Nonsevere Community-Acquired Pneumonia

Falguera, Miquel; Sacristán, Óscar; Nogués, A; Ruiz-González, Agustı́n; García, M.; Manonelles, Anton; Rubio-Caballero, Manuel

doi:10.1001/archinte.161.15.1866

Cited by 74 publications

(9 citation statements)

References 25 publications

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“…According to etiologic categories the profile of patients is similar to the combined information from previous studies of CAP [1-4,8]: infections by atypical agents were characterized by milder episodes, while more severe infections were caused by conventional bacteria. In fact, patients with conventional bacteria have higher hospitalization rate, higher CURB65 scores at admission, more bilateral radiographic involvement and more adverse clinical evolution and outcomes such as severe sepsis, septic shock, ICU admission and longer length of stay.…”

Section: Discussionsupporting

confidence: 63%

“…Some studies have found atypical bacteria to be the predominant microorganism for cases of ambulatory CAP [6] and for patients hospitalized with milder episodes of pneumonia [8]. However, population-based studies [1,9] have showed that S. pneumoniae was also the organism most frequently isolated in outpatients, and for each age group, the etiologic profile could be similar among inpatients and outpatients [9].…”

Section: Introductionmentioning

confidence: 99%

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Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes

et al. 2012

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BackgroundThe etiologic profile of community-acquired pneumonia (CAP) for each age group could be similar among inpatients and outpatients. This fact brings up the link between etiology of CAP and its clinical evolution and outcome. Furthermore, the majority of pneumonia etiologic studies are based on hospitalized patients, whereas there have been no recent population-based studies encompassing both inpatients and outpatients.MethodsTo evaluate the etiology of CAP, and the relationship among the different pathogens of CAP to patients characteristics, process-of-care, clinical evolution and outcomes, a prospective population-based study was conducted in Spain from April 1, 2006, to June 30, 2007. Patients (age >18) with CAP were identified through the family physicians and the hospital area.ResultsA total of 700 patients with etiologic evaluation were included: 276 hospitalized and 424 ambulatory patients. We were able to define the aetiology of pneumonia in 55.7% (390/700). The most frequently isolated organism was S. pneumoniae (170/390, 43.6%), followed by C. burnetti (72/390, 18.5%), M. pneumoniae (62/390, 15.9%), virus as a group (56/390, 14.4%), Chlamydia species (39/390, 106%), and L. pneumophila (17/390, 4.4%). The atypical pathogens and the S. pneumoniae are present in pneumonias of a wide spectrum of severity and age. Patients infected by conventional bacteria were elderly, had a greater hospitalization rate, and higher mortality within 30 days.ConclusionsOur study provides information about the etiology of CAP in the general population. The microbiology of CAP remains stable: infections by conventional bacteria result in higher severity, and the S. pneumoniae remains the most important pathogen. However, atypical pathogens could also infect patients in a wide spectrum of severity and age.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes

et al. 2012

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“…The identification rate of the causative pathogens of CAP varied from approximately 30% to 85%, depending on the study design, population included, and examination methods of pathogen identification. S. pneumoniae , M. pneumoniae , C. pneumoniae , and Q fever account for 5.6–85%, 0.7–61.3%, 0.1–11%, and 0.3–24%, respectively [18], [21], [29], [30], [33], [35]–[37], [61], [62]. However, the prevalence of S. pneumoniae is 6.6%, M. pneumoniae is 9.0%, and C. pneumoniae is 7.8%, but no Q fever was identified in this study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Q Fever and Etiology of Community-Acquired Pneumonia in a Tropical Region of Southern Taiwan: A Prospective Observational Study

et al. 2014

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BackgroundThe clinical characteristics of Q fever are poorly identified in the tropics. Fever with pneumonia or hepatitis are the dominant presentations of acute Q fever, which exhibits geographic variability. In southern Taiwan, which is located in a tropical region, the role of Q fever in community-acquired pneumonia (CAP) has never been investigated.Methodology/Principal FindingsDuring the study period, May 2012 to April 2013, 166 cases of adult CAP and 15 cases of acute Q fever were prospectively investigated. Cultures of clinical specimens, urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila, and paired serologic assessments for Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Q fever (Coxiella burnetii) were used for identifying pathogens associated with CAP. From April 2004 to April 2013 (the pre-study period), 122 cases of acute Q fever were also included retrospectively for analysis. The geographic distribution of Q fever and CAP cases was similar. Q fever cases were identified in warmer seasons and younger ages than CAP. Based on multivariate analysis, male gender, chills, thrombocytopenia, and elevated liver enzymes were independent characteristics associated with Q fever. In patients with Q fever, 95% and 13.5% of cases presented with hepatitis and pneumonia, respectively. Twelve (7.2%) cases of CAP were seropositive for C. burnetii antibodies, but none of them had acute Q fever. Among CAP cases, 22.9% had a CURB-65 score ≧2, and 45.8% had identifiable pathogens. Haemophilus parainfluenzae (14.5%), S. pneumoniae (6.6%), Pseudomonas aeruginosa (4.8%), and Klebsiella pneumoniae (3.0%) were the most common pathogens identified by cultures or urine antigen tests. Moreover, M. pneumoniae, C. pneumoniae, and co-infection with 2 pathogens accounted for 9.0%, 7.8%, and 1.8%, respectively.ConclusionsIn southern Taiwan, Q fever is an endemic disease with hepatitis as the major presentation and is not a common etiology of CAP.

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“…Mycoplasma has a predilection for the upper, as well as Gastrointestinal involvement is typical for Mycoplasma, and is much less common with C. pneumoniae pneumonia. In a patient with CAP and otherwise unexplained watery diarrhoea associated with pneumonia, the differential diagnostic possibilities are limited to Legionella and Mycoplasma [4][5][6][7][8][9][10][50][51][52][53][54][55][56][57][58]. In patients with advanced cardiopulmonary disease and in compromised hosts, M. pneumoniae or C. pneumoniae CAP may present as severe CAP [59,60].…”

Section: P N E U M O N I a E A N D C P N E U M O N I A E C A Pmentioning

confidence: 99%

The atypical pneumonias: clinical diagnosis and importance

Cunha

2006

Clinical Microbiology and Infection

238

167

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The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three nonzoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella. These atypical agents, unlike the typical pathogens, often cause extrapulmonary manifestations. Atypical CAPs are systemic infectious diseases with a pulmonary component and may be differentiated clinically from typical CAPs by the pattern of extrapulmonary organ involvement which is characteristic for each atypical CAP. Zoonotic pneumonias may be eliminated from diagnostic consideration with a negative contact history. The commonest clinical problem is to differentiate legionnaire's disease from typical CAP as well as from C. pneumoniae or M. pneumonia infection. Legionella is the most important atypical pathogen in terms of severity. It may be clinically differentiated from typical CAP and other atypical pathogens by the use of a weighted point system of syndromic diagnosis based on the characteristic pattern of extrapulmonary features. Because legionnaire's disease often presents as severe CAP, a presumptive diagnosis of Legionella should prompt specific testing and empirical anti-Legionella therapy such as the Winthrop-University Hospital Infectious Disease Division's weighted point score system. Most atypical pathogens are difficult or dangerous to isolate and a definitive laboratory diagnosis is usually based on indirect, i.e., direct flourescent antibody (DFA), indirect flourescent antibody (IFA). Atypical CAP is virtually always monomicrobial; increased IFA IgG tests indicate past exposure and not concurrent infection. Anti-Legionella antibiotics include macrolides, doxycycline, rifampin, quinolones, and telithromycin. The drugs with the highest level of anti-Legionella activity are quinolones and telithromycin. Therapy is usually continued for 2 weeks if potent anti-Legionella drugs are used. In adults, M. pneumoniae and C. pneumoniae may exacerbate or cause asthma. The importance of the atypical pneumonias is not related to their frequency (approximately 15% of CAPs), but to difficulties in their diagnosis, and their nonresponsiveness to beta-lactam therapy. Because of the potential role of C. pneumoniae in coronary artery disease and multiple sclerosis (MS), and the role of M. pneumoniae and C. pneumoniae in causing or exacerbating asthma, atypical CAPs also have public health importance.

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Nonsevere Community-Acquired Pneumonia

Abstract: Among low-risk patients with community-acquired pneumonia, there was a certain correlation between severity and cause. In contrast, the existence of a comorbidity did not have a predictive causative value.

Cited by 74 publications

References 25 publications

Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes

Etiology of community-acquired pneumonia in a population-based study: Link between etiology and patients characteristics, process-of-care, clinical evolution and outcomes

Clinical Characteristics of Q Fever and Etiology of Community-Acquired Pneumonia in a Tropical Region of Southern Taiwan: A Prospective Observational Study

The atypical pneumonias: clinical diagnosis and importance

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