Aspiration-Related Pulmonary Syndromes

Hu, Xiaowen; Lee, Joyce; Pianosi, Paul; Ryu, Jay H.

doi:10.1378/chest.14-1049

Cited by 130 publications

(92 citation statements)

References 75 publications

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“…For both HAPs and CAPs, the primary route of bacterial lung infection is by aspiration of microbes colonizing the oropharyngeal tract or, less commonly, the GI tract (54,96). Certain conditions increase the risk of aspiration of microbes, including alcohol intoxication, radiation therapy, and endotracheal intubation (97). Likewise, the chance that one has of developing a CAP caused by K. pneumoniae increases greatly if one has some form of defect in the defenses of the respiratory tract, such as a deficiency in mucociliary clearance, or immunosuppression (98).…”

Section: Patient Risk Factorsmentioning

confidence: 99%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,364

1,345

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SUMMARYKlebsiella pneumoniaecauses a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically,K. pneumoniaehas caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore,K. pneumoniaestrains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity inK. pneumoniaestrains, and not every factor plays the same critical role in all virulentKlebsiellastrains. Recent studies have identified additionalK. pneumoniaevirulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.

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Section: Patient Risk Factorsmentioning

confidence: 99%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,364

1,345

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“…Many cases of frail elderly nursing home residents with aspiration pneumonia show sporadic fever, such as one day per week for several months, suggesting that aspiration of small amounts of not so virulent materials occur continuously once a week (16,17). In these patients ( Figure 1A), chest CT shows very solid consolidation in the back ( Figure 1B) (18)(19)(20).…”

Section: Chronic Inflammation In Aspiration Pneumonia In the Elderlymentioning

confidence: 99%

Dysphagia, dystussia, and aspiration pneumonia in elderly people

Ebihara¹,

Sekiya²,

Miyagi³

et al. 2016

J. Thorac. Dis.

140

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Despite the development and wide distribution of guidelines for pneumonia, death from pneumonia is increasing due to population aging. Conventionally, aspiration pneumonia was mainly thought to be one of the infectious diseases. However, we have proven that chronic repeated aspiration of a small amount of sterile material can cause the usual type of aspiration pneumonia in mouse lung. Moreover, chronic repeated aspiration of small amounts induced chronic inflammation in both frail elderly people and mouse lung. These observations suggest the need for a paradigm shift of the treatment for pneumonia in the elderly. Since aspiration pneumonia is fundamentally based on dysphagia, we should shift the therapy for aspiration pneumonia from pathogen-oriented therapy to function-oriented therapy. Function-oriented therapy in aspiration pneumonia means therapy focusing on slowing or reversing the functional decline that occurs as part of the aging process, such as "dementia → dysphagia → dystussia → atussia → silent aspiration". Atussia is ultimate dysfunction of cough physiology, and aspiration with atussia is called silent aspiration, which leads to the development of life-threatening aspiration pneumonia. Research pursuing effective strategies to restore function in the elderly is warranted in order to decrease pneumonia deaths in elderly people.

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“…Aspiration pneumonia may develop as an acute or subacute respiratory event in any CTD patients, especially in older and debilitated ones [24,182,183]. However, scleroderma and DM-PM significantly surpass the other CTDs concerning this complication, due to the fact that both diseases are characterized by pathophysiologic mechanisms seriously predisposing to impaired function of swallowing and thus to overt acute aspiration or occult chronic microaspiration of oropharyngeal and/or gastropharyngeal contents [143,184].…”

Section: Acute Gastroesophageal Content Aspiration Pneumonitismentioning

confidence: 99%

“…the development of acute hypercapnic respiratory failure related to acute ventilatory muscle myositis in DM-PM [16]). In addition, acute respiratory events may precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia as well as the far less frequently occurring Mendelson syndrome with digestive tract involvement, mainly in scleroderma and DM-PM [17,18,19] as well as in acute heart-related respiratory events in myocarditis or pericarditis with tamponade [20]. Last but not least, acute antirheumatic drug-related respiratory toxicity as well as acute lung infections related to the ‘mater' disease, specific manifestations of rheumatic disease in the lung, and/or immunosuppressive treatment (including the widespread use of biological factors) complete the spectrum of acute respiratory events in CTDs (table 1) [4,21,22,23,24].…”

Section: Introductionmentioning

confidence: 99%

Acute Respiratory Events in Connective Tissue Disorders

Papiris¹,

Manali²,

Kolilekas³

et al. 2016

Respiration

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Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the ‘mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the ‘vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.

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Aspiration-Related Pulmonary Syndromes

Cited by 130 publications

References 75 publications

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Dysphagia, dystussia, and aspiration pneumonia in elderly people

Acute Respiratory Events in Connective Tissue Disorders

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