Recurrence Of Pneumonia Research Articles

Extraluminal nitinol prosthesis in the treatment of intrathoracic tracheal collapse in a dog

ABSTRACT: A six-month-old male Brazilian Terrier with persistent cough and dyspnea was diagnosed with intrathoracic tracheal collapse and pneumonia after chest radiographics. The medical treatment was performed, and an extraluminal nitinol prosthesis was placed through thoracic access. The dog did not presented recurrence of dyspnea or pneumonia for four years after the surgical procedure. Placement of the extraluminal prosthesis with the thoracic approach effectively stabilized intrathoracic tracheal collapse without causing any structural damage in the thoracic region. Therefore, this is the first report of a successful use of this prosthesis with an intercostal approach in dogs for intrathoracic trachea collapse.

Evaluating a novel swallowing assessment as a predictor of mortality and recurring pneumonia in elderly patients with pneumonia.

Assessment of swallowing functions in elderly people with pneumonia is important. Videofluoroscopic and videoendoscopic examinations have been known as reliable assessments of swallowing functions. However, it is often difficult to use these tools in patients with pneumonia due to their poor condition and/or inadequate hospital facilities. We have previously constructed the Assessment of Swallowing Ability for Pneumonia (ASAP) as a straightforward evaluation for swallowing function. This study investigates the efficacy of the ASAP in predicting several outcomes in elderly patients with pneumonia. Elderly patients with pneumonia (n=130) who were admitted to Tobata Kyoritsu Hospital from January to June 2016 were enrolled prospectively. Associations between their ASAP scores and in-hospital mortality, recurrence of pneumonia within 30 days, 6-month mortality, and detection of antibiotic-resistant bacteria were evaluated. Lower ASAP scores were associated with higher rates of in-hospital mortality, recurrence of pneumonia, and 6-month mortality. The areas under the curve were 0.84 (95% confidence interval [CI], 0.72-0.96) for in-hospital mortality, 0.76 (95% CI, 0.67-0.85) for recurrence of pneumonia, 0.74 (95% CI, 0.64-0.84) for 6-month mortality, and 0.67 (95% CI, 0.52-0.82) for detection of antibiotic-resistant bacteria. Multivariate analysis showed that a lower ASAP score was an independent risk factor for in-hospital mortality, recurrence of pneumonia, and 6-month mortality. The ASAP was useful for predicting short- and long-term mortalities and recurrence of pneumonia.

O4‐5: Combination of tryptase and IL‐33 in bronchoalveolar lavage fluid may predict the types of eosinophilic pneumonia and disease recurrence

O4‐5: Combination of tryptase and IL‐33 in bronchoalveolar lavage fluid may predict the types of eosinophilic pneumonia and disease recurrence

Comparison of clinical features and prognosis in patients with cryptogenic and secondary organizing pneumonia

BackgroundOrganizing pneumonia (OP) can be diagnosed pathologically, and cryptogenic OP (COP) and secondary OP (SOP) have been classified by cause and particular underlying context. Because it is clinically difficult to differentiate between COP and SOP, this study investigated characteristics that could distinguish between COP and SOP.MethodsThe medical records of patients who underwent lung biopsy for a diagnosis of OP at a single tertiary hospital from January 2016 to December 2018 were retrospectively reviewed.ResultsEighty-five patients had pathologically proven OP, including 16 diagnosed with COP and 69 diagnosed with SOP. The most common cause of SOP was infectious pneumonia, observed in 57 (82.6%) of the 69 patients, followed by cancer and radiation pneumonitis. The pathogens causing infectious pneumonia were identified in 45 (65.2%) patients. There were no differences in age, sex, and lung function between the COP and SOP groups. Median body mass index was significantly lower (P = 0.030), and median time from symptom onset to hospital admission significantly shorter (P = 0.006), in the SOP than in the COP group. Fever was more common in the SOP group (P = 0.024), and CURB 65, an index of pneumonia severity, tended to be higher in the SOP group (P = 0.017). Some laboratory results differed significantly between the two groups. Lymphocyte counts in bronchoalveolar lavage (BAL) fluid were significantly higher in the COP than in the SOP group (P = 0.012). Radiologic findings showed that effusion was more common in the SOP group (P = 0.036). There were no between-group differences in steroid use, 30 day and in-hospital mortality rates, and rates of OP outcomes and recurrences. Pneumonia recurrence rate was significantly higher in SOP patients who were than were not treated with steroids (P = 0.035).ConclusionsInfection is the main cause of SOP. Symptom onset is more rapid in patients with SOP than with COP. Some blood and BAL fluid test results differed significantly in the COP and SOP groups. Pleural effusion was more common in the SOP group but there were no differences in clinical course. Recurrence in patients with SOP was more common in those who were than were not treated with steroids.

Study of factors related to recurrence within 30 days after pneumonia treatment for community-onset pneumonia

IntroductionIt is not uncommon for patients hospitalized with pneumonia to experience an early relapse. Here, we investigated the factors related to pneumonia recurrence in Japan. PurposeWe aimed to elucidate the factors related to early recurrence after completion of pneumonia treatment. MethodsWe examined 696 patients with community-acquired pneumonia (CAP) and nursing and healthcare-associated pneumonia (NHCAP) who were admitted to our hospital between October 2010 and February 2018, excluding those who died during hospitalization. Logistic regression analysis was used to assess the endpoint of recurrence within 30 days after the end of antibiotic treatment. ResultsNHCAP, chronic lung disease and duration of antibiotic treatment were significant risk factors for recurrence of pneumonia within 30 days after antibiotic discontinuation. Aspiration pneumonia was not be a significant factor in the early recurrence of pneumonia. ConclusionsLong-term use of antimicrobials may be a risk factor in early recurrence of pneumonia.

P447 Combined fibrin glue with infliximab therapy of postoperative anastomotic fistula in patients with Crohn’s disease: A Pilot study

Abstract Background Postoperative anastomotic fistula is one of the most frequent and potentially life-threatening complications following gastrointestinal resections in patients with Crohn’s disease. The purpose of this study was to report the results of infliximab promoting healing of postoperative anastomotic fistula in patients with Crohn’s disease. Methods In this randomized controlled trial, 37 patients with postoperative fistula were assigned to combined(n=18) or control(n=19) groups and followed up for 6 months. The combined group received usual management protocol for fistula plus an intravenous infliximab therapy for 6 months. The control group received usual fistula protocol. The primary outcome was fistula closure time. The secondary outcome was any infectious complication such as recurrence of ECF, abdominal abscess, pneumonia, infectious diarrhea and other signs of infection. Results Thirty-seven patients with postoperative anastomotic fistula were evaluated. There were18 patients randomized to the combined group who received fibrin glue combined with infliximab therapy. There were 19 patients randomized to the control group who received fibrin glue sealant therapy alone. No significant differences in demographic or clinical characteristics were found between the two groups( P>0.05). The combined group had a shorter closure time than the control group(50.5±11.1 vs 76.2±26.2 days, P=0.011). The combined group did not show higher infectious complications than the control group(P=0.167). Conclusion Infliximab strategy with combining fibrin glue is a safe and effective treatment alternative in the management of postoperative anastomotic fistula in Crohn’s disease, offering the advantage of reduced heal time of fistula.

The incidence of pneumonia in the paediatric population in Poland in light of the maps of health needs

In Poland, no statistical data are available concerning the analysis of the incidence of pneumonia in inpatient children. The requirement for these data results mainly from the need to prepare systemic and economic solutions.AimThis study aimed to use reported data for evaluating pneumonia incidence rates among hospitalised children and other parameters in various age groups.Subject and methodsA detailed analysis was performed as part of the Operational Programme Knowledge Education Development co-financed by the European Social Fund. Services reported to the National Health Fund in 2014 were considered, including pneumonia incidence among hospitalised children and mortality in specific age groups.ResultsIn 2014, a total of 68,543 children were hospitalised for pneumonia (68% of all hospitalisations for acute respiratory diseases). Within each of the analysed age groups, boys were hospitalised more frequently. Irrespective of the place of residence, infants were most commonly hospitalised. It was observed that there was a significant difference between the incidence rate of pneumonia among hospitalised children in all analysed groups depending on the province. The average length of stay was 7.29 days, with infants requiring the longest stays (7.96 days), and 1.8% of children were rehospitalised within 30 days due to recurrence of pneumonia. The most commonly coded pathogens responsible for pneumonia included Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia spp. A total of 19 inpatient hospital deaths in the course of pneumonia were reported.ConclusionsBased on our findings, it is warranted to utilize epidemiological knowledge for the planning of an appropriate level of service commissioned both in outpatient and inpatient facilities as well as for the estimation of institutional and staff needs necessary to secure these services.

Discontinuing β-lactam treatment after 3 days for patients with community-acquired pneumonia in non-critical care wards (PTC): a double-blind, randomised, placebo-controlled, non-inferiority trial

Shortening the duration of antibiotic therapy for patients admitted to hospital with community-acquired pneumonia should help reduce antibiotic consumption and thus bacterial resistance, adverse events, and related costs. We aimed to assess the need for an additional 5-day course of β-lactam therapy among patients with community-acquired pneumonia who were stable after 3 days of treatment. We did this double-blind, randomised, placebo-controlled, non-inferiority trial (the Pneumonia Short Treatment [PTC]) in 16 centres in France. Adult patients (aged ≥18 years) admitted to hospital with moderately severe community-acquired pneumonia (defined as patients admitted to a non-critical care unit) and who met prespecified clinical stability criteria after 3 days of treatment with β-lactam therapy were randomly assigned (1:1) to receive β-lactam therapy (oral amoxicillin 1 g plus clavulanate 125 mg three times a day) or matched placebo for 5 extra days. Randomisation was done using a web-based system with permuted blocks with random sizes and stratified by randomisation site and Pneumonia Severity Index score. Participants, clinicians, and study staff were masked to treatment allocation. The primary outcome was cure 15 days after first antibiotic intake, defined by apyrexia (temperature ≤37·8°C), resolution or improvement of respiratory symptoms, and no additional antibiotic treatment for any cause. A non-inferiority margin of 10 percentage points was chosen. The primary outcome was assessed in all patients who were randomly assigned and received any treatment (intention-to-treat [ITT] population) and in all patients who received their assigned treatment (per-protocol population). Safety was assessed in the ITT population. This study is registered with ClinicalTrials.gov, NCT01963442, and is now complete. Between Dec 19, 2013, and Feb 1, 2018, 706 patients were assessed for eligibility, and after 3 days of β-lactam treatment, 310 eligible patients were randomly assigned to receive either placebo (n=157) or β-lactam treatment (n=153). Seven patients withdrew consent before taking any study drug, five in the placebo group and two in the β-lactam group. In the ITT population, median age was 73·0 years (IQR 57·0-84·0) and 123 (41%) of 303 participants were female. In the ITT analysis, cure at day 15 occurred in 117 (77%) of 152 participants in the placebo group and 102 (68%) of 151 participants in the β-lactam group (between-group difference of 9·42%, 95% CI -0·38 to 20·04), indicating non-inferiority. In the per-protocol analysis, 113 (78%) of 145 participants in the placebo treatment group and 100 (68%) of 146 participants in the β-lactam treatment group were cured at day 15 (difference of 9·44% [95% CI -0·15 to 20·34]), indicating non-inferiority. Incidence of adverse events was similar between the treatment groups (22 [14%] of 152 in the placebo group and 29 [19%] of 151 in the β-lactam group). The most common adverse events were digestive disorders, reported in 17 (11%) of 152 patients in the placebo group and 28 (19%) of 151 patients in the β-lactam group. By day 30, three (2%) patients had died in the placebo group (one due to bacteraemia due to Staphylococcus aureus, one due to cardiogenic shock after acute pulmonary oedema, and one due to heart failure associated with acute renal failure) and two (1%) in the β-lactam group (due to pneumonia recurrence and possible acute pulmonary oedema). Among patients admitted to hospital with community-acquired pneumonia who met clinical stability criteria, discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment. These findings could allow substantial reduction of antibiotic consumption. French Ministry of Health.

Zootechnical and health performance of Holstein x Gir crossbred calves.

Crossbreeding is used to increase production and disease resistance in adult animals, and there is no research to assess the performance of animals in the early stages. The aim of this study was to evaluate the zootechnical and health performance of Holstein x Gir calves (½ HG: ½ Dutch ½ Gir and ¾ HG: ¾ Dutch ¼ Gir), from birth to 80 days of age, and compare metabolic parameters between groups. In this sense, calves were monitored for zootechnical parameters; epidemiological indexes such as morbidity, mortality, recurrence of diarrhea, pneumonia, and other diseases; as well as serum concentrations of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, total proteins, cholesterol, triglycerides, albumin, urea, and paraoxonase1 (PON1). ¾ HG calves showed higher morbidity for diarrhea and remained with diarrhea for longer compared to ½ HG calves, and this was reflected in the average daily weight gain until the 42nd day, with ½ HG calves performing better. There were no differences regarding passive immune transfer between groups, as well as no differences in morbidity and mortality from pneumonia. Regarding biochemical analyses, a difference was found only in the concentrations of PON1, which were higher in ¾ HG calves. The findings show that blood degree influences the occurrence and duration of diarrhea, negatively impacting the zootechnical performance of the animals. Crossbreeding bulls with zebu cattle can be an alternative to increase calf resistance and reduce diarrhea, thus lowering economic losses and improving animal performance.

Head positioning in suspected patients with acute stroke from prehospital to emergency department settings: a systematic review and meta-analysis.

AimThis study aimed to clarify whether the lying‐flat position from prehospital to emergency department settings more effectively improves neurological outcomes of patients suspected with acute stroke over the sitting‐up position.MethodsWe searched PubMed, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for published randomized controlled trials until September 2019. The study population included patients suspected with acute stroke from prehospital to emergency department settings. We compared outcomes between the lying‐flat position and sitting‐up position groups. The critical outcome was the modified Rankin Scale score at 90 days, and important composite outcomes were 90‐day mortality, pneumonia recurrence, and recurrent ischemic stroke. The certainty of evidence of the outcome level was compared using the Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsIn total, 881 studies were identified from the databases, and two randomized controlled trials were included in the analysis. The pooled risk ratio of 90‐day modified Rankin Scale score was not statistically significant (risk ratio 0.86; 95% confidence interval [CI] 0.56–1.32) between the lying‐flat position and sitting‐up position groups. When comparing the 90‐day mortality, pneumonia occurrence, and recurrent ischemic stroke, no significant differences were observed between the two groups. Risk ratio was 1.00 (95% CI 0.87–1.14), 0.90 (95% CI 0.74–1.11), and 0.81 (95% CI 0.14–4.64) for 90‐day mortality, pneumonia occurrence, and recurrent ischemic stroke, respectively.ConclusionThis study suggests that the lying‐flat position is not more effective than the sitting‐up position in terms of 90‐day modified Rankin Scale score in patients suspected with acute stroke.

Prevalence and impact on outcome of sodium and potassium disorders in patients with community-acquired pneumonia: A retrospective analysis

Introduction: Disorders of sodium and potassium are common and predictors of adverse outcome. Prevalence and impact on outcome of hypokalemia, hyperkalemia, hyponatremia and hypernatremia were investigated in emergency patients with community-acquired pneumonia (CAP). Methods: Patients ≥18 years presenting to our emergency department between January 1st 2017 and December 31st 2018 with on-admission electrolyte measurements were included. Chart reviews were performed to identify patients with CAP. Results: 19.948 cases had measurements of sodium and potassium of which 469 had CAP (2.4%). Prevalence of hypo- and hypernatremia was significantly increased in patients with compared to those without CAP (hyponatremia: 28.8% vs. 10.5% respectively, p<0.0001; hypernatremia: 1.9% vs. 0.6% respectively, p=0.002). The prevalence of hypo- and hyperkalemia was significantly higher in patients with than without CAP (hypokalemia 15.6% vs. 11.4% respectively, p=0.004; hyperkalemia: 4.5% vs. 2.0% respectively, p=0.001). Hyponatremia was significantly associated with longer hospital stay in patients with CAP (regression coefficient 0.194, standard error 0.079, p=0.015). None of the investigated electrolyte disorders were predictive of 30-day re-admission and 180-day pneumonia recurrence rates. Use of loop diuretics was an independent predictor for 30-day re-admission (OR 2.351 (1.099-5.03). p=0.028). Pneumonia Severity Index (PSI) risk class was an independent predictor of 180-day pneumonia recurrence (OR 1.494 (1.022-2.184), p=0.038). Conclusion: Dysnatremias and dyskalemias are common findings complicating CAP in emergency patients. Prevalence of hyponatremia was highest followed by hypokalemia. Hyponatremia was an independent predictor of prolonged length of hospital stay. Loop diuretic use was associated with 30-day readmission and PSI risk class with 180-day pneumonia recurrence.

Clinical profile and risk factors of recurrent pneumonia in children at Qena governorate, Egypt

There is a scarce research study on recurrent pneumonia in children, particularly in the developing world. This study aimed to analyse the clinical characteristics, risk factors and underlying causes of recurrent pneumonia in children. It was a case-control study involved 87 children with ≥2 episodes of radiographically confirmed pneumonia in a single year or ≥3 episodes at any time with a radiographic clearing of densities between attacks. Controls were 87 age and gender-matched children who had never suffered pneumonia. Demographic and clinical characteristics of patients and controls were compared and evaluated for the detection of possible underlying conditions that may be the incriminated risk factor of pneumonia recurrence. During one-year study, 763 patients were admitted with pneumonia and 87 (11.4%) of them met the definition of recurrent pneumonia. There were 48 (55.2%) males and 39 (44.8%) females. The mean age at diagnosis of recurrent pneumonia was 7.15±1.72years. Prematurity, small birth weight and presence of respiratory distress at birth were significantly different between patients and controls. Aspiration, congenital heart disease, gastroesophageal reflux, oro-motor incoordination, wheezing and asthma were significant risk factors for recurrent pneumonia. Our study showed that 11.40% of children with pneumonia had recurrent form and that most of them had an underlying illness. The most common detected risk factors for recurrent pneumonia were rural residence, low socioeconomic standard, over-crowding, prematurity and presence of respiratory distress at birth. Aspiration, congenital heart diseases, wheezing and asthma were found to be the main underlying illnesses associated with pneumonia recurrences.

Puzzling onsets of pneumonia sequentially after each session of bronchial thermoplasty: a case report

BackgroundBronchial thermoplasty (BT) is a novel bronchoscopic intervention for severe persistent asthma. An increase in transient respiratory adverse events associated with BT were noted over the treatment periods, however, these events appear sporadic and should not always recur in a single individual and BT-related pneumonia has rarely been reported.Case presentationWe present a case of uncontrolled severe asthma who developed puzzling pneumonia sequentially after each session of BT procedures. After each operation of three sequential BT procedures, she developed cough and purulent expectoration when her chest radiology showed new infiltrates right in the treatment regions. After empirical use of antibacterial agents plus physiotherapy and postural sputum drainage, her symptoms vanished and chest imaging resumed normal.ConclusionThe originality of our case report is related to the recurrence of pneumonia after three sequential BT procedures. To date, similar report has not been available in the literature. We hope to prompt alerts for post-BT respiratory infections, although most of them, along with other adverse events, are mild and tractable.

Determination of Some Environmental Factors and Underlying Diseases on the Occurrence or Recurrence of Pneumonia in Patients Referring to Infectious Wards in Hospitals in Yasuj from March 2019 to March 2020

Pneumonia is one of the most common causes of death in patients of all ages, and the rate varies between 20 and 30 percent depending on its severity. CAP is the third most common diagnosis in hospital patients 65 years of age or older. Pneumonia is one of the leading causes of complications and mortality worldwide and in developed countries. It is the seventh leading cause of death in the United States. In Korea, pneumonia ranks tenth. The leading cause of death in children is under 5 years of age. It is estimated that in this age group the prevalence rate is 0.29 per child per year in developing countries and 0.05 per capita per year in developed countries. Hospital pneumonia is also dangerous. In one study, the risk of organ failure was far greater than the acquired pneumonia from the community. Pneumonia is one of the most common causes of pneumonia in Iran. The aim of this study is to identify the factors that somehow lead to the re-emergence or recurrence of pneumonia in patients who are admitted to the infectious department of Yasuj Educational Hospitals. To investigate the relationship between some environmental factors and underlying diseases with the occurrence or recurrence of pneumonia in patients over 15 years of age who referred to the infectious department of Yasuj hospitals, from March 2019 to March 2020.This study will be a cross-sectional study of all 15-year-olds in 7 educational courses in Yasuj from March 2019 to March 2020. Patients in the age group of 15 years to 65 years and the 65 of the AlAnalysis in Word. The diagnosis of pneumonia in the patient, despite the symptoms and symptoms of the lower respiratory tract and pulmonary infiltration of the patients, will be left in chest. After justification of patients in relation to the study and acquiring their satisfaction, in us of free individuals, based on demographic information, among soils, clinical signs and symptoms, radiological and laboratory findings, the type of antibiotic treatment, duration of hospitalization and related outcomes will be 36% of the subjects were aged over 66 years old and 64% of the age 64-15 years were determined in this study that 16% of the participants were hospitalized less than 5 times, and 19% 10-15 times and 65% of the subjects had more than 10 times.72% of the subjects had a history of hospital hospitalization, 92% due to 6% pneumonia due to asthma and 1% due to internal illness. The most significant factor in environmental factors was the incidence of pneumonia (1.42%) and the lowest factor with pulmonary and myocarditis masses.

Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia

BackgroundHyponatremia is the most common electrolyte disorder in hospitalized patients with pneumonia. Different studies have shown an association of hyponatremia on admission and worse patient's outcome. Yet, the impact of hyponatremia at discharge or of hyponatremia correction on patient's prognosis is unknown. MethodsThis is a preplanned secondary data analysis from a double-blind, randomized, placebo-controlled trial of hospitalized patients with community-acquired pneumonia and prednisone treatment. The primary outcome was the impact of hyponatremia on admission and at discharge on patient relevant outcomes (i.e. mortality, rehospitalization and recurrence rate) within 180 days. ResultsOf the 708 included patients, 185 (26.1%) were hyponatremic on admission. Of these, 28 (15.1%) were still hyponatremic at discharge. 34 (4.8%) patients developed hyponatremia during hospitalization despite being normonatremic on admission. Patients with hyponatremia at discharge had a higher rate of pneumonia recurrence as compared to normonatremic patients (OR 2.68; 95%-CI 1.09–6.95; p = 0.037). Among patients with hyponatremia at discharge, patients who were already hyponatremic on admission showed the strongest association with increased recurrence rate (OR 4.01; 95%-CI 1.08–12.64; p = 0.022). In contrast, recurrence rate was not affected in patients who were hyponatremic on admission but had normalized serum sodium levels at discharge (p = 0.73). ConclusionMild to moderate hyponatremia at discharge is associated with an increased risk of recurrence in hospitalized patients with pneumonia. This association is particularly strong for patients who are hyponatremic both on admission and at discharge, emphasizing the importance of hyponatremia correction during hospitalization.

Recurrence of WHO-defined fast breathing pneumonia among infants, its occurrence and predictors in Pakistan: a nested case–control analysis

ObjectivesStudies in low-income and middle-income countries have shown an adverse association between environmental exposures including poverty. There is little literature from South Asia. We aimed to test the associations between...

Impact of Energy intake at One Week after Hospitalization on Prognosis for Older Adults with Pneumonia.

This study objectives to investigate the influence of average energy intake at 1 week of hospitalization on prognosis for older adults with pneumonia. Retrospective observational cohort study. The Japan Rehabilitation Nutrition Database comprise those with pneumonia in acute care hospitals. The study included 329 pneumonia patients (aged over 65 years) who entered into the Japan Rehabilitation Nutrition Database (JRND) from November 2015 to March 2018. Logistic regression analysis was performed to confirm the relationship of energy intake with the rate of mortality, discharge home, and pneumonia recurrence during hospitalization. Variables included in the multiple regression analysis model were age, sex, Mini Nutritional Assessment-Short Form score (MNA-SF) at hospitalization, A-DROP, Charlson comorbidity index (CCI), and presence or absence of rehabilitation. Of 315 patients with pneumonia (median age 85 years), 63.8% were men. 57.7% were assigned to the lack of energy intake (LEI) at 1 week after admission. Patients in the LEI group were older (p = 0.033), had higher A-DROP score (p < 0.001), and showed higher malnutrition rate in MNA-SF at hospitalization (p < 0.001) than those in the control group. Mortality, pneumonia recurrence (p = 0.001), median body mass index (p = 0.012), and low malnutrition in MNA-SF (p < 0.001) at discharge were significantly higher in the LEI group than in the control group. Logistic regression analysis showed that LEI was an independent risk factor for mortality (Odds ratio: 5.07, p = 0.002), discharge home (Odds ratio: 0.33, p = 0.007), and pneumonia recurrence (Odds ratio: 3.26, p = 0.007). LEI at 1 week after hospitalization in older adults with pneumonia was an independent risk factor for mortality, difficult at-home recovery, and pneumonia recurrence. These findings suggest the importance of adequate energy intake from the early days of hospitalization.

1775 Tracheoesophageal Fistula Managed With Double Stenting of Bronchus and Esophagus

INTRODUCTION: Malignancy is responsible for 5-15% of acquired tracheoesophageal fistulas (TEF). Such patients have a short survival and management of these fistulas is a challenge. We present a case of TEF secondary to esophageal malignancy that was managed with double stenting of the bronchus and esophagus. CASE DESCRIPTION/METHODS: The patient is a 56 year old black female with no known past medical history who presented to our emergency department with complaints of chest pain, shortness of breath and a productive blood tinged cough. She had been recently discharged from another facility for a diagnosis of bronchitis, however symptoms had not abated. She reported a fifty-pound weight loss with poor oral intake. Her vital signs and labs on arrival were stable. Initial imaging in the ER was consistent with pneumonia of the right middle and lower lobes. She underwent a CT Neck, which showed esophageal wall thickening and a mass suspicious for an esophageal neoplasm. Due to concern of her recurrence of pneumonia and esophageal mass, she underwent an esophagram, which showed a stricture of the middle third of the esophagus with a fistula from the esophageal tumor to the right lower lobe bronchus. Due to concern of airway collapse with upper endoscopy, Pulmonology was consulted. The patient first underwent a bronchoscopy in which a Novatech Y-stent was deployed stabilizing the airway. The patient then underwent an endoscopy in which an esophageal stent was placed. Both procedures were successful and she tolerated oral intake well thereafter. She was discharged in stable condition to palliative hospice services. DISCUSSION: The case has relevance from both an interesting initial clinical presentation as well as management of this patient from both a technical and procedural aspect. This patient had continual infections from continuous overspill of esophageal contents into the respiratory tree. Although her prognosis to begin with was quite poor, these interventions allowed the patient some quality of life. This case also commands procedural respect. The patient’s left mainstem bronchus was extremely friable and actually ruptured during the initial course of balloon dilation. The stent in position did not completely cover the TEF however it did keep the central airway open. A long esophageal stent was placed by gastroenterology, which did completely cover the fistula. This patient’s case highlights potential difficulties in double stenting and anticipatory management by utilization of other services.

AN UNUSUAL CASE OF DESQUAMATIVE INTERSTITIAL PNEUMONIA RECURRENCE AFTER LUNG TRANSPLANT

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Desquamative interstitial pneumonia (DIP) is a form of interstitial lung disease that is characterized by diffuse interstitial infiltrates on chest X-ray, restrictive pulmonary function tests and intra-alveolar accumulation of macrophages. We report a rare case of DIP recurrence after lung transplantation complicated by Aspergillus and Cytomegalovirus (CMV) infection. CASE PRESENTATION: The patient is a 59 year-old male former smoker with a history of Hepatitis C treated in 2006 with Ribavirin and Interferon. He was evaluated for progressive hypoxic respiratory failure requiring bilateral lung transplantation in December 2017. Explanted lung pathology was consistent with end-stage DIP. Post-surgical course was complicated with antibody-mediated rejection requiring intravenous immunoglobulin therapy and plasmapheresis, Aspergillus pneumonia and Cytomegalovirus (CMV) viremia. 14 months later, he presented to hospital with dyspnea and cough. He was hypoxic requiring 2L/min at rest. Computed tomogram (CT) of the chest showed diffuse ground glass opacities bilaterally and a new patchy left basilar airspace opacity. His bronchoscopy and transbronchial biopsy showed a DIP-like injury pattern, focal interstitial fibrosis and chronic bronchiolitis. Respiratory cultures grew Pseudomonas putida for which IV Piperacillin and Tazobactam was given. Laboratory studies showed speckled pattern ANA with a titre of 1:160 and negative anti Ds-DNA, RF, anti-CCP, anti ScL-70, ANCA, SSA/SSB and CPK. HCV RNA was undetected with normal cryoglobulin levels. While he responded to Medrol 32 mg daily and was discharged home without oxygen supplementation, the mechanism for the DIP-like pattern is not well understood. His immunosuppressive regimen post lung transplantation was tacrolimus and mycophenolate. DISCUSSION: In our patient, DIP recurrence post lung transplantation suggests presence of a systemic disease. Though the patient did not show any evidence of connective tissue disease, further workup is pending. The reported association between history of Hepatitis C and DIP in previous case reports may explain this patient’s presentation, however undetected HCV RNA with normal liver function would not support this theory. It is also possible that Aspergillus and CMV infection may have triggered a DIP-like pattern as described in another case post lung and renal transplantation. To our knowledge, this is the second reported case of DIP recurrence after lung transplant. Early recognition and treatment of DIP is essential as it has the most favorable prognosis of all Idiopathic Interstitial Pneumonia subtypes. In cases where DIP occurs in lung transplant patients, opportunistic pathogens might be suspected as causative agents. CONCLUSIONS: It is important to diagnose and treat the underlying etiology that causes DIP so that recurrence after lung transplantation can be prevented. Reference #1: King, M. B., et al. (1997). "Recurrence of desquamative interstitial pneumonia after lung transplantation.” Am J Respir Crit Care Med 156(6): 2003-2005. DISCLOSURES: No relevant relationships by alaa abu-sayf, source=Web Response No relevant relationships by Bathmapriya Balakrishnan, source=Web Response No relevant relationships by Aditya Kotecha, source=Web Response no disclosure on file for Lisa Stagner; No relevant relationships by Krishna Thavarajah, source=Web Response

Analysis of serious adverse events in a paediatric fast breathing pneumonia clinical trial in Malawi

IntroductionPneumonia is the leading infectious killer of children. We conducted a double-blind, randomised controlled non-inferiority trial comparing placebo to amoxicillin treatment for fast breathing pneumonia in HIV-negative children aged 2–59...