, Santiago Ewig, Mathias W. Pletz, Gernot Rohde, Hartwig Schütte, Tom Schaberg and Tobias Welte for the CAPNETZ study group.<i>Eur Respir J</i>2012; 39: 1156–1161.

Community-acquired pneumonia in younger patients is an entity on its own

Community-acquired pneumonia (CAP) is now most frequent in elderly patients. CAP in the younger patient has attracted much less attention. Therefore, we compared patients with CAP aged 18 to <65 yrs with those aged ≥ 65 yrs. Data from the prospective multicentre Competence Network for Community Acquired Pneumonia Study Group (CAPNETZ) database were analysed for potential differences in baseline characteristics, comorbidities, clinical presentation, microbial investigations, aetiologies, antimicrobial treatment and outcomes. Overall, 7,803 patients were studied. The proportion of younger patients (aged <65 yrs) was 52.3% (18 to <30 yrs 6.4%; <40 yrs 17.1%; <50 yrs 29.4%). Comorbidity was present in only half of the younger patients (46.6% versus 88.2%). Fever and chest pain were more common. Most younger patients presented with mild CAP (74.0% had a CRB-65 [corrected] score of 0 (confusion of new onset, [corrected] respiratory rate of ≥ 30 breaths · min(-1), blood pressure <90 mmHg or diastolic blood pressure ≤ 60 mmHg, age ≥ 65 yrs)). Overall, Streptococcus pneumoniae and Mycoplasma pneumoniae were the most frequent pathogens in the younger patients. Short-term mortality was very low (1.7% versus 8.2%) and even lower in patients without comorbidity (0.3% versus 2.4%). Long-term mortality was 3.2% versus 15.9%, also lower in patients without comorbidity (0.8% versus 6.1%). Most of the differences found clearly arise after the fifth or within the middle of the sixth decade. CAP in the younger patient is a clinically distinct entity.

A 24-Year-Old Man With Cough, Rhabdomyolysis, and Pneumomediastinum

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes severe necrotizing pneumonia in young patients. We present the case of a 24-year-old male, who was brought to the emergency department with persistent fevers, confusion, and severe cough. He was found to have necrotizing pneumonia, pneumomediastinum, and rhabdomyolysis with renal failure. Cultures were positive for influenza A and CA-MRSA. After a prolonged intensive care unit (ICU) stay, he made a complete recovery. Community-acquired MRSA pneumonia is a growing health threat that typically presents in young adults after, or in conjunction with, a flu-like illness. It is characterized by a rapidly progressive deteriorating clinical course.

Manejo clínico de las neumonías adquiridas en la comunidad

Streptococcus pneumoniae is the most common cause of CAP, at a rate of 9.6% to 48.8% of cases with an etiologic diagnosis. Mycoplasma pneumoniae is one of the primary causes of pneumonia in young patients, mainly those under 20 years old. Chlamydia pneumoniae can affect young patients and adults with underlying diseases, causing 5%-15% of CAP episodes. Chlamydia psittaci and Coxiella burnetii are uncommon causes of CAP, as are viral influenza and respiratory syncytial virus, which can cause pneumonia in adults during the cold months. Legionella pneumophila accounts for 2%-6% of CAP in the majority of series of hospitalized patients. Haemophilus influenzae is an infrequent cause of pneumonia in adults, affecting mainly elderly people and patients with underlying diseases, such as chronic airway obstruction and tobacco use. Moraxella catarrhalis mainly affects patients with underlying bronchopulmonary disease, such as chronic airway obstruction. Staphylococcus aureus is also an uncommon causal agent, accounting for 1.7% of 2145 cases of pneumonia,5 although it is more frequent in patients with severe CAP. Aerobic gram-negative bacilli, such as Klebsiella spp. (1.2% of 2458 cases of CAP) and Escherichia coli (0.8%) are infrequent causes of CAP5. In severe cases, the frequency of enterobacteria is higher, causing 11.8% of the episodes. Pseudomonas aeruginosa is a quite infrequent causal agent, accounting for 0.5% of cases without criteria of severity and with an etiologic diagnosis, and 3.8% of severe cases5. The frequency of CAP involving anaerobic microorganisms is unknown, though it has been estimated at about 10%. The most common predisposing factor is the aspiration of oropharyngeal secretions during episodes of altered mental status or other circumstances favoring this event, such as dysphagia, intestinal obstruction, periodontal disease, tonsillectomy or dental extractions. In series of patients with severe community pneumonia, the most frequent agents are S. pneumoniae, followed by Legionella spp. and H. influenzae6 and other gram-negative bacilli, and aspiration pneumonia, whereas in series of cases treated on an outpatient basis, pneumococcus, Chlamydia spp. and M. pneumoniae predominate. The relationships among the various etiologic agents and predisposing factors are summarized in Table 1.

Neumonías adquiridas en la comunidad en pacientes mayores de 60 años. Incidencia de gérmenes atípicos y evolución clinicorradiológica

Seventy five patients older than 60 years with a community acquired pneumonia followed up in an outpatient clinic, were prospectively studied in order to determine the incidence of atypical agents, clinical-radiological characteristics, progression and the differences with pneumonia in younger patients. Clinical-radiological evaluation protocols were activated in the first visit and in two subsequent controls. Etiological diagnosis was made by means of serology (in the first visit and three weeks later). Initially, 85 patients older than 60 years were included of which 75 non hospitalized were fully followed up. Also, in the comparative study, 216 outpatient clinic patients 60 years old or younger were followed up during the same period. In the first group the frequency of atypical agents was 33.3%. The most frequently isolated bacteria was Coxiella burnetii (13.3%)followed by virus and Legionella pneumophila. No case of Mycoplasma pneumoniae was diagnosed. The most frequent radiological onset was alveolar infiltrate (85%). The comparative study between the two populations (older or younger than 60 years), found few clinical differences (dyspnea more frequent in older,feverish chill in younger) and auscultation (crackles more frequent in older). We did not find differences remaining clinical-radiological or laboratory data. Most patients presented a favourable clinical and radiological progression. Only 2 patients needed hospital admission (2.7%). In outpatient clinic patients older than 60 years with community acquired pneumonia a high number of atypical agents have been found. The clinical-radiological evolution was satisfactory for most of them. Age was not a decisive element in determining hospital admissions.

Antibacterial therapy for lower respiratory tract infections in adults: a review.

Because of difficulties in accurately determining an etiologic diagnosis, the ideal treatment for acute community-acquired lower respiratory tract infections remains to be established. Suggested regimens, in the absence of persuasive findings from gram-stained preparations of sputum, are best guesses made on the basis of clinical and epidemiological data. Results from randomized controlled trials are only partially helpful since most trials require the isolation of a potential pathogen, a condition that excludes as many as half of all potential study participants. Nonetheless, initial therapy for patients producing phlegm with abundant polymorphonuclear leukocytes should be chosen on the basis of the predominant organisms seen on a stained sputum smear. Patients who are admitted to the hospital from home, greater than 50 years of age, and not producing phlegm can be safely treated with amoxicillin or a second-generation cephalosporin. Atypical pneumonia in younger patients is best treated with erythromycin or tetracycline. Patients admitted from nursing homes, who frequently fail to respond to an initial treatment course in the absence of a diagnostic sputum sample, should receive empirical therapy with an agent that is also active against aerobic gram-negative rods.