Community-Acquired Pneumonia in the Elderly: Association of Mortality With Lack of Fever and Leukocytosis

Ahkee, Sunket; Srinath, Latha; Ramirez, Julio A.

doi:10.1097/00007611-199703000-00006

Cited by 94 publications

(52 citation statements)

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“…Respiratory rate, blood urea and confusion were not found to be independently associated with mortality; the key factors that comprise the BTS mortality severity score. Absence of pyrexia was found to be an important prognostic factor confirming the finding of other studies which used only univariate analysis [10,14,15] or a small number of patients [11]. Absence of a febrile response to infection may reflect an impaired immune response.…”

Section: Discussionsupporting

confidence: 83%

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

Lim

Jt²

2001

Eur Respir J

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Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ¢75 yrs. W.-S. Lim, J.T. Macfarlane. #ERS Journals Ltd 2001. ABSTRACT: Severity assessment in the elderly with community acquired pneumonia (CAP) may be different compared with younger patients. In particular, age per se may not be of prognostic significance in older patients. A case-control study in 158 patients aged ¢75 yrs with CAP was conducted to determine the factors associated with in-hospital mortality.Cases were drawn from all patients aged ¢75 yrs with CAP who died in 1997 in five hospitals in the mid-Trent region of the UK (Nottingham City Hospital, University Hospital Nottingham, Derby Royal Infirmary, Derby City General Hospital and Kings Hill Hospital). Controls were randomly selected from survivors also aged ¢75 yrs. Factors associated with mortality were identified following a review of the medical casenotes and the contribution of these factors to mortality was determined using multivariate analysis.Absence of fever, tachycardia and chest radiograph features of bilateral involvement or an effusion were independently associated with mortality on multivariate analysis. The British Thoracic Society (BTS) severity rule was 50% sensitive and 64% specific in predicting death while the modified BTS rule displayed 67% sensitivity and 58% specificity.Age was not significantly associated with mortality in this group of patients aged ¢75 yrs. Similarly, the clinical features employed in the British Thoracic Society rule, namely respiratory rate, diastolic blood pressure and blood urea, were not of prognostic significance and the rule itself performed poorly. The modified British Thoracic Society rule performed better.

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Section: Discussionsupporting

confidence: 83%

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

Lim

Jt²

2001

Eur Respir J

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“…For example, the induction of fever after inoculation with malaria can serve as a treatment against Treponema pallidum (34). It has also been shown that febrile core temperature is essential for optimal host defense against Klebsiella pneumoniae peritonitis in mice (11) and that fever in elderly patients with community-acquired pneumonia is positively correlated with high survival rates (1). Finally, maintaining a normal core body temperature (36.6 Ϯ 0.5°C) after anesthesia has been shown to decrease the incidence of infectious complications in patients undergoing colorectal resection (16).…”

Section: Discussionmentioning

confidence: 99%

Microbial Growth Inhibition by Alternating Electric Fields in Mice withPseudomonas aeruginosaLung Infection

Giladi

Porat²,

Blatt³

et al. 2010

Antimicrob Agents Chemother

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High-frequency, low-intensity electric fields generated by insulated electrodes have previously been shown to inhibit bacterial growth in vitro. In the present study, we tested the effect of these antimicrobial fields (AMFields) on the development of lung infection caused by Pseudomonas aeruginosa in mice. We demonstrate that AMFields (10 MHz) significantly inhibit bacterial growth in vivo, both as a stand-alone treatment and in combination with ceftazidime. In addition, we show that peripheral (skin) heating of about 2°C can contribute to bacterial growth inhibition in the lungs of mice. We suggest that the combination of alternating electric fields, together with the heat produced during their application, may serve as a novel antibacterial treatment modality.The 20th century was the golden era of the antibacterial agents, with millions of people owing their lives to the discovery of and treatment with the numerous antibiotic families used today. Surely, antibacterial agents will continue to play a major role in the battle against pathogenic bacteria in the 21st century; however, the extensive use of antibiotics holds a threat of a far less optimistic future due to the rapid rise of multidrugresistant bacteria. Recently, the potential use of physical means as an aid to antibiotics in the battle against bacterial pathogens has been studied: photodynamic therapy (12, 21, 35), ultrasound wave therapy (7,23,25), thermotherapy (26), and weak electric currents (4,6,24,32,33) are all being tested as treatment modalities against pathogenic microorganisms. The major drawback of the methods mentioned above is their low therapeutic index due to the high levels of heating produced by ultrasonic waves, thermotherapy, and photodynamic therapy (36) and the activated oxygen generated by photodynamic therapy, both of which can damage the tissues in and around the target area (22). In addition, the use of conductive electrodes for the generation of electric currents is associated with the release of metal ions and free radicals at the electrode surface, all of which are toxic to living cells (18). Indeed, as of today, none of the above-mentioned means has matured into an approved treatment modality against bacterial pathogens.Recently, we demonstrated that low-intensity alternating electric fields of high frequencies (antimicrobial fields [AMFields]) have an in vitro inhibitory effect on the growth of pathogenic bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa (8). AMFields were generated using electrically insulated electrodes and therefore were not associated with the production of free radicals, toxic metal ions, or electrolysis at the electrode surface. Fields of the relatively high frequency at which the AMFields effects were observed (with an optimum at 10 MHz) have no known effect on human cells (13,14). Indeed, we found that AMFields have no effect on the growth of cell cultures in vitro (unpublished results). Furthermore, the high frequencies of the AMFields allow for the application of relatively h...

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“…However, if the decreased TNF-· response following stimulation in centenarians compared to 81-year-olds were due to an effect of aging, it would have been expected that the 81-year-olds would also have shown a decreased TNF-· response following stimulation compared to the young controls. It has been suggested that aging is associated with an impaired acute-phase response, based on clinical studies of acute serious illness, indicating that aged humans are less likely to develop fever and leukocytosis than younger age groups [24,25]. However, these findings may reflect an effect of underlying diseases rather than age per se.…”

Section: Discussionmentioning

confidence: 99%

High Circulating Levels of Tumor Necrosis Factor-α in Centenarians Are Not Associated with Increased Production in T Lymphocytes

et al. 2003

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Background: Aging is characterized by increased inflammatory activity reflected by increased plasma levels of proinflammatory cytokines, concomitant with an altered cytokine profile of T lymphocytes. High plasma levels of tumor necrosis factor (TNF)-α are strongly associated with morbidity and mortality in elderly humans. However, the cellular source and mechanisms for the increased circulating TNF-α levels are unknown. Objective: The aim of the present study was to investigate if high plasma levels of TNF-α are associated with increased production of TNF-α by T lymphocytes in elderly humans. Methods: TNF-α production by CD4+ and CD8+ T lymphocytes was measured by flow cytometry following stimulation with phorbol 12-myristate 13-acetate and ionomycin in 28 young controls, 14 81-year-olds and 25 centenarians. Results: Plasma levels of TNF-α increased with increasing age. An increased percentage and number of T lymphocytes from the 81 year olds expressed TNF-α, whereas centenarians did not show this altered TNF-α secretion profile. Conclusion: T cells may contribute to the elevated levels of plasma TNF-α in healthy elderly subjects, whereas other mechanisms are responsible in very old individuals.

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Community-Acquired Pneumonia in the Elderly: Association of Mortality With Lack of Fever and Leukocytosis

Cited by 94 publications

References 0 publications

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

Defining prognostic factors in the elderly with community acquired pneumonia: a case controlled study of patients aged ≥75 yrs

Microbial Growth Inhibition by Alternating Electric Fields in Mice withPseudomonas aeruginosaLung Infection

High Circulating Levels of Tumor Necrosis Factor-α in Centenarians Are Not Associated with Increased Production in T Lymphocytes

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