Community-acquired pneumonia: impact of immune status.

Abstract

This cross-sectional and prospective one year study evaluated adults admitted to an inner city hospital with community-acquired pneumonia. The study used extensive diagnostic methods to evaluate the etiologies of community-acquired pneumonia in hospitalized patients with differing immunologic status. Of 385 study patients, concurrent problems associated with immunosuppression were noted in 221 (57%) patients, 180 of whom were human immunodeficiency virus (HIV)-infected. The five most common causes of community-acquired pneumonia were: Streptococcus pneumoniae, Pneumocystis carinii, aspiration, Hemophilus influenzae, and gram-negative bacilli. Only 8.3% of patients had either Legionella, Chlamydia pneumoniae or Mycoplasma pneumoniae. Despite use of state-of-the-art diagnostic techniques, no diagnosis was made in 46 of 180 (25.6%) HIV-infected patients, 56 of 164 (34.1%) immunocompetent patients, and 20 of 41 (48.8%) non-HIV-infected immunosuppressed patients. The diagnostic yield of pre-antibiotic sputum culture for conventional bacteria was 99/155 (63.9%) compared to 52 of 169 patients (32.7%) with adequate post-antibiotic sputum culture (p < 0.0001). Although S. pneumonia continues to be the most commonly identified etiologic agent of community-acquired pneumonia, it is surpassed by P. carinii in the HIV-infected patient population. The apparent decline in the frequency of S. pneumoniae in our series presumably reflects administration of antibiotics prior to procurement of sputum culture. The paucity of atypical agents in this study support the current American Thoracic Society guidelines for selective use of macrolide therapy in immunocompetent adults hospitalized with community-acquired pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

Legionnaires′ Disease ‐ Results of a Multicenter Canadian Study

“…Because of the requirements for informed consent, it is possible that enrollment was biased toward patients who were not seriously ill and, hence, less likely to have Legionnaires' disease. However, the overall mortality rate was 9.5%, which is similar to that in population-based studies (31,32). Another limitation is that the only test for Legionnaires' infection given to the entire population was the urinary antigen test.…”

Nosokomiale Pneumonien bei malignen hämatologischen Erkrankungen in der internistischen Intensivmedizin

“…Zwei auf die ICU eingewiesene Patienten hatten eine ambulant erworbene Pneumonie und wurden nicht in der Studie berücksichtigt. Jedoch trägt auch bei ambulant erworbenen Pneumonien der Immunstatus entscheidend zur Morbidität bei [11]. …”

Community-acquired pneumonia in adult HIV-infected patients: course, treatment, and prevention

“…Самой частой этиологической причиной ВП у боль ных ВИЧ инфекцией является Streptococcus pneumo niae, реже -Haemophilus influenzae [25][26][27][28][29][30].…”

“…Замечено, что у больных ВИЧ инфек цией чаще, чем в общей популяции регистрируются MRSA штаммы S. aureus, особенно при низком со держании CD4 клеток [31,32] Pseudomonas aerugi nosa также значительно чаще, чем у лиц без ВИЧ, выступает патогеном тяжелой ВП. В свою очередь, роль таких атипичных возбудителей, как Legionella pneumophila, Mycoplasma pneumoniae и Chlamydophi la pneumoniae значительно скромнее в этиологии ВП у больных ВИЧ инфекцией, чем у лиц без ВИЧ [27][28][29][30][31].…”